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Impact Of Minimally Invasive Coronary Artery Bypass Grafting Peer-to-peer Training On Surgeon And Program Development
Omar Toubar1, Sydney Beiko
1, Hugo Issa
1, Menaka Ponnambalam
1, Keita Kikuchi
2, Piroze Dawierwala
3, Prem Rabindranauth
4, Joseph McGinn
5, Marc Ruel
1.
1University of Ottawa Heart Institute, Ottawa, ON, Canada,
2Tokyo Bay Urayasu Ichikawa Medical Center, Tokyo, Japan,
3Peter Munk Cardiac Centre, Toronto, ON, Canada,
4Gundersen Health System, La Crosse, WI, Canada,
5Miami Cardiac & Vascular Institute, Miami, FL, Canada.
Background: Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) is increasingly recognized as a safe alternative to traditional CABG. However, questions persist regarding the learnability of this innovative technique. We identified surgeons who received Peer-to-Peer (P2P) training with experienced MICS CABG surgeons at various centers and assessed the subsequent adoption of this technique.
Methods: In consultation among 5 experienced surgeons, we designed a structured survey including questions about training details, integration of MICS CABG into practice, and complications encountered during the learning curve
(figure 1). Questions included multiple-choice, Likert scale, and free-text formats. Descriptive statistics were applied to analyze continuous variables and categorical data.
Results: A total of 259 surgeons who underwent MICS CABG P2P training with five experienced surgeons over a 16-year period were contacted. Responses continue to accrue and final results will be communicated at the time of manuscript submission and presentation. The time since completion of initial P2P training was 5.6 ± 4.3 years. Most surgeons (75%) reported having access to adequate resources during training. Of the 80% of surgeons who integrated MICS CABG into their practice, 50% performed at least 100 cases and 69% reported the lack of a dedicated MICS CABG team at their center. Over 60% of the MICS CABG cases performed by 81% of surgeons involved single-vessel revascularization. Additionally, 81% reported having converted less than 5% of their cases to a sternotomy. Common complications encountered postoperatively were renal, cardiac, and respiratory. All surgeons indicated a mortality rate below 1% following the procedure. Rapid recovery and a lower rate of surgical site infections were considered as key advantages of MICS CABG, while 69% of surgeons cited the challenging technical nature of the operation as the most significant barrier to its adoption.
Conclusions: MICS CABG programs can be safely implemented with adequate investment in resources and P2P training from experienced surgeons. Despite its implementation challenges, MICS CABG is viewed as a valuable addition to cardiac surgery centers, contributing to enhanced patient outcomes. The challenging technical aspects of MICS CABG should remain a primary focus of enabling technologies and educational platforms, particularly through P2P training.
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