Cardiovascular surgery training in Japan

Abstract

The history of cardiovascular surgery in Japan dates back to 1928 when Seo and associates first reported on surgeries for constrictive pericarditis in 3 patients, as described by Kimoto. 1 Unfortunately, the advancement of cardiac surgery was completely interrupted by World War II. During the 1950s and 1960s, however, Japanese cardiovascular surgeons made significant contributions to the clinical application of hypothermia and total circulatory arrest, along with the development of techniques of cardiopulmonary bypass. [2][3][4] Starting in the 1970s, various innovative techniques were developed in Japan, including aortic annular enlargement by Konno and associates 5 ; right ventricle to pulmonary artery shunt for hypoplastic left heart syndrome by Sano and associates 6 ; and retrograde cerebral perfusion technique as an adjunct to deep hypothermic circulatory arrest by Ueda and associates. 7 Japan has a population of approximately 120 million people, with 28.4% older than 65 years of age; importantly, this cohort is expected to grow and reach 39.9% in 2060 (Figure E1). 8 Accordingly, the mean age of the Japanese cardiovascular surgical population increased from 67.0 years in 2007 to 70.6 years in 2018 and is expected to increase further in the near future.The number of cardiovascular surgery cases in Japan has steadily increased from approximately 19,000 cases in 1986 to 48,000 cases in 2000, and most recently to 69,000 cases in 2016 (Figure 1). The number of coronary artery bypass procedures peaked at 23,000 cases in 2002 and has gradually decreased since then, whereas steady growth has been observed in the number of valve and aortic

Independent practice should require thoracic board certification

“…5 Likewise in Japan, "No trainees are allowed to operate independently before obtaining Japanese Board of Cardiovascular Surgery certification." 6 The same can be said for other countries we reviewed (Australia and New Zealand, 7 Canada, 8,9 France, and Germany 10 ). After finishing an accredited training program in all these countries, successful completion of specialty board certification is mandatory to become eligible for independent practice.…”

Commentary: Cardiothoracic surgery training: Global challenges without universal solutions

“…These challenges are not unique to training programs in the United States, Tanemoto and colleagues face similar pressures in Japan. 1 The authors describe the all-toofamiliar difficulties of decreasing case volume, increasing patient and case complexity, decreasing operative times due to economic constraints, and reduced training time to remain attractive to the most talented medical students. They have responded by placing a heavy emphasis on simulator-based training, by structuring their training and accreditation systems to be competency-based rather than time-based, and by having trainees rotate at multiple sites run by different programs to gain breath of experience in a variety of cardiothoracic operations.…”