Efficacy of simulation training for beating heart coronary anastomosis using BEAT + YOUCAN simulator

Background We sought to evaluate our distributed practice program developed for training for beating heart anastomosis by employing a novel beating heart simulator. Methods Eleven trainees watched and reviewed instructional video recordings of coronary anastomosis methods with a BEAT + YOUCAN training device, then performed coronary anastomosis procedures under a beating condition. Next, they participated in a four-hour training program developed by faculty surgeons. Ten different anastomosis components were assessed on a five-point rating scale (5, good; 3, average; 1, poor). After finishing the training program, each trainee again performed a coronary anastomosis procedure. Component scores were then compared before and after the training program. Results The mean time to completion of the procedure improved from 1033 ± 424 to 795 ± 201 s (p < 0.05). Assessment scores improved from 1.88 ± 0.41 to 2.57 ± 0.30 (p < 0.05). Improvements in some technical components related to handling of instruments were noted (p < 0.05), whereas no significant improvement was seen with arteriotomy, graft orientation, suture management, or knot tying after finishing the training program. Conclusion Trainees who participated in our four-hour focused training program for coronary anastomosis with a novel beating heart simulator showed improved ability under the beating condition in regard to technical skills related to handling instruments.

Cardiac surgery simulation – Part 3: Coronary anastomosis

Our group has previously described how dedicated practice outside the operating room can improve surgical technique and enhance intraoperative performance. We have also recently developed a "do-it-yourself" simulator made from inexpensive, easily obtainable materials to practice a variety of operative scenarios in cardiac surgery. This video tutorial demonstrates our Coronary Anastomosis Module, which is designed for practice of both distal and proximal coronary anastomoses.

64 Seizing an Opportunity: Setting Up A Virtual Wetlab During the COVID19 Pandemic

Aim The COVID19 pandemic has negatively impacted surgical training across the globe. In the UK, educational events and training days were cancelled for trainees at all levels. However, these unusual times provide opportunity to develop novel teaching methods. Our aim was to design a “virtual cardiac surgery wetlab” that allows real-time skills training. Method With support from industry partners Edwards Lifesciences, Wetlab and Connexon365 (Webinar Hosting Platform) all the necessary materials were distributed. A package was sent to trainer and trainees that included microinstruments, sutures, synthetic vessels and valve models, high-definition camera, along with printed instructions and video to outline set-up of the rig. Trainees only need to provide is a computer. A consultant surgeon demonstrated how to perform a coronary anastomosis and aortic valve replacement and was then able to supervise trainees and provide real-time feedback using the online platform. Results Feedback from trainer and trainees has shown that the system is an easy-to-set-up, effective training tool for teaching cardiac surgery skills including coronary anastomosis and valve surgery. The online platform enabled good vision and engagement between trainer and trainee and also enabled recording of the session. Distributing all of the materials nationwide means the virtual wetlab can take place anywhere, including in the comfort of home, for both trainee and trainer. Conclusions Surgical skills training can still take place effectively in the absence of “real life” wetlabs. Given the current COVID19 pandemic continues to interrupt traditional surgical teaching, this method has potential to be adopted nationwide to minimise the disruption.

Drugs For Attenuation of Hemodynamic Responses In Patients Undergoing Elective Off-Pump Coronary Artery Bypass Graft: A Randomized Clinical Trial

Objective: We aimed to compare the effectiveness of esmolol (ESM) vs. dexmedetomidine (DEX) in the treatment of increased hemodynamic response during coronary artery bypass. Methods: Following the approval of the Local Committee Research and Ethics Health Research, a controlled randomized clinical trial, in patients undergoing elective coronary revascularization during off-pump coronary artery bypass surgery, was performed under standardized general anesthesia. Patients randomly received infusions of ESM 0,5 mg /kg or DEX 0,5 cg/kg/hr. Hemodynamic variables of study: heart rate and MAP were analyzed at different times: t1) baseline, t2) sternotomy, t3) time of coronary anastomosis and t4) sternal closure. Results: In group DEX, a statistic significance was found in the heart rate sternotomy (t2) p=0,004 and heart rate (t3= time of coronary anastomosis) p=0,026 and MAP during (t3) p=0,002. Conclusions: Although ESM and DEX attenuate hemodynamic response during coronary artery bypass, in the DEX group, hemodynamic stabilization was observed in heart rate and MAP during coronary artery bypass.

HOW TO RECYCLE A MISUSED LEFT INTERNAL THORACIC ARTERY: TIPS AND TRICKS

In this case report we describe how to recycle the Left Internal Thoracic Artery (LITA) when misused but not damaged. 8 years after a Left Anterior Small Thoracotomy followed by LAD stenting for STEMI in 1st post-operative day, a 67 years old woman had a NSTEMI with angiographic evidence of intra-stent re-stenosis with a perfectly patent LITA, harvested only from the 4th to the 6th intercostal space. During redo surgery, LITA was harvested as a pedicle from the anastomosis to the 4th intercostal space and primarily from the 1st to the 4th intercostal space. Special attention was paid at the level of the 4th intercostal space where the vessel was stuck to the sternum: a 15 blade was used being scissors or cautery too dangerous. At the end of harvesting, the LITA was full-length available for a new coronary anastomosis on LAD, distal to the previous one.

How to perform a distal coronary anastomosis

The purpose of this chapter is to describe in detail the technical nuances and planning necessary to construct high-quality, long-lasting anastomoses during coronary artery bypass grafting. Issues to be covered include suture selection, needle manipulation techniques, correct exposure of the coronary target, and various types of anastomoses. These recommendations are intended to support and guide, rather than to dictate one or another approach, as every surgeon will develop their own preferred techniques. The chapter summarizes the technical approaches of two cardiothoracic surgeons from different academic backgrounds and training programmes who have developed their practices on two different continents. Modification of these recommendations is not only permitted but encouraged, as long as the fundamental principles of spatial proportion, quality, and sound technique are preserved.