Interest of évaluation of teaching in thoracic and cardiovascular surgery

The aim of this work is to reflect on different teaching methods can be used in a surgical teaching and its assessment methods. Two sessions of Multiple Choice Questions (MCQ) have been proposed, the first before all education, the second after education in order to assess its impact on knowledge. Script Concordance Test (SCT) will replace the traditional interactive case report. Eighteen participants (Group 1) completed both sessions of MCQ: 9 residents (R), 2 equivalent resident (ER), 4 Clinical Fellow (CF), 1 Professor (Pr) and 2 senior surgeons (SS). Sixteen participants (group 2) were present at the first session of MCQ: 6 R, 1 ER, 4 CF, 2 Pr, 2 SS and 1 indeterminate status. Finally, 12 participants (group 3) were present at the second session: 6 R, 1 ER, 1 CF, 1 SS and 3 indeterminate status. The results of “seniors” in Group 1 were higher than those of “juniors” at the first session. MCQ results for the second session were higher in the subgroup CF. A more marked progression in knowledge was observed in resident and Clinical Fellow. Finally, the score obtained by the group 3 was lower than in group 1. The format of the MCQ was particularly heterogeneous. The SCT will help to assess the capacity of decision making in a context of uncertainty (as unexpected surgery requiring quick decisions with immediate effect, surgical strategy in an unusual clinical situation). The different tools available would allow the establishment of an evaluation of teaching, but also to assess the development of thinking skills in situations of uncertainty. Their implementation will take place with the participation and support of the largest number of teachers in our specialty

080: Long-term outcomes after heart transplantation for Emery-Dreifuss muscular dystrophy

BackgroundEmery-Dreifuss muscular dystrophy (EDMD) is an hereditary syndrome related to mutations in lamin A/C gene (LMNA) and is characterised by severe dilated cardiomyopathy, mostly slight peripheral muscular dystrophy, supra-ventricular arrhythmia and atrio-ventricular (AV) block. Transplantation for EDMD is rarely reported in the ISHLT registry. We aim to study outcomes after heart transplantation (HTx) for end-stage heart failure in twelve EDMD patients.Methods12 cases of HTx performed for EDMD confirmed by genetic analysis in a single institution between 1997 and 2011 were compared to 12 patients age, sex and year of transplantation matched. Survival curves were analysed by Kaplan-Meier method.ResultsBefore transplantation, EDMD patients had similar age (56 vs 57 yo, p=0,81), sex ratio (42% male), pre-transplantation NYHA functional class III (p=0,207), left ventricular ejection fraction (LVEF=33% vs 32%, p=0,89), higher rate of supra-ventricular arrythmia (100% vs 45%, p=0,002) and AV block (58% vs 12.5%, p=0,042) compared to non-EDMD. After HTx, NYHA functional class was similar (I, p=1,00), LVEF (72+/-5,91% vs 69+/-11,3%, p=0,49), rejection rate (19+/-3,8% vs 40+/-8,2% by year, p=0,45), infection rate (14% vs 6% by year, p=0,087), renal function (eGFR=89+/-49 vs 66+/-37ml/min, p=0,22) were similar after HTx in EDMD and non-EDMD group. Survival rate at 1 year, 2 years, 5 years were not significantly different (respectively 91.6%, 90.9%, 81.5% versus 100%, 100%, 100% p=0,146). 42% EDMD patients had slight muscular dysfunction, compatible with good quality of life.ConclusionDespite reluctance for heart transplantation in end-stage HF patients with EDMD, long term outcomes are similar to non EDMD patients at 1,2 and 5-year follow-up in our institution

Insuffisance tricuspide en 2023 : modalités de traitement pour la valve oubliée [Tricuspid regurgitation in 2023 : Where are we with the treatment of the forgotten valve?]

The negative impact of tricuspid regurgitation on prognosis in now well established. It also appears clear that surgical and possibly percutaneous treatment should be performed before reaching a point of no return with advanced heart failure and deterioration of right ventricle function. Percutaneous treatment has been divided into coaptation restoration devices, annuloplasty devices, and ortho- or heterotopic valve replacement. The present article offers a brief review of diagnostic modalities beyond echocardiography, surgical treatment as well as of the multiple recent development in the percutaneous treatment of this frequent condition