1
|
Plaisted J, Christensen E, Kowalsky M, Rooke D, Clendenen N. Year in Review 2023: Noteworthy Literature in Cardiac Anesthesiology. Semin Cardiothorac Vasc Anesth 2024; 28:80-90. [PMID: 38593818 DOI: 10.1177/10892532241246431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Notable clinical research published in 2023 related to cardiac anesthesia included studies focused on resuscitation and pharmacology, regional anesthesia, technological advances, and novel gene therapies. We reviewed 241 articles to identify 25 noteworthy studies that represent the most significant research related to cardiac anesthesia from the past year. Overall, improvements in clinical practice have enabled decreased morbidity and mortality with a renewed focus on mechanical circulatory support and transplantation.
Collapse
Affiliation(s)
- Jacob Plaisted
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Markus Kowalsky
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Douglas Rooke
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | |
Collapse
|
2
|
Gikandi A, Stock E, DeMatt E, Hirji S, Awtry J, Quin JA, Tolis G, Biswas K, Zenati MA. Performance of left internal thoracic artery-left anterior descending artery anastomosis by residents versus attendings and coronary artery bypass grafting outcomes. Eur J Cardiothorac Surg 2024; 65:ezae155. [PMID: 38598201 DOI: 10.1093/ejcts/ezae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Performance of a technically sound left internal thoracic artery to left anterior descending artery (LITA-LAD) anastomosis during coronary artery bypass grafting (CABG) is critically important. We used prospectively collected data from the multicentre, randomized REGROUP (Randomized Endograft Vein Perspective) trial to investigate CABG outcomes based on whether a resident or an attending surgeon performed the LITA-LAD anastomosis. METHODS This was a post hoc subanalysis of the REGROUP trial, which randomized veterans undergoing isolated on-pump CABG to endoscopic versus open vein harvest from 2014 through 2017. The primary end point was major cardiac adverse events, defined as the composite of all-cause deaths, nonfatal myocardial infarctions or repeat revascularizations. RESULTS Among 1,084 patients, 344 (31.8%) LITA-LAD anastomoses were performed by residents and 740 (68.2%), by attending surgeons. Residents (compared to attendings) operated on fewer patients with high tercile SYNTAX scores (22.1% vs 37.4%, P < 0.001), performed fewer multiarterial CABGs (5.2% vs 14.6%, P < 0.001) and performed more anastomoses to distal targets with diameters > 2.0 mm (19.0% vs 10.9%, P < 0.001) and non-calcified landing zones (25.1% vs 21.6%, P < 0.001). During a median observation time of 4.7 years (interquartile range 3.84-5.45), major cardiac adverse events occurred in 77 patients (22.4%) in the group treated by residents and 169 patients (22.8%) in the group treated by attendings (unadjusted HR 1.00; 95% confidence interval, 0.76-1.33; P = 0.99). Outcomes persisted on adjusted analyses. CONCLUSIONS Based on this REGROUP trial subanalysis, under careful supervision and with appropriate patient selection, LITA-LAD anastomoses performed by the residents yielded clinical outcomes similar to those of the attendings.
Collapse
Affiliation(s)
- Ajami Gikandi
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eileen Stock
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Ellen DeMatt
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jake Awtry
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacquelyn A Quin
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - George Tolis
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kousick Biswas
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Marco A Zenati
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Oh NA, Blitzer D, Chen L, Guariento A, Fuller S, Subramanyan RK, St Louis JD, Karamlou T. The Impact of Congenital Cardiac Surgery Fellowship on Training and Practice. Ann Thorac Surg 2023; 116:1320-1327. [PMID: 37419170 DOI: 10.1016/j.athoracsur.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/21/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND In 2007, congenital cardiac surgery became a recognized fellowship by the American Council of Graduate Medical Education (ACGME). Beginning in 2023, the fellowship transitioned from a 1-year to a 2-year program. Our objective is to provide current benchmarks by surveying current training programs and assessing characteristics contributing to career success. METHODS This was a survey-based study in which tailored questionnaires were distributed to program directors (PDs) and graduates of the ACGME accredited training programs. Data collection included responses to multiple-choice and open-ended questions relevant to didactics, operative training, training center characteristics, mentorship, and employment characteristics. Results were analyzed using summary statistics and subgroup and multivariable analyses. RESULTS The survey yielded responses from 13 of 15 PDs (86%) and 41 of 101 graduates (41%) from ACGME accredited programs. Perceptions among PDs and graduates were somewhat discordant, with PDs more optimistic than graduates. Of PDs, 77% (n = 10) believed current training adequately prepares fellows and is successful in securing employment for graduates. The responses from graduates demonstrated 30% (n = 12) were dissatisfied with operative experience and 24% (n = 10) with overall training. Being supported during the first 5 years of practice was significantly associated with retention in congenital cardiac surgery and greater practicing case volumes. CONCLUSIONS Dichotomous views exist between graduates and PDs regarding success in training. Mentorship during the early career was associated with increased case volumes, career satisfaction, and retention in the congenital cardiac surgery field. Educational bodies should incorporate these elements during training and after graduation.
Collapse
Affiliation(s)
- Nicholas A Oh
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Blitzer
- Department of Cardiothoracic Surgery, Columbia University, New York, New York
| | - Lin Chen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alvise Guariento
- Department of Cardiac Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ram Kumar Subramanyan
- Division of Cardiac Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - James D St Louis
- Section of Pediatric and Congenital Heart Surgery, Children's Hospital of Georgia, Augusta, Georgia
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
4
|
Dimagli A, Angelini GD. On the left or on the right…side of the table. Where do you stand? J Card Surg 2022; 37:3799-3800. [PMID: 36098375 DOI: 10.1111/jocs.16935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/28/2022]
Abstract
Being able to perform surgery first-hand represents the backbone of every training program and the key to successful development of the new generation of skilful surgeons. In this issue of the Journal, Comanici et al. presented a thorough systematic summary of the current evidence on the outcomes of cardiothoracic operations performed by trainees. Taking for granted the importance of training young surgeons, it is paramount to identify and tackle any potential obstacles hindering the surgical growth of a trainee.
Collapse
Affiliation(s)
- Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol, UK.,Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | | |
Collapse
|
5
|
Zientara A, Hussein N, Bond C, Jacob KA, Naruka V, Doerr F, Nägele F, Pölzl L, Eid M, Jarral O, Cerqueira R, Haunschild J, Sádaba JR, Gollmann-Tepeköylü C. Basic principles of cardiothoracic surgery training: a position paper by the European Association for Cardiothoracic Surgery Residents Committee. Interact Cardiovasc Thorac Surg 2022; 35:6677230. [PMID: 36018268 PMCID: PMC9479886 DOI: 10.1093/icvts/ivac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/14/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospital , England, UK
| | - Nabil Hussein
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham , England, UK
| | - Chris Bond
- Department of Cardiac Surgery, Queen Elizabeth University Hospital , Birmingham, UK
- Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative , Ann Arbor, MI, USA
| | - Kirolos A Jacob
- Department of Cardiothoracic Surgery, University Medical Center , Utrecht, Netherlands
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Barts Health NHS Trust, St Bartholomew’s hospital , London, UK
| | - Fabian Doerr
- Department of Cardiothoracic Surgery, University Hospital of Cologne , Cologne, Germany
| | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Maroua Eid
- Department of Cardiac Surgery, University of Angers , Angers, France
| | - Omar Jarral
- Division of Cardiovascular and Thoracic Surgery, Duke University , Durham, NC, USA
| | - Rui Cerqueira
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário São João , Porto, Portugal
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, University of Leipzig , Leipzig, Germany
| | - J Rafael Sádaba
- Department of Cardiac Surgery, Hospital Universitario de Navarra , Pamplona, Spain
| | | |
Collapse
|
6
|
Mehaffey JH, Kron I. General Principles of Teaching Cardiac Surgery. J Thorac Cardiovasc Surg 2022; 164:e487-e490. [DOI: 10.1016/j.jtcvs.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
|