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  • Meeting abstract
  • Open Access

Lessons from modular approach to training for minimally invasive aortic valve replacement : implications for training and outcome

  • 1,
  • 1 and
  • 1
Journal of Cardiothoracic Surgery201510 (Suppl 1) :A292

https://doi.org/10.1186/1749-8090-10-S1-A292

  • Published:

Keywords

  • Aortic Valve Replacement
  • Individual Trainee
  • Logistic euroSCORE
  • Trainee Experience
  • Premorbid Status

Background/Introduction

Minimally-invasive Aortic Valve Replacement (mini-AVR) is being increasingly adopted in clinical practice. Training can be a challenge due to the inherent difficulties of limited surgical exposure. We analysed individual trainee experience in our institutional undergoing mini-AVR training within a series of our cases where all AVRs are routinely undertaken by this approach.

Aims/Objectives

We assessed the impact and outcome on training in mini-AVR in our centre at both the trainee cohort and individual trainee levels. We assessed the complication rates between trainees and consultant surgeon undertaking mini-AVR in the context of challenging surgical access.

Method

A single consultant surgeon undertook minimally-invasive aortic valve replacement for all isolated first-time aortic valve replacement, without any selection. Operative records and cardiac surgery database of all patients who had undergone mini-AVR between 2006-2015 were retrieved. Patient demographics, premorbid status, operating surgeon, operative details and outcome were evaluated. We constructed learning curves of individual trainees and compared. Part-procedures were defined and enumerated, and individual experience over time was plotted. Risk stratification was also analysed. p < 0.05 was defined to be statistically significant.

Results

171 mini-AVRs were undertaken between 2006 and 2015. We defined a case as all parts being undertaken by the operator. Mini-AVR was divided into nine component part-procedures including mini-sternotomy, cannulation, aortotomy, decalcification, implantation, aortotomy closure, de-airing and weaning, decannulation and sternotomy closure. 13% of cases (n = 23) were undertaken by trainees. The proportion of part-procedures undertaken by trainees varied between 13% (all part-procedures) to 87% (single part-procedures) of all cases. The learning curve of five trainees with the highest operative numbers were plotted. The learning curve of a single trainee over time was plotted in part-procedures. (Figure 2). Logistic euroSCORE was not significantly different between trainees and consultants, however trainees took longer bypass and cross-clamp times.

Discussion/Conclusion

We demonstrate detailed learning curves and outcomes comparison in learning minimally-invasive aortic valve replacement. The challenge in mini-AVR is the access - mini-sternotomy and cannulation, which is the focus in our training programme.

Authors’ Affiliations

(1)
Cardiothoracic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK

Copyright

© Aslam et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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