Simulation and skills training in mitral valve surgery

Joyce, David L.; Dhillon, Tanvir S.; Caffarelli, Anthony D.; Joyce, Daniel; Tsirigotis, Dimitrios N.; Burdon, Thomas A.; Fann, James I.

doi:10.1016/j.jtcvs.2010.08.059

Cited by 77 publications

(60 citation statements)

References 18 publications

(31 reference statements)

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“…Several studies have documented resident skills improvement on coronary anastomosis and mitral valve simulators at a single institution [9,10]. Recorded video has become an important adjunct to assessment based on direct observation, and interrater reliability of video-based grading has been established among experienced CT surgeons [11].…”

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confidence: 99%

“Top Gun” Competition: Motivation and Practice Narrows the Technical Skill Gap Among New Cardiothoracic Surgery Residents

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Lee

Fann

et al. 2015

The Annals of Thoracic Surgery

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confidence: 99%

“Top Gun” Competition: Motivation and Practice Narrows the Technical Skill Gap Among New Cardiothoracic Surgery Residents

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Lee

Fann

et al. 2015

The Annals of Thoracic Surgery

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“…Conventional or open mitral valve repair is technically challenging, and investigators have reported the improvement in trainee performance after simulation training for open or conventional mitral valve surgery. 17 Because of this repeated-measures study design, the results may have been limited by subject fatigue after several trials, carry-over effects from one technique to the next, and the order of technique presentation. To minimize these effects, the order of trials with 2D and 3D visualization was randomized for each subject.…”

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Evaluating the Effect of Three-Dimensional Visualization on Force Application and Performance Time during Robotics-Assisted Mitral Valve Repair

Currie

Trejos

Rayman

et al. 2013

Innovations�(Phila)

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Objective The purpose of this study was to determine the effect of three-dimensional (3D) binocular, stereoscopic, and two-dimensional (2D) monocular visualization on robotics-assisted mitral valve annuloplasty versus conventional techniques in an ex vivo animal model. In addition, we sought to determine whether these effects were consistent between novices and experts in robotics-assisted cardiac surgery. Methods A cardiac surgery test-bed was constructed to measure forces applied during mitral valve annuloplasty. Sutures were passed through the porcine mitral valve annulus by the participants with different levels of experience in robotics-assisted surgery and tied in place using both robotics-assisted and conventional surgery techniques. Results The mean time for both the experts and the novices using 3D visualization was significantly less than that required using 2D vision (P < 0.001). However, there was no significant difference in the maximum force applied by the novices to the mitral valve during suturing (P = 0.7) and suture tying (P = 0.6) using either 2D or 3D visualization. The mean time required and forces applied by both the experts and the novices were significantly less using the conventional surgical technique than when using the robotic system with either 2D or 3D vision (P < 0.001). Conclusions Despite high-quality binocular images, both the experts and the novices applied significantly more force to the cardiac tissue during 3D robotics-assisted mitral valve annuloplasty than during conventional open mitral valve annuloplasty. This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery.

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“…Hybrid coronary revascularization is also an option but the comparative effectiveness to both conventional CABG and multivessel stenting should be evaluated. Reliability of Skills Assessment in Cardiac Surgery Cardiac surgery simulation-based learning has been directed at technical skills training in small vessel anastomosis, beating heart surgery, and valve surgery (1)(2)(3)(4)(5)(6)(7). In the simulation laboratory, the trainee needs to demonstrate knowledge of anatomy,…”

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“…Such an approach permits creation of assessment tools based on principles of cognitive task analysis (1)(2)(3)(4)(5)7). In addition, for whole-task training, such as in crisis management, a computer-controlled, tissue-based simulator that simulates the entire cardiac procedure is employed (4,6).…”

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confidence: 99%

“…To review, the use of part-task simulators for vessel anastomosis demonstrated the value of distributed and deliberate practice based on assessments of the components of technical skill and times to completion (1,2,5). Focused training or massed practice at the Thoracic Surgery Directors Association Boot Camp using synthetic and tissue-based models resulted in improved ability to perform vessel anastomosis (2).…”

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2016

J. J. C. V. S.

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Ever since the introduction of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in 1964 and 1977, respectively, these complementary strategies of revascularization for coronary artery disease have been used extensively. Many randomized clinical trials have compared both strategies During the last decade the introduction of drug eluting stents, together with antiplatelet and antithrombotic treatments has improved the outcome of PCI by reducing the number of repeat revascularizations. Coronary bypass surgery has improved as well by using more arterial grafts, better perioperative care and optimizing medical treatment postoperatively. CABG surgery remains superior to PCI and medical treatment for the long term relief of angina for patients with complex coronary artery disease with little difference in overall costs between PCI (with the need for repeat procedures) and CABG.The SYNTAX trial randomized 1800 patients in 85 centers with multivessel and/or left main coronary disease to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Approximately two-thirds of the left main subjects with a SYNTAX score of 32 or below had comparable clinical overall outcomes (including lower mortality) achieved with PCI at 5 years follow-up which may justify the use of PCI with DES in these subjects. However, these subgroup analyses were post hoc and underpowered, and as such must be considered hypothesis-generating.The ongoing EXCEL trial is expected to provide a better answer on the optimal treatment strategy for left main disease patients.Outcomes after revascularization with either PCI or CABG are often worse in diabetic compared to nondiabetic patients.Patients with diabetes that undergo PCI have higher rates of restenosis and lower rates of event-free survival than nondiabetic patients. Although diabetes does not appear to affect in-hospital mortality after PCI and CABG, short-and long-term survival after PCI and CABG are significantly reduced in diabetic patients. The SYNTAX trial included 452 patients with diabetes. At five-year follow-up, the rate of repeat revascularization of patients undergoing PCI (n = 231) was higher in patients with diabetes (29 versus 19 percent). Mortality was also increased in the diabetic population Coronary artery bypass surgery and PCI The are complimentary. In patients with severe three-vessel coronary artery disease and left main disease coronary bypass surgery with at least one arterial graft is still the most effective treatment at this moment and the therapy of choice. In patients with less severe coronary artery disease PCI is the more attractive therapy due to its limited invasiveness.To select the most optimal treatment strategy for individual patients with stable complex coronary artery disease, multidisciplinary decision-making has gained more emphasis over the recent years. However, so called Heart Teams have not been widely implemented. Yet, decision-making has shown to remain suboptimal. There is large variability in...

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Simulation and skills training in mitral valve surgery

Cited by 77 publications

References 18 publications

“Top Gun” Competition: Motivation and Practice Narrows the Technical Skill Gap Among New Cardiothoracic Surgery Residents

“Top Gun” Competition: Motivation and Practice Narrows the Technical Skill Gap Among New Cardiothoracic Surgery Residents

Evaluating the Effect of Three-Dimensional Visualization on Force Application and Performance Time during Robotics-Assisted Mitral Valve Repair

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