Surgeon Versus Center Mitral Repair Volume and Repair Utilization in Primary Mitral Regurgitation: A Statewide Quality Collaborative Analysis.

OBJECTIVE: To evaluate the relative influence of surgeon- and center-level mitral valve repair volume with repair utilization and early outcomes among adults undergoing isolated surgery for primary mitral regurgitation. METHODS: Using the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (March 2011- March 2025), we identified adults undergoing isolated mitral valve surgery for primary mitral regurgitation. High-volume centers (>50 repairs annually) and high-volume surgeons (>25 repair over two consecutive years) were identified. The primary outcome was mitral valve repair versus replacement. Secondary outcomes included operative times and selected early postoperative outcomes. RESULTS: Among 6,649 mitral valve surgery patients, the repair rate was 80% (n = 5,329). Only 3 (9%) of 33 centers and 6 (3.8%) of 146 surgeons were high-volume. High-volume centers had higher observed repair rates (87%, n = 3,027 vs 73%, n = 2,302), non-significant after adjustment (odd ratios: 1.23, 95% confidence interval: 0.61-2.45; p = .56). High-volume surgeons had higher adjusted repair rates (93%, n = 2,613 vs 70%, n = 2,716; odd ratio (95% confidence interval): 1.45(1.1-1.9), p = .003), shorter median cross-clamp times (75 min, interquartile range (55-111) vs 91 min, (71-117), p = .001), and had lower permanent pacemaker implantation rates (1.0%, vs 3.0%, p < .001). CONCLUSIONS: In contradistinction to high-volume, higher surgeon-level mitral repair volume remained associated with greater repair utilization. Moreover, high vs low volume surgeons had shorter operative times, and fewer selected early postoperative complications.