title: Training residents in off-pump coronary artery bypass surgery: a 14-year experience.
abstract: OBJECTIVE
  Off-pump coronary artery bypass grafting (OPCAB) is an established procedure in many cardiothoracic centers. For it to be widely applicable, however, teaching methods must be developed for surgical trainees. Early clinical outcomes and long-term survival of patients who underwent OPCAB at our institution by trainees supervised and unsupervised were compared with those of patients whose procedures were performed by senior surgeons. To evaluate evolution of training, outcomes were analyzed according to 3 different periods (1996-1999, 2000-2004, 2005-2009) and trainee seniority level.
  
  
  METHODS
  This was a retrospective, observational cohort study of prospectively collected data from 5566 consecutive patients who underwent isolated OPCAB performed by trainees (1589, 28.6%; 1111 supervised, 478 unsupervised) and by senior surgeons (3977, 71.4%).
  
  
  RESULTS
  Patients of senior surgeons were more likely to have left ventricular dysfunction (P = .001), peripheral vascular disease (P = .05), more extensive coronary artery disease (P = .001), and higher EuroSCOREs than patients of trainees. In addition, trainees were less likely to have performed urgent operations (P = .02) or reoperations (P = .03) but more likely to have operated on patients with previous percutaneous coronary intervention (P = .006). Early clinical outcomes and long-term survival were similar between groups and not related to trainee seniority, level of supervision by senior surgeon, or period during which training took place.
  
  
  CONCLUSIONS
  OPCAB is a safe and reproducible surgical technique that can be taught successfully to cardiothoracic trainees. Clinical outcomes are unrelated to level of supervision or seniority of trainees.
authors: Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
authors: Michele
authors: M
authors: Murzi
authors: Massimo
authors: M
authors: Caputo
authors: Giuseppe
authors: G
authors: Aresu
authors: Simon
authors: S
authors: Duggan
authors: Gianni D
authors: GD
authors: Angelini
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D004503:Education, Medical, Graduate; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome