Rotations

Our fellows spend a total of eight 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.  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
• Robotic mitral valve and atrial septal surgery
• Adult congenital heart surgery
• Major aortic surgery- ascending, arch, and descending thoracic aorta, thoracoabdominal aortic repair
• Procedures including deep hypothermic circulatory arrest
• Heart transplantation- one of the largest programs in the country
• Ventricular assist device implantation, including investigational devices
• Minimally invasive, including a large TAVR program
• Routine thoracic surgery- VATS, pulmonary resections
• 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
• Interventional pulmonary procedures such as bronchial stents and robotic lung biopsies
• Hybrid surgical procedures
• Catheter-based interventions including valve implantation and repair
• Electrophysiology procedures- pacemaker insertion, implantable cardiac defibrillator, atrial fibrillation and ventricular tachycardia ablations

For the performance of the procedures, fellows gain advanced experience with several anesthetic and cardiothoracic-related techniques including transesophageal echocardiography, high frequency jet ventilation, pulmonary artery catheters, thoracic epidural anesthesia, spinal drain catheters with and without fluoroscopic guidance, and thromboelastometry, as well as placement and management of double lumen tubes and bronchial blockers.

ACTA fellows spend a total of four weeks, divided into two 2-week blocks, in the Cardiothoracic Intensive Care Unit (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 the month.  In addition, they attend 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.  ACTA fellows gain expertise in performing diagnostic and therapeutic procedures and focused ultrasonographic evaluation.  The CTICU rotation provides an invaluable 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, divided into 2-week blocks, during their fellowship year.  There are several options for electives:

• Perfusion Service: 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).
• Invasive And Valvular Echocardiography, with Division of Cardiology: Many ACTA fellows choose this rotation, gaining experience in perioperative 2D and 3D TEE for patients undergoing catheter-based valvular replacement or repair.
• Pediatric Cardiac Anesthesiology: This rotation is completed with the Pediatric Anesthesiology division at Children’s Hospital of New York (CHONY), under direct supervision from pediatric anesthesiology faculty.
• Research: The Cardiothoracic Division, the Critical Care Division, as well as other areas of the Department of Anesthesiology have several opportunities for fellows who wish to conduct research.  A well-established basic and clinical science research infrastructure is available, in addition to resources for epidemiological studies, and opportunities for educational research.
• Other Elective Rotations
  • Pulmonary Medicine
  • Transfusion Medicine
  • Heart Failure Service
  • Cardiac Critical Care
  • Adult Liver Transplantation
  • Elective rotations can also be tailored to the fellow’s interests