Soppa Gopal, Yates Martin, Viviano Alessandro, Smelt Jeremy, Valencia Oswaldo, van Besouw Jean Pierre, Jahangiri Marjan
Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK.
Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK
Interact Cardiovasc Thorac Surg. 2015 Apr;20(4):458-62. doi: 10.1093/icvts/ivu428. Epub 2015 Jan 7.
Minimally invasive aortic valve replacement (Mini-AVR) is a technically advanced procedure. However, it results in equivalent operative mortality, less bleeding and reduced intensive care/hospital stay when compared with conventional AVR. Our aim was to assess the impact of trainee performance on short-term outcomes of patients undergoing elective and urgent Mini-AVR where a significant proportion were performed by trainees.
All patients undergoing non-emergency, elective and urgent, isolated Mini-AVR between September 2005 and December 2012 were studied. Operative details and short-term outcomes, with particular attention to trainee performance, were analysed.
During the study period, there were 205 Mini-AVR with a median age of 67 years (range 29-86); 74 (36%) operations were performed by trainees. The overall median cross-clamp and bypass times were 42 (range 33-63) and 59 min (range 59-94) for the attending surgeon and 52 (range 42-63) and 71 min (range 59-94) for the trainee (P = 0.03). Five Mini-AVR patients (2.4%) required conversion to full sternotomy for ascending aortic replacement, right ventricular bleeding, coronary artery bypass graft surgery and failure to cardiovert. None of these cases were performed by trainees. Median lengths of intensive care and hospital stay were 1 and 5 days and were not different for attending surgeon and trainee. Only 1 (0.5%) patient died in hospital.
Mini-AVR can be performed with a low conversion rate and hospital stay and taught to trainees without compromising safety.
微创主动脉瓣置换术（Mini-AVR）是一项技术先进的手术。然而，与传统主动脉瓣置换术相比，其手术死亡率相当，出血更少，重症监护/住院时间缩短。我们的目的是评估学员操作对接受择期和急诊Mini-AVR患者短期结局的影响，其中很大一部分手术由学员完成。
对2005年9月至2012年12月期间接受非急诊、择期和急诊单纯Mini-AVR的所有患者进行研究。分析手术细节和短期结局，尤其关注学员的操作表现。
在研究期间，共进行了205例Mini-AVR手术，患者中位年龄为67岁（范围29 - 86岁）；74例（36%）手术由学员完成。主刀医生的总体中位主动脉阻断时间和体外循环时间分别为42分钟（范围33 - 63分钟）和59分钟（范围59 - 94分钟），学员的分别为52分钟（范围42 - 63分钟）和71分钟（范围59 - 94分钟）（P = 0.03）。5例Mini-AVR患者（2.4%）因升主动脉置换、右心室出血、冠状动脉旁路移植手术和未能复律而需要转为全胸骨切开术。这些病例均非学员完成。重症监护和住院的中位时长分别为1天和5天，主刀医生和学员的情况无差异。仅1例（0.5%）患者在医院死亡。
Mini-AVR手术的转化率和住院时间较低，可教授给学员且不影响安全性。
