Objective

It is a commonly held belief that patients undergoing cardiac valve surgery have better outcomes when their surgery is performed by a consultant rather than a surgical trainee. However, there are few studies that analyse the relationship between operator grade and clinical outcomes. This study investigates the effect of operator grade on the outcomes of aortic valve replacement (AVR) surgery in the setting of a tertiary centre with a nationally accredited cardiac surgical training programme.

Methods

A retrospective, observational cohort study was performed on prospectively collected data for all patients undergoing first time isolated aortic valve replacement between April 2004 and July 2013.

Results

A total of 1255 patients were grouped by operator training grade, with trainees performing 237 cases (18.9%). There were no significant differences between the groups for any pre-operative variables. Pre-operative additive EuroSCORES between consultants and trainee groups were also comparable with mean values of 6.2 and 5.9 respectively. In-hospital and one year all-cause mortality were 1.9% and 5.5% for consultants and 0.4% and 3.4% for trainees (p = 0.2).

Conclusion

Despite similar pre-operative risk profiles, there was no difference in mortality between the consultants and trainee cohorts. This suggests that consultants select training cases based on additional criteria to that included in our current risk-stratification models. We conclude that trainees can safely perform AVR with excellent outcomes in a centre with a dedicated training programme under direct consultant supervision.