非体外循环冠状动脉旁路移植术后早期死亡风险预测——SinoSCORE与EuroSCORE评分的对比

目的 比较中国冠状动脉旁路移植手术评分系统(SinoSCORE)和欧洲心脏外科手术风险评分系统(EuroSCORE)对中国人群非体外循环冠状动脉旁路移植(OPCAB)术后早期死亡风险的预测价值.方法 OPCAB病人资料来自中国心血管外科注册登记研究2004-2005年数据库,观察终点为术后院内死亡.分别用SinoSCORE和logistic EuroSCORE两种模型计算病人预计病死率,并与实际病死率比较.校准度采用Hosmer-Lemeshow拟合优度检验,利用 ROC曲线下面积(AUC)评价模型的区分度.结果 4920例病人中73例发生院内死亡,实际病死率1.48%,SinoSCORE模型和EuroSCORE模型预测的病死率分别为2.73%、4.13%.SinoSCORE模型Hosmer-Lemeshow拟合优度检验P=0.636,AUC=0.794;EuroSCORE模型Hosmer-Lemeshowrny拟合优度检验P=0.01,AUC=0.756.SinoSCORE和logistic EuroSCORE两种模型的区分度均较好,但SinoSCORE的校准度明显优于后者,即两种模型均能预测术后死亡,但SinoSCORE对术后病死率的预测更加准确.结论 SinoSCORE模型比EuroSCORE模型更适用于中国非体外循环冠状动脉旁路移植病人术后早期死亡预测.     

An Evaluation of Histomorphometric Properties of Coronary Arteries,Saphenous Vein,and Various Arterial Conduits for Coronary Artery Bypass Grafting

Purpose. We evaluated the histomorphological properties of the coronary arteries, saphenous vein, and five arterial conduits for coronary artery bypass grafting, and compared them with each other. Methods. All vessels were harvested from seven cadavers, eight autopsied individuals, and 14 patients. The length, lumen diameter, wall thickness, and histological structures were examined based on samples obtained from the coronary arteries and the conduits. The dimensions and wall thicknesses of the coronary arteries and the conduits were compared using a one-sided variance analysis. The similarities between the coronary arteries and the conduits were investigated by Duncan's multiple range tests. Results. The internal mammary and intercostal arteries were elastic, while the others were muscular. The lengths of all conduits were adequate for use as coronary artery grafts. The dimensions and wall thicknesses of the coronary arteries and the conduits showed no statistically significant differences, except for the proximal portion of the saphenous vein. Conclusions. These findings emphasize the justification of continued use of the ideally matching internal mammary artery, either as an in situ or free graft, in coronary artery bypass grafting, although other arterial grafts can be used in coronary artery bypass grafting. In addition, the intercostal artery was found to have relatively favorable properties regarding its potential suitability as a coronary bypass conduit.     

Asymptomatic severe carotid stenosis undergoing staged carotid artery stent and coronary artery bypass grafting: decisive role of brain single photon emission computed tomography

Effort angina of a 70-year-old man was diagnosed as due to triple coronary vessel disease, and he was scheduled to undergo coronary artery bypass surgery. Preoperative carotid duplex scan revealed more than 75% stenosis of the right internal carotid artery, which was functionally proven to be significantly ischemic on brain single photon emission computed tomography. Although he was neurologically asymptomatic, we chose staged surgery for fear of stroke during coronary artery bypass surgery. He had successful carotid artery stenting first by neurosurgeons; then, 2 months later he underwent uneventful coronary artery bypass surgery. This experience prompted us to report the case.     

影响冠状动脉旁路移植术手术死亡的危险因素分析

目的探讨影响我国冠状动脉旁路移植术(coronary artery bypass grafting,CABG)手术死亡的危险因素。方法选择北京阜外心血管病医院2002年1月1日至2003年12月31日(以手术日期为准)行CABG的冠心病患者2251例,确定潜在危险因素后,根据潜在危险因素从其临床资料中收集数据,对影响手术死亡的潜在危险因素进行单因素分析和logistic多因素回归分析,最终确立影响我国CABG手术死亡的危险因素,并对分析结果的校准度和分辨能力进行检验。结果全组手术死亡率为1.87%(42/2251),手术时年龄60.3±9.3岁,女性436例(19.4%)。logistic多因素回归分析结果:心源性休克、心律失常、左主干病变>50%、左心室射血分数(LVEF)、二尖瓣反流、肺动脉瓣反流、术前最后一次肌酐值、手术状态(非择期手术)、合并主动脉瘤手术等9个因素是本组CABG手术死亡的独立危险因素。受试者工作特征(Receiver-Operating Characteristic,ROC)曲线检验结果:曲线下面积为0.842。结论通过logistic多因素回归分析得出,心源性休克、心律失常、左主干病变>50%、LVEF、二尖瓣反流、肺动脉瓣反流、术前最后一次肌酐值、手术状态(非择期手术)、合并主动脉瘤手术等9个影响我国患者CABG手术死亡的危险因素。分析结果具有良好的校准度和分辨能力。     

高危冠心病患者体外和非体外循环冠状动脉旁路移植术近期疗效比较

目的 比较EuroSCORE≥7分的高危冠心病患者体外和非体外循环冠状动脉旁路移植手术治疗冠状动脉旁路移植效果的优劣.方法 2008年9月至2011年3月,145例EuroSCORE≥7分冠心病患者以抽签方式随机分为体外循环组(on-pump组,71例)和非体外循环组(off-pump组,74例),onpump组17例患者自愿选择非体外循环手术、6例未完成术后随访,均予以剔除;off-pump组2例选择体外循环手术、3例术中转on-pump、3例未完成术后随访,均予以剔除.最终114例冠状动脉旁路移植冠心病患者入选,on-pump组48例,off-pump组66例.收集患者术前、术中及围手术期详细资料.术后进行1个月随访.结果 两组术前临床资料差异无统计学意义.两组乳内动脉应用率、正性肌力药物应用和IABP辅助方面相似,P＞0.05.而on-pump组与off-pump组相比,手术时间较长,但旁路移植支数更多,再血管化率更高[(3.71±0.55)支对(2.82±0.39)支],P＜0.05.两组在围手术期病死率和多种术后并发症方面差异无统计学意义,P ＞0.05.on-pump组比off-pump组术后24 h胸腔引流量[(875.0±134.2)ml对(589.4±102.5)nl]及输血量[(656.3±84.4)ml对(433.3±62.9)ml]明显增多,P＜0.05.术后1个月两组心功能、心绞痛症状及心脏超声指标,组间相比差异无统计学意义,P＞0.05.结论 高危冠心病患者,与OPCAB相比,on-pump CABG并未增加术后肾功能衰竭、神经系统并发症及肺损伤的发生,而再血管化更完全,但缺点在于术后出血多、血制品使用多.     

Comparison of patency of single and sequential radial artery grafting in coronary artery bypass

Open in a separate window OBJECTIVESSequential radial artery (RA) grafting has the potential to enhance arterial revascularization compared to single grafting. Sequential RA grafting was performed predominantly with a single side-to-side anastomosis. The study aimed to assess if sequential RA grafting improved long-term graft patency compared to single RA grafting. In addition, the anastomotic patencies of side-to-side and end-to-side anastomoses in sequential RA grafting were assessed.METHODSTwo hundred nineteen patients underwent isolated coronary artery bypass grafting with skeletonized RA conduits between 2005 and 2016. Of these, 208 patients underwent radiological graft assessment; thus, 125 and 83 patients underwent single and sequential RA grafting, respectively. The graft and anastomotic patency rates were estimated using the Kaplan–Meier method.RESULTSThe median follow-up period was 9.1 years, and the radiological assessment lasted 5.1 years. The overall RA graft patency rates at 1, 5 and 10 years were 99.4%, 92.7% and 88.1%, respectively. The RA graft patency rate for sequential grafting was similar to that for single grafting (88.7% vs 87.4% at 10 years; P = 0.88). In the stratified analysis of anastomotic patency, the patency rate of side-to-side anastomoses of sequential RA grafting was significantly better than that of end-to-side anastomoses (100% vs 88.7% at 10 years; P = 0.01).CONCLUSIONSThe long-term RA graft patencies of sequential and single grafting were equally high. The anastomotic patency of side-to-side anastomoses of sequential RA grafting was remarkably high. Considering these findings, the RA can be effectively used for multiple arterial coronary revascularizations.     

再次冠状动脉旁路移植术术前静脉桥通畅率的造影分析

目的　比较单一静脉桥与序贯静脉桥在冠状动脉旁路移植 (CABG)术后的通畅率和寿命。方法　收集 30 0例再次CABG病人术前的冠状动脉造影资料。其中 10 6例既有单一桥 (15 9条 ) ,又有序贯桥 (118条 )。结果　 10 6例病人单一桥对序贯桥的堵塞率和狭窄率 (≥ 5 0 % )为 :1年 ,1%和 1%对 2 %和 0 ;5年 ,1%和 0对 2 %和 1% ;10年 ,8%和 7%对 7%和 9% ;15年 ,2 4%和 18%对 2 3%和 2 5 % ;2 3年 ,45 %和 31%对 39%和 42 %。结论　序贯吻合本身不影响静脉桥的通畅率     

Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients: expansion of the indication?

Objectives: The effectiveness of a concomitant anti-arrhythmic surgical procedure in coronary artery bypass grafting (CABG) patients with permanent atrial fibrillation (AF) was evaluated. Methods: This prospective study included 36 CABG patients, who had a concomitant anti-arrhythmic procedure using irrigated cooled-tip radiofrequency ablation. Follow-up included a 24 h EKG and ultrasound examination at 3, 6, 12 months. Results: Mean (SD) age was 68.7 years (8.0), left atrial diameter 44.9 mm (6.7), preoperative duration of AF 67 months (73), left ventricular ejection fraction 54% (14), euroscore 5.5 (2.6), number of distal anastomoses 3.3 (1.2), aortic cross-clamp time 90 (19) min, extracorporeal bypass time 156 (38) min. Thirty-day mortality was 2.8% (1/36). Mean (SD) follow-up was 25.3 months (17.9). Cumulative survival rates (SE) at 12 and 24 months were 0.94 (0.04) and 0.90 (0.06). Cumulative postoperative sinus rhythm (SR) rates (SE) at 6 and 12 months were 0.60 (0.08) and 0.75 (0.08). Restored bi-atrial contraction occurred in 73% (19/26) of all SR patients. As a consequence coumadine was stopped, after the 6th postoperative month, in 76% (16/21) in this subset of patients, corresponding with 44% (16/36) of all study group patients. One patient experienced a sick sinus syndrome 12 months postoperatively, for which a DDD pacemaker was implanted. Three out of five patients with a preexistent VVI pacemaker regained a stable postoperative SR with bi-atrial contraction, obviating the need of any pacemaker support.     

非停跳冠脉搭桥术中氧供和氧耗的变化

实施非停跳冠状动脉搭桥术,暴露和固定各支冠状动脉使跳动的心脏解剖位置发生改变,必然影响到心脏的功能,引起全身血液动力学的改变,继而使全身氧供(DO2)和氧耗(VO2)发生改变。本研究通过观察非停跳冠状动脉搭桥术中,使用Octopus心脏固定器,暴露和固定三支主要冠状动脉时引起的     

体外循环下冠脉搭桥术后急性肾损伤的危险因素和预后分析

【摘要】〓目的〓探讨体外循环下冠脉搭桥患者术后发生急性肾损伤(Acute kidney injury, AKI)的危险因素及预后。 方法〓根据AKI诊断标准:48 h血肌酐升高绝对值≥26.4 umol/L,或血肌酐较基础值升高≥50%;尿量减少(尿量<0.5 mL·kg-1·h-1,时间超过6 h),将2007年1月至2013年10月收治的189例体外循环下冠脉搭桥患者分为急性肾损伤组(AKI组,18例)和非急性肾损伤组(非AKI组,171例),比较二组临床特点及并发症和死亡率。结果〓AKI发生率9.5%(18例)。AKI组住院死亡率为22.2%,明显高于非AKI组3.5%(P<0.05)。AKI组与非AKI组在,平均年龄(P=0.019),糖尿病患病率(P=0.035),原发性高血压患病率(P=0.026),慢性阻塞性肺疾病患病率(P=0.024),EuroSCORE (The European System for Cardiac Operative Risk Evaluation)评分(P=0.002),术中体外循环时间(P=0.012),主动脉内球囊反搏(IABP)使用率(P=0.028),术后肾小球滤过率(P<0.001)等方面存在统计学差异。结论〓年龄、糖尿病、原发性高血压、慢性阻塞性肺疾病、EuroSCORE评分、术中体外循环时间、主动脉内球囊反搏(IABP)使用是体外循环下冠脉搭桥术后发生AKI的危险因素,发生AKI患者死亡风险较高。     

非体外循环双乳内动脉序贯旁路移植加选择性心中静脉动脉化手术的疗效分析

目的评价非体外循环双乳内动脉序贯旁路移植加选择性心中静脉动脉化（CVBG）手术的临床疗效。方法回顾性分析2004年3月至2010年8月首都医科大学附属北京安贞医院38例有弥漫性右冠状动脉狭窄患者行手术治疗的临床资料。按手术方式不同将其分为两组,CVBG组：17例,男11例,女6例;年龄46.1±6.2岁;行非体外循环双乳内动脉序贯旁路移植加选择性心中静脉动脉化。对照组：21例,男14例,女7例;年龄45.9±5.7岁;仅行双乳内动脉序贯旁路移植,但对右冠状动脉系统未做处理。术中采用血流量仪测量移植血管的血流量,并对两组移植血管支数、气管内插管时间、住院时间、主要并发症发生情况、超声心动图指标、心肌核素扫描和冠状动脉造影检查结果等进行比较。结果围术期两组患者均无死亡,均无脑部、胸骨和纵隔感染等并发症发生。CVBG组移植血管支数与对照组比较差异有统计学意义（3.3±1.1支vs.2.2±1.6支,P〈0.05）。CVBG组乳内动脉主干（81.5±32.7ml/min vs.76.8±28.4ml/min）、左乳内动脉主干（32.5±18.8ml/min vs.28.1±16.7ml/min）和右乳内动脉主干血流量（39.6±19.0ml/min vs.35.9±18.3ml/min）与对照组比较差异无统计学意义（P〉0.05）。随访38例,随访率100%,随访时间3～55个月（37.4±9.8个月）。CVBG组所有患者均未出现心绞痛,心电图示：下壁心肌缺血明显改善;对照组术后有8例患者出现心绞痛,心电图示：有下壁心肌缺血,ST-T改变;两组间差异有统计学意义（P〈0.05）。两组患者术后3个月心功能较术前明显改善。心肌核素扫描显示：CVBG组患者下壁心肌血液供应明显改善;冠状动脉造影证实动脉化后的冠状静脉内有血流通过。结论在非体外循环下行双乳内动脉序贯旁路移植加选择性心中静脉动脉化是可行的,术后患者心功能和生活质量均得到改善,为弥漫性右冠状动脉狭窄患者提供了新的外科治疗方法。     

SinoSCORE对冠状动脉旁路移植术患者生活质量的预测价值

目的 探讨中国冠状动脉旁路移植手术风险评估系统（Sino System for Coronary Operative Risk Evaluation,SinoSCORE）对冠状动脉旁路移植术（CABG）患者生活质量的预测价值。 方法 选取2008年11月至2010年9月在北京大学人民医院行CABG患者共234例,其中男172例,女62例;年龄（63.0±10.1）岁。分别于术前和术后6个月向患者发放SF-36 生活质量调查简表评估患者生活质量。将234例患者根据其SinoSCORE评分分成低危组（≤1分、67例）,中危组（2～5分、77例）和高危组（≥6分、90例）3组。收集所有患者的围手术期资料,使用SinoSCORE对每位患者进行评分,分析SinoSCORE评分与生活质量评分的相关性。 结果 各组患者术后生活质量评分均较术前提高,且差异有统计学意义（P＜0.05）,3组患者生活质量改善程度差异无统计学意义。相关性分析表明,多个维度的生活质量评分与SinoSCORE评分相关（r值：-0.150～0.255,P＜0.05）。线性回归分析显示,术后躯体健康总评分等多个维度与SinoSCORE评分之间有线性关系（P＜0.05）,但相关性较弱（r2＜0.1）。 结论SinoSCORE评分与患者生活质量相关,尤其是在躯体健康方面相关性更强,SinoSCORE有预测CABG患者生活质量的价值,但预测价值有限。     

非体外循环冠状动脉旁路移植术中血液回输对围手术期血浆细胞因子、心肌损伤及肺功能的影响

目的 研究非体外循环冠状动脉旁路移植术(CABG)术中血液回输与术后血浆细胞因子水平的关系及对心肌损害、肺功能的影响.方法 将患者分为三组:非体外循环CABG术中回输血量≥600ml为OPCABG 1组(16例),<600ml为OPCABG 2组(15例);心肺转流下CABG作为对照组(13例).分别于术前,术后1、4、24和72 h取静脉血,采用液相芯片法检测细胞因子IL-6、IL-8、IL-10和TNF-α,并记录CK-MB、TnI、AaDO2、PaO2/FiO2的变化.结果 三组患者的一般情况、既往史、射血分数、左心室舒张末期内径(LVED)、冠状动脉旁路数量、术中出血量均无差异.术中回输血量OPCABG1组(800.0±246.3)ml,OPCABG2组(276.0±136.9)ml.三组患者IL-6、IL-8、IL-10水平均于术后1 h达到峰值,并于术后72 h恢复到术前水平.术后1 h,CABG组和OPCABG1组IL-6、IL-8的水平均高于OPCABG2组(P<0.05).CABG 组术后4 h的CK-MB、TnI水平及术后24小时TnI水平均高于OPCABG1组和OPCABG2组(P<0.05).三组间同一时间点AaDO2、PaO2/FiO2差异均无显著性意义(P>0.05).结论 OPCABG中的大量血液回输会提高血浆细胞因子IL-6、IL-8的水平,但尚不足以引起显著的心肌损害和影响肺换气功能.     

Coronary artery bypass grafting for left main disease and the risk of stroke: Incidence,aetiology and prevention

This review explores the association between left main disease and the increased risk of perioperative stroke following coronary artery bypass grafting, specifically addressing the potential underlying mechanisms and its potential prevention. In particular, this correlation appears stronger for patients with left main disease when compared to patients with isolated triple vessel disease. Even though evidence on this topic is limited and of modest quality, there appears to be a significant association between ascending aorta atherosclerosis and coronary artery disease. Furthermore, there seems to be a relationship between the severity and extent of carotid artery stenosis and coronary artery disease. Carotid artery disease is itself associated with atherosclerosis of the ascending aorta, a well-recognised risk factor for postoperative atheroembolic stroke. The association between left main disease, ascending aorta atherosclerosis and carotid artery stenosis may reflect an increased systemic atherosclerotic burden and hence explain, at least partially, the higher risk of perioperative cerebrovascular events. Potential pre-, intra- and post-operative strategies for stroke prevention are discussed.     

Laparoscopic cholecystectomy after coronary artery bypass grafting using the right gastroepiploic artery: report of a case

A laparoscopic cholecystectomy (LC) was successfully performed on a 61-year-old man who had undergone coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). He complained of right hypochondralgia 20 days after CABG. Gallstones were diagnosed and a cholecystectomy was performed 9 months after CABG. Under general anesthesia, the operation was performed using a pneumoperitonium. When a laparoscope was inserted, the RGEA pedicle could be clearly recognized. The pedicle obstructed the operating field and made the working space narrower than usual. No ST changes on the electrocardiogram were seen during LC, especially during the initiation of pneumoperitonium, the insertion of the ports, or when retracting the gallbladder. The postoperative course was uneventful. To avoid complications, care should be taken not to stretch the RGEA pedicle during LC, and careful monitoring of the electrocardiogram is also necessary. It is difficult to view the operating field and the RGEA pedicle together. It is therefore better to insert another laparoscope for concomitant monitoring of the RGEA pedicle. Received: June 25, 2001 / Accepted: January 8, 2002     

Skeletonized harvesting improves the early-term and mid-term perfect patency of a radial artery graft

Objective A radial artery (RA) graft is frequently used for coronary artery bypass grafting (CABG), but little information exists regarding the early- and mid-term patency associated with the harvesting procedure. The objective of this study is to compare the early- and midterm patency of the RA graft obtained using non-skeletonized and skeletonized harvesting. Methods Altogether, 131 patients and 159 anastomoses were studied. In 85 patients the RA was harvested non-skeletonized (group A: procedures between September 2000 and November 2002), whereas in 46 patients the RA was harvested skeletonized (group B: procedures between November 2002 and April 2004). Angiography results were analyzed before discharge [A: postoperative day (POD) 14.7 ± 2.9, 75 patients, 90 anastomoses; B: POD 13.7 ± 1.9, 38 patients, 47 anastomoses], and after 1 year (A: POD 386.8 ± 149.3, 44 patients, 51 anastomoses; B: POD 267.1 ± 148.7, 11 patients, 13 anastomoses). Results There was no difference in patency between the two groups (group A vs group B, 96.7% vs 100%, P = not significant [NS], in the early-term, 96.2% vs 100%, P = NS, in the mid-term). However, the perfect patency rates for groups A and B were 86.7% and 98.1%, respectively, in the early-term (P = 0.034) and 77.5% and 100%, respectively, in the mid-term (P = 0.048). The location and severity of the target vessel did not influence the angiographic results. Conclusion The early- and mid-term patency of RA grafts was excellent, and skeletonized harvesting improved the perfect patency rates at both time points.     

Diagnosis and management of the coronary-subclavian steal syndrome

A patient is presented with recurrent angina due to a coronary-subclavian steal syndrome 3 years after left internal mammary to left anterior descending coronary artery bypass grafting. Myocardial ischaemia could easily be provoked by selective exercise of the left upper limb. Coronary angiography showed reversal of flow in the left internal mammary artery. Suggestions are given for prevention of the coronary-subclavian steal syndrome by identification of patients who are at risk of developing subclavian artery occlusive disease. Performance of coronary and brachiocephalic angiography is indicated in recurrence of angina in patients with internal mammary artery bypass grafts. Doppler spectral analysis may be a valuable technique for detection of a haemodynamically significant stenosis of the left subclavian artery. Carotid-subclavian bypass grafting is the procedure of choice for management of the coronary-subclavian steal syndrome.     

Congenital atresia of the left main coronary artery: management of a 5-year-old child in extremis

Atresia of the left main coronary artery is a rare coronary anomaly. We describe the case of a 5-year-old child presenting in emergency in extremis. Clinical findings of haemodynamic collapse, malignant ventricular tachyarrhythmias and severe mitral regurgitation were indicative of a possible ischaemic aetiology. Surgical revascularization of the atretic left main coronary artery segment using an interposition autologous saphenous vein graft was successfully performed.     

Reoperative Coronary Artery Bypass Grafting Via a Left Thoracotomy and a Small Laparotomy Without Cardiopulmonary Bypass: Report of a Case

A 66-year-old woman with aortic stenosis underwent an aortic root replacement with a composite graft and coronary artery reconstruction 2 years before presentation. On coronary angiography performed 2 years after operation, saphenous vein graft (SVG) to right coronary artery and SVG to first diagonal branch had both become totally occluded. SVG to left anterior descending artery showed 75% stenosis on the heel side of the distal anastomosis. The patient underwent a second coronary artery bypass via a left thoracotomy (the left internal thoracic artery was anastomosed to the first diagonal branch by interposing it with the left radial artery) and a small laparotomy (the right gastroepiploic artery was anastomosed to the right coronary artery) without a cardiopulmonary bypass. This approach is preferable to avoiding both a resternotomy and cardiopulmonary bypass in patients requiring repeat surgery. Received: September 29, 2000 / Accepted: May 15, 2001     

Humanoids for teaching and training coronary artery bypass surgery to the next generation of cardiac surgeons

 Open in a separate windowOBJECTIVESTechnical skills are an essential component of cardiac surgery, and the operating room is becoming an even more challenging environment for trainees who want to acquire such skills. Simulation, which partially overcomes this limitation, represents a valid adjunct to surgical education. We describe an original simulator and provide results in terms of trainees’ evaluations and ratings.METHODSWe used a humanoid that is a silicone replica of the chest of an adult human that provides a complete anatomical platform for hands-on skin-to-skin practice of surgical techniques in arrested heart coronary artery bypass graft (CABG) surgery cases. Learners were residents in cardiac surgery. The teaching sessions included 2 full three-vessel CABG procedures using both mammary arteries and a hydrogel vein. Five board-certified cardiovascular surgeons scored the surgical activity of all trainees. The trainees were asked to complete an exit questionnaire to evaluate their course.RESULTSOverall, 16 residents participated in the simulation, including 5 women and 11 men, with a mean age of 30 ± 4 years, all of whom had at least 2 years of cardiac surgery training. All participants completed the 2 CABG operations. Three mammary arteries (4.6%) were seriously damaged during harvesting. In 1 case (3.1%), an aortic tear occurred during aortic cannulation. Each trainee performed overall 6 distal and 2 proximal coronary anastomoses. All participants agreed that the ‘humanoid reproduces real-life situations, the feeling is realistic, and they are now more confident in performing coronary anastomosis’.CONCLUSIONSTrainees involved in this simulation curriculum acquired and refined technical skills that could be applied directly to human patients. In addition, we were able to foster a higher level of teamwork within the operating room team.