Clinical translation of surgical simulated closure of a ventricular septum defect.

To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septum defect (VSD) closure simulation translates to better patient outcomes. Seven trainees were divided into 2 groups. Experienced-fellows group included 4 senior trainees who had performed >5 VSD closures. Residents group consisted of 3 residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a 4-week simulation requiring each participant to complete 2 VSD closures on three-dimensional printed models per week. One month later, all trainees returned for a post-test operation in real patients. All performances were recorded, blinded and scored independently by 2 cardiac surgeons using the validated Hands-On Surgical Training-Congenital Heart Surgery (HOST-CHS). Predefined surgical outcomes were analysed. The median HOST-CHS score increased significantly from week 1 to 4 [50 (39, 58) vs 73 (65, 74), P < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition [HOST-CHS score 72.5 (71, 74) vs 54 (51, 60), P < 0.001], with better patients outcomes including shorter total cross-clamp time [pretest: 86 (70, 99) vs post-test: 60 (53, 64) min, P = 0.006] and reduced incidence of major patch leak requiring multiple pump runs [pretest: 4/11 vs post-test: 0/9, P = 0.043]. After simulation, the technical performance and surgical outcomes of Residents were comparable to Experienced-fellows in real patients, except for significantly longer cross-clamp time [Residents: 76.5 (71.7, 86.8) vs Experienced-fellows: 60 (53, 64) min, P = 0.002]. Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Citation

Qi Li, Nabil Hussein, Yunyi Zhang, Yibing Fang, Yue Wang, Qi An, Osami Honjo, Shuhua Luo. Clinical translation of surgical simulated closure of a ventricular septum defect. Interactive cardiovascular and thoracic surgery. 2022 Aug 03;35(3)

Mesh Tags

PMID: 35604086

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