From bench to theatre: coronary anastomosis simulation in early UK cardiothoracic training – a review

INTRODUCTION: Coronary anastomosis and artery bypass grafting remain fundamental components of cardiothoracic surgical practice. We review coronary anastomosis simulators, compare their educational evidence and practical trade-offs, and propose incorporation of simulation longitudinally into early UK cardiothoracic training. METHODS: A search of PubMed/MEDLINE and Google Scholar was undertaken for English-language publications from January 2000 to August 2026. Reference lists of relevant reviews were hand-searched. UK policy and programme material was identified from the Intercollegiate Surgical Curriculum Programme, the Society for Cardiothoracic Surgery in Great Britain and Ireland and associated professional sources. Studies describing a simulator, educational intervention, validation, assessment or transfer outcome were prioritised. FINDINGS: Low-fidelity models, including silicone tubes, foam-based vessels, and 3D-printed constructs, provide affordable and accessible opportunities for repetitive practice and early skills acquisition. High-fidelity simulators, such as beating-heart systems, offer enhanced realism suitable for advanced training levels. Biological models deliver superior anatomical fidelity but present logistical and cost limitations. Across modalities, simulation training consistently improves technical performance, including suture quality, procedural precision, OSATS scores and anastomosis time. Evidence demonstrating transfer of simulator-acquired skills to real operative performance remains sparse. Current UK training delivers simulation primarily through isolated short courses rather than structured longitudinal curricula. CONCLUSIONS: Simulation-based coronary anastomosis training is a valuable tool for front-loading technical skill acquisition in early cardiothoracic training. Educational impact is driven less by fidelity and more by structured curricula, deliberate practice and timely feedback. Future priorities include national standardisation, validation of clinical skill transfer and improving equitable access to simulation resources.