Operative Teaching of Coronary Bypass and Need for Repeat Catheterization: Does it Matter Who is Sewing?

OBJECTIVE: There are no studies to date comparing the patency of coronary bypass grafts constructed by attending surgeons versus trainees and the potential consequences of any such disparities. We explored this issue by comparing the patency of individual anastomo-ses performed by residents versus the attending surgeon.DESIGN: We reviewed 765 continuous cases performed by a single surgeon which involved at least 1 coronary bypass anastomosis, totaling 2,173 distal anastomoses. At a median follow-up time of 36 months (interquartile range 20.5-47.3), 83 (10.9%) patients had undergone 110 cardiac catheterization procedures after their origi-nal operation for various indications. This angiographic information provided the data for our comparison cohorts.SETTING: Cardiac surgery practice within an academic settingPARTICIPANTS: Adult patient undergoing coronary bypass graftingRESULTS: Of the 83 patients that underwent repeat cath-eterization, 23 (27.7%) were resident cases, 25 (30.1%) were attending cases and 35 (42.2%) were mixed. There were 4/83 (4.8%) patients with angiographic evidence of internal mammary artery graft compromise of which 3/4 (75%) had been constructed by the attending sur-geon. Angiographic evidence of saphenous vein graft compromise was appreciated in 16/83 (19.3%) patients of which 9/16 (56.3%) of the grafts were constructed by the attending surgeon. CONCLUSIONS: Liberal involvement of surgical trainees as primary operators in coronary revascularization cases led to equivalent rates of postoperative ischemic compli-cations between the attending and resident groups. The outcome equivalence was also maintained when evalu-ated at the individual anastomosis patency level between the 2 groups. We conclude that academic programs should continue providing trainees significant experi-ence as primary operating surgeons without fear of clini-cal outcome compromise. ( J Surg Ed 80:826-832.(c) 2023 Association of Program Directors in Surgery. Pub-lished by Elsevier Inc. All rights reserved.)