Adult Cardiothoracic Anesthesiology

Our adult and pediatric caseload is diverse and of high acuity as we provide state-of-the art care for a catchment area of three million residents of Westchester County and further Upstate New York, affording fellows access to extensive clinical learning resources. The curriculum of our Adult Cardiothoracic Anesthesia Fellowship Program includes both clinical experience and didactic teaching.

The Fellows attend weekly didactic lectures covering the wide range of topics related to the practice of cardiac and thoracic anesthesiology, as well as transesophageal echocardiography. These well-structured presentations circumscribe all required curricular topics of the Accreditation Council for Graduate Medical Education (ACGME) and the American Society of Echocardiography (ASE).

In anticipation of the new Adult Cardiac Anesthesiology Certification Examination starting in December 2023, the Program completed the revision of didactic lectures such that all areas of the Content Outline for the upcoming test are comprehensively covered. Acquisition of the state-of-the-art Heartworks/Bodyworks ultrasound simulation platform offers our fellows a great introduction to the cardiac ultrasound field and facilitates fast gaining of echocardiography skills. In addition, there is protected weekly time outside of the operating room for echocardiography case review with faculty members. We hold the annual Pig Heart Dissection workshop with our ACTA fellows. This is an interdisciplinary workshop with our cardiac surgeon, demonstrating surgical anatomy and with our cardiac anesthesiologist, demonstrating echocardiographic correlation. This session is designed to improve spatial understanding of echocardiography.

The Fellows attend weekly departmental Grand Rounds and patient safety conferences. They are encouraged to attend relevant conferences and lectures in other hospital departments including cardiac surgery, critical care, general cardiology, cardiac catheterization, electrophysiology, and echocardiography. The Fellows are engaged in teaching of the rotating residents from the core Anesthesiology program and, on occasion, in teaching of New York Medical College medical students and rotating student nurse anesthetists.

The Fellows gain clinical experience in the following areas:

• Preoperative patient assessment and optimization of clinical status prior to cardiothoracic surgery
• Interpretation of noninvasive cardiac diagnostic tests and cardiac catheterization data
• Interpretation of pulmonary function tests
• Interpretation of arterial and venous blood gases
• Anesthesia consultation for preoperative cardiothoracic patients
• Insertion of intravascular monitoring catheters and interpretation of hemodynamic data
• TEE probe placement, examination, and interpretation of study
• Ischemic heart disease and elective or emergency revascularization procedure
• Complex repair and replacement of heart valves
• Percutaneous valve repair and replacement (TAVR, MitraClip)
• Dilated, restrictive and hypertrophic obstructive cardiomyopathies
• Heart transplantation
• Ventricular Assist Device implantation (LVAD, RVAD, BIVAD)
• Extracorporeal Membrane Oxygenation (ECMO) device implantation
• Intra Aortic balloon pump counterpulsation (IABP), Impella device
• Intracardiac masses and tumors
• Pericardial tamponade
• Thoracic aortic surgery, including ascending, arch, and descending thoracic aorta
• Thoracic endovascular aortic repair (TEVAR)
• Pulmonary embolectomy and pulmonary thromboendarterectomy surgeries
• Pediatric and adult palliation or correction of congenital heart lesions
• Cardiopulmonary bypass (CPB) – perfusion strategies, temperature management, and fluid management
• Assessment of vital organ dysfunction during and after CPB
• Deep hypothermic circulatory arrest
• Coagulation/anticoagulation management before, during and after CPB
• Pharmacologic support of the heart and circulation during all phases of cardiac surgery
• Extensive perioperative transesophageal echocardiography in preparation for the National Board of Echocardiography Advanced PTeXAM® certification
• Thoracic surgeries, including pulmonary wedge resection, lobectomy or pneumonectomy for neoplasm, vascular malformation or infectious processes
• Thoracic cage surgery
• Lung isolation/one lung ventilation techniques
• Fiber optic bronchoscopy
• Interventional transbronchial pulmonary and mediastinal surgery
• Tracheal surgery (stent placement, dilation and resection)
• Esophageal surgery
• Ventilation management during cardiac and thoracic surgery
• Regional anesthesia and pain management for patients undergoing cardiothoracic procedures
• Care of critically ill patients post-cardiothoracic surgery (CTICU)
• Cardiac electrophysiologic diagnostic and/or arrhythmia ablation procedures
• Cardiac pacemakers (permanent or temporary) and ICD implantation

• Eight (8) four-week rotations in adult and pediatric cardiothoracic operating rooms and other cardiac anesthetizing sites.
• One (1) four-week rotation in the 15-bed Cardiothoracic Intensive Care Unit.
• Eight weeks of elective rotations; each elective rotation is a minimum two weeks in duration; each Fellow has the opportunity to choose potential elective rotations from: thoracic anesthesia, pediatric cardiac anesthesia, interventional catheter-based cardiac anesthesia, extracorporeal perfusion technology, cardiology echo lab and quality improvement and patient safety. Fellows involved in a research project in cardiothoracic anesthesia could potentially substitute research time for an elective clinical rotation.
• Four (4) weeks of vacation

The Fellows are required to participate actively in scholarly activities during their fellowship. Each Fellow must complete at least one academic assignment on a cardiothoracic anesthesia-related topic. Academic projects may include: Grand Rounds presentations, case reports, preparation and publication of review articles, book chapters, manuals for teaching or clinical practice, and clinical research investigation. The Fellow is encouraged to either participate in the ongoing clinical studies or develop an independent research project with Faculty support. The Division of Cardiothoracic Anesthesiology at the Westchester Medical Center is academically involved in national professional societies and meetings. We encourage our Fellows to present abstracts and interesting cases at major meetings; assist with workshops and problem-based learning discussions. Financial support is available if presenting original work. Our highly motivated Faculty members act as mentors and assist Fellows as necessary with the scholarly activity of their interest. Fellows have access to statistical support and research design at New York Medical College.

Faculty members responsible for teaching review the Fellows’ performance using a confidential online system. Feedback from multi-source evaluations by Faculty, peers, Anesthesiology residents, surgeons, OR and ICU nurses, perfusionists, anesthesia technicians and program coordinator is shared with the fellow, and with Clinical Competency Committee, who utilize this information to assess the fellow’s Milestones which are communicated by the Program Director. The Program Director meets with the Fellows to provide formative written feedback on all elements of the Fellows’ performance at least semi-annually. After completion of 12 months of education, the Program Director provides a written Summative Evaluation.