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Clinical Translation Of Surgical Simulation In Ventricular Septum Defect Closure
Shuhua Luo1, Hussein Nabil2, Yunyi Zhang1, Yibing Fang1, Yue Wang1, Ke Lin1, Qi An1, Osami Honjo3
1West China Hospital Sichuan University, Chengdu, China, 2Yorkshire Heart Centre, Leeds, United Kingdom, 3The Hospital for Sick Children, Toronto, ON, Canada

Purpose: To demonstrate the translatability of improvement in simulation to surgical performance of congenital heart surgical trainees and VSD patients' outcomes.
Methods: Group A included four trainees(two junior staff two fellows) who have performed at least five VSD closures. Group B consisted of three residents who had never performed VSD closure. Group A completed VSD closure in real patients(n=12) as a pretest. Both groups participated in a four-week simulation program requiring each participant to complete two VSD closures on 3D-printed models weekly. All trainees returned for a posttest in real patients(n=15) one-month later. All performances were filmed and graded blindly by two surgeons using Hands-On-Surgical-Training-Congenital-Heart-Surgery(HOST-CHS).The predefined surgical outcomes were analyzed.
Results: The median HOST-CHS score increased significantly from week one to week four(p < 0.05) during simulation. The improvement in the simulation of group A successfully transferred to skill acquisition(p=0.00), with better surgical outcomes in real patients including shorter total cross-clamp time(p=0.02), less occurrence of multiple pump-run(p=0.03), and important residual leaks(p=0.04). After simulation, the technical performance and surgical outcomes of Group B were comparable to group A in real patients, except for longer duration of operation(p=0.04) and cross-clamp time(p=0.01).
Conclusions: Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who have never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.


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