Impact of Individual Surgeon Volume on Outcomes Following LVAD Implantation

Abstract

<h3>Purpose</h3> Surgeon volume affects outcomes of complex operations. However, it is not clear if individual surgeon volume in a large volume program affects left ventricular assist device (LVAD) outcomes. <h3>Methods</h3> We reviewed primary LVAD implants at our center between 2013 and 2020. Cases were dichotomized into a high-volume group (surgeons averaging more than 10 LVAD cases per year), and a low-volume group (10 or less cases per year). Propensity score matching was performed. Survival and incidence of major adverse events were compared; predictors of survival were identified with multivariable analysis. <h3>Results</h3> There were 315 patients who met inclusion criteria- 45 implants in the low-volume group, 270 in the high-volume group. In the propensity matched cohort, there was no difference in survival to hospital discharge between the low (91.9%) and high (91.7%) volume groups (p=1). Survival at 1-year was also similar between the groups (85.4% vs 88.6%, p=0.732). There was no difference in the incidence of major adverse events between the groups. Predictors of mortality in the first year included: age (Hazards Ratio [HR] 1.061, p<0.001), prior sternotomy (HR 1.991, p=0.014), elevated INR (HR 4.748, p<0.001), higher AST (HR 1.001, p=0.001), higher bilirubin (HR 1.081, p=0.014), and pre-operative mechanical ventilation (HR 2.662, p=0.005). Individual surgeon volume was not an independent predictor of discharge or one-year survival. <h3>Conclusion</h3> There was no difference in survival or adverse events between high and low volume surgeons suggesting that, in an experienced center, low-volume VAD surgeons can achieve similar outcomes to their high-volume colleagues.