title: Comprehensive Middle-Fidelity Simulator for Training in Aortic Root Surgery.
abstract: OBJECTIVE
  The current training in aortic root surgery is affected by several factors: complexity of surgical procedures and the complex 3-dimensional anatomy of the aortic root. The aortic root simulator proposed in this study is an additional low-cost, reusable, and portable tool to improve surgical skills in a middle-fidelity model.
  
  
  METHODS
  The aortic root surgery simulator is a self-made portable box that can be used for an unrestricted number of procedures. It is supplied with a self-made aortic root substitute, which was tested to simulate the flexible property of the aortic root components. The building process is detailed in this study. Aortic root procedures were performed by use of this simulator, in which surgical handling was tested. The total cost was calculated in euros.
  
  
  RESULTS
  Building the aortic root simulator resulted in the development of a new training tool for aortic root surgery. The use of silicone led to the construction of the aortic root components with similar diameters and properties as those of a real aortic root, which permitted performing the surgical procedures in unrestricted numbers. This involved the aortic valve including all types of aortic valve replacements such as interrupted and semicontinuous, and all types of aortic root procedures like enlargement, remodeling, reimplantation, and replacement. Moreover, the silicone allowed modeling of various pathological replicas of the aortic valve, which resulted in facilitating the practice of aortic valve repair techniques according to El Khoury׳s classification. The cost was approximately €1.
  
  
  CONCLUSIONS
  Surgical skills in aortic root surgery could be improved by using a middle-fidelity simulator. The high cost of the training for residents and junior surgeons could be reduced effectively through the use of this low-cost, portable, reusable simulator and its accessories (aorta and valves). Familiarity with performing the surgical procedures could reduce the time consumed in the operation room.
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: drhosabd@yahoo.com.
authors.forename: Abdullrazak
authors.initials: A
authors.lastname: Hossien
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D004503:Education, Medical, Graduate / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D008955:Models, Cardiovascular; D012828:Silicones; D013903:Thoracic Surgery / Q000193:education*
chemical_list: D012828:Silicones
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; aortic root; middle fidelity; simulation; training