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Ann Thorac Surg 1998;66:580-581
© 1998 The Society of Thoracic Surgeons

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How to Do It

Training model for "beating-heart" coronary artery anastomoses

^a Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong

Accepted for publication March 20, 1998.

Address reprint requests to Dr Izzat, Section of Cardiac Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, NT, Hong Kong
e-mail: (izzat{at}cuhk.edu.hk)

	Abstract

Top Abstract Introduction The model Comment Footnotes References

 
The principal technical challenge in "off-pump" coronary surgery is to perform an accurate coronary anastomosis on a beating heart. For the purpose of training our residents in performing off-pump coronary artery anastomoses, we have developed a mechanical heart simulator in which trainees can practice performing these anastomoses repeatedly until a satisfactory level of skill and confidence is attained.

	Introduction

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The known morbidity associated with cardiopulmonary bypass and the concept that trauma of access is often worse than the surgical procedure per se have resulted in the recent surge of interest in "off-pump" coronary surgery and minimally invasive direct coronary artery bypass grafting [1, 2]. Indeed, there is already substantial experience with coronary artery grafting without cardiopulmonary bypass to indicate that this approach is becoming a permanent part of the cardiac surgeon’s armamentarium [3].

The principal technical challenge in these techniques is to perform accurate coronary anastomoses on the constantly moving target vessels. The significance of this endeavor is clearly reflected by the range of instruments and techniques that have been developed to reduce the motion of the segment of the coronary vessel to be grafted [4, 5]. Still, there is no alternative to the skill of the surgeon in determining the outcome of this surgical procedure.

It is important to have a training method available so that surgeons can achieve this skill before attempting the technique on patients. Animal laboratories can be used for practice, but these have their drawbacks and are not widely available. For the purpose of training, therefore, we have developed a mechanical model of a beating heart.

	The model

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The device described here^* is a simulator in which a coronary artery representative (we usually use a porcine mammary artery) is mounted on a floating platform, which mimics the epicardial surface (Fig 1). An motor underneath the platform carries projecting wheels (Fig 2), the space between which is adjustable. With the rotations of the motor, the wheels intermittently elevate the platform, simulating heart beats. Adjusting the speed of motor rotations can reproduce heart rates between 40 and 150 beats/min, and varying the distance between the projecting wheels can simulate various dysrrhythmias. It is also possible to adjust the degree of excursion of the platform to make the procedure more challenging. An advanced version of the model with electronic controls capable of simulating specific dysrrhythmias (eg, extrasystole, bigeminy, atrial fibrillation) is now being developed.

View larger version (86K): [in this window] [in a new window]   Fig 1. External view of the simulator showing the operating surface and an access aperture to the operating field where a coronary artery representative is held on a floating platform. Dials control the rate and rhythm of platform excursions.

View larger version (121K): [in this window] [in a new window]   Fig 2. The inside mechanism of the simulator. A motor carries versatile projecting wheels responsible for generating platform excursions.

	Comment

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This model was developed for the purpose of training residents in cardiac surgery. We have already found this device to be quite useful in preparing our trainees for minimally invasive direct coronary artery bypass grafting as well as "off-pump" surgery. It is inexpensive and reusable, and a trainee can practice in his or her own time instead of being limited by the availability of the animal laboratory facilities. Comparisons between the range of motion of targeted vessels in the model and that in the clinical situation are now being performed with high-resolution laser displacement sensors [5].

The world of medicine is rapidly changing, and the practice of cardiac surgery at the turn of the millennium will probably be very different from that we were trained for. As "beating-heart" surgery and other new approaches evolve and become established as standard practice, parallel training methods will have to be developed to prepare the upcoming surgeons for these new technical challenges.

	Footnotes

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^* US patent pending.

	References

Top Abstract Introduction The model Comment Footnotes References

 

1. Buffolo E., de Andeade J.C.S., Branco J.N.R., Teles C.A., Aguiar L.F., Gomes W.J. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 1996;61:63-66.[Abstract/Free Full Text]
2. Calafiore A.M., Di Giammarco G., Teodori G., et al. Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg 1996;61:1658-1665.[Abstract/Free Full Text]
3. Izzat M.B., Yim A.C.P. Minimally invasive cardiac surgery, a fleeting fancy or a lasting prospect?. Int J Cardiol 1997;59:223-225.[Medline]
4. Izzat M.B., Yim A.C.P. Cardiac stabilizer for minimally invasive direct coronary artery bypass. Ann Thorac Surg 1997;64:570-571.[Abstract/Free Full Text]
5. Shennib H., Lee A.G.L., Akin J. Safe and effective method of stabilization for coronary artery bypass grafting on the beating heart. Ann Thorac Surg 1997;63:988-992.[Abstract/Free Full Text]
6. Yim A.P.C., Izzat M.B. Training the locksmith [Editorial]. Int J Cardiol 1997;62(Suppl 1):S71-S72.

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mohammad Bashar Izzat Anthony P.C. Yim Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Izzat, M. B. Articles by Yim, A. P.C. Search for Related Content PubMed PubMed Citation Articles by Izzat, M. B. Articles by Yim, A. P.C.