Introduction of a Training Matrix in OPCAB Training

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The cardio-surgical community has not readily adopted off-pump coronary artery bypass surgery.  The frequently-cited paucity of evidence favoring OPCAB is probably only an excuse, certainly when compared to the paucity of evidence in favor of, and yet the widespread application of radial artery grafting and complete arterial revascularisation. The core issue we feel is the realisation that a more complete reengineering of the surgical and anesthesiologic management is mandatory for a successful conversion to OPCAB.  The medical device industry has invested major resources in this reengineering process by depending upon previously used training resources, and also by extensively exploring new ones.  These resources were sometimes invested at the request of scientific communities, sometimes at the request of surgeons interested in OPCAB, and finally at the Industry's own initiative.

In 2001 and 2002, the K.U.Leuven OPCAB International Training Centre has given numerous presentations to large audiences, and has organised 22 one-day interactive workshops in 5 countries, 3 animal labs in 2 countries, 290 in-house training programs of at least one day for participants from 26 countries, provided 12 on-site training in 5 countries, and produced teaching CD-ROMs.  In the same interval two young surgeons were trained from general surgery level to complete off-pump CABG, without on-pump intermediary training.  Experience has been gained with an inanimate model.  The feedback and in depth follow up after participation in these training opportunities have shown that some trainees were efficient, while others failed completely.

The following components of an OPCAB training opportunity have been identified over the course of these two years: the optimal number of participants; the optimal professional participation (only surgeons, only anaesthesiologists or team participation); the precise objective and the logical sequence in the training process.  The economic world has since long identified that a training process is comparable to a manufacturing process, and that the precise location, the precise participation and the precise objectives are all quality and efficiency parameters.  The economic world then uses matrices to structure this information.

The K.U.Leuven OPCAB International Training Centre proposes in this document a training matrix and an optimal training pathway for OPCAB training:

The K.U.Leuven OPCAB training matrix. On the horizontal axis: the different training opportunities, on the vertical axis: the possible objectives. The number of X in the matrix is symbol of the performance of the resource: X is minimally, XX is reasonable and XXX is extreme.

  The optimal sequence for a team desirous of moving towards OPCAB surgery is: (1) to attend, separately or as a team, a large audience meeting where the interest is optimised, the anesthesia parameters are explored and defined, and some general concepts of the surgical approach are presented.  (2) The next step is the participation, as a team, in a one-day interactive discussion meeting that is moderated by a group of experts.  (3) The surgeon then should train on the inanimate model, refining his shunting and anastomotic techniques, using the appropriate instrumentation.   Only after these preliminary steps does a visit to a centre of expertise make any sense.  The in-house training should consist in a hands-on approach of the visiting team under the direct guidance of the expert team.  The trainee should learn to translocate and manipulate the beating heart.  Recently, the anaesthesiologists also have been asked to perform these maneuvers, so that they gain insight into the relationship between subtle cardiac manipulations and hemodynamic stability.  Several days of hands-on training might be mandatory before different clinical problems are encountered.   Live procedures, animal laboratories and on-site visits to improve an underperforming OPCAB team are very inefficient, and are better replaced by alternative training resources.  Total commitment of the participants is certainly to be desired, but at times is insufficient.  CD-ROMs are often used as teaching tools, but are rarely explored in their entirety.   By using this matrix, we believe the investments of both Industry and the medical community would become more cost-effective.  At the same time the training teams would be more willing to share their expertise with others.  And finally, the surgical teams utilizing OPCAB would have a higher success rate and a lower complication rate if they follow this optimal pathway of training.  

Publication Date: 6-Jan-2003
Last Modified: 11-Jan-2007