Education

• Fellows are responsible for managing pre/post-op open heart cardiac surgery patients, and all necessary invasive procedures with supervision.
• They will be an integral member of the pulmonary embolism response team.
• As part of a multidisciplinary team, fellows are the lead and contact for Cardiovascular Intensive Care Unit (CVICU) cases, and are responsible for decision making during consults related to ECMO/ECPR selection

Cardiac OR

Fellows participating in this rotation will gain comprehensive knowledge and practical skills in several key areas including:

• Learning from cardiac perfusionists about cardiac-pulmonary bypass cannulations, physiology, and evidence-based blood transfusion medicine. 
• Receiving education from cardiac anesthesiologists on pre-operative and intra-operative hemodynamic and respiratory management. 
• Hands-on training in intra-operative transesophageal echocardiography (TEE).
• Learning precise surgical techniques to open and close the sternum in preparation for emergent post-surgical chest opening in post-cardiotomy tamponade at the bedside. 
• Gaining an understanding of the aortic, cardiac and peripheral cannulation process for cardiopulmonary bypass surgery. 
• Learning specific surgical techniques and aspects of placement and purpose of epicardial wires, mediastinal and pleural chest tubes, and gross knowledge of nuances of coronary artery bypass graft surgery (CABG), surgical valve replacements, aortic aneurysm/dissection repairs, etc.

Advanced Heart Failure/Transplant/MCS 

During this rotation the fellow will be an integral team member in learning the evidence-based and program specific criteria for advanced heart failure management, ranging from:

• Initiation of goal directed therapy
• Selection of AICD/CRT
• Indications for surgical intervention due to ischemic cardiomyopathy/valvulopathy
• Identification and management of pulmonary hypertension
• Overview of durable and short-term mechanical circulatory support systems
• Characterization and management of stages of heart failure
• Characterization and management of cardiogenic shock using SCAI classification scheme  

Extra-corporeal Membrane Oxygenation (ECMO)

Fellows will obtain extensive knowledge in understanding physiology of veno-venous, veno-arterial, and other modalities of peripheral and central extra-corporeal membrane oxygenation. They will:

• Learn to Identify which modality to choose in refractory respiratory and cardiogenic failure. 
• Become proficient on daily management of ECMO circuit including evaluation for any potential complications associated with ECMO including but not limited to acute limb ischemia, infection at site of insertion, recognition of north-south syndrome, re-circulation deficits, suction events, correct radiographic positioning of cannulas, hematologic and hemodynamic effects of presence of ECMO circuit.
• Learn how to cannulate peripherally using ultrasound guidance with assistance of from certified ecmo cannulator. 

Electrophysiology

During this rotation, fellows will round with electrophysiologists (EP) during consults in the CVICU and attend monthly electrocardiogram (ECG/EKG) sessions with EP physicians.  They will also learn how to:

• Recognize indications for patient’s receiving pacemakers and automated internal cardiac defibrillators in post-op period.
• Recognize and manage common life-threatening malignant arrhythmias and heart blocks
• Recognize and manage patients who develop complications following invasive electro-physiology studies/interventions.
• Place and manage temporary pacemakers.

Interventional Cardiology

This rotation takes place in the cardiac catheterization (cath) lab.  Fellows are trained to interpret cardiac catheterizations to identify the vessels grafted during surgery. They will also learn indications for the initiation of temporary mechanical circulatory support devices including, impellas and intra-aortic balloon pumps.

Additionally, to provide comprehensive experience regarding resuscitation, fellows will learn how to manage the critically ill acute STEMI/code heart patient.

Adult Congenital Heart Disease (ACHD)

During this rotation, fellows will gain an understanding of the embryology, anatomy, physiology, and natural history of simple and complex congenital heart disease lesions.

They will become familiar with genetic syndromes associated with congenital heart disease.

They will be required to evaluate ACHD patients, and perform the following: 

• Review and interpret the ECG/EK and surface echocardiogram
• Review all available multi-modality imaging including TEE, CT, and cardiac MRI
• Manage and participate in care of post-operative ACHD patients using principles of their underlying physiology post neonatal and pediatric surgery, including interpretation of right and left heart catheterizations.
• Become familiar with medical, interventional, and surgical options of the ACHD patient.
• Participate in the assessment and management of pregnant ACHD patients.
• Understand the cause, pathophysiology, therapeutic, and prognostic implications of pulmonary hypertension in adult patients with congenital heart disease.
• Recognize and manage the short and long-term sequelae and/or residual of surgery in adults with congenital heart disease. 
• Become familiar with advanced treatment of congestive heart failure and electrophysiological abnormalities and recognize the indications for specialized consultation by congestive heart failure and/or electrophysiologist consultants. 
• Understand the role of cardiac transplantation in adults with congenital heart disease

Elective/Research

For additional experience, fellows can undertake research opportunities and/or enroll in one of the above rotations for an additional two weeks.

• Fellows will spend approximately twenty-two weeks dedicated to training^* and working in the Cardiovascular Intensive Care Unit (CVICU) split between night and day coverage. 
• Shifts are approximately 12-hours. 
• Two full-time CVICU attending physicians are on during the day and one or two are on at night. 
• Fellows will manage a 26-bed CVICU unit in addition to handling consults for high risk PCI patients, cardiogenic shock call, and emergent cardiac surgeries. 

*Schedule may be subject to change