Objective We evaluated focused training in coronary artery anastomosis with a porcine heart model and portable task station. Methods At “Boot Camp,” 33 first-year cardiothoracic surgical residents participated in 4-hour coronary anastomosis sessions (6–7 attending surgeons per group of 8–9 residents). At beginning, midpoint, and session end, anastomosis components were assessed on a 3-point rating scale (1 good, 2 average, 3 below average). Performances were video recorded and reviewed by 3 surgeons in a blinded fashion. Participants completed questionnaires at session end, with follow-up surveys at 6 months. Results Ten to 18 end-to-side anastomoses with porcine model and task station were performed. Initial assessments ranged from 2.11 ± 0.58 (forceps use) to 2.44 ± 0.48 (needle angles). Midpoint scores ranged from 1.76 ± 0.63 (forceps use) to 1.91 ± 0.49 (needle angles). Session end scores ranged from 1.29 ± 0.45 (needle holder use) to 1.58 ± 0.50 (needle transfer and suture management and tension; P < .001). Video recordings confirmed improved performance (interrater reliability > 0.5). All respondents agreed that task station and porcine model were good methods of training. At 6 months, respondents noted that the anastomosis session provided a basis for training; however, only slightly more than half continued to practice outside the operating room. Conclusions Four-hour focused training with porcine model and task station resulted in improved ability to perform anastomoses. Boot Camp may be useful in preparing residents for coronary anastomosis in the clinical setting, but emphasis on simulation development and deliberate practice is necessary.

Overall performance in component tasks and complete cardiac surgical procedures improved during simulation-based training. Simulation-based training imparts skill sets for management of adverse events and can help produce safer surgeons.

By providing the necessary tools, such as task trainers and assessment instruments, the Senior Tour may be one means to enhance simulation-based learning in cardiothoracic surgery. The Senior Tour members can provide regular programmatic evaluation and critical analyses to ensure that proposed simulators are of educational value.

ABO-mismatched platelet transfusions are associated with unfavorable outcomes in cardiac surgery, a relationship that remains unexplained. As this association has been found in three cohort studies in various clinical settings, further investigation of this association is warranted.

Objectives To determine if serum markers for collagen I and III synthesis, the C-terminal peptide from Pro-collagen-I (PICP) and the N-terminal peptide from Pro-Collagen III (PIIINP), correlate with LA fibrosis and post-operative AF. Background Atrial fibrillation (AF) after cardiac surgery is associated with adverse outcomes. We recently demonstrated that left atrial (LA) fibrosis is associated with post-operative AF in patients with no previous history of AF. Methods Fifty-four patients having cardiac surgery without a history of AF consented to left and right atrial biopsies, and a pre-operative peripheral blood draw. Picrosirius red staining quantified the percentage of fibrosis, and RT-PCR assessed atrial tissue mRNA transcripts involved in the fibrosis pathway. PICP and PIIINP levels were measured using an enzyme immunosorbant assay. Results Eighteen patients developed AF, while 36 remained in normal sinus rhythm (NSR). Left atrial fibrosis was higher in patients who developed AF vs. NSR (6.13 ±2.9% vs. 2.03± 1.9%, p =0.03). LA mRNA transcripts for collagen I, III, transforming growth factor, and angiotensin were 1.5-2.0 fold higher in AF patients. Serum PICP and PIIINP levels were highest in AF vs. NSR (PICP: 451.7±200 vs. 293.3±114 ng/ml, p=0.006; PIIINP: 379±286 vs. 191.6±162 pg/ml, p=0.01). Further there was a linear correlation between LA fibrosis and serum PICP levels (R2= 0.2; p = 0.01), and of the markers only PICP was independently associated with AF. Conclusions This demonstrates that serum PICP and PIIINP levels correlate with the presence of left atrial fibrosis and may act as a predictor for post-operative AF even in the absence of previous history of AF.