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Massimo Caputo
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Franco Ciulli
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Ann Thorac Surg 2002;74:S1403-S1407
© 2002 The Society of Thoracic Surgeons

Supplement: Cardiothoracic Techniques and Technologies

The evolution of training in Off-Pump coronary surgery in a single institution

Massimo Caputo, MDa, Alan J. Bryan, FRCSa, Radek Capoun, MDa, Balakrishnan Mahesh, FRCSa, Franco Ciulli, MDa, Jonathan Hutter, FRCSa, Gianni D. Angelini, FRCSa*

a Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom

* Address reprint requests to Professor Angelini, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, BS2 8HW, United Kingdom.
e-mail: g.d.angelini{at}bristol.ac.uk

Presented at the Eighth Annual Cardiothoracic Techniques and Technologies Meeting 2002, Miami Beach, FL, Jan 23–26, 2002.

BACKGROUND: This study analyses the development of off-pump coronary artery bypass (OPCAB) surgery training at a single institution, and compares the early and midterm clinical outcomes of OPCAB and conventional coronary artery bypass grafting (CABG) procedures performed by trainees with or without direct consultant cardiothoracic surgeon supervision.

METHODS: Analysis was undertaken on data prospectively recorded on a computer database (Patient Analysis and Tracking System). Of the 2,422 CABG operations performed between January 1999 and December 2001, 969 (40%) were carried out by trainees either off pump (422) or on pump (547).

RESULTS: Although the total number of CABG operations performed by trainees remained constant, there was a significant increase in the number of OPCAB operations during the study period compared with conventional CABG, as well as an increase in the average number of grafts per patient in the OPCAB group (both p < 0.05). Furthermore, a significant trend towards using two or more arterial conduits in the OPCAB group was observed in the study period. The number of OPCAB operations performed by trainees as independent operators without direct consultant supervision also increased significantly (p < 0.05). Early and midterm clinical outcomes were similar between patients operated by trainees on pump or off pump as independent operators versus under direct consultant supervision.

CONCLUSIONS: The significant increase in OPCAB operations performed by trainees as independent operators or under direct consultant supervision, as well as the increase in the number of grafts per patient and arterial conduits used for myocardial revascularization, demonstrate a progression of training in beating heart surgery for cardiothoracic trainees. Improvements in the techniques have made it safe to teach trainees off-pump multivessel coronary artery revascularization.




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