Training residents in mitral valve surgery.
BACKGROUND
The safety of training residents in complex procedures has not been elucidated. In particular, the impact of resident-performed mitral valve surgery on patient outcomes is unknown.


METHODS
All mitral valve procedures performed by residents between 1998 and 2003 were compared with those performed by staff surgeons. Operative mortality and a composite morbidity (reoperation for bleeding, myocardial infarction, infection, stroke, or ventilation > 24 hours) were compared using multivariate analysis. Individual outcomes were compared with the use of propensity scores.


RESULTS
There were 1020 cardiac surgeries performed by residents, including 165 mitral valve procedures (86 replacements, 79 repairs). In the same period, the staff surgeons performed 261 mitral procedures. Crude operative mortality for isolated mitral procedures was 5.4% and 4.7% (resident and staff, respectively, p = 1.00). Mitral valve repair including combined procedures had an operative mortality of 3.8% and 4.3% (resident and staff, respectively, p = 1.00). The composite morbidity outcome was 29.7% and 35.3% for resident and staff-performed cases, respectively (p = 0.24). In multivariate analysis, resident was not associated with the adverse outcomes examined (OR 0.80, 95% CI, 0.47, 1.37). The incidence of major adverse outcomes for propensity score-matched mitral valve cases, including combined procedures, were similar between residents and staff, respectively: mortality, 7.4% versus 8.7% (p = 0.67), stroke, 4.0% versus 6.7% (p = 0.30), and reoperation for bleeding, 4.7% versus 9.4% (p = 0.11).


CONCLUSIONS
There were no significant differences in morbidity and mortality in patients undergoing mitral valve surgery between resident and staff surgeons. It is possible to train residents to perform complex cardiac cases without adversely affecting outcomes.
The Maritime Heart Center, Halifax, Nova Scotia, Canada. rogerbaskett@hotmail.com
Roger J F
RJ
Baskett
Dimitri
D
Kalavrouziotis
Karen J
KJ
Buth
Gregory M
GM
Hirsch
John A P
JA
Sullivan
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000193:education* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D002983:Clinical Competence; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000193:education* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D009674:Nova Scotia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012372:ROC Curve; D013903:Thoracic Surgery; D016896:Treatment Outcome