Training Residents in Off-pump Coronary Artery Bypass Surgery: A 14-year Experience

OBJECTIVE:

Off-pump coronary artery bypass grafting (OPCAB) is an established procedure in many cardiothoracic centers. For it to be widely applicable, however, teaching methods must be developed for surgical trainees. Early clinical outcomes and long-term survival of patients who underwent OPCAB at our institution by trainees supervised and unsupervised were compared with those of patients whose procedures were performed by senior surgeons. To evaluate evolution of training, outcomes were analyzed according to 3 different periods (1996-1999, 2000-2004, 2005-2009) and trainee seniority level.

METHODS:

This was a retrospective, observational cohort study of prospectively collected data from 5566 consecutive patients who underwent isolated OPCAB performed by trainees (1589, 28.6%; 1111 supervised, 478 unsupervised) and by senior surgeons (3977, 71.4%).

RESULTS:

Patients of senior surgeons were more likely to have left ventricular dysfunction (P = .001), peripheral vascular disease (P = .05), more extensive coronary artery disease (P = .001), and higher EuroSCOREs than patients of trainees. In addition, trainees were less likely to have performed urgent operations (P = .02) or reoperations (P = .03) but more likely to have operated on patients with previous percutaneous coronary intervention (P = .006). Early clinical outcomes and long-term survival were similar between groups and not related to trainee seniority, level of supervision by senior surgeon, or period during which training took place.

CONCLUSIONS:

OPCAB is a safe and reproducible surgical technique that can be taught successfully to cardiothoracic trainees. Clinical outcomes are unrelated to level of supervision or seniority of trainees.