Complex off-pump coronary artery bypass surgery can be safely taught to cardiothoracic trainees
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Résumé
OBJECTIVES: Off-pump coronary revascularisation is demanding technically as the surgeon is faced with a beating heart and not a bloodless field. The potential clinical advantages of off-pump coronary revascularisation have made this procedure an essential part of a cardiothoracic training program. The aim of this study is to investigate the impact of teaching trainees complex off-pump coronary artery surgery (arterial grafting, 'Y' grafts, sequential grafting and minimally invasive direct coronary artery bypass) on clinical outcomes. METHODS: All 323 off-pump coronary revascularisation cases performed by one service over a 24-month period were analysed. The 125 (39%) operations performed by two trainees with previous exposure in on-pump surgery were compared with the 198 (61%) performed by an experienced consultant surgeon. Patient and disease characteristics, intra- and post-operative data, morbidity and mortality were analysed using uni- and multivariate analysis. RESULTS: The trainees performed 51% of the MIDCABs, 36% of the 'Y' grafts and 27.5% of the sequential grafts. The internal thoracic artery was used in 96% of the cases, radial artery in 49% and bilateral internal thoracic arteries in 11% equally distributed between trainees and consultant. The average number of grafts per case was 3.7 for the consultant and 3.3 for the trainees. Patients operated by the consultants were more likely to have unstable angina (P=0.008), ejection fraction <30% (P=0.01) previous cardiac surgery (P=0.027) and more likely to receive over 4 grafts (P=0.01). Operative mortality was 1.5% for the consultant and 0 for the trainees (P=0.17). Post-operative morbidity, such as re-operation for bleeding (consultant 1% vs. trainee 0.8%), stroke (0.5% vs. 0.8%), haemofiltration (3.5% vs. 0.8%) was similar between the two groups. Hospital stay was also similar. CONCLUSIONS: The results of this study suggest that trainees under supervision perform complex off-pump coronary artery surgery safely with low rate of mortality and complications. These findings are in agreement with previous literature reports. Trainees should be allowed to operate on sufficient number of patients undergoing off-pump surgery according to their skills and abilities. Patients should be reassured that safety is not compromised by the presence of a trainee as a primary surgeon.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle