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OBJECTIVES We have developed a high-fidelity minimally invasive mitral valve surgery (MIMVS) simulator that provides a platform to train skills in an objective and reproducible manner, which has been incorporated in the European Association for Cardiothoracic Surgery (EACTS) endoscopic mitral valve repair course. The aim of the study is to provide data on the application of simulation-based training in MIMVS using an air-pilot training concept. METHODS The 2-day EACTS endoscopic mitral training course design was based on backwards chaining, pre- and post-assessment, performance feedback, hands-on training on MIMVS, theoretical content and follow-up. One hundred two participants who completed the full programme throughout 2016–2018 in the EACTS endoscopic mitral training courses were enrolled in the current study. RESULTS Of the 102 participants, 83 (83.3%) participants were staff/attending surgeons, 12 (11.8%) participants had finished residency and 5 (4.9%) participants were residents. Theoretical pre- and post-assessment showed that participants scored significantly higher on post-assessment (median score 58% vs 67%, P &amp;lt; 0.001). Pre- and post-assessment of skills on MIMVS showed that participants could work with long-shafted instruments more accurately (suture accuracy 43% vs 99%, P &amp;lt; 0.001) and faster (87 vs 42 s, P &amp;lt; 0.001). Follow-up, based on course evaluation and a survey, had a response rate of 55% (57 participants). Of all surveyed participants, 33.3% (n = 19) had started an endoscopic mitral programme successfully, while 66.7% (n = 38) did not yet start. CONCLUSIONS The MIMVS is a valuable tool for the development and assessment of endoscopic mitral repair skills. This EACTS course provides surgeons with theoretical knowledge and necessary skills to start an endoscopic mitral valve programme successfully.

The EACTS simulation-based training course for endoscopic mitral valve repair: an air-pilot training concept in action