Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting
Keywords:Education, Simulation, Surgical training. Minimally invasive direct coronary artery bypass grafting, Off-pump
Background: To evaluate the effect of minimally invasive direct coronary artery bypass (MIDCAB) simulator for cardiac residency training.
Methods: A total of 26 resident surgeons who had never trained for coronary artery anastomosis participated in this training program. They received coronary artery anastomosis training on off-pump coronary artery bypass grafting (OPCAB) simulator for 15 h. After training, their performance of anastomosis was evaluated on the OPCAB simulator according to 12 items and a 5-point global rating scale. Based on the total score of assessment, those with an individual score of 12-36 formed group A, while group B was composed of the remaining trainees. The two groups then received another 15 h coronary artery anastomosis training on the MIDCAB simulator, and the performance was assessed.
Results: Trainees improved their performance of coronary artery anastomosis after training on the OPCAB simulator. Group A was composed of 7 trainees with an individual with a total score of 12–36 points and group B was composed of the remaining 19 trainees. After MIDCAB simulator training, significant differences were noted in the pre- and post-training values in the A group (P < .001), and the assessment value of group A was significantly better than those of group B (P < .05). No significant difference was detected between pre- and post-training values in group B after MIDCAB simulator training (P > .05).
Conclusion: We concluded that trainees who performed well in OPCAB simulation training can also perform better in MIDCAB, and our designed MIDCAB simulator was useful for residency training.
Babliak O, Demianenko V, Melnyk Y, et al. 2020. Multivessel arterial revascularization via left anterior thoracotomy. Semin Thorac Cardiovasc Surg 27 pii: S1043-0679(20)30047-2.
Baker CJ, Sinha R, Sullivan ME. 2012. Development of a cardiac surgery simulation curriculum: from needs assessment results to practical implementation. J Thorac Cardiovasc Surg 144:7-16.
Cavalli F, Izadi A, Ferreira AP, et al. 2011. Interobserver Reliability among Radiologists and Orthopaedists in Evaluation of Chondral Lesions of the Knee by MRI. Adv Orthop 2011:743742.
Enter DH, Lou X, Hui DS, et al. 2015. Practice improves performance on a coronary anastomosis simulator, attending surgeon supervision does not. J Thorac Cardiovasc Surg 149:12-6, 17.e1-2.
Fann JI, Calhoon JH, Carpenter AJ, et al. 2010. Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: the boot camp experience. J Thorac Cardiovasc Surg 139:1275-81.
Fann JI, Feins RH, Hicks GL Jr, et al. 2012. Senior tour in cardiothoracic surgery. Evaluation of simulation training in cardiothoracic surgery: the senior tour perspective. J Thorac Cardiovasc Surg 143:264-72.
Feins RH, Burkhart HM, Conte JV, et al. 2017. Simulation-based training in cardiac surgery. Ann Thorac Surg 103:312-21.
Ghista DN, Kabinejadian F. 2013. Coronary artery bypass grafting hemodynamics and anastomosis design: a biomediacal engineering review. Biomed Eng Online 13:129.
Holzhey DM, Jacobs S, Mochalski M, et al. 2007. Seven-year follow-up after minimally invasive direct coronary artery bypass: experience with more than 1300 patients. Ann Thorac Surg. 83:108-14.
Izzat MB, EI-Zufari MH, Yim AP. 1998. Training model for beating heart coronary artery anastomoses. Ann Thorac Surg 66:580-1.
Kofidis T, Emmert MY, Paeschke HG, et al. 2009. Long-term follow-up after minimal invasive direct coronary artery bypass grafting procedure: a multi-factorial retrospective analysis at 1000 patient-years. Interact Cardiovasc Thorac Surg 9:990-4.
Liu X, Yang Y, Meng Q, et al. 2016. Secure and high-fidelity live animal model for off-pump coronary bypass surgery training. J Surg Educ 73:583-8.
Lou X, Enter D, Sheen L, et al. 2013. Sustained supervised practice on a coronary anastomosis simulator increases medical student interest in surgery, unsupervised practice does not. Ann Thorac Surg 95:2057-63.
Lou X, Lee R, Feins RH, et al. 2014. Training less-experienced faculty improves reliability of skills assessment in cardiac surgery. J Thorac Cardiovasc Surg 148:2491-6.e1-2.
Matsuura K, Jin WW, Liu H, et al. 2019. Computational fluid dynamic study of different incision length of coronary artery bypass grafting in a native coronary stenosis model. J Thorac Dis 11:393-9.
Mokadam NA, Fann JI, Hicks GL, et al. 2017. Experience with the cardiac surgery simulation curriculum: results of the resident and faculty survey. Ann Thorac Surg 103:322-8.
Murzi M, Caputo M, Aresu G, et al. 2012. Training residents in off-pump coronary artery bypass surgery: a 14-year experience. J Thorac Cardiovasc Surg 143:1247-53.
Nambiar P, Kumar S, Mittal CM, et al. 2018. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future? J Thorac Cardiovasc Surg 155:190-7.
Nesbitt JC, St Julien J, Absi TS, et al. 2013. Tissue-based coronary surgery simulation: medical student deliberate practice can achieve equivalency to senior surgery residents. J Thorac Cardiovasc Surg 145:1453-8; discussion 1458-9.
Raja SG, Garg S, Rochon M, et al. 2018. Short-term clinical outcomes and long-term survival of minimally invasive direct coronary artery bypass grafting. Ann Cardiothorac Surg 7:621-7.
Ramphal PS, Coore DN, Craven MP, et al. 2005. A high fidelity tissue-based cardiac surgical simulator. Eur J Cardiothorac Surg 27:910-6.
Repossini A, Di Bacco L, Nicoli F, et al. 2019. Minimally invasive coronary artery bypass: twenty-year experience. J Thorac Cardiovasc Surg 158:127-38.
Reuthebuch O, Lang A, Groscurth P, et al. 2002. Advanced training model for beating heart coronary artery surgery: the Zurich heart-trainer. Eur J Cardiothorac Surg 22:2448-8.
Reznick RK, MacRae H. 2006. Teaching surgical skills-changes in the wind. N Engl J Med 355:2664-9.
Ribeiro IB, Ngu JMC, Gill G, et al. 2017. Development of a high fidelity pressurized porcine beating heart simulator for cardiac surgery training. Perfusion 32:568-73.
Sadeghifar A, Kahani AK, Saied A, et al. 2018. Interobserver and intraobserver reliability of different methods of examination for presence of palmaris longus and examination of fifth superficial flexor function. Anat Cell Biol 51:79-84.
Vaporciyan AA, Yang SC, Baker CJ, et al. 2013. Cardiothoracic surgery residency training: past, present, and future. J Thorac Cardiovasc Surg 146:759-67.
Wu S, Ling Y, Fu Y, et al. 2017. Mid-term follow-up outcomes of 2-staged hybrid coronary revascularization compared with off-pump coronary artery bypass for patients with multivessel coronary artery disease.Wideochir Inne Tech Maloinwazyjne 12:178-185.
Zhang L, Cui Z, Song Z, et al. 2016. Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization -analysis of 300 cases. Wideochir Inne Tech Maloinwazyjne 10: 548-54.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).