A. Surgical training
|
1. | Surgeons performing mitral valve repair surgery should have undergone specific training in mitral valve repair, including participation in established repair workshops |
2. | Surgical skills laboratories should be available to develop, maintain, and teach surgical technique |
B. Intraoperative echocardiography issues
|
1. | Mitral valve repair should be undertaken only with availability of high quality intraoperative TOE |
2. | Anaesthetists for mitral repair surgery should have expertise in intraoperative TOE and should hold UK (ACTA/BSE), European (EACTA/EAE), or US (NBE) accreditation. Where the intraoperative echocardiography service is provided by cardiologists, they should be similarly accredited |
C. Surgery for atrial fibrillation
|
1. | Hospitals should provide surgical ablation of atrial fibrillation |
2. | Surgeons undertaking mitral valve repair surgery should have expertise in surgical ablation of atrial fibrillation |
D. Volume thresholds
|
1. | Surgeons undertaking mitral repair surgery should be doing more than 25 repairs each year |
2. | Hospitals undertaking mitral repair surgery should be doing more than 50 repairs each year |
E. Audit
|
1. | Surgeons undertaking mitral repair surgery should subject their results to regular audit |
2. | Audit of mitral valve surgery should include an analysis of the mitral procedures stratified by aetiology |
3. | Audit should include an analysis of mortality, residual regurgitation on discharge, recurrence of regurgitation, and reoperation rates |
4. | Mortality for isolated repairs on degenerative disease should be less than 1% and five year reoperation rate should be less than 5%. |
5. | Audit data on results of mitral valve repair should be available to patients and referring cardiologists |
F. Cardiology and imaging issues
|
1. | Local guidelines for referral of patients should be available to all cardiologists |
2. | Hospitals undertaking mitral repair surgery should have at least one designated cardiology consultant with a subspecialist interest in mitral valve disease |
3. | Validated quantitative echocardiography should be routinely available |
4. | Patients after mitral repair should have follow up echocardiography before discharge from hospital or at the first postoperative outpatient visit to quantify residual regurgitation |
5. | Both preoperative and perioperative echocardiography data should be regularly audited to ensure quality control and to provide continuing education |
6. | Multidisciplinary meetings should be held focusing on mitral repair including discussion of discrepancies between echocardiographic and surgical findings |