title: Trainees can learn minimally invasive aortic valve replacement without compromising safety.
abstract: OBJECTIVE
  Minimally invasive aortic valve replacement (Mini-AVR) is a technically advanced procedure. However, it results in equivalent operative mortality, less bleeding and reduced intensive care/hospital stay when compared with conventional AVR. Our aim was to assess the impact of trainee performance on short-term outcomes of patients undergoing elective and urgent Mini-AVR where a significant proportion were performed by trainees.
  
  
  METHODS
  All patients undergoing non-emergency, elective and urgent, isolated Mini-AVR between September 2005 and December 2012 were studied. Operative details and short-term outcomes, with particular attention to trainee performance, were analysed.
  
  
  RESULTS
  During the study period, there were 205 Mini-AVR with a median age of 67 years (range 29-86); 74 (36%) operations were performed by trainees. The overall median cross-clamp and bypass times were 42 (range 33-63) and 59 min (range 59-94) for the attending surgeon and 52 (range 42-63) and 71 min (range 59-94) for the trainee (P = 0.03). Five Mini-AVR patients (2.4%) required conversion to full sternotomy for ascending aortic replacement, right ventricular bleeding, coronary artery bypass graft surgery and failure to cardiovert. None of these cases were performed by trainees. Median lengths of intensive care and hospital stay were 1 and 5 days and were not different for attending surgeon and trainee. Only 1 (0.5%) patient died in hospital.
  
  
  CONCLUSIONS
  Mini-AVR can be performed with a low conversion rate and hospital stay and taught to trainees without compromising safety.
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK.
authors.forename: Gopal
authors.initials: G
authors.lastname: Soppa
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Yates
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Viviano
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Smelt
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK.
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Valencia
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: van Besouw
authors.affiliation: Department of Cardiothoracic Surgery and Anaesthesia, St George's Hospital, London, UK marjan.jahangiri@stgeorges.nhs.uk.
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000193:education* / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000193:education* / Q000379:methods / Q000401:mortality; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic valve replacement; Minimally invasive aortic valve replacement; Training