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Thorac Cardiovasc Surg 2014; 62(03): 199
DOI: 10.1055/s-0034-1372534
Editorial
Georg Thieme Verlag KG Stuttgart · New York

Train the Trainer

Markus K. Heinemann
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Publication Date:
21 April 2014 (online)

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This issue brings you two commentaries regarding a provocative article published last year and dealing with the shortcomings of training in surgery for congenital heart disease in Germany.[1] In summary the original authors made the point that training in this very special specialty can only be done in large centers, at the same time pointing out that a lot of German units are one-man shows run by soloists. I am sorry that we did not get more outspoken opinions, especially because I know from my informants that there is a lot of ongoing debate behind the scenes.

The problem starts, like heart surgery did, with the closure of a secundum type ASD. This operation, which you may call the appendectomy of the cardiac surgeon, almost disappeared with the refinement of interventional closure techniques. The young surgical patients remaining tend to have particular defects if they underwent a correct evaluation. And on top of this they or their parents increasingly have the expectation to have the operation done through some kind of minimally invasive access. This makes operating much harder - and assisting even more so.

On the other end of the spectrum are adults with a normal ASD II, or PFO even, who are referred to a surgeon by an adult cardiologist not familiar with interventional closure who, for fear of “losing” them, is hesitant about sending them to a proper interventionalist. The surgeons tend to be happy about such “training cases” but must not forget that surgery starts with a correct indication – which is also the ultimate prerequisite for responsible surgical training. Moreover, even an ASD closure can be quite amateurishly done if it's done only once in a while.

The debate stimulated by this journal cannot provide a solution. However, it is common sense that training should be restricted to institutions with a definitive proof of practice in it – which might even serve as a model for cardiac surgical training in general. Wouldn't it be wonderful if those who care for the youngest of our patients could/would also exemplify the care for our young surgeons?