Interactive cardiovascular and thoracic surgery最新文献

{"title":"The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: a systematic review.","authors":"Nabil Hussein,&nbsp;Jef Van den Eynde,&nbsp;Connor Callahan,&nbsp;Alvise Guariento,&nbsp;Can Gollmann-Tepeköylü,&nbsp;Malak Elbatarny,&nbsp;Mahmoud Loubani","doi":"10.1093/icvts/ivac194","DOIUrl":"https://doi.org/10.1093/icvts/ivac194","url":null,"abstract":"<p><strong>Objectives: </strong>With reductions in training time and intraoperative exposure, there is a need for objective assessments to measure trainee progression. This systematic review focuses on the evaluation of trainee technical skill performance using objective assessments in cardiothoracic surgery and its incorporation into training curricula.</p><p><strong>Methods: </strong>Databases (EBSCOHOST, Scopus and Web of Science) and reference lists of relevant articles for studies that incorporated objective assessment of technical skills of trainees/residents in cardiothoracic surgery were included. Data extraction included task performed; assessment setting and tool used; number/level of assessors; study outcome and whether the assessments were incorporated into training curricula. The methodological rigour of the studies was scored using the Medical Education Research Study Quality Instrument (MERSQI).</p><p><strong>Results: </strong>Fifty-four studies were included for quantitative synthesis. Six were randomized-controlled trials. Cardiac surgery was the most common speciality utilizing objective assessment methods with coronary anastomosis the most frequently tested task. Likert-based assessment tools were most commonly used (61%). Eighty-five per cent of studies were simulation-based with the rest being intraoperative. Expert surgeons were primarily used for objective assessments (78%) with 46% using blinding. Thirty (56%) studies explored objective changes in technical performance with 97% demonstrating improvement. The other studies were primarily validating assessment tools. Thirty-nine per cent of studies had established these assessment tools into training curricula. The mean ± standard deviation MERSQI score for all studies was 13.6 ± 1.5 demonstrating high validity.</p><p><strong>Conclusions: </strong>Despite validated technical skill assessment tools being available and demonstrating trainee improvement, their regular adoption into training curricula is lacking. There is a need to incorporate these assessments to increase the efficiency and transparency of training programmes for cardiothoracic surgeons.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/a4/ivac194.PMC9403301.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40641092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An ounce of prevention is worth a pound of cure.","authors":"Zohair Al Halees","doi":"10.1093/icvts/ivac216","DOIUrl":"https://doi.org/10.1093/icvts/ivac216","url":null,"abstract":"Atrioventricular groove disruption is a rare and potentially fatal complication of mitral valve replacement. It does not occur with mitral valve repair. Friable tissues, advanced age and posterior annular calcification are important predisposing factors. Most ruptures usually occur in the operating room, which gives the operating surgeon a better chance at salvaging the situation. Nevertheless, mortality remains high particularly if the rupture happened in the intensive care unit or later and it can be as high as 50–90%. In dealing with this complication surgically, there are 2 major approaches that have been described in the literature, the ‘external’ and the ‘intracardiac’ the external repair technique is usually conducted on cardiopulmonary bypass using direct suturing or felt-reinforced suturing or both of the ruptured atrioventricular groove. This can be supplemented with the application of bioglue (cryolife). Further atrial patching and coronary bypass grafting of the circumflex coronary artery may be required [1]. The intracardiac approach entails going back on pump and under cardioplegic arrest, explant the MV prosthesis and patch the posterior atrioventricular groove with fresh autologous pericardium or bovine pericardium then place the prosthetics valve again [2]. There are case reports of utilizing other additional technical tips. Raevsky et al. present a case report of a 23-year-old female with shone complex, who developed atrioventricular groove disruption after mitral valve replacement. To accomplish the repair and because of difficult exposure, they had to utilize ‘the commando procedure principles’, sacrificing the native ‘bicuspid’ aortic valve [3]. That was a commendable salvage for a deadly complication. The way the problem was handled is innovative and though very complicated, the outcome was good. However, in our opinion, this is not for the average cardiac surgeon and the principle remains to emphasize that such complication should not happen. We should teach young surgeons how to avoid such a complication. Simple preservation of the posterior leaflet or at least part of it prevents this complication. In Deniz et al.’s series of 513 mitral valve replacement patients, there were no cases of ventricular rupture with preservation of the posterior leaflet [4]. Being careful in detaching the mitral valve from the papillary muscles and paying attention to details is of utmost importance. This case report involves a young patient with probably ‘good’ tissue quality and preserved left ventricular function. No doubt this contributed to patient’s recovery. Imagine this patient was a 70–75 years old (most patients reported in the literature are in the older age range) who has some mitral valve annular calcification, left ventricular dysfunction and friable tissues and underwen this procedure that took 475 min (almost 8 h) of pump time and 310 min (5 h) of aortic cross-clamping was performed. What would be the chances of survival? Hones","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9415191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40703588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular plugs to occlude proximal entries in chronic aortic dissection.","authors":"Charlotte Sandström,&nbsp;Håkan Roos,&nbsp;Olof Henrikson,&nbsp;Erika Fagman,&nbsp;Åse A Johnsson,&nbsp;Anders Jeppsson,&nbsp;Mårten Falkenberg","doi":"10.1093/icvts/ivac201","DOIUrl":"https://doi.org/10.1093/icvts/ivac201","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with expanding chronic aortic dissection and patent proximal entries are sometimes poor candidates for open surgery or TEVAR. Occlusion of proximal entries with endovascular plugs has previously been suggested in selected patients, but clinical results over time are unknown. This study analyses aortic remodelling and clinical outcome after proximal entry occlusion.</p><p><strong>Methods: </strong>Between 2007 and 2016, 14 patients, with expanding chronic aortic dissection, considered poor candidates for standard treatment, were treated with endovascular plugs in proximal entries located in the arch (n = 6) or descending aorta (n = 8). The Amplatzer™ Vascular Plug II was used for entries ≤4 mm and the Amplatzer™ Septal Occluder or Amplatzer™ Muscular VSD Occluder for entries 5-16 mm. Patients were followed for 0.5-13 years (median 7.3) with clinical visits and computed tomography. Diameters and cross-sectional areas along the aorta were measured.</p><p><strong>Results: </strong>Occlusion of proximal entries was achieved in 10/14 patients (71%), including 4 patients with an adjunctive reintervention needed for complete seal in the segment. Unchanged or reduced maximum thoracic aortic diameter was observed in all 10 patients with successful occlusion. In 4 patients, proximal occlusion was not achieved and early conversion to FET (n = 1), FET/TEVAR (n = 2) or TEVAR (n = 1) was performed. Two aorta-related deaths occurred during follow-up, both after early conversion.</p><p><strong>Conclusions: </strong>Endovascular occlusion of proximal dissection entries of expanding chronic aortic dissections can induce favourable aortic remodelling and may be considered in selected patients with expanding chronic aortic dissection who are poor candidates for open surgery or stent graft repair.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/8c/ivac201.PMC9346262.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40537628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex vivo evaluation of the Ozaki procedure in comparison with the native aortic valve and prosthetic valves.","authors":"Hiroyuki Saisho,&nbsp;Michael Scharfschwerdt,&nbsp;Tim Schaller,&nbsp;Najla Sadat,&nbsp;Anas Aboud,&nbsp;Stephan Ensminger,&nbsp;Buntaro Fujita","doi":"10.1093/icvts/ivac199","DOIUrl":"https://doi.org/10.1093/icvts/ivac199","url":null,"abstract":"<p><strong>Objectives: </strong>We investigated the hydrodynamic performance and cusp kinematics of the Ozaki neocuspidized aortic valve in comparison with the native aortic and prosthetic valves in an ex vivo study.</p><p><strong>Methods: </strong>Native aortic valves of swine hearts were replaced by aortic valve substitutes, and their hydrodynamic performance (effective orifice area and mean pressure gradient) was evaluated in a mock circulation under defined conditions. The following aortic valve substitutes were investigated: native aortic valve, Ozaki valve, Perimount Magna Ease, Trifecta and St. Jude Medical Masters. All prosthetic valves had a labelled size of 21 mm.</p><p><strong>Results: </strong>The Ozaki valve and native aortic valve showed a similar and significantly larger orifice area than all investigated prosthetic valves particularly at high flow rates. There was no significant difference between the Ozaki valve and the native aortic valve. The native aortic valve and Ozaki valve showed a similar increase in orifice area with increasing flow through the valve while prosthetic valves showed a markedly weaker increase. Similarly, the native and Ozaki valve showed a similar increase in mPG with forward flow which was weaker than prosthetic valves. Cusp kinematics were similar between the native and Ozaki valve, whilst prosthetic valves were clearly distinguishable from them.</p><p><strong>Conclusions: </strong>The Ozaki procedure showed excellent hydrodynamic performance compared to prosthetic valves and showed similar cusp motion characteristics to the native aortic valve. Our results suggest that the Ozaki neocuspidized valve behaves physiologically in many aspects, which may contribute to beneficial clinical outcomes.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9443990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40635449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of sizing in sutureless valves.","authors":"Bart Meuris,&nbsp;Marie Lamberigts,&nbsp;Delphine Szecel","doi":"10.1093/icvts/ivac206","DOIUrl":"https://doi.org/10.1093/icvts/ivac206","url":null,"abstract":"This year, the Perceval sutureless valve is reaching its 15th anniversary. The first-in-man trial of this tissue valve was performed in 2007 and later completed with larger prospective trials for CE approval and initiation of commercial use [1, 2]. Since then, many centres across the world are using this tissue valve on a regular basis in a wide variety of patients with aortic valve disease. At this moment, Perceval is the only truly sutureless valve on the market, allowing aortic valve replacement without the use of a single suture that has to be knotted. Roughly estimated, around 75 000 valves have been implanted worldwide at this moment. Around 2016–2017, 9 years after the first-in-man experience, the manufacturer decided to change their advice towards sizing of the prosthesis. After the observation of high pacemaker rates in the largest valve size (XL size) and some isolated cases of stent invagination due to oversizing, a new advice was given to use the commercial valve sizers differently. The actual valve is still slightly bigger in diameter compared to the white side of the corresponding sizer, so if this side fits into annulus with slight resistance, this is the correct size to choose. In the meantime, additional evidence exists that demonstrates the clear negative effects of oversizing this nitinol-based, sutureless valve [3]. Fabre et al. [4] are to be congratulated on their correct reporting of their overall experience and outcome with this technology. In the article, the authors focus specifically on the need for permanent pacemaker implantation, early after valve surgery using this sutureless valve. Two chronological study cohorts were defined: the experience before and after 2016. The new sizing strategy and which elements were changed are well described in the article. The need for pacemaker implantation decreased significantly from 16% to 5.9%. We recently published our experience with Perceval, also looking at 2 cohorts in time, namely before and after 2017 [5]. A similar observation of a significantly decreased need for postoperative pacemakers from 11% to 6% was made, strengthening the observation made by Fabre. Regarding the analysis of the reasons why this pacemaker rate drops, we certainly agree with the new sizing method as an important factor in avoiding conduction disturbance after placement of the valve. We showed that just by downsizing by 1 size, the higher pacemaker rates disappear. The effect of the balloon dilation and the effect of the height of the Perceval positioning are more debatable in our opinion. Correct and complete decalcification on the other hand—as also mentioned by Fabre et al.—is important to obtain a good result with sutureless technology. In conclusion, the observation made in this article is correct and corresponds to experiences in other centres. The main driver behind the decrease in pacemaker rate, however, in our opinion, is the new sizing method. The effect of ballooning and the higher implan","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9372564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40669772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of a retrocrural lymph node metastasis from a chromophobe renal cell cancer: complete thoracoscopic resection with a new multi-joint articulating surgical instrument.","authors":"Alexander Kern,&nbsp;Christian Thomas,&nbsp;Olaf Holotiuk,&nbsp;Steffen Drewes","doi":"10.1093/icvts/ivac204","DOIUrl":"https://doi.org/10.1093/icvts/ivac204","url":null,"abstract":"<p><p>We report a rare case of a 69-year-old man with a solitary retrocrural lymph node metastasis in the posterior mediastinum of an oligo-metastatic chromophobe renal cell cancer that was radically resected in a curative intent using new articulating Artisential® instruments.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/1c/ivac204.PMC9443982.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40535671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenge of a therapeutic sequence: rare case of heart failure in mitral valvular disease intensified by an extreme mediastinal shift from major diaphragmatic eventration.","authors":"Françoise Le Pimpec-Barthes,&nbsp;Charles Al Zreibi,&nbsp;Guillaume Reverdito,&nbsp;Pascal Leprince","doi":"10.1093/icvts/ivac181","DOIUrl":"https://doi.org/10.1093/icvts/ivac181","url":null,"abstract":"<p><p>Extreme mediastinal shift due to major diaphragm eventration is complex when mitral-valve repair is required. We report the case of a 59-year-old woman with diaphragmatic eventration who had 2 recent episodes of heart failure due to arrythmia associated with severe mitral-valve regurgitation (regurgitant orifice area 47 mm2). Forced expiratory flow-volume in the first second and vital capacity (VC) were at 32% and 33%, respectively,decreasing to 20% and 30% when she was in a supine position. We found it impossible to repair the valve first because of the extreme mediastinal shift and respiratory dysfunction. Therefore, we decided to perform diaphragm plication first followed 3 months later by mitral valve repair. Six months after the cardiac operation, the patient showed significant clinical improvement. Forced expiratory flow-volume in the first second and vital capacity increased to 58% and 55%, respectively. The decision to perform the thoracic operation first, followed by the cardiac operation, was the key to improving the patient's respiratory function and to medializing the heart to safely support cardiac surgery.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9443986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40578060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of blood pressure and hypertension long-term after treatment of isolated coarctation of the aorta in children-a population-based study.","authors":"Mari K Ylinen,&nbsp;Jaana I Pihkala,&nbsp;Jukka T Salminen,&nbsp;Taisto Sarkola","doi":"10.1093/icvts/ivac212","DOIUrl":"https://doi.org/10.1093/icvts/ivac212","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to assess predictors of BP and hypertension and relations between BP and LV mass in a population-based retrospective study of repaired isolated coarctation of aorta.</p><p><strong>Methods: </strong>We collected follow-up data until 2018 of 284/304 (93%) patients with coarctation treated by surgery (n = 235) or balloon angioplasty/stent (n = 37/12) in our unit 2000-2012. Systolic hypertension was defined as systolic BP (SBP) z-score ≥+2 standard deviation (SD) or regular use of BP medication. LV hypertrophy was defined as LV mass z-score ≥+2 SD or LV mass index g/m2.7 ≥95th percentile.</p><p><strong>Results: </strong>The median (25-75th percentiles) follow-up time and age at follow-up were 9.7 years (6.9-13.2) and 11.8 years (7.9-16.0), respectively. Age at first procedure (P = 0.011) and systolic arm-leg-gradient (P = 0.007) were positively and transverse arch (P = 0.007) and isthmus diameter (P = 0.001) z-scores at follow-up were negatively associated with SBP z-score adjusted for age at follow-up and need for reintervention for coarctation. Systolic hypertension was present in 53/284 (18.7%) and related with increasing age at first procedure (median 33.2 vs 0.6 months; P < 0.001) and arm-leg-gradient at follow-up (mean ± SD, -0.3 ± 14.6 vs -6.4 ± 11.6 mmHg; P = 0.047) adjusted for reintervention for coarctation and age at follow-up. LV hypertrophy was present in 20/227 (9.3%) and related with SBP z-score.</p><p><strong>Conclusions: </strong>Higher SBP and hypertension in repaired coarctation of aorta are related with increasing age at first procedure and arm-leg-gradient at follow-up. Transverse arch and isthmus diameters at follow-up are inversely related with SBP.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9380783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe acute ischaemic stroke early after wedge resection in middle-aged patients: analysis and endovascular treatment.","authors":"Chong Zhang,&nbsp;Di Meng,&nbsp;Jinming Xu,&nbsp;Jinlin Cao,&nbsp;Jian Hu","doi":"10.1093/icvts/ivac211","DOIUrl":"https://doi.org/10.1093/icvts/ivac211","url":null,"abstract":"<p><p>Severe acute ischaemic stroke early after wedge resection is very rare in healthy middle-aged patients. Here, we reviewed the data and characteristics of 9 cases. The infarction resulted from embolism in intracranial arteries, severely impacting the quality of life. In the first 2 patients, the onset symptom was confused with residual anaesthetic effects early after surgery. Drawing from the initial 2 cases, the following 7 patients received accurate diagnosis and emergent endovascular thrombus aspiration with good outcome due to immediate reperfusion. Furthermore, we discuss the principal causes of severe acute stroke in healthy middle-aged patients and the efficacy of endovascular thrombus aspiration.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"35 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/77/ivac211.PMC9380782.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10310611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nothing changes if nothing changes.","authors":"Michael Salna,&nbsp;Brett R Anderson,&nbsp;Emile Bacha,&nbsp;Paul Kurlansky","doi":"10.1093/icvts/ivac217","DOIUrl":"https://doi.org/10.1093/icvts/ivac217","url":null,"abstract":"A musician would not play a concert piece without repeatedly practicing each measure flawlessly. Similarly, the first time a professional basketball player takes a three-pointer is not during a televised playoff game. That shot is taken after countless iterations of microimprovements in their stance, jump, and wrist motion on the practice court. These performance-based professionals practice until their default is near perfection, and then they continue to be coached throughout their professional career. With an arguably steeper learning curve, why are surgeons not afforded this luxury of preparation and ongoing mentorship? The clock cannot be stopped in the operating room and, unlike hitting a wrong note on the piano, every misplaced stitch or cut may have irreversible consequences, which may not be apparent at the time. Learning cardiac surgery is stressful. The stakes are high, crossclamp and bypss times are precious and the cognitive burden can be immense. To further complicate matters, as outcome measures become increasingly scrutinized and operative costs rise in the face of declining reimbursement, stress falls not only upon the trainee but upon the attending surgeon as well. Despite these rigours, cardiac surgery is still fundamentally taught within a mentor-mentee apprenticeship training model that largely ends after fellowship. It may be more sophisticated nowadays, but a cardiac surgeon teaches residents the same way a violin master would teach an apprentice to build a violin in the 15thcentury Florence or a stone mason an apprentice during the building of a great cathedral. Why has it not changed? Every case is a playoff game for surgeons. Every day we must perform technically and physically demanding tasks, aspiring to nothing short of excellence. Nathan et al. [1] previously demonstrated that technical performance in paediatric cardiac surgery was strongly associated with outcomes—to the point where optimal technical performance can overcome adverse intraoperative events. By extension, poor performance is associated with shortand long-term mortality and reintervention [2, 3]. So, if technique is so important, surely there are objective measures to assess technical performance in trainees? Hussein et al. performed a systematic review of 54 studies evaluating the use of competency-based assessments in the evaluation of technical skills in cardiothoracic surgery. Cardiac surgery was the most common specialty using objective assessment methods with coronary anastomosis being the most frequently tested task (28%). Thirty studies (56%) assessed objective changes in technical performance (the others validated the assessment tools) and 97% of them found improvement in their trainees. Despite this obvious benefit, it was surprising that only 21 (39%) of the 54 studies incorporated assessment methods into their training curricula. Clearly, there is a mismatch between our acknowledgement of the importance of simulation and technical preparatio","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40424192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}