Rotations

Our fellows spend a total of seven months in the cardiothoracic operating rooms, gaining expertise in the perioperative management of patients undergoing cardiac, thoracic and aortic surgery as well as patients undergoing interventional cardiac procedures and electrophysiology interventions. Fellows are the primary providers for the majority of the cases. Opportunities for fellows to gain experience in teaching and supervising junior residents are provided throughout the year.

Clinical experience

• Coronary revascularization surgery
• Valve surgery – repair and replacement
• Adult congenital heart surgery
• Major aortic surgery – ascending, arch and descending thoracic aorta
• Procedures including circulatory arrest
• Heart transplantation – one of the largest programs in the country
• Ventricular assist device implantation – including investigational devices
• Minimally invasive and robotic techniques including a large TAVR program
• Routine thoracic surgery - VATS, pulmonary resections
• Thoracic epidural insertion
• Esophageal surgery
• Tracheal surgery
• Lung transplantation – one of the largest programs in the country
• Lung volume reduction surgery (in NIH sponsored trial)
• Pulmonary thromboendarterectomy surgery
• Hybrid surgical procedures
• Catheter-based interventions including valve implantation and repair
• Electrophysiology procedures – pacemaker insertion, implantable cardioverter defibrillator testing, atrial fibrillation and ventricular tachycardia ablations

ACTA fellows spend a total of 4 weeks in the CTICU. During the CTICU rotation, ACTA fellows have the same responsibilities as the fellows in our ACGME accredited Critical Care Medicine (CCM) fellowship program. They actively participate in daily ICU rounds, and are directly involved in patient care during the day. They participate in all the educational activities offered to the CCM fellows during that month. In addition, they attend the regularly scheduled lectures given to the ACTA fellows. The primary goal for ACTA fellows on this rotation is to develop proficiency in the perioperative management of adults with a variety of critical cardiothoracic illnesses. In addition, ACTA fellows gain expertise in performing diagnostic and therapeutic procedures and focused ultrasonographic evaluation. The CTICU rotation provides experience with postoperative management of assist devices, extracorporeal membrane oxygenators and advanced modes of mechanical ventilation.

ACTA fellows have a total of two months of elective rotations during their fellowship year.

All ACTA fellows spend two weeks working with the perfusionists to gain better understanding of the cardiopulmonary bypass machine, as well as coordinating initiation and discontinuation of cardiopulmonary bypass. In addition, during this rotation, ACTA fellows can choose to gain experience with management of extracorporeal membrane oxygenators (ECMO).

Most ACTA fellows choose to spend two weeks in the Invasive and Valvular Echocardiography division of Cardiology, gaining experience in perioperative 2D and 3D TEE for patients undergoing catheter-based valvular replacement or repair.

Fellows who elect a rotation in Pediatric Cardiac Anesthesia spend 2 weeks to one month in the Pediatric Anesthesia division at Children’s Hospital of New York (CHONY), under direct supervision from pediatric anesthesia faculty.

Other elective rotations available include Transfusion Medicine, Pulmonary Medicine, Heart failure, Cardiac Critical Care rotation. In addition, elective rotations can be tailored to the fellow’s interests.

Fellows may choose to dedicate the elective months to research relevant to cardiothoracic practice. The Department of Anesthesiology has several opportunities for fellows who wish to conduct research, with a well-established basic science research infrastructure, resources for epidemiological studies, and opportunities for clinical and educational research.