The motivators and barriers to a career in cardiothoracic surgery: a cross-sectional study among surgical residents in India

Introduction

A consistent decline in the number of applicants to cardiothoracic and vascular surgery (CTVS) training programs has been observed across the country over the last few years. This disenchantment with the speciality will lead to a shortage of trained CTVS surgeons at a time when incidence of cardiovascular diseases is continuously rising in India.

Aims/Objectives

The aim of the study was to reflect on the reasons that averted applicants from pursuing a career in CTVS and measures that would make CTVS a more attractive option to future applicants.

Methods

An online nationwide prospective cross-sectional survey was conducted. The participants were from a pool of general surgery residents/residents who had just completed the training. A 5-point Likert scale was utilized to rate and evaluate the factors influencing CTVS as the primary choice, factors influencing any super-speciality, and factors that would aid in decision-making and encourage an interest in CTVS.

Results

A total of 618 responses were obtained, 25.6% (N = 158) of the responses were from female residents. Only 10.7% (N = 66) of the respondents wanted to pursue CTVS as their primary choice. While interest in CTVS among the 1st year residents was 26%, it was further observed to decline to 18.72% after completion of training. The main disincentives for pursuing CTVS were the need for a hospital with required infrastructure and the dependence on a multi-disciplinary team. The perception of the participants that the cardiologist will take over CTVS procedures was another misguided but important factor. Those residents interested in pursuing CTVS identified the dynamic nature of the speciality as well as the thrills of being a cardiac surgeon as important motivators. Participants felt that adding catheter-based technology to the CTVS curriculum, mandatory CTVS rotation during surgical training, and closer interaction with CTVS residents will generate more interest in CTVS.

Conclusion

Although surgical residents report early interest in CTVS, a lack of adequate exposure to the speciality leads to a decline in interest in CTVS. An overhaul of the surgical training that mandates rotating to CTVS, increased interactions with medical students and surgical trainees by CTVS faculty, and incorporation of catheter-based training in the CTVS syllabus is urgently required to increase the number of applicants to CTVS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12055-022-01406-2.

Post mastectomy immediate breast reconstruction 13 years experience in a single centre

Early diagnosis and multi-modality treatment has resulted in prolonged survival of many patients with carcinoma of breast. It is important that the surgeons who handle breast malignancies look at the psychological and cosmetic aspects without compromising the oncologic principles of surgery in carcinoma of the breast. Post mastectomy immediate breast reconstruction (IBR) addresses the psychological and cosmetic problems that follow mastectomy. There are various techniques available for post mastectomy primary breast reconstruction. The technique should be affordable to the large number of economically poor patients and should be less time consuming. During the period of 13 years from January 1996 to December 2008, we have operated 2932 cases of carcinoma breast, of which 546 patients had IBR using various procedures. In our centre, TRAM flap was found to be the best procedure for post mastectomy immediate breast reconstruction. Immediate reconstruction whenever possible is the best option. Presence of the tissue used for reconstruction was not found to affect any form of local adjuvant treatment like radiotherapy, or delay the detection of local recurrent disease.

Hemorrhagic shock due to intrathoracic rupture of an osteosarcoma of the rib

A 13-year-old girl presented with dyspnea and chest pain. Chest radiography showed a massive left pleural effusion. Computed tomography revealed a tumor of the fourth rib. A large bloody effusion was drained. Her anemia worsened (hemoglobin: 4.8 g/dl), and hemorrhagic shock ensued. An emergency thoracotomy was performed. Bleeding from the ruptured tumor was identified. The fourth rib, the tumor, and the adjacent tissues were resected. Histopathologic examination revealed a ruptured primary osteosarcoma of the rib with pleural dissemination.

Prevention of surgical site infection by antibiotic spraying in the operative field during cardiac surgery

OBJECTIVE

Despite the many procedures introduced to prevent surgical site infection during cardiothoracic surgery, serious infections still occur. We attempted to reduce surgical site infection by spraying antibiotic solution in the operative field--a procedure since introduced at 4 other Japanese institutions.

METHODS

In the latter half of 1990, we began spraying an antibiotic solution of cefazolin (1g) and gentamicin (40 mg)/40 ml of saline placed in a 50 ml syringe and dispensed through an 18 G needle bent at 60 to 80 degrees to clean the wound during surgery.

RESULT

No deep surgical site infections or deaths due to infection have occurred among the 502 patients undergoing cardiothoracic surgery under cardiopulmonary bypass at our hospital. This method was used in over 2,100 cases of similar procedures at 4 other institutions. There were 3 deaths due to severe surgical site infection (0.11%). At one institution treating over 1,000 cases a year, the incidence of death due to surgical site infection decreased significantly after this method was introduced.

CONCLUSION

These preliminary experiences show that spraying antibiotic solution in the operative field reduces the risk of surgical site infection in cardiothoracic surgery.

Simultaneous repair of arch and abdominal aortic aneurysms. A simple new technique using a temporary bypass graft

OBJECTIVE

Atherosclerotic aneurysms in the aortic arch are associated with abdominal aortic aneurysms in up to 37% of cases. We have developed a single-stage approach to the repair of both aneurysms using a temporary bypass.

SUBJECTS

Since November 1996, 5 patients underwent simultaneous repair of aneurysms in the aortic arch and in the infrarenal abdominal aorta, using a new temporary bypass graft technique. Entire arch replacement with simultaneous abdominal aortic aneurysmectomy was performed in one patient. The other 4 patients underwent distal hemi-arch replacement distal from the orifice of the brachiocephalic artery with simultaneous repair of the abdominal aortic aneurysm.

METHOD

For the entire arch replacement procedure, blood flow to all major branches of the aortic arch was established using a bifurcated graft. This graft anastomosed to the ascending aorta was used as the proximal inflow of the temporary bypass graft. For the hemi-arch replacement procedure, the proximal inflow segment of the temporary bypass graft was anastomosed to the brachiocephalic artery. In both cases, the distal outflow segment of the temporary bypass graft was the graft used for repair of the abdominal aortic aneurysm. In order to prevent any clamp injury, Teflon felt was tightly wrapped around the aorta before the clamp was applied.

RESULTS

Evaluation of the hemodynamic parameters measured during cross-clamping of the aortic arch revealed stable distal perfusion to the visceral organs and no excessive increase in cardiac afterload. All patients had an uneventful postoperative course and were discharged within 1 month of surgery.

CONCLUSION

Our temporary bypass method is recommended for simultaneous replacement of aneurysms in the aortic arch and the abdominal aorta.

High gradient magnetic separation of cells on the basis of expression levels of cell surface antigens

The possibility of separating cells on the basis of levels of antigen expression was explored in a model system using fixed erythrocytes and high gradient magnetic separation (HGMS). Fixed human erythrocytes were labelled to varying degrees with tetrameric monoclonal antibody complexes specific for both dextran and glycophorin A-M. The cells were then mixed and incubated with dextran iron particles prior to magnetic separation. The small size of the dextran iron particles (less than 0.2 microns) resulted in quantitative magnetic labelling of cells as shown using fluoresceinated anti-dextran antibodies and flow cytometry. The relationships between the initial percentage of labelled cells, cell recovery, non-specific entrapment of unlabelled cells, the purity of the removed fraction, the degree of antigen expression and separation conditions (flow rate and field strength) were determined and used to establish separation conditions that allowed recovery of cells that differ only in the degree of antibody labelling.