Cardiac Surgery Trainees as “Skin-to-Skin” Operating Surgeons: Midterm Outcomes

Bloom, Jordan P.; Heng, Elbert E.; Auchincloss, Hugh; Melnitchouk, Serguei; D’Alessandro, David A.; Villavicencio, Mauricio A.; Sundt, Thoralf M.; Tolis, George

doi:10.1016/j.athoracsur.2019.02.008

Cited by 27 publications

(21 citation statements)

References 12 publications

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“… 24 On the other hand, there have been several reports reporting that cardiac surgery can be safely performed by trainee despite prolonged operative time factors if patient selection was correct and operations were performed under proper supervision of experienced attending surgeons. 25 26 We agree with such previous studies because the experience of the operator did not influence in-hospital mortality + major complications in our study. The present study demonstrated that prolonged time factors by trainee in TAR is allowed without affecting patient safety if patient selection is correct and surgery is done under proper supervision.…”

Section: Discussionsupporting

confidence: 93%

Proximalized Total Arch Replacement Can Be Safely Performed by Trainee

Nakanishi

Wakabayashi

Ise

et al. 2020

Thorac Cardiovasc Surg

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Abstract Background The aim of the present study was to validate safety of total arch replacement (TAR) using a novel frozen elephant trunk device, operated by trainees as surgical education. Methods Sixty-four patients including 19 patients (29.6%) with acute aortic dissection type A (AADA) underwent TAR in our institute between April 2014 and March 2019 were retrospectively analyzed. Twenty-nine patients were operated by trainees (group T) and 35 patients were operated by attending surgeons (group A). Results Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes, p = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes, p = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes, p = 0.001) were significantly shorter in group A than in group T, but aortic clamping time did not differ between groups (115.3 ± 55.7 vs. 114.2 ± 35.0 minutes, p = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%, p = 0.014). Thirty-day mortality was 3.1% in the entire cohort. Although operation time was longer in group T, there were no significant difference in postoperative results between the groups, and the experience levels of the main operator were not independent predictors for in-hospital mortality + major postoperative complications. There was no difference in late death and aortic events between groups. Conclusions The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.

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Section: Discussionsupporting

confidence: 93%

Proximalized Total Arch Replacement Can Be Safely Performed by Trainee

Nakanishi

Wakabayashi

Ise

et al. 2020

Thorac Cardiovasc Surg

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“…Moreover, only 2 studies reported on the comparison of mid- and long-term mortality between trainees’ and consultants’ cases and no difference was found [ 11 , 12 ]. Compared to these studies, we reported on longer mean follow-up outcome and demonstrated that the equipoise between trainees’ and consultants’ cases persists during a longer follow-up.…”

Section: Discussionmentioning

confidence: 99%

The impact of surgical training on early and long-term outcomes after isolated aortic valve surgery

Dimagli

Sinha

Benedetto

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Patients presenting with more comorbidities, requiring more complex cardiac surgical procedures and an increase in public scrutiny are impacting on training programme because of the perceived risk of worse outcomes. Hence, we aimed to provide evidence that trainees as the first operator can achieve comparable results to consultants when performing isolated surgical aortic valve replacement. METHODS From 1996 to 2017, 2919 patients underwent surgical aortic valve replacement at the Bristol Heart Institute, operated on by either a consultant (n = 2220) or a trainee (n = 870) as the first operator. Propensity score matching was used to adjust for imbalance in the baseline characteristics of the 2 groups. RESULTS Over a 21-year period, the proportion of trainee cases dropped from 41.5% to 25.9%. No differences in the rates and risk of in-hospital mortality, new cerebrovascular accidents, re-exploration for bleeding, deep sternal wound infection and length of stay were found between patients operated on in the 2 groups. Also, there was a comparable risk of late death between the 2 groups (HR 0.88; 95% CI 0.73–1.06; P = 0.27) and this was present regardless of trainees career level and patients surgical risk based on the EuroSCORE. Finally, we showed an increase in patients risk profile in the latest year but, this was not associated with the worst outcomes when trainees performed the operation. CONCLUSIONS Surgical aortic valve replacement is a safe and reproducible technique and regardless of the patient’s risk profile, and no differences in the outcomes between trainees and consultant cases were found.

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“…The group of the Mass General Hospital in Boston has published several highly interesting papers on that topic that I would warmly recommend for further reading. 2 3 4 …”

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confidence: 99%

“…The group of the Mass General Hospital in Boston has published several highly interesting papers on that topic that I would warmly recommend for further reading. [2][3][4] Thierry Carrel received 2015 the Da Vinci award of the European Association for cardiothoracic surgery as the best surgical teacher in Europe.…”

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confidence: 99%