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Cardiac surgical education in Canada is designed for trainees to develop the operative and clinical skills required for cardiac surgical care safely and efficiently, as outlined by the Royal College [...], Background: Research has demonstrated equivalent patient safety outcomes for various cardiac procedures when the primary surgeon was a supervised trainee. However, cardiac surgery cases have become more complex, and the Canadian cardiac surgery education model has undergone some changes. We sought to compare patient safety and efficiency of aortic valve replacement (AVR) between Canadian patients treated by senior cardiac trainees and those treated by certified cardiac surgeons. Methods: We completed a single-centre, case-matched, prospectively collected and retrospectively analyzed study of AVR. Patients were matched between trainees and consultants for age, sex, New York Heart Association and Canadian Cardiovascular Society status, urgency of operation and diabetes status. Results: We analyzed 1102 procedures: 624 isolated AVRs and 478 AVRs with coronary artery bypass graft (CABG). For isolated AVR, there was no significant difference in 30-d mortality (p = 0.13) or in major adverse events (p = 0.38) between the groups. In the AVR+CABG group, there was no significant difference in 30-day mortality (p = 0.10) or in the rates of major adverse events (p = 0.37) between the groups. Secondary outcomes (hospital and intensive care unit lengths of stay, valve size and type) did not differ significantly between the groups for isolated AVR or AVR+CABG. Conclusion: Despite a higher-risk patient population and changes in the cardiac surgery training model, it appears that outcomes are not negatively affected when a senior trainee acts as the primary surgeon in cases of AVR. Contexte: La recherche a fait etat de resultats equivalents au plan de la securite des patients lors de diverses interventions cardiaques lorsque le chirurgien principal etait un resident supervise. Toutefois, la chirurgie cardiaque se complexifie et le modele de formation canadien en chirurgie cardiaque a subi quelques transformations. Nous avons voulu comparer la securite de patients canadiens et l'efficience du remplacement de la valvule aortique (RVA) selon que les patients etaient traites par des residents seniors en chirurgie cardiaque ou par des chirurgiens certifies. Methodes: Nous avons procede a une collecte prospective de cas assortis, dans 1 seul centre, puis a une analyse retrospective des cas de RVA. Les patients ont ete repartis entre residents et experts et assortis selon l'age, le sexe, la classification de la NYHA (New York Heart Association) et de la Societe canadienne de cardiologie, le caractere urgent de l'intervention et le statut a l'egard du diabete. Resultats: Nous avons analyse 1102 interventions: 624 RVA isoles et 478 RVA avec pontage aorto-coronarien (PAC). Dans les cas de RVA isoles, on n'a note aucune difference significative pour ce qui est de la mortalite a 30 jours (p = 0,13) ou des effets indesirables majeurs (p = 0,38) entre les groupes. Pour ce qui est du groupe RVA+PAC, on n'a note aucune difference significative quant a la mortalite a 30 jours (p = 0,10) ou quant aux taux d'effets indesirables majeurs (p = 0,37) entre les groupes. Les parametres secondaires (duree du sejour a l'hopital et a l'unite des soins intensifs, taille et type de valvule) n'ont pas ete significativement differents entre les groupes qu'il s'agisse de RVA isole ou de RVA+PAC. Conclusion: Malgre une population de patients a risque plus eleve et les transformations apportees au modele de formation en chirurgie cardiaque, il semble que les resultats ne soient pas affectes negativement lorsqu'un resident senior agit a titre de chirurgien principal dans les cas de RVA.

Penetrating injuries caused by nail guns most frequently involve the extremities. Injuries to other organs such as the head, lungs and aorta have been occasionally reported. (1,2) Cardiac penetrating trauma [...]