Omar A. Khan

Impact of Surgeon-Specific Data Reporting on Surgical Training

INTRODUCTIONnSince April 2002, collection and publication of surgeon-specific data in adult cardiac surgery has become mandatory in the UK. It has been suggested that this may discourage consultants from allowing trainees to perform cases. The aim of this study was to attempt to analyse the effect of the introduction of surgeon-specific data (SSD) on surgical training in a large cardiac surgical centre.nnnPATIENTS AND METHODSnA retrospective analysis was performed on 2111 consecutive patients undergoing elective coronary artery bypass surgery, aortic and mitral valve surgery at Southampton General Hospital between April 2000 and April 2004. Results were analysed and compared over a 2-year period prior to and a 2-year period following the introduction of SSD.nnnRESULTSnThere were no changes in the overall mortality rate following the introduction of SSD. SSD was associated with a reduction in the overall proportion of cases performed by trainees (49% versus 42.8%; P = 0.004) and, in particular, a reduction in the proportion of aortic and mitral valve procedures performed by trainees. In addition, the proportion of cases performed by the trainees without consultant supervision declined significantly following SSD (18.7% versus 10.4%; P < 0.001).nnnCONCLUSIONSnPublication of surgeon-specific data has coincided with a decrease in both the proportion and variety of cases performed by trainees.

Early gestation undernutrition causes increased expression of myosin light chain kinase in adult sheep coronary arteries [In special abstracts issue]

Objectives: We have previously shown that cyclin G1nexpression is reduced in fetal hearts after in utero proteinnrestriction (PR) suggesting reduced cardiac cell cycle.nHowever no difference in cyclin G1 expression was seen innadult offspring hearts. We hypothesised that the hearts of adult PR group should be under greater stress to maintainncardiac output. We therefore measured brain natriureticnpeptide (BNP) expression in fetal hearts and left ventriclesnof adult offspring in the control (C) and PR groups becausenBNP is a marker of left ventricular dysfunction during volumenoverload or cardiac fibrosis (Nishikimi et al. Cardiovasc Res.n2006). Methods and results: Pregnant CD1 mice were placed on Cn(18% casein) or PR (9% casein) diet. Fetal hearts werencollected on day 12 of gestation (C, n =11, PR, n =10) andnthe left ventricles (LV) of adult offspring at 6 months (C,nn =17, PR, n =17). Fetal heart BNP mRNA expression relativento unit total RNA as measured by real-time PCR was similarnin C and PR (C, 0.858F0.104 vs. PR, 0.761F0.096, p =NS).nHowever, BNP expression in adult LV was greater in the PRnthan C (C, 7.043F0.68 vs. PR, 11.012F1.54, p =0.04). Conclusion: These results indicate that protein restrictionnin pregnancy induces cellular changes (indicated by cyclinnG1 changes) in the fetal heart which places it under stress innadulthood (elevated BNP production). Because BNP cannsuppress ventricular remodelling, we are presently investigatingncardiac structural changes to assess whether thesenalterations are adaptive or maladaptive.Objectives: Multiple pregnancy affects size at birth andngrowth pattern from as early as 8 weeks gestation (Iffy etnal., 1983. Am. J. Obstet. Gynecol. 146, 970—972). Malenembryos grow at a greater rate than females (Pedersen,n1980. Br. Med. J. 281, 1253). We hypothesised thatnmoderate maternal undernutrion in early gestation willnhave a greater effect on male offspring growth, particularlynif combined with the increased constraint of being a twin.nMethods: Welsh Mountain ewes received 100% (C, n =41) orn50% nutrient requirements (U, n =47) from 1 to 31 daysngestation (dGA), and 100% thereafter. Ewes were weighednweekly and blood samples were collected at 1, 30, and 65ndGA for cortisol analysis (Immulite analyser, DPC).nResults: At day 31, U ewes had gained less weight than Cnewes and had a lower plasma cortisol concentrationn( p b0.05). During 1—31 dGA, twin bearing ewes gained lessnweight than singleton bearing ewes. At birth, twins werensmaller than singleton lambs ( p b0.05). Weight gainednbetween birth and 12 weeks old and weight at 12 weeksnold were greater in U males compared to C males, an effectnthat was predominantly in twins ( p b0.01). Data werenanalysed by ANOVA.nConclusion: The increased constraint of being a twin and anmale embryo in a nutrient-restricted intrauterine environmentninduces a phenotype more likely to gain weight in angood postnatal environment.nSupported by the British Heart Foundation.