Ann Thorac Surg 2001;71:1219
© 2001 The Society of Thoracic Surgeons
Invited commentary
Louis P. Perrault, MD, PhDa
a Department of Surgery, Montreal Heart Institute, 5000 Belanger East, Montreal, Quebec H1T 1C8, Canada
e-mail: lpperrau{at}icm.umontreal.ca
The article from Caputo and colleagues addresses an important academic question that arises whenever a new surgical approach is introduced and has the potential of being applied to a greater number of patients in a very short time span: can off-pump coronary artery bypass (OPCAB) be taught safely to surgical trainees? This question is particularly pertinent considering the fact that OPCAB represents a technique that differs substantially from the principles of coronary artery bypass grafting on cardiopulmonary bypass with cardioplegic arrest. The OPCAB which requires the performance of microsurgical anastomosis on moving perfused target arteries on a filled heart susceptible to hemodynamic compromise is universally recognized as more technically demanding, at least during the learning curve.
Numerous key issues stand out in this report. First, the researchers have convincingly demonstrated that, in their setting, OPCAB can indeed be taught without adverse effects. Second, exposure of the trainees at an early stage of their training concomitantly with the development of skills for coronary artery bypass grafting on pump may be a worthwhile principle for development of psychomotor proficiency with this technique so that trainees have the opportunity of going through their learning curve of this procedure while adequate supervision and backup from the consultants is available. Third, adequate case loads are necessary to achieve the transfer of experience to the younger surgeons and I echo the recommendation of the necessity of a significant minimum of cases per year for the teaching of this technique. Finally, most of the recent reports have highlighted the feasibility and safety of OPCAB performed and, at times, have shown benefits in nonprospective studies of nonrandomized populations with a large number of procedures performed by small groups of surgeons. It is essential to remember that conclusions from these studies cannot be extrapolated outright to other settings with different case loading and different experience. Moreover, reporting of the percentage and outcome of procedures performed by trainees in an academic center is essential to evaluate the applicability of new procedures and a mandatory variable in comparing different studies.
Related Article
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Off-pump coronary operations can be safely taught to cardiothoracic trainees
- Massimo Caputo, Martin H. Chamberlain, Faruk Özalp, Malcolm J. Underwood, Franco Ciulli, and Gianni D. Angelini
Ann. Thorac. Surg. 2001 71: 1215-1219.
[Abstract]
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