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J Thorac Cardiovasc Surg 2008;136:1486-1491
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Improvement in coronary anastomosis with cardiac surgery simulation

^a Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
^c Department of Anesthesiology, Stanford University, Stanford, Calif
^d SUMMIT, Stanford University, Stanford, Calif
^b Cardiothoracic Surgery Section, VA Palo Alto Health Care System, Palo Alto, Calif

Received for publication May 15, 2008; revisions received July 17, 2008; accepted for publication August 7, 2008.

^_* Address for reprints: James I. Fann, MD, Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr, Stanford, CA 94305. (Email: jfann{at}stanford.edu).

Objective: Cardiac surgery trainees might benefit from simulation training in coronary anastomosis and more advanced procedures. We evaluated distributed practice using a portable task station and experience on a beating-heart model in training coronary anastomosis.

Methods: Eight cardiothoracic surgery residents performed 2 end-to-side anastomoses with the task station, followed by 2 end-to-side anastomoses to the left anterior descending artery by using the beating-heart model at 70 beats/min. Residents took home the task station, recording practice times. At 1 week, residents performed 2 anastomoses on the task station and 2 anastomoses on the beating-heart model. Performances of the anastomosis were timed and reviewed.

Results: Times to completion for anastomosis on the task station decreased 20% after 1 week of practice (351 ± 111 to 281 ± 53 seconds, P = .07), with 2 residents showing no improvement. Times to completion for beating-heart anastomosis decreased 15% at 1 week (426 ± 115 to 362 ± 94 seconds, P = .03), with 2 residents demonstrating no improvement. Home practice time (90–540 minutes) did not correlate with the degree of improvement. Performance rating scores showed an improvement in all components. Eighty-eight percent of residents agreed that the task station is a good method of training, and 100% agreed that the beating-heart model is a good method of training.

Conclusions: In general, distributed practice with the task station resulted in improvement in the ability to perform an anastomosis, as assessed by times to completion and performance ratings, not only with the task station but also with the beating-heart model. Not all residents improved, which is consistent with a "ceiling effect" with the simulator and a "plateau effect" with the trainee. Simulation can be useful in preparing residents for coronary anastomosis and can provide an opportunity to identify the need and methods for remediation.

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