Propensity-matched analysis of outcomes after mitral valve surgery between trainees and consultants (institutional report)

Objectives: Mitral valve (MV) repair has demonstrated excellent short-and longterm outcomes, however, its merit in the elderly population is still debated. We conducted a meta-analysis of studies that have compared the MV repair to replacement in the elderly population.Methods: A systematic literature search was conducted for any study published on MV surgery on elderly patients (≥75 years old). A pooled risk-ratio meta-analysis was done to evaluate short-term mortality, postoperative complications, surgical timings, and long-term survival rates.Results: A total of nine retrospective observational studies were included in the quantitative meta-analysis. Pooled meta-analysis showed a reduced risk of short-term mortality for the MV repair group (risk ratio [RR] = 0.41 [0.24-0.71], p-value = .005). Postoperative neurological complications were in favor of repair, although not significantly (RR = 0.49 [0.21-1.11], p-value = .07). Operative timings (cardiopulmonary bypass and crossclamp time) were not different between the groups although no data were available on the complexity of the repairs. Long-term survival rates were in favor of the repairs (pooled treatment effect of −0.47 [−0.64; −0.29], p = .005).Conclusions: MV surgery is a safe and effective procedure for the elderly. MV repair demonstrated better short-term outcomes compared to replacement. Long-term survival rates are significantly better after repair. elderly, meta-analysis, mitral valve, mitral valve repairThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Section: Operative Surgical Timessupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Benefits of mitral valve repair over replacement in the elderly: a systematic review and meta‐analysis

Tommaso

Rapetto

Guida

et al. 2021

“…There were no mortality differences between TS and FTS. The in‐hospital mortality for TS is reported as 2% versus 6% in FTS cohorts 24–26 …”

Section: Resultsmentioning

confidence: 99%

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Objectives We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. Methods EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety‐two results were obtained, 27 represented best evidence (2‐meta‐analyses, 1‐RCT, and 24 retrospective cohort studies). Results In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on‐pump vs. 3206 off‐pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty‐nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high‐risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in‐hospital or midterm mortality out to 5‐years. Discussion Trainees can perform cardiothoracic surgery in dedicated high‐volume units with outcomes comparable to those of fully trained surgeons.

“…3 It is also challenging for the institutions responsible for the training programs, since they are expected to offer an efficient and adequate curriculum, which relies on a paradox of providing safe surgical opportunity without compromising the postoperative outcomes and excellent patient care. 4 Operating room surgical training has significant limitations indeed, considering it provides short time to develop technical skills and has low tolerance for learning mistakes. In this context, we believe that incorporating simulation on biological models in our residency program could improve cardiovascular surgical training and patient safety, due to its potentiality to avoid surgical technical failure that would compromise the outcomes, bringing more safety, efficacy, and better results in the longer term.…”

Section: Introductionmentioning

confidence: 99%

“…It is also challenging for the institutions responsible for the training programs, since they are expected to offer an efficient and adequate curriculum, which relies on a paradox of providing safe surgical opportunity without compromising the postoperative outcomes and excellent patient care 4 . Operating room surgical training has significant limitations indeed, considering it provides short time to develop technical skills and has low tolerance for learning mistakes.…”

Section: Introductionmentioning

confidence: 99%

Evaluation method of training simulation on biological models for cardiovascular surgery residents

Brandão

Dallan

Dinato

et al. 2021

Objectives: The goal of this study was to describe and evaluate our simulation training program on biological models for the cardiovascular surgery residency program at our institution.Material and Methods: Since 2016, with the purpose to develop better practical performance and evaluate the improvement of resident's surgical skills, a simulation training program was implemented, composed of some elemental procedures in cardiovascular surgery. It was established with one wet lab session weekly lasting 2 h, coached by two expert cardiovascular surgeons. Bovine and porcine hearts were used as biological models. At the end of the hands-on program, an objective assessment consisting of two practical modules was applied and performance was rated by way of a 5-point scale. In addition, to provide a subjective assessment, each resident filled out a questionnaire consisting of three items reviewing the overall quality of the workshops on a 10-point scale.Results: The objective evaluation applied at the end of the training program consisted of valve replacement and coronary artery bypass grafting (CABG) modules.The mean performance rating scores for the valve replacement module ranged from 4.2 to 4.79, and CABG, from 4.33 to 4.87. Regarding subjective assessment, all items evaluated, such as expert's didactics, simulation performance, and biological simulator fidelity, received high grades (above 9 on a 10-point scale). Conclusions:Simulator training on biological models for cardiac surgery medical residents is a simple and effective learning method of surgical skills.