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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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  • References

  • 1 Gaudino M, Angelini GD, Antoniades C. et al; Arterial Grafting International Consortium (ATLANTIC) Alliance. Off-pump coronary artery bypass grafting: 30 years of debate. J Am Heart Assoc 2018; 7 (16) e009934
    CrossrefPubMedGoogle Scholar
  • 2 Shroyer AL, Grover FL, Hattler B. et al; Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009; 361 (19) 1827-1837
    CrossrefPubMedGoogle Scholar
  • 3 Møller CH, Penninga L, Wetterslev J, Steibrüchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease (Review) Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Rev 2012; (03) CD007224
    PubMedGoogle Scholar
  • 4 Raja SG, Benedetto U. Off-pump coronary artery bypass grafting: Misperceptions and misconceptions. World J Methodol 2014; 4 (01) 6-10
    CrossrefPubMedGoogle Scholar
  • 5 Shroyer AL, Hattler B, Wagner TH. et al; Veterans Affairs ROOBY-FS Group. Five-year outcomes after on-pump and off-pump coronary-artery bypass. N Engl J Med 2017; 377 (07) 623-632
    CrossrefPubMedGoogle Scholar
  • 6 Lamy A, Devereaux PJ, Prabhakaran D. et al; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012; 366 (16) 1489-1497
    CrossrefPubMedGoogle Scholar
  • 7 Diegeler A, Börgermann J, Kappert U. et al; GOPCABE Study Group. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 2013; 368 (13) 1189-1198
    CrossrefPubMedGoogle Scholar
  • 8 Almassi GH, Carr BM, Bishawi M. et al; Veterans Affairs #517 Randomized On/Off Bypass (ROOBY) Study Group. Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg 2015; 150 (06) 1428-1435 , 1437.e1, discussion 1435–1437
    CrossrefPubMedGoogle Scholar
  • 9 Smith TA, Asimakopoulos G. How safe is it to train residents to perform off-pump coronary artery bypass surgery?. Interact Cardiovasc Thorac Surg 2015; 20 (05) 658-661
    CrossrefPubMedGoogle Scholar
  • 10 Karagounis A, Asimakopoulos G, Niranjan G, Valencia O, Chandrasekaran V. Complex off-pump coronary artery bypass surgery can be safely taught to cardiothoracic trainees. Interact Cardiovasc Thorac Surg 2006; 5 (03) 222-226
    CrossrefPubMedGoogle Scholar
  • 11 Jarral OA, Baig K, Pettengell C. et al; United Kingdom and Republic of Ireland Consultant Cardiothoracic Surgeons. National survey of UK consultant surgeons' opinions on surgeon-specific mortality data in cardiothoracic surgery. Circ Cardiovasc Qual Outcomes 2016; 9 (04) 414-423
    CrossrefPubMedGoogle Scholar
  • 12 Murzi M, Caputo M, Aresu G, Duggan S, Angelini GD. Training residents in off-pump coronary artery bypass surgery: a 14-year experience. J Thorac Cardiovasc Surg 2012; 143 (06) 1247-1253
    CrossrefPubMedGoogle Scholar
  • 13 Messina A, Villa E, Mhagna Z. et al. Medium-term results of systematic off-pump coronary surgery performed by trainee surgeons. Eur J Cardiothorac Surg 2010; 38 (03) 380-386
    CrossrefPubMedGoogle Scholar