{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:07:08Z","timestamp":1790863628873,"version":"4.1.0"},"reference-count":36,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"unspecified","delay-in-days":92,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,9,11]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate trends, early clinical outcomes and surgeon-variation and hospital-variation in trainees performing isolated aortic valve replacement (AVR) and mitral valve (MV) surgery, including replacement (MVR) and MV repair (MVr) in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All adults undergoing elective or urgent isolated AVR or isolated MVr\/MVR in the National Adult Cardiac Surgery Audit between 1996 and 2019 were included. Temporal trends and early clinical outcomes were compared between consultants and trainees as primary operators. Three-level multilevel logistic regression was used to quantify hospital-level and consultant-level variation in the proportion of cases performed by trainees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 71\u2009710 isolated AVR and 25\u2009197 isolated MV surgery cases, 13\u2009432 (18.7%) and 2472 (9.8%) were performed by trainees, respectively. MV surgery included 9893 MVR and 15\u2009292 MVr, of which 1226 (12.4%) and 1246 (8.1%) were performed by trainees, respectively.<\/jats:p>\n                    <jats:p>Propensity matching generated balanced cohorts of 13\u2009432 AVR, 1223 MVR and 1243 MVr pairs. Trainee-led procedures were not associated with higher in-hospital morbidity or mortality.<\/jats:p>\n                    <jats:p>Multilevel modelling demonstrated substantial variation in trainees being the primary operator, with 59.6%, 57.1% and 44.8% of variation at hospital-level and surgeon-level for AVR, MVr and MVR, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this national UK cohort, trainees performed approximately one in five isolated AVR operations and one in ten isolated MV operations. Trainee exposure was the lowest in MVr. Trainee-led procedures were not associated with an increase in in-hospital mortality or early morbidity. There was a marked hospital-level and consultant-level variation in trainees\u2019 operating opportunities. These findings support continued structured exposure to isolated aortic and MV surgery, with particular attention to a specific MVr training pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004389","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:41:44Z","timestamp":1790862104000},"page":"e004389","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Trainee exposure to valve surgery in the UK: safety, decline and organisational inequality in a national cohort"],"prefix":"10.1136","volume":"13","author":[{"given":"Jeremy","family":"Chan","sequence":"first","affiliation":[{"name":"Bristol Heart Institute, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Comanici","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3843-1338","authenticated-orcid":false,"given":"Pradeep","family":"Narayan","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1953-0063","authenticated-orcid":false,"given":"Tim","family":"Dong","sequence":"additional","affiliation":[{"name":"University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3009-5712","authenticated-orcid":false,"given":"Gianni D","family":"Angelini","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2026100106151774000_13.2.e004389.1","doi-asserted-by":"crossref","first-page":"2140060","DOI":"10.1155\/2024\/2140060","article-title":"Training in Advanced Coronary Artery Bypass Surgery in the United Kingdom","volume":"2024","author":"Chan","year":"2024","journal-title":"J Card Surg"},{"key":"2026100106151774000_13.2.e004389.2","doi-asserted-by":"crossref","DOI":"10.1093\/ejcts\/ezaf228","article-title":"An Analysis of Trainees\u2019 Operative Experiences Over the Past 16 Years Based on the Requirements of the New 2021 Cardiothoracic Surgery Curriculum in the United Kingdom and Ireland","volume":"67","author":"Chan","year":"2025","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026100106151774000_13.2.e004389.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"2026100106151774000_13.2.e004389.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"2026100106151774000_13.2.e004389.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(19)33215-2"},{"key":"2026100106151774000_13.2.e004389.6","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/jamacardio.2020.2221","article-title":"Volume-Outcome Association of Mitral Valve Surgery in the United States","volume":"5","author":"Badhwar","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2026100106151774000_13.2.e004389.7","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1016\/j.jtcvs.2018.11.076","article-title":"Cardiothoracic surgery training in the United Kingdom","volume":"157","author":"Zakkar","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026100106151774000_13.2.e004389.8","unstructured":"Intercollegiate Surgical Curriculum Programme . 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