Current Status of Endovascular Training for Cardiothoracic Surgery Residents in the United States

Background Endovascular interventions for cardiovascular pathology are becoming increasingly relevant to cardiothoracic surgery. This study assessed the perceived prevalence and efficacy of endovascular skills training and identified differences among training paradigms. Methods Trainee responses to questions in the 2016 In-Service Training Examination survey regarding endovascular training were analyzed based on the four different cardiothoracic surgery training pathways: traditional 2- and 3-year thoracic, integrated 6-year, and combined 4+3 general and thoracic residency programs. Results The duration of endovascular training was substantially different among programs, at a median of 17 weeks for integrated 6-year, 8.5 weeks for 3-year, 6 weeks for 4+3, and 4 weeks for 2-year residency (p < 0.0001). After adjusting for year of training and program type, the duration of endovascular rotations was significantly associated with self-assessed comfort with catheter-based skills (p < 0.0001). Eighty-two percent of residents rotated with trainees from other specialties, and 58% experienced competition for cases. Residents reported greater exposure to transcatheter aortic valve replacement than to thoracic endovascular aortic repair, cardiac catheterization, percutaneous closure of atrial septal defect, and transcatheter mitral valve surgery (p < 0.0001). A significant proportion of responders reported feeling uncomfortable performing key steps of transcatheter aortic valve replacement (52%) or thoracic endovascular aortic repair (49%). Conclusions Considerable heterogeneity exists in endovascular training among cardiothoracic surgery training pathways, with a significant number of residents having minimal to no exposure to these emerging techniques. These findings highlight the need for a standardized curriculum to improve endovascular exposure and training

How to Survive Residency

In a discussion filmed at the 2017 STS Annual Meeting in Houston, Texas, a panel of current cardiothoracic surgery residents share their tips and tricks for thriving during residency and fellowship. Amy Fiedler of the Massachusetts General Hospital is joined by Elizabeth Stephens of Columbia University, Hugh Auchincloss of the Massachusetts General Hospital, Gregory Pattakos of the Texas Heart Institute/ Baylor College of Medicine, and Kristin Sell-Dottin of the University of North Carolina Hospitals. The panelists discuss the different training pathways available to cardiothoracic surgery residents, identifying mentors, and how to balance clinical responsibilities with research

Open Surgical Repair for the Removal of an Atrial Septal Amplatzer™ Device Eroding the Aortic Root

<p><strong>Objectives</strong></p><p>The Amplatzer™ Septal Occluder is a minimally invasive device used to treat atrial septal defects (ASD). Despite the low associated complication rates, the Amplatzer™ device has, on rare occasions, been found to erode surrounding structures. The authors describe a case in which a patient presented with an aortic root fistula and underwent open surgical repair to remove an Amplatzer™ device that had been percutaneously inserted nine years earlier to repair an ostium secundum ASD.</p><div><p><strong>Methods</strong></p><p>A 33-year-old woman presented for evaluation of device erosion into the aortic root, with continuous blood flow between the aorta and right atrium consistent with a fistula. The patient underwent elective surgical repair via a median sternotomy to remove the Amplatzer™ device from the atrial septum. Exploration revealed a fistula from the noncoronary sinus of the aortic root into the right atrium. Repair consisted of removing the device, replacing the aortic wall of the entire noncoronary sinus and the right atrial wall with bovine pericardium, and replacing the atrial septum with autogenous pericardium.</p><p><strong>Results</strong></p><p>The patient had an uneventful recovery with no complications—including no dysrhythmia or heart block—and was discharged on postoperative day six. Postoperative transesophageal echocardiography showed no postrepair shunt from the noncoronary sinus to the right atrium and an entirely competent aortic valve. The patient has returned to work and remains well five months after the procedure.</p><p><strong>Conclusion</strong></p><p>Although complications are uncommon after closure of an ASD with an Amplatzer™ Septal Occluder, the device may erode surrounding structures and produce a fistula. Such complications can be successfully repaired with extensive open surgical techniques.</p><p>This educational content was originally presented during the STSA 64th Annual Meeting. This content is published with the permission of the <a href="https://stsa.org/">STSA</a>. For more information on the STSA and its next Annual Meeting, please click <a href="http://stsa.org/annualmeeting/">here</a>.<br></p></div