Jeremy Chan, Shubhra Sinha, Daniel P. Fudulu, Tim Dong, Pradeep Narayan, Gianni D. Angelini
{"title":"英国高级冠状动脉搭桥手术培训","authors":"Jeremy Chan, Shubhra Sinha, Daniel P. Fudulu, Tim Dong, Pradeep Narayan, Gianni D. Angelini","doi":"10.1155/2024/2140060","DOIUrl":null,"url":null,"abstract":"<div>\n <p><i>Objective</i>. The learning curve of coronary artery bypass grafting with multiple arterial grafting and without the use of cardiopulmonary bypass (off-pump) is perceived as an advanced subspeciality associated with increased surgical risk. We compared the trends and early clinical outcomes between trainees and consultants as the first operator in the United Kingdom. <i>Methods</i>. All patients who underwent elective or urgent isolated coronary artery bypass grafting from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. Trends and early clinical outcomes between trainees and consultants as the first operator were compared in the whole cohort and after propensity score matching. <i>Results</i>. Of the total coronary artery bypass graft procedures, trainees performed 24.39% (<i>n</i> = 79759/327025). Trainees performed 27.10% (63934/235920) on-pump without multiple arterial graft procedures compared to consultants. The consultants had a shorter cardiopulmonary bypass time (82.81 (SD: 35.36) vs 86.21 (SD: 30.07) minutes, <i>p</i> < 0.001) and aortic cross-clamp time (48.05 (SD: 22.46) vs 50.66 (SD: 19.49) minutes, <i>p</i> < 0.001). However, consultants had a higher mortality (1.6% vs 1.0%, <i>p</i> < 0.001) and incidence of postoperative dialysis (2.1% vs 1.5%, <i>p</i> < 0.001). Trainees performed 16.78% (8089/48220) multiple arterial graft procedures, with no differences compared with consultants for in-hospital mortality (1.0% vs 0.9%, <i>p</i> = 0.42), cerebral vascular accident (transient ischaemic attack (0.5% vs 0.5%) and permanent stroke (0.6% vs 0.4%), <i>p</i> = 0.33), return to theatre (4.2% vs 4.47%, <i>p</i> = 0.089), postoperative renal dialysis (1.4% vs 1.1%, <i>p</i> = 0.076), and deep sternal wound infection (0.6% vs 0.6%, <i>p</i> = 0.87). Trainees performed 17.17% (8661/41778) off-pump cases. Consultants had a higher in-hospital mortality (1.2% vs 0.9%, <i>p</i> = 0.045) with no differences in cerebral vascular accident (transient ischaemic attack (0.2% vs 0.3%) and permanent stroke (0.4% vs 0.4%), <i>p</i> = 0.27), return to theatre (3.8% vs 3.9%, <i>p</i> = 0.69), postoperative renal dialysis (2.0% vs 1.6%, <i>p</i> = 0.059), and deep sternal wound infection (1.0% vs 0.8%, <i>p</i> = 0.66). <i>Conclusion</i>. Trainees in the United Kingdom have adequate exposure to advanced coronary surgery without compromising patients’ safety.</p>\n </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/2140060","citationCount":"0","resultStr":"{\"title\":\"Training in Advanced Coronary Artery Bypass Surgery in the United Kingdom\",\"authors\":\"Jeremy Chan, Shubhra Sinha, Daniel P. Fudulu, Tim Dong, Pradeep Narayan, Gianni D. Angelini\",\"doi\":\"10.1155/2024/2140060\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n <p><i>Objective</i>. The learning curve of coronary artery bypass grafting with multiple arterial grafting and without the use of cardiopulmonary bypass (off-pump) is perceived as an advanced subspeciality associated with increased surgical risk. We compared the trends and early clinical outcomes between trainees and consultants as the first operator in the United Kingdom. <i>Methods</i>. All patients who underwent elective or urgent isolated coronary artery bypass grafting from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. Trends and early clinical outcomes between trainees and consultants as the first operator were compared in the whole cohort and after propensity score matching. <i>Results</i>. Of the total coronary artery bypass graft procedures, trainees performed 24.39% (<i>n</i> = 79759/327025). Trainees performed 27.10% (63934/235920) on-pump without multiple arterial graft procedures compared to consultants. The consultants had a shorter cardiopulmonary bypass time (82.81 (SD: 35.36) vs 86.21 (SD: 30.07) minutes, <i>p</i> < 0.001) and aortic cross-clamp time (48.05 (SD: 22.46) vs 50.66 (SD: 19.49) minutes, <i>p</i> < 0.001). However, consultants had a higher mortality (1.6% vs 1.0%, <i>p</i> < 0.001) and incidence of postoperative dialysis (2.1% vs 1.5%, <i>p</i> < 0.001). Trainees performed 16.78% (8089/48220) multiple arterial graft procedures, with no differences compared with consultants for in-hospital mortality (1.0% vs 0.9%, <i>p</i> = 0.42), cerebral vascular accident (transient ischaemic attack (0.5% vs 0.5%) and permanent stroke (0.6% vs 0.4%), <i>p</i> = 0.33), return to theatre (4.2% vs 4.47%, <i>p</i> = 0.089), postoperative renal dialysis (1.4% vs 1.1%, <i>p</i> = 0.076), and deep sternal wound infection (0.6% vs 0.6%, <i>p</i> = 0.87). Trainees performed 17.17% (8661/41778) off-pump cases. Consultants had a higher in-hospital mortality (1.2% vs 0.9%, <i>p</i> = 0.045) with no differences in cerebral vascular accident (transient ischaemic attack (0.2% vs 0.3%) and permanent stroke (0.4% vs 0.4%), <i>p</i> = 0.27), return to theatre (3.8% vs 3.9%, <i>p</i> = 0.69), postoperative renal dialysis (2.0% vs 1.6%, <i>p</i> = 0.059), and deep sternal wound infection (1.0% vs 0.8%, <i>p</i> = 0.66). <i>Conclusion</i>. Trainees in the United Kingdom have adequate exposure to advanced coronary surgery without compromising patients’ safety.</p>\\n </div>\",\"PeriodicalId\":15367,\"journal\":{\"name\":\"Journal of Cardiac Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-06-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/2140060\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiac Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1155/2024/2140060\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiac Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/2024/2140060","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的。多动脉移植和不使用心肺旁路(非泵)的冠状动脉旁路移植术的学习曲线被认为是与手术风险增加相关的高级亚专科。我们比较了英国受训者和顾问作为第一手术者的趋势和早期临床结果。方法从国家成人心脏外科审计数据库中提取了 1996 年至 2019 年期间接受择期或紧急孤立冠状动脉旁路移植术的所有患者。在整个队列和倾向得分匹配后,比较了受训者和顾问作为第一操作者的趋势和早期临床结果。结果在所有冠状动脉旁路移植手术中,受训人员完成了 24.39% 的手术(n = 79759/327025)。与顾问相比,受训人员进行了27.10%(63934/235920)的泵上无多处动脉移植手术。顾问医师的心肺旁路时间(82.81 (SD: 35.36) vs 86.21 (SD: 30.07) 分钟,p < 0.001)和主动脉交叉钳夹时间(48.05 (SD: 22.46) vs 50.66 (SD: 19.49) 分钟,p < 0.001)更短。然而,顾问的死亡率(1.6% vs 1.0%,p <0.001)和术后透析发生率(2.1% vs 1.5%,p <0.001)较高。受训人员进行了 16.78% (8089/48220)的多次动脉移植手术,与顾问相比,在院内死亡率(1.0% vs 0.9%,p = 0.42)、脑血管意外(短暂性缺血发作(0.5% vs 0.5%)和永久性中风(0.6% vs 0.4%),p = 0.33)、重返手术室(4.2% vs 4.47%,p = 0.089)、术后肾透析(1.4% vs 1.1%,p = 0.076)和胸骨深伤口感染(0.6% vs 0.6%,p = 0.87)。受训人员实施了17.17%(8661/41778)的非泵手术。顾问医师的院内死亡率较高(1.2% vs 0.9%,p = 0.045),而脑血管意外(短暂性缺血发作(0.2% vs 0.3%)和永久性中风(0.4% vs 0.4%,p = 0.27)、重返手术室(3.8% vs 3.9%,p = 0.69)、术后肾透析(2.0% vs 1.6%,p = 0.059)和胸骨深伤口感染(1.0% vs 0.8%,p = 0.66)方面没有差异。)结论英国的受训人员有足够的机会接触先进的冠状动脉手术,同时不会影响患者的安全。
Training in Advanced Coronary Artery Bypass Surgery in the United Kingdom
Objective. The learning curve of coronary artery bypass grafting with multiple arterial grafting and without the use of cardiopulmonary bypass (off-pump) is perceived as an advanced subspeciality associated with increased surgical risk. We compared the trends and early clinical outcomes between trainees and consultants as the first operator in the United Kingdom. Methods. All patients who underwent elective or urgent isolated coronary artery bypass grafting from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. Trends and early clinical outcomes between trainees and consultants as the first operator were compared in the whole cohort and after propensity score matching. Results. Of the total coronary artery bypass graft procedures, trainees performed 24.39% (n = 79759/327025). Trainees performed 27.10% (63934/235920) on-pump without multiple arterial graft procedures compared to consultants. The consultants had a shorter cardiopulmonary bypass time (82.81 (SD: 35.36) vs 86.21 (SD: 30.07) minutes, p < 0.001) and aortic cross-clamp time (48.05 (SD: 22.46) vs 50.66 (SD: 19.49) minutes, p < 0.001). However, consultants had a higher mortality (1.6% vs 1.0%, p < 0.001) and incidence of postoperative dialysis (2.1% vs 1.5%, p < 0.001). Trainees performed 16.78% (8089/48220) multiple arterial graft procedures, with no differences compared with consultants for in-hospital mortality (1.0% vs 0.9%, p = 0.42), cerebral vascular accident (transient ischaemic attack (0.5% vs 0.5%) and permanent stroke (0.6% vs 0.4%), p = 0.33), return to theatre (4.2% vs 4.47%, p = 0.089), postoperative renal dialysis (1.4% vs 1.1%, p = 0.076), and deep sternal wound infection (0.6% vs 0.6%, p = 0.87). Trainees performed 17.17% (8661/41778) off-pump cases. Consultants had a higher in-hospital mortality (1.2% vs 0.9%, p = 0.045) with no differences in cerebral vascular accident (transient ischaemic attack (0.2% vs 0.3%) and permanent stroke (0.4% vs 0.4%), p = 0.27), return to theatre (3.8% vs 3.9%, p = 0.69), postoperative renal dialysis (2.0% vs 1.6%, p = 0.059), and deep sternal wound infection (1.0% vs 0.8%, p = 0.66). Conclusion. Trainees in the United Kingdom have adequate exposure to advanced coronary surgery without compromising patients’ safety.
期刊介绍:
Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide.
With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery.
In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.