Quantifying the effects of training in lung transplantation: Lessons from NASA

\ua9 2024. Background: Sequential lung transplantation is a complex procedure. The traditional training model continues to center around operative experience with progressively increasing delegation of stages of the procedure. However, little evidence exists on the effects this has on surgical trainers. The NASA-TLX is a subjective, multidimensional assessment tool that rates perceived workload. We sought to employ this as a means of assessing the impact that training in lung transplantation has on trainers. Methods: We prospectively collected the NASA-TLX data for 60 patients undergoing bilateral sequential lung transplantation. In 30 cases, the operation was performed entirely by the senior surgeon (SS) who implanted both lungs. In 30 operations, the senior surgeon implanted the right lung (SSR) and supervised a trainee implanting the left lung (TL). Results: The overall weighted rating was significantly lower for the surgeons undertaking the case themselves rather than training (p < 0.001). Cases were comparable in terms of case type, donor ischemic time, and peri-operative characteristics. Mental and temporal demands were greater throughout training cases (p < 0.001, p < 0.05). There was less effect on frustration, physical demand, and effort. Perceived performance showed no significant difference between the groups. Conclusions: The NASA task load index can be used to inform the effects of training in lung transplantation on trainers. Training leads to greater mental and temporal demands with less effect on other factors. Crucially, there was no significant difference in perceived performance. As the specialty continues to be confronted with diverse challenges, this study should give confidence to those training the transplant surgeons of the future, as well as provide them with a mechanism to reflect on their own training performance. ACGME Competencies: Interpersonal and communication skills. Practice-based learning and improvement

A Split-Lung Ex Vivo Perfusion Model for Time- and Cost-Effective Evaluation of Therapeutic Interventions to the Human Donor Lung

Copyright \ua9 2024 Chilvers, Gilmour, Brown, Bates, Pang, Pauli, Dark and Fisher.With the ongoing shortage of donor lungs, ex vivo lung perfusion (EVLP) offers the opportunity for objective assessment and potential therapeutic repair of marginal organs. There is a need for robust research on EVLP interventions to increase the number of transplantable organs. The use of human lungs, which have been declined for transplant, for these studies is preferable to animal organs and is indeed essential if clinical translation is to be achieved. However, experimental human EVLP is time-consuming and expensive, limiting the rate at which promising interventions can be assessed. A split-lung EVLP model, which allows stable perfusion and ventilation of two single lungs from the same donor, offers advantages scientifically, financially and in time to yield results. Identical parallel circuits allow one to receive an intervention and the other to act as a control, removing inter-donor variation between study groups. Continuous hemodynamic and airway parameters are recorded and blood gas, perfusate, and tissue sampling are facilitated. Pulmonary edema is assessed directly using ultrasound, and indirectly using the lung tissue wet:dry ratio. Evans blue dye leaks into the tissue and can quantify vascular endothelial permeability. The split-lung ex vivo perfusion model offers a cost-effective, reliable platform for testing therapeutic interventions with relatively small sample sizes

Birth to adulthood – modern day congenital cardiac surgery

\ua9 2023. The first Blalock–Taussig shunt (BTS) performed in 1944 marks the dawn of modern heart surgery and is an inspirational tale of diversity in healthcare. Helen Taussig, the conceptual pioneer of the BTS and one of the first women to study medicine at Harvard; Alfred Blalock, the surgeon; and Vivienne Thomas, a young African-American carpenter employed as a laboratory assistant. At the time of the first BTS in a human, Vivienne who had performed more than 200 shunts in dogs, stood on a step at Alfred\u27s shoulder and coached him through the procedure step-by-step. At the time, the only other black employees at the institute were janitors. Alfred was nominated for a Nobel prize. Helen was elected the first female President of the American Heart Association. Vivienne\u27s contribution went unrecognized publicly until 1976, when John Hopkins University presented him an honorary doctorate. In 2024, a year of confronting our social bias, we should honour and be inspired by this diverse team for their outstanding contribution to medical science. Today, we stand firmly on the shoulders of such bold and revolutionary giants and present a view on the current landscape of the specialty, a budding surgeon\u27s approach to the congenital heart and the challenges faced by the patient and multidisciplinary team