Digital Theses Archive


Tesi etd-10092019-160451

Type of thesis
Master univ. II liv.
E-mail address
Analysis of the logistical, economical and minimally invasive cardiac surgical training difficulties in India: A systematic review of literature
Innovation in Cardiac Surgery: Advances in Minimally Invasive Therapeutics
relatore Prof. PASSINO, CLAUDIO
  • coronary artery bypass grafting
  • minimally invasive aortic valve replacement
  • minimally invasive cardiac surgery
  • minimally invasive mitral valve surgery
Exam session start date
ABSTRACT:<br><br>BACKGROUND: Significant inroads and advancements have been made in Minimally invasive cardiac surgery (MICS) over the past 3 decades. However, the acceptance and practice of MICS continues to remain rather low in the developing world owing to several challenges – economical, logistical and paucity of training opportunities.<br><br>OBJECTIVES: The objective of this study was to analyse the logistical, economical and training difficulties in MICS with a special focus on the Indian scenario.<br><br>METHODS: A systematic review of the current literature on MICS with an emphasis on the economical, logistical and training challenges was done on the basis of pertinent studies and database studies retrieved by a selective search in the MEDLINE/PubMed Central and EMBASE/SCOPUS databases as well as by the Google Scholar search engine.<br><br>RESULTS: A PubMed search employing the search term “minimally invasive cardiac surgery” yielded nearly 11,694 hits. All studies carrying relevant data from these databases were pooled in for this study. Minimally invasive mitral valve surgeries (MIMVS), mini-aortic valve replacement (mini-AVR) and MICS CABG have been shown to have a clear cost-benefit advantage that stems from shorter ICU and hospital stay, lesser transfusion requirements and avoidance of sternal wound complications. However, only limited reports are currently available detailing the economical and training challenges for the application of MICS in the developing world, particularly India. These reports highlight the reasons for the low rate of MICS practice in India and also offer solutions to overcome these challenges such as public-private partnerships and the introduction of training curriculum for MICS in India to avoid the over dependence on foreign fellowships which not many can afford.<br><br>CONCLUSION: Several challenges exist in widening the practice of MICS in India which are mainly economical and lack of training facilities. However, these can be overcome through certain target oriented steps with the aid of public sector which can foster a lasting partnership with the private healthcare and by the setting up of training curriculum as well as skills laboratories and simulation centres to roll out MICS surgeons to meet the needs of present day cardiac surgery.