ArticleJournal of cardiothoracic surgery2022
Institutional case volume and mortality after aortic and mitral valve replacement: a nationwide study in two Korean cohorts.
Article in Journal of cardiothoracic surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- The functional landscape of critical care: a nationwide study of volume, capability, and institutional variation in South Korea.Acute and critical care · 2026Article
- A Novel Approach to Assessing In-Hospital Mortality After On-Pump Aortic Valve Replacement.Life (Basel, Switzerland) · 2025Article
- Interhospital variability in failure to rescue rates following aortic valve surgery.JTCVS open · 2023Article
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6 authors.
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Abstract
backgroundThere are only a handful of published studies regarding the volume-outcome relationship in heart valve surgery. We evaluated the association between institutional case volume and mortality after aortic valve replacement (AVR) and mitral valve replacement (MVR).
methodsTwo separate cohorts of all adults who underwent AVR or MVR, respectively, between 2009 and 2016 were analyzed using a Korean healthcare insurance database. Hospitals performing AVRs were divided into three groups according to the average annual case volume: the low- (< 20 cases/year), medium- (20-70 cases/year), and high-volume centers (> 70 cases/year). Hospitals performing MVRs were also grouped as the low- (< 15 cases/year), medium- (15-40 cases/year), or high-volume centers (> 40 cases/year). In-hospital mortality after AVR or MVR were compared among the groups.
resultsIn total, 7875 AVR and 5084 MVR cases were analyzed. In-hospital mortality after AVR was 8.3% (192/2318), 4.0% (84/2102), and 2.6% (90/3455) in the low-, medium-, and high-volume centers, respectively. The adjusted risk was higher in the low- (OR 2.31, 95% CI 1.73-3.09) and medium-volume centers (OR 1.53, 95% CI 1.09-2.15) compared to the high-volume centers. In-hospital mortality after MVR was 9.3% (155/1663), 6.3% (94/1501), and 2.9% (56/1920) in the low-, medium-, and high-volume centers, respectively. Compared to the high-volume centers, the medium- (OR 1.97, 95% CI 1.35-2.88) and low-volume centers (OR 2.29, 95% CI 1.60-3.27) showed higher adjusted risk of in-hospital mortality.
conclusionsLower case volume is associated with increased in-hospital mortality after AVR and MVR. The results warrant a comprehensive discussion regarding regionalization/centralization of cardiac valve replacements to optimize patient outcomes.
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