Objective. Despite the challenges of surgical management of congenital heart disease excellent outcomes are being achieved. Newly appointed congenital heart surgeons may have limited first operator experience for many complex conditions but are expected to achieve similar outcomes. A strategy of routine mentorship from more experienced surgeons may be the key to enabling new
surgeons to become proficient while maintaining excellent outcomes for patients.
Methods. The arterial switch operation is a technically demanding but relatively commonly performed, reproducible, and easily visualised neonatal procedure, making it valuable for mentoring newly appointed congenital heart surgeons. We examined early and late mortality, and markers of both morbidity and technical proficiency following 449 arterial switch operations at a single institution over 26 years during which time three new surgeons were appointed and each mentored by a more experienced surgeon, to observe the effect of mentorship.
Results. Overall survival was 96.5% at 15 years, with an early mortality of 1.2% (5/449). There was no significant difference in mortality between surgeons, or with time. Freedom from re-intervention following the arterial switch operation was not significantly different between the four surgeons. All new surgeons underwent similar periods and levels of mentorship with zero mortality.
Conclusion. Newly appointed surgeons can become proficient in performing the arterial switch procedure without compromising patient outcomes, through a process of mentorship utilising standardised techniques and close teamwork.
- Arterial switch operation
- Learning curve