Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.
Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom of Great Britain and Northern Ireland.
Thorac Cardiovasc Surg. 2020 Dec;68(8):674-678. doi: 10.1055/s-0040-1701668. Epub 2020 Mar 21.
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.
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.
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 ( = 1 vs. 2, = 0.759), resternotomy for bleeding ( = 3 vs. 7, = 0.431), and mediastinal infection ( = 2 vs. 3, = 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).
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.
非体外循环冠状动脉旁路移植术（OPCAB）培训的安全性以及受训者应在何时接触该技术仍然存在争议。本单中心回顾性研究旨在比较顾问医师和受训者施行 OPCAB 手术的结果。
分析了 2014 年至 2018 年间在顾问外科医生（G.A.）的护理下进行的所有孤立 OPCAB 手术。将至少完成 70%远端吻合术的外科医生低于顾问级别指定为“受训者病例”，其余病例指定为“顾问病例”。前瞻性收集并分析患者的基线特征、围手术期数据和短期结果。
在研究期间，共确定了 245 例 OPCAB 手术：142 例（58%）为顾问病例，103 例（42%）为受训者病例。受训者病例仅由英国国家心胸培训计划最后 2 年的受训者进行。顾问组和受训者组的死亡率均较低，两组各有 1 例围手术期死亡。严重术后并发症（包括卒中）的发生率较低，分别为 1 例（=1，=0.759）和 2 例（=0.431），需要再次开胸止血的发生率分别为 3 例（=3，=0.431）和 7 例（=0.431），纵隔感染的发生率分别为 2 例（=2，=0.926）和 3 例（=0.926），且两组之间无显著差异。与由顾问外科医生手术的患者相比，由受训者手术的患者的住院时间略长，但无统计学意义（9.9 天 vs. 7.9 天）。
这些结果表明，顾问外科医生和受训者施行 OPCAB 手术的结果相当。本研究支持的结论是，在心脏手术培训的最后几年，对受训者进行 OPCAB 培训是合适的。
