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Publication - Professor Massimo Caputo

    Propensity-matched analysis of outcomes after mitral valve surgery between trainees and consultants (institutional report)

    Citation

    Bruno, VD, Chivasso, P, Hayat, A, Marsico, R, Benedetto, U, Caputo, M, Ascione, R, Angelini, G, Ciulli, F & Vohra, H, 2017, ‘Propensity-matched analysis of outcomes after mitral valve surgery between trainees and consultants (institutional report)’. Interactive Cardiovascular and Thoracic Surgery.

    Abstract

    OBJECTIVES

    We
    aimed to determine whether early outcomes and long-term survival after
    mitral valve surgery performed by trainee residents are equivalent in
    terms of safety and efficacy when compared with consultant surgeons.

    METHODS

    Between
    January 2000 and December 2015, a total of 1742 patients who underwent
    mitral valve surgery were identified. Of these, 1622 operations were
    performed by consultants (Group I) and 120 operations were performed by
    trainees (Group II). A propensity score-matched analysis has been used
    to minimize selection bias. Early postoperative outcomes were defined as
    in-hospital mortality, cerebrovascular accident, postoperative
    requirement of renal replacement therapy, reoperation for bleeding and
    postoperative length of hospital stay. Long-term outcomes were evaluated
    using late survival data after discharge.

    RESULTS

    Before
    matching, the 2 groups differed significantly in terms of gender and
    reduced left ventricular ejection fraction, but these differences were
    solved after matching. Also, Group I included significantly more
    patients with mitral regurgitation (83% vs 62%; P < 0.01), but after matching, this difference was corrected (62% vs 59%; P = 0.71). Consultant group was associated with a higher in-hospital mortality (6% vs 2%; P = 0.04)
    in the unmatched population. Moreover, in the unmatched cohort, this
    group had longer cross-clamp time compared with the trainees group
    (91 ± 38 vs 89 ± 26 min; P = 0.47) and longer cardiopulmonary bypass time (132 ± 58 vs 121 ± 33 min; P = 0.27);
    these differences were not statistically significant. There were no
    significant differences in postoperative dialysis, cerebrovascular
    accident, reoperation for bleeding and length of hospital stay. Even
    after matching, no significant differences were found in terms of
    perioperative complications. The Kaplan–Meier survival curves at 1, 5
    and 10 years were similar between the 2 groups.

    CONCLUSIONS

    Mitral
    valve surgery can be safely performed by trainees and provides similar
    short- and long-term results compared with consultant surgeons.

    Full details in the University publications repository