AATS: Complex cardiac surgeries may require continued training

Cardiac surgeons may benefit from continuous training if they perform complex or rare procedures, according to an abstract presented April 28 at the American Association for Thoracic Surgery meeting in Toronto.

Andrew W. ElBardissi, MD, MPH, and colleagues evaluated data from January 2002 to June 2012 on five different cardiac surgical procedures at one institution to track surgeons’ learning curves and long-term patient survival rates for each. They used cardiopulmonary bypass and X-clamp times as measures of efficiencies.

The analysis included 4,072 isolated CABG procedures; 1,626 aortic valve replacements; 731 mitral valve repairs; 324 mitral valve replacements and 184 aortic valve replacements/mitral valve replacements. They adjusted for patient risk and surgeon clustering to calculate efficiencies.

Mean surgeon experience after graduating from a fellowship was 16 years and mean patient follow-up was five years. Unadjusted 30-day mortality rates were 1.3 percent for CABG; 2.4 percent for aortic valve replacements; 0.7 percent for mitral valve repairs; 4.9 percent for mitral valve replacements and 4.3 percent for aortic valve replacements/mitral valve replacements.

After adjustments, they found that efficiency increased significantly with post-graduate surgical experience and long-term survival was associated with increased experience for all procedures except CABG.  

“[D]espite excellent mortality rates, these results suggest that long-term survival is directly related to surgical experience in complex cardiac surgery,” ElBardissi and colleagues concluded. They pointed out that training for CABG appears to be adequate, but in an era when PCI may be overtaking CABG, continuing education and apprenticeships for other procedures may be in order.