Simulation training in minimally invasive cardiac surgery: novel methodologies

Aim: analysis of simulation training experience in minimally invasive cardiac surgery with evaluation of a beating-heart simulator efficacy.

Methods: а cardiac surgery training simulator was developed to practice skills while simulating myocardial contractions and maintaining intracavitary/intravascular circulation. Two training programs were implemented: 1) off-pump coronary artery bypass grafting (OPCAB), including minimally invasive coronary artery bypass (MIDCAB), and 2) thoracoscopic left atrium ablation (T-Maze). The OPCAB program involved 5 students/residents (full course) and 15 (partial course), while the T-Maze program trained 15 cardiovascular surgeons. Procedures were performed on porcine hearts (WetLab). OPCAB training stages are: 1) anastomoses technique demonstration, 2) Practice on arrested hearts, 3) beating-heart anastomoses (Pomor Beating Heart simulator). Trained LAD bypass with 15 repetitions per participant. Evaluated parameters: conduit preparation, anastomosis time, procedural duration, shunt routing, tightness, patency, and stenosis absence. The T-Maze training stages: 1) lecture course, 2) simulation training, 3) participation in surgery, 4) supervised independent performance.

Results: аn improvement in anastomosis quality was observed. The average quality score increased from 1.8 to 3.8 (scale: 1-5) between the first and fifteenth attempt, while procedure time decreased from 20 to 15 minutes. Currently, no standardized assessment methods exist for T-Maze procedure skill acquisition. Following the training program, two cardiac surgery centers successfully implemented isolated atrial fibrillation treatment protocols.

Conclusion. Аlthough limited in scale, this experience demonstrates initial progress in addressing surgical training challenges. The evolution of cardiac surgery necessitates training in novel techniques. A structured, step-by-step approach to minimally invasive surgery education is crucial for achieving optimal clinical outcomes. The WetLab method remains the gold standard for simulation. The Pomor Beating Heart simulator shows potential as a comprehensive cardiac surgery training device, combining accessibility, versatility, realistic tissue handling, and hemodynamic accuracy to significantly enhance surgical skill acquisition.

1. Makarov A.I., Sorokin R.O., et al. Regulations of the Selection Stage for the Northwestern Federal District at the 32nd Moscow International Student Surgical Olympiad Named After Academician M.I. Perelman. Available at: https://psv4.u serapi.com/s/v1/d/AziJuwX28f3mY8g2wqe_LsnMEIl7iuSOU1MDBAx8pOSXwwwlQQJlXEdHfEby7pu_9ISs8GKJqRUJGjXMdnvZMiyDJ-SESGM-kcmDMjezwn U11o5egeWcA/32_SZFO_Reglament_V_2_0.pdf. (accessed: 14.07.2025) [In Russ].

2. Noly Pierre E., Rubens Fraser D., Maral O. Cardiac surgery training in Canada: Current state and future perspectives. J Thorac Cardiovasc Surg. 2017; 154 (3): 998-1005. PMID: 28495057. https://doi.org/10.1016/j.jtcvs.2017.04.010.

3. Mehaffey Hunter J., Irving K. General principles of teaching cardiac surgery. J Thorac Cardiovasc Surg. 2022;164(6): e487-e490. PMID: 35989119. DOI: 10.1016/j.jtcvs.2022.07.023

4. Song W., Yuan-hao F., Hong Z., et al. Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting. The Heart Surgery Forum. 2020; 23 (6): 774-780. PMID: 33234215. DOI: 10.1532/hsf.3185

5. Sergeant Paul. Experience, insights and techniques for cardiac surgeons and their teams. OPCAB Procedure Guide. Medtronic. Available at: https://europe.medtronic.com/content/dam/medtronic-com/us-en/hcp/therapiesconditions/cardiovascular/mics-therapy/documents/opcabprocedure-sergeant-guide-us-en.pdf. (accessed: 14.07.2025)

6. Reuthebuch O., Lang A., Groscurth P., et al. Advanced training model for beating heart coronary artery surgery: the Zurich heart-trainer. European Journal of Cardio-thoracic Surgery 22 (2002) 244–248. PMID: 12142193. DOI: 10.1016/s1010-7940(02)00269-5.

7. Feins Richard H., Burkhart Harold M., Conte John V., et al. Simulation-Based Training in Cardiac Surgery. Ann Thorac Surg. 2017; 103: 312–321. PMID: 27570162. DOI: 10.1016/j.athoracsur.2016.06.062.