Perspectives of a cardiac surgery resident in-training on off-pump coronary bypass operation.

BACKGROUND

Contemporary residency training in the cardiac component of cardiothoracic operation is focused mainly on attaining technical proficiency in coronary artery revascularization. Most trainees in cardiothoracic operation are required to perform 35 cases of coronary revascularization in order to fulfill the minimum requirements for certification by the American Board of Thoracic Surgery. Although experience in minimally invasive coronary revascularization is not required for board certification in cardiothoracic operation, it is recognized by both trainees and program directors as an important component of contemporary training in less-invasive surgical approaches (LISA) for coronary artery disease. The objective of this study was to describe the training of residents in off-pump coronary revascularization in an accredited training program.

METHODS

A retrospective analysis of a single resident's experience in minimally invasive coronary revascularization over an 18 month period in a 2-year residency program in cardiothoracic operation was carried out.

RESULTS

Of the 166 total cases of coronary bypass operation, the resident performed 61 cases (37% of the total) off-pump as primary surgeon with attending supervision. Patients undergoing off-pump coronary bypass had an average of 2.4 grafts (range 1 to 5) and conventional coronary artery surgeon (on cardiopulmonary bypass) performed by the resident had an average of 4 grafts (range 2 to 5). The marginal/circumflex system was bypassed in patients that required revascularization of the marginal/circumflex system, which was 56% (n = 36 of 62) in the off-pump group and 90% for the conventional group using cardiopulmonary bypass. The conversion rate from off-pump technique to conventional coronary bypass using cardiopulmonary bypass was 3.2% in this series.

CONCLUSIONS

Technical innovations and evolution of techniques to better stabilize the heart for off-pump coronary revascularization have made the procedure both effective and safe. Our experience has shown that cardiothoracic residents can be taught the skills necessary to perform coronary revascularization off cardiopulmonary bypass. There are currently no standards for the training of cardiothoracic residents in off-pump coronary artery operation. We propose that at least 50 cases be performed under supervision by a trained surgeon to obtain adequate credentials in minimally invasive coronary revascularization.