Cardiothoracic Surgery Residency Training in Surgical Ablation for Atrial Fibrillation

Abstract

Background : As no standardized curriculum exists for training cardiothoracic surgery residents in surgical ablation for atrial fibrillation, there is potential for variation in operative technique, patient selection, and overall application. Thus we sought to assess the exposure of current residents in order to identify areas for improvement in their education. Methods : A survey was emailed to residents inquiring about their training experience in surgical ablation for atrial fibrillation. Residents were asked about case volume, procedural variety, and guideline-based clinical scenarios where they felt ablation would be appropriate. Residents were also queried about their abilities to perform various lesion sets and overall satisfaction with training. Results : The respondents performed a median of five cases during training with pulmonary vein isolation the most common lesion set. Seventy seven percent of residents are unable to independently perform a bi-atrial (Cox-Maze IV) lesion set. Residents are neutral regarding their satisfaction with training in surgical ablation for atrial fibrillation. Conclusions : The findings of low case volume, incomplete lesion set use, and lack of training satisfaction suggests residents are being insufficiently exposed to surgical ablation of atrial fibrillation. These findings should inform educators on the importance of a more thorough experience during training given the increasing prevalence of atrial fibrillation and the need for appropriate and durable surgical intervention.

Case Report: The Cox-Maze IV Procedure in the Mirror: The Use of Three-Dimensional Printing for Pre-operative Planning in a Patient With Situs Inversus Dextrocardia

“…Exposure to complete ablations and familiarization with the anatomic boundaries may be accomplished in the way of simulation, tissue labs, or higher-fidelity models ( 16 ). In the case herein, the 3D printing model enabled a dynamic visualization of the spatial relationship between the specific ablation lines and the critical anatomic references such as the coronary sinus, the mitral isthmus, the posterior mitral annulus, and the right coronary artery.…”

The Convergent procedure for AF: A surgeon's perspective

“…examined cardiothoracic surgery resident aptitude with the Cox-Maze surgery. 11 The study revealed a significant lack of perceived competence and training. Trainees on average ranked a 3 out of 5 (Likert scale) for "satisfaction with surgical ablation training," and 2 out of 5 for "satisfaction with Cox-Maze IV.…”

“…Also, even though I mentioned that recent graduating cardiothoracic surgeons are more facile with thoracoscopic techniques, it is equally important to mention that unfortunately most junior attendings are not comfortable with surgical ablation. A recent study from Dr. DeBoard et al examined cardiothoracic surgery resident aptitude with the Cox‐Maze surgery 11 . The study revealed a significant lack of perceived competence and training.…”