Training Cardiac Surgeons: Safety and Requirements

      To analyze whether cardiac surgical residents can perform their first surgeries without compromising patients’ safety or outcomes, by comparing their performance and results to those of senior surgeons. All documented CABGs conducted between 2002 and 2020 were included. Surgeries were divided according to the experience level of the main surgeon (defined by the number of CABG conducted by him/her) using the following thresholds: 1000; 150; 80 and 35. This resulted in 5 groups: senior surgeons (the reference group); attending surgeons; fellow surgeons; advanced residents and new residents. Primary endpoint was 30 day mortality. Secondary endpoints included a list of intra and post-operative parameters (including in-hospital complications). A multivariable analysis was conducted. 16,486 CABG were conducted by 66 different surgeons over a period of 18 years. Multivariable analysis did not find significant differences between both the primary and the secondary endpoints. Skin-to-skin time correlated significantly with experience level, as new residents needed almost 30% more time than senior surgeons (234 vs 180 minutes). With a suitable supervision by experienced surgeons, patient selection and sufficient resources (longer duration of surgery), surgical residents can perform CABGs with good results and without compromising the patient's outcome.

      Graphical abstract



      CABG (coronary artery bypass graft surgery), ITA (internal thoracic arteries), CPR (cardiopulmonary resuscitation), ICU (intensive care unit), DM (diabetes mellitus), COPD (chronic obstructive pulmonary disease), EF (cardiac ejection fraction), ANOVA (analysis of variances), OR (odds ratio)
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      • Commentary: Walking the Tightrope
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
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          Achieving the best possible outcomes for our patients and teaching the next generation are obligations fundamental to experienced cardiothoracic surgeons since the earliest years of the field, but balancing the 2 may be harder than ever. Patient populations get older with more comorbidities, improved transcatheter therapies reduce surgical volume and raise expectations for excellent surgical results, and scrutiny on resource utilization increases each year. In this issue, Chaban, and co-authors1 demonstrate how they have walked this tight rope at their institution.
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