Clinical translation of surgical simulated closure of a ventricular septum defect

Abstract

Objectives To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septal defect(VSD) closure simulation translates to better patient outcomes. Methods Seven trainees were divided into two groups. Experienced-fellows group included four senior trainees who had performed>five VSD closures. Residents group consisted of three residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a four-week simulation requiring each participant to complete two VSD closures on 3D-printed models per week. One-month later all trainees returned for a posttest operation in real patients. All performances were recorded, blinded and scored independently by two cardiac surgeons using the validated Hands-On Surgical Training–Congenital Heart Surgery(HOST-CHS). Predefined surgical outcomes were analyzed. Results The median HOST-CHS score increased significantly from week one to four [50(39,58) vs.73(65,74), p < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition[HOST-CHS score 72.5(71, 74)vs.54(51, 60), p < 0.001], with better patients outcomes including shorter total cross-clamp time[pretest: 86(70,99) vs.posttest: 60(53, 64) min, p = 0.006], and reduced incidence of major patch leak requiring multiple pump runs[pretest: 4/11vs.posttest: 0/9, p = 0.043]. After simulation, the technical performance and surgical outcomes of residents were comparable to experienced-fellows in real patients, except for significantly longer cross-clamp time[Residents : 76.5(71.7,86.8)vs.Experienced-fellows : 60(53,64) min, p = 0.002]. Conclusions Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.

Longitudinal Evaluation of Congenital Cardiovascular Surgical Performance and Skills Retention Using Silicone-Molded Heart Models

“…2 Li and colleagues specifically addressed this limitation by evaluating the impact of previous HOST simulations on the surgical outcomes for ventricular septal defect repair performed by residents and fellows. 9 Interestingly, shorter cross-clamp time and lower incidence of residual patch leak requiring multiple pump runs were documented after HOST simulations, independently from the surgical experience of trainees. Similarly, Wang et al reported better patient outcomes (in terms of operative times, postoperative complications, and length of stay, as well as echocardiographic results) in the setting of left ventricular outflow tract obstruction, if a simulation was performed before the Morrow operation.…”

“…Procedural time for CoA repair showed a significant early reduction between the first and second HOST simulations (mean [SD]: 29 [14] respectively, P = .034), but no further significant improvements with the third HOST session (25 [15] min vs 23 [9] min at one and four weeks, respectively, P = .662, Figure 3).…”

“…Previous larger studies have already documented the benefit of a single HOST session in ameliorating the technical performance of participants. 1,6,7,9,14 Future studies aim to study larger cohorts of trainees who are at different stages of their residency/fellowship/early staff position and establish whether the role of repetition changes as trainees become more experienced. Moreover, the impact of HOST sessions on patient outcomes needs further investigation, especially for complex operations such as the ASO.…”

“…7,8 Furthermore, the incorporation of HOST into congenital heart surgery (CHS) training holds tangible potential to result in improved outcomes in clinical practice. 3,4,9 To date, the assessment of CHS trainees' surgical skills and performance is based on supervisors' judgment and approval, while a standardized and objective-specific CHS training program implemented with HOST is still in evolution. Given the extremely wide spectrum of technical difficulty and required surgical skills for the correction of CHDs, a single training protocol is not considered sufficient.…”

“…7,8 Furthermore, the incorporation of HOST into congenital heart surgery (CHS) training holds tangible potential to result in improved outcomes in clinical practice. 3,4,9…”