The importance of off the job training in surgical education are widely recognized. The Japanese Board of Cardiovascular Surgery has required a board candidate to do at least 30 hours of off the job training from 2017. U-40 Basic Lecture Course are held annually for young cardiovascular surgeon to learn about basic surgical skills. U-40 Advanced Lecture Course was started to provide opportunity to have more advanced hands-on lecture for young cardiovascular surgeon. However, after the COVID-19 pandemic, the opportunity to hold hands-on seminars are highly limited. In such circumstances, we held a hybrid hands-on seminar. We report details about the hybrid hands-on seminar.

A 65-year-old man who had been taking warfarin for a mitral mechanical valve, was transported to our hospital for acute heart failure 3 months after switching to edoxaban. The fluoroscopy revealed restriction of the mechanical valve opening, and the catheterization showed an increased pressure gradient of the mechanical valve. The patient was diagnosed with valve thrombosis, and emergency redo mitral valve replacement was performed. The patient recovered well without complication. In cases with mechanical heart valves, sufficient explanation and education about warfarin administration is mandatory for patients' home doctors as well as patients and their families.