Since its inception in the 1970s, our Cardiothoracic Anesthesiology Fellowship has prepared fellows for independent practice by providing an opportunity to develop skills in clinical care, judgment, teaching, and research. Pivotal to our continued success is a highly motivated team of academic cardiothoracic anesthesiologists, a comprehensive didactic teaching program, and a very busy cardiothoracic surgical service.
Each year, we perform more than 1,800 cardiac surgical procedures utilizing cardiopulmonary bypass. Of these, approximately 25 percent are coronary revascularizations and approximately 50 percent are complex valve procedures (particularly mitral valve repairs). The remaining bypass cases include major aortic reconstructions, major pediatric congenital procedures, implantation of a large number of mechanical circulatory support devices (VADs), adult and pediatric heart transplantation, and congenital procedures on adults. Non-bypass procedures include off-pump coronary revascularization, transcatheter valve implantations, and approximately 700 video-assisted and open procedures on the lungs and esophagus. Additionally, we routinely provide care to pediatric patients undergoing diagnostic and therapeutic interventional cardiology procedures, and to pediatric and adult patients undergoing percutaneous electrophysiologic studies and cutting-edge interventions.
Our division performs over 2,000 transesophageal echocardiograms (TEE) each year, and our training program emphasizes training of fellows in advanced perioperative TEE. All of our cardiac anesthesia attending staff are certified by the National Board of Echocardiography to perform perioperative TEE or are in the certification process. The vast majority of our previous fellows who took the perioperative TEE exam passed on the first attempt.
Didactics
Complementing the varied and busy clinical experience of our fellowship is a comprehensive series of 41 didactic lectures covering topics pertinent to the practice of cardiac and thoracic anesthesiology and TEE. These talks cover all required curricular topics of the ACGME and the American Society of Echocardiography. In addition to these scheduled presentations, there are weekly reviews of intraoperative TEE examinations. An abundance of teaching also takes place daily during the course of patient care.
Rotations
Fellows will spend 8 of the 12 months assigned to clinical duty in the adult and pediatric cardiothoracic operating rooms and other cardiac anesthetizing locations at The Mount Sinai Hospital. In accordance with ACGME guidelines, there is a one-month rotation in the 24-bed Cardiothoracic Surgical Intensive Care Unit at Mount Sinai and 8 weeks of elective rotations chosen by the fellows. Available elective rotations currently include pediatric cardiac anesthesia, thoracic anesthesia, interventional and diagnostic cardiac anesthesia, perfusion, transthoracic echocardiography, and research. Each fellow is entitled to four weeks of paid vacation during the 12 months of training.
Scholarly Activity
The Division of Cardiothoracic Anesthesiology at The Mount Sinai Hospital is academically involved in both national and international professional societies and symposia, and our attendings have authored numerous important textbooks and textbook chapters in the field of cardiac and thoracic anesthesiology. Areas of active research currently include neurological outcomes in cardiac surgery; coagulation and hemostasis; pediatric cardiac anesthesia; geriatric cardiac anesthesia; new pharmacologic agents; and new monitoring technologies. Fellows are encouraged to participate in research projects that are of interest to them, to present abstracts and interesting cases at major meetings, and to assist with the writing of articles and book chapters for publication. Each fellow is expected to complete at least one writing assignment, to run at least one journal club and to give at least one didactic presentation to the division about complications of cardiac surgery. Faculty mentors are chosen to assist fellows with their scholarly activity in accordance with each fellow’s interests. Each year, our fellows present complex cases at the Annual Meeting of the Society of Cardiovascular Anesthesiologists (SCA), one presents a complex case at the New York TEE Symposium, and Fellows assist with workshops and PBLDs at the Postgraduate Assembly of Anesthesiologists (PGA) in New York.