Monitoring the performance of residents during training in off-pump coronary surgery.

OBJECTIVE: Control charts (eg, cumulative sum charts) plot changes in performance with time and can alert a surgeon to suboptimal performance. They were used to compare performance of off-pump coronary artery bypass surgery between a consultant and four resident surgeons and to compare performance of off-pump coronary artery bypass surgery and conventional coronary artery bypass grafting within surgeons. METHODS: Data were analyzed for consecutive patients undergoing coronary artery bypass grafting who were operated on by one consultant or one of four residents. Conversions were analyzed by intention to treat. Perioperative death or one or more of 10 adverse events constituted failure. Predicted risks of failure for individual patients were derived from the study population. Variable life-adjusted displays and risk-adjusted sequential probability ratio test charts were plotted. RESULTS: Data for 1372 patients were analyzed; 769 of the procedures were off-pump coronary artery bypass operations (56.0%). The consultant operated on 382 patients (293 off-pump, 76.7%), and the residents operated on 990 (474 off-pump, 47.9%). Patients operated on by residents tended to be older, more obese, more likely to require an urgent operation, and more likely to need a circumflex artery graft but less likely to have triple-vessel disease. There were 7 conversions (consultant 5, residents 2). The overall failure rate was 8.5% (9.2% for consultant's operations and 8.2% for residents' operations), including 10 deaths (0.7%). Predicted and observed risks of failure were similar for all five surgeons. After 100 off-pump coronary artery bypass operations, performance was the same or better for the residents as for the consultant. For all surgeons, performance was the same or better for off-pump as for conventional coronary artery bypass grafting. CONCLUSIONS: Off-pump coronary artery bypass surgery can be safely taught to cardiothoracic residents. Implementation of continuous performance monitoring for residents is practicable

The ongoing impact of COVID-19 on adult cardiac surgery and suggestions for safe continuation throughout the pandemic:a review of expert opinions

OBJECTIVES: To establish the impact of the COVID-19 pandemic on adult cardiac surgery by reviewing current data and use this to establish methods for safely continuing to carry out surgery. METHODS: Conduction of a literature search via PubMed using the search terms: ‘(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)’. Thirty-two articles were selected. RESULTS: Cardiac surgery patients have an increased risk of complications from COVID-19 and require vital finite resources such as intensive care beds, also required by COVID-19 patients. Thus reducing their admission and potential hospital-acquired infection with COVID-19 is paramount. During the peak, only emergencies such as acute aortic dissections were treated, triaging patients according to surgical priority and cancelling all elective procedures. Screening and 2-week quarantine prior to admission were essential changes, alongside additional levels of PPE. Focus was on reducing length of stay and switching to day-cases to reduce post-operative transmission risk, whilst several hospitals adopted ‘hot’ and ‘cold’ operating theatres for covid-confirmed and covid-negative patients. CONCLUSIONS: This paper suggests a ‘CARDIO’ approach for reintroducing elective procedures: ‘Care, Assess, Re-Evaluate, Develop, Implement, Overcome’; prioritising the mental and physical health of the workforce, learning from and sharing experiences and objectively prioritising patients to improve case load

Shapley Supercluster Survey: Construction of the photometric catalogues and i-band data release

The Shapley Supercluster Survey is a multi-wavelength survey covering an area of ~23 deg2 (~260 Mpc2 at z = 0.048) around the supercluster core, including nine Abell and two poor clusters, having redshifts in the range 0.045-0.050. The survey aims to investigate the role of the cluster-scale mass assembly on the evolution of galaxies, mapping the effects of the environment from the cores of the clusters to their outskirts and along the filaments. The optical (ugri) imaging acquired with OmegaCAM on the VLT Survey Telescope is essential to achieve the project goals providing accurate multi-band photometry for the galaxy population down to m * + 6. We describe the methodology adopted to construct the optical catalogues and to separate extended and point-like sources. The catalogues reach average 5s limitingmagnitudes within a 3 arcsec diameter aperture of ugri=[24.4,24.6,24.1,23.3] and are 93 per cent complete down to ugri = [23.8,23.8,23.5,22.0] mag, corresponding to ~mr * + 8.5. The data are highly uniform in terms of observing conditions and all acquired with seeing less than 1.1 arcsec full width at half-maximum. The median seeing in r band is 0.6 arcsec, corresponding to 0.56 kpc h70 -1 at z = 0.048. While the observations in the u, g and r bands are still ongoing, the i-band observations have been completed, and we present the i-band catalogue over the whole survey area. The latter is released and it will be regularly updated, through the use of the Virtual Observatory tools. This includes 734 319 sources down to i = 22.0 mag and it is the first optical homogeneous catalogue at such a depth, covering the central region of the Shapley supercluster

A survey of minimally invasive cardiac surgery during the COVID-19 pandemic

BACKGROUND: Lack of scientific data on the feasibility and safety of minimally invasive cardiac surgery (MICS) during the COVID-19 pandemic has made clinical decision making challenging. This survey aimed to appraise MICS activity in UK cardiac units and establish a consensus amongst front-line MICS surgeons regarding standard best MICS practise during the pandemic. METHODS: An online questionnaire was designed through the ‘googleforms’ platform. Responses were received from 24 out of 28 surgeons approached (85.7%), across 17 cardiac units. RESULTS: There was a strong consensus against a higher risk of conversion from minimally invasive to full sternotomy (92%; n = 22) nor there is increased infection (79%; n = 19) or bleeding (96%; n = 23) with MICS compared to full sternotomy during the pandemic. The majority of respondents (67%; n = 16) felt that it was safe to perform MICS during COVID-19, and that it should not be halted (71%; n = 17). London cardiac units experienced a decrease in MICS (60%; n = 6), whereas non-London units saw no reduction. All London MICS surgeons wore an FP3 mask compared to 62% (n = 8) of non-London MICS surgeons, 23% (n = 3) of which only wore a surgical mask. London MICS surgeons felt that routine double gloving should be done (60%; n = 6) whereas non-London MICS surgeons held a strong consensus that it should not (92%; n = 12). CONCLUSION: Whilst more robust evidence on the effect of COVID-19 on MICS is awaited, this survey provides interesting insights for clinical decision-making regarding MICS and aids to facilitate the development of standardised MICS guidelines for an effective response during future pandemics

Minimally invasive versus transcatheter closure of secundum atrial septal defects:a systematic review and meta-analysis

BACKGROUND: Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to transcatheter (TC) closure of atrial septal defects (ASD). This systematic review and meta-analysis aims to compare post-operative outcomes of MIS versus TC repair in ASD closure. METHODS: PubMed, Medline and EMBASE were searched from inception until June 2018 for randomised and observational studies comparing post-operative outcomes for MIS and TC repair. The studies were reviewed for bias using the ROBINS-I Score and pooled in a meta-analysis using STATA (version 15). RESULTS: Six observational studies, involving 1524 patients assessing three primary and five secondary outcomes were included. Evidence suggests TC repair yielded shorter hospital stay (MD = 3.32, 95% CI 1.04–5.60) and lower rates of transient atrial fibrillation (AF) (RR = 0.48, 95% CI 0.20–1.15). TC repair patients also had fewer pericardial effusions (RR = 0.27, 95% CI 0.05–1.54, I(2) = 0.0%) and pneumothoraxes (RR = 0.18, 95% CI 0.04–0.80, I(2) = 0.0%). However, TC repair results in more minor residual shunts (RR = 6.04, 95% CI 1.69–21.63 in favour of MIS, I(2) = 39.0%). No differences were found for incidences of strokes (RR = 1.58, 95% CI 0.23–10.91, I(2) = 19.3%), unexpected bleeding (RR = 0.44, 95% CI 0.19–1.04, I(2) = 0.0%) and blood transfusion (RR = 0.39, 95% CI 0.09–1.59, I(2) = 0.0%). CONCLUSIONS: MIS closure for ASD has similar outcomes compared to TC repair. However, the lack of randomised literature related to MIS versus TC repair for ASD closure warrants further evidence in the form of RCTs to further support these findings