Evaluating Cardiac Surgery Outcomes in the Context of a High-Risk Patient Population and its Implications for the Training of Future Surgeons

Abstract

Our dissertation evaluated the outcomes of cardiac surgery in the context of an increasingly high-risk patient cohort. It demonstrated the utility of clinical registries and risk-assessment tools in optimizing outcomes of high-risk patients. These tools have allowed comparative analyses to be performed which have demonstrated the safety and efficacy of novel surgical techniques in high-risk patients. Our dissertation also established the increased risk of early and mid-term mortality associated with AF across a spectrum of cardiac surgery procedures. There are two major implications of this finding. Firstly, AF warrants consideration as an independent risk factor in future risk stratification tools. Secondly, surgeons should consider treating AF at the time of cardiac surgery with a concomitant AF surgery procedure. The safety and efficacy of this procedure has been demonstrated in many studies but it is currently underutilized. Finally, we demonstrated the safety and efficacy of cardiac surgery performed by trainee surgeons. This is a relevant finding in the contemporary era where surgeons may be reluctant to provide training opportunities to junior surgeons because of the increased scrutiny on outcomes and the perception of increased risk. Our data demonstrated that properly supervised trainees achieve equivalent outcomes to their consultant peers. Nevertheless, given the gradual shift of cardiac surgery into a specialty which incorporates more minimally invasive procedures and percutaneous interventions, there is an urgent need to train surgeons in these approaches. Moreover, the training deficit in AF surgery needs to be rectified. These actions will ensure that the future generation of cardiac surgeons is trained to deal with the increasingly high-risk patient cohort that they will encounter.