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Thorac Cardiovasc Surg 2020; 68(08): 674-678
DOI: 10.1055/s-0040-1701668
Original Cardiovascular

Establishing the Safety of Training in Off-Pump Coronary Artery Bypass Surgery: A Retrospective Comparison of Outcomes between Trainees and a Consultant Surgeon

Soumik Pal
1   Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
,
Philip Hartley 
1   Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
2   Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom of Great Britain and Northern Ireland
,
Yousuf Salmasi
3   Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
,
George Asimakopoulos
1   Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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Abstract

Background The safety of training in off-pump coronary artery bypass (OPCAB) surgery and the stage at which trainees should be exposed to this technique remain controversial. This single-center retrospective study aimed to compare outcomes of OPCAB surgery in consultant and trainee cases.

Methods Between 2014 and 2018, all isolated OPCAB operations performed under the care of a consultant surgeon (G.A.) were analyzed. Cases where a surgeon below consultant grade performed at least 70% of the distal anastomoses were designated as “trainee cases” with the remaining cases designated as “consultant cases.” The baseline characteristics of patients, perioperative data, and short-term outcomes were prospectively collated and analyzed.

Results During the study period, 245 OPCAB cases were identified: 142 (58%) consultant and 103 (42%) trainee cases. The trainee cases were performed exclusively by trainees in the final 2 years of the UK National Cardiothoracic Training Program. Both trainee and consultant groups had low mortality with two perioperative deaths occurring in either group. The rates of serious postoperative complications including stroke (n = 1 vs. 2, p = 0.759), resternotomy for bleeding (n = 3 vs. 7, p = 0.431), and mediastinal infection (n = 2 vs. 3, p = 0.926) were low and not significantly different between the two groups. Patients operated on by trainees had a slightly longer hospital stay than those operated on by the consultant surgeon, although this did not reach statistical significance (9.9 vs. 7.9 days).

Conclusions These results demonstrate comparable outcomes in OPCAB surgery between a consultant surgeon and trainees. This study supports the conclusion that training surgeons in OPCAB is appropriate for trainees in the final years of cardiac surgery training.

Keywords

ischemic heart disease - off-pump surgery - atherosclerosis


Publication History

Received: 19 November 2019

Accepted: 08 January 2020

Article published online:
21 March 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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