Table 1 Best practice standards for mitral repair services.
| Criteria | |
|---|---|
| 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 |
ACTA, Association of Cardiothoracic Anaesthetists; BSE, British Society of Echocardiography; EACTA, European Association of Cardiothoracic Anaesthesiologists; EAE, European Association of Echocardiography; NBE, National Board of Echocardiography; TOE, transoesophageal echocardiography.