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When is your surgeon good enough? When do you need a “referent surgeon”?

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Abstract

Recent American College of Cardiology/American Heart Association guidelines recommend mitral valve repair in asymptomatic patients at an experienced center, assuming the likelihood for repair is ≥ 90%. This has raised the question of how you define an experienced center (or surgeon). This article describes thoughts on the criteria that should make up a Center of Excellence: surgical training; intraoperative echocardiography; high volume; cardiology involvement; audit of clinical outcomes and outcomes of repair; and associated surgery for atrial fibrillation and tricuspid regurgitation. High-volume programs (≥ 140 mitral valve operations per year) have the lowest mortality and highest repair rate. Although some pathologic conditions may be repaired with a high degree of certainty by experienced (nonreferent) surgeons, considerable variation still exists. Recent publications of repair rates and outcomes using minimally invasive surgery and conventional surgery highlight this variability.

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Correspondence to Patrick M. McCarthy.

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McCarthy, P.M. When is your surgeon good enough? When do you need a “referent surgeon”?. Curr Cardiol Rep 11, 107–113 (2009). https://doi.org/10.1007/s11886-009-0017-9

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