UK Training Pathway for Congenital Cardiac Surgery

Applying Congenital Cardiac Surgery (CCS) is a GMC-recognised sub-specialty within the main specialty of Cardiothoracic Surgery (CTh). (https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/congenital-cardiac-surgery-curriculum) Trainees on the CTh training pathway compete for a place in the two-year training programme for CCS (National Fellowship in Congenital Cardiac Surgery). CCS subspecialty training positions are advertised on Oriel (https://www.oriel.nhs.uk/) for national selection. Applicants are

ASD closure

Smaller skin incision from sternal angle – if so, free up some soft tissue superiorly. Clear the pericardium of fat and layers using a dry swab after removing the thymus before opening the pericardium. Use scissors to open pericardium to get cleaner edges. Leave the right pleura closed till the end to avoid the lungs

Coarctation repair

Right radial art line. Positioned with a roll under the rib cage and left arm above head with securing tape. Slightly rolled anteriorly. Strapped at the hip to the table. Soft roll between legs. Mark spine, nipple, scapular tip. Feel the rib spaces to note how horizontal or oblique they are, as neonates tend to

ECMO

Position to the top of the bed, towards the middle of the bed, maybe slightly to the right. (Head slightly down makes the vein bigger.) Shoulder roll to extend until chin is away. Head pointing to the left with ETT on the left. (If rotated too much to the left, then the lateral and medial

VAD chamber change

Note the following on the existing VAD before scrubbing. Membrane up or Blood up? Inflow and outflow directions? Tubing Length – Measure tubing length including any connectors.  Ensure it’s long enough for further device change but short enough it doesn’t cause problems when walking. Connector sizes. Where to clamp, where to reattach Heparin bolus 20-50u/kg

FRCS Cardiothoracic Surgery

Part 1 Taken in local Pearson Vue test centres. Only Single best answers (SBA) – choose one correct answer out of five options. Previously one paper had EMQs (extended matching questions), but no longer included. Two papers (AM and PM) – 120 SBA questions each (total 240 questions) in 135 minutes (67.5 seconds per question).

Ross

Dissect out the aortic root, taking care to recognise the coronaries. Mobilise the MPA. Transect the aorta/aortotomy. Transect the main pulmonary artery with the suitable length. Visualise the valve leaflets, use a right-angle and bluntly puncture the RVOT free wall with the finger against the tip. Use fine scissors to cut the anterior wall. Use

VSD Closure

XC. Cardioplegia. Snare the SVC. Wait for the heart to arrest (or continue while snaring the IVC, opening RA fully, and PFO (with 11 blade or right angle to stretch) to vent). Stop cardioplegia, snare the IVC and open the RA. Once open, continue cardioplegia. Open the RA parallel to the AV groove. Table tilted

PDA ligation

Right lateral decubitus position with gamgee roll under right chest. Further gamgee over left face and between legs. Left arm over the head. Mark the tip of the scapula and the vertebral column. Place a small gamgee on the hip and affix a tape across the table over the hip. Prep and drape with ioban.