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The apprentice model has traditionally been the primary method of teaching cardiac surgery trainees. Limitations of this model include insufficient time to learn all neces sary skills, minimal exposure to rare cases and to complex repair techniques, small number of patients in small centres, high cost and absence of objective measures of feedback. In recent years, simulation-based training (SBT) has been used in order to address the gaps left by the apprentice model. We performed a systematic review of PubMed and Embase for articles investigating the use of SBT in teaching surgical valve techniques published in 2022 or earlier in order to summarize the current literature regarding the use of SBT for trainees learning surgical valve repair and replacement techniques. We compiled data on the impact of SBT on time to completion of tasks, proportion of trainees who committed technical errors, skills scores and theoretical knowledge. Studies in which outcomes were evaluated showed significant improvement in these measures after participation in SBT. Simulationbased training has been shown to improve the surgical skills of trainees in a relatively short period. As hands-on experience in the feld of cardiac surgery is invaluable and often difficult to reproduce effectively, it is likely that a combination of hands-on training and SBT will be adopted moving forward to provide optimal exposure for surgical trainees. Le modele de l'apprenti est la principale methode traditionnelle de formation des stagiaires en chirurgie cardiaque. Ce modele comporte toutefois des limites : manque de temps pour apprendre toutes les competences necessaires, exposition minime aux cas rares et aux techniques de reparation complexes, faible nombre de patients dans les petits centres, cout eleve et absence de mesures de retroaction objectives. Depuis plusieurs annees, la formation par simulation est employee pour combler ces lacunes. Nous avons realise une revue systematique d'articles trouves dans PubMed et Embase portant sur le recours a la formation par simulation dans l'enseignement des techniques de chirurgie valvulaire, publies en 2022 ou avant, afin de resumer la litterature sur le sujet. Nous avons compile des donnees mesurant l'incidence de la formation par simulation sur le temps de realisation des taches, la proportion de stagiaires ayant commis des erreurs techniques, les scores de competence et les connaissances theoriques chez les stagiaires. Ces mesures, pour les etudes les ayant evaluees, se sont signi ficativement ameliorees apres la participation a la formation par simulation. Il a ete demontre que cette modalite ameliore les competences chirurgicales des stagiaires en une periode assez courte. L'experience pratique dans le domaine de la chirurgie cardiaque est inestimable et souvent complexe a reproduire efficacement; a l'avenir, la formation des stagiaires en chirurgie associera probablement la pratique et la simulation pour une exposition optimale. Valvular heart disease is a relatively common condition affecting an estimated 2.5% of the population in developed nations. (1-4) The mitral valve (MV) and aortic valve (AV) are the 2 most commonly diseased valves. (2,4) Severe valvular heart disease is not amenable to pharmacotherapy, and, thus, the only definitive treatment is surgical repair or replacement of the diseased valve. Heart valve repair and replacement are complex procedures requiring years of training to achieve proficiency. Surgical trainees have traditionally learned these technical skills in the operating room through the apprentice model, which entails a surgical resident's being taught by a single mentor at a time. (5,6), Although hands-on experience is irreplaceable and has a record of proven success, several limitations have been identified with the apprentice model. (7,8) These limitations include insufficient time to learn all [...]

OBJECTIVES There remains debate over the optimal mitral valve replacement (MVR) option for patients aged 50–70 years. The objective of this study was to retrospectively compare the long-term outcomes of mechanical and bioprosthetic MVR in this patient population. METHODS Data from patients undergoing MVR between 2004 and 2018 were retrospectively reviewed. The primary outcome was all-cause mortality. Secondary outcomes included perioperative and late morbidity. RESULTS Two hundred and eight-six propensity-matched patients (n  = 143 mechanical; n  = 143 bioprosthetic) aged 50–70 years were included in the final analysis. Maximum follow-up was 15.8 years. There was no significant difference in all-cause mortality between the groups at 30 days, 1 year, 5 years, 10 years, and at the longest follow-up. Patients who underwent mechanical MVR experienced significantly lower rates of postoperative atrial fibrillation (P  = 0.001). There were no significant differences in rates of sepsis, acute kidney injury, superficial and deep sternal wound infection, mediastinal bleeding, and permanent pacemaker implantation. At the longest follow-up, there were no differences in myocardial infarction, stroke, heart failure or overall rehospitalization. At the same time point, there was an increased rate of MVR in patients receiving a bioprosthetic valve (P  = 0.015). CONCLUSIONS Survival following mechanical and bioprosthetic MVR in patients 50–70 years of age is similar to up to 15 years of follow-up. Bioprosthetic MVR is associated with an increased risk of repeat MVR. Mechanical MVR is not associated with an increased risk of stroke. Valve selection in this patient population requires diligent consideration of structural valve deterioration and subsequent reoperation risk as well as bleeding and thromboembolic risk. [ABSTRACT FROM AUTHOR]

OBJECTIVES The Dissected Aorta Repair Through Stent (DARTS) Implantation trial demonstrated positive proximal aortic remodelling following aortic dissection repair with the AMDS hybrid prosthesis. In this study, we look to identify predictors of aortic remodelling following aortic dissection repair with AMDS including whether communications between branch vessels and the false lumen (FL) predict aortic growth. METHODS The DARTS implantation trial included patients who underwent acute DeBakey type I aortic dissection (ATAD I) repair with the AMDS from March 2017 to January 2019. Anatomic measurements were collected from original computerized tomography scans. Measurements were taken at zones 2, 3, 6 and 9. Patients were grouped based on the number of FL communications with the supra-aortic branch vessels or visceral branch vessels. RESULTS Forty-seven patients were included in the original DARTS implantation trial. Patients with FL communications with the supra-aortic branch vessels tended to have significant growth at zone 3 (P  = 0.02–0.0018), while greater numbers of visceral FL communications tended to predict aortic growth at zones 3 (P  = 0.003), 6 (P  = 0.017–0.0087) and 9 (P  = 0.0016–0.0003). CONCLUSIONS Aortic remodelling following ATAD I repair using the AMDS may be predicted by local FL communications with branch vessels. Patients undergoing ATAD I repair were more likely to experience significant aortic growth in zone 3 with more head vessel communications and in zones 3, 6 and 9 with more visceral FL communications. Predictors of aortic remodelling may help to guide initial surgical management for aortic dissection patients. [ABSTRACT FROM AUTHOR]