Adult Cardiothoracic Anesthesiology(ACTA) Fellowship

The Stanford University Cardiothoracic Anesthesia Division offers an Adult Cardiothoracic Anesthesiology (ACTA) Fellowship, an intensive, one-year clinical training program designed to prepare graduates for clinical and academic leadership positions in the subspecialty practice of cardiothoracic anesthesiology and cardiovascular critical care. The ACTA fellowship program is dedicated to providing state-of-the-art training and experience in a multidisciplinary academic environment so that Fellows can achieve competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice in the field of cardiothoracic anesthesiology and critical care.

Clinical instruction is provided in the cardiothoracic operating rooms under the supervision of cardiothoracic anesthesia faculty members. The Fellow is assigned to provide comprehensive anesthetic and perioperative care. Fellows are also responsible for the supervision and education of Stanford Anesthesiology residents on the cardiothoracic anesthesiology and echocardiography rotations. Elective rotations at the Santa Clara Valley Medical Center and the Santa Clara Kaiser Permanente Medical Center provide opportunities to care for cardiac surgery patients in community hospital settings, and an elective rotation at the Lucile Packard Children’s Hospital provides the opportunity to care for children with complex congenital heart disease.

The intraoperative experience in cardiothoracic anesthesiology is supplemented with an immersive clinical experience in the postoperative management of cardiothoracic and major vascular surgical patients in the Cardiovascular Intensive Care Unit (CVICU). The CVICU is a multidisciplinary unit based on the model of the Perioperative Surgical Home, where the Fellow will have the opportunity to work collaboratively with cardiac, thoracic, and vascular surgeons; heart failure, heart transplant, and lung transplant teams; and other consultant services to provide comprehensive care to the cardiothoracic surgical patient.

Echocardiography training includes a period of formal instruction in perioperative transesophageal echocardiography (TEE), as well as hands-on training and direct clinical performance, interpretation, and application of intraoperative echocardiography in surgical decision-making. Fellows will also learn to formulate, generate, and archive a formal report of the comprehensive intraoperative TEE examination. During the year, ACTA fellows will also gain experience with 3-D echocardiography, transthoracic echocardiography, and the application of echocardiography in the management of critically ill patients.

The Stanford Cardiothoracic Anesthesiology Division, together with the Department of Anesthesiology, Perioperative, and Pain Medicine and the Department of Cardiothoracic Surgery, will provide Fellows the opportunity to gain extensive clinical experience in the following areas:

  • Transesophageal echocardiography (2-D and 3-D)
  • Coronary revascularization
  • Cardiac valve repair and replacement 
  • Thoracic aortic operations
  • Heart, lung, and multi-organ transplantation
  • Mechanical ventricular assist devices (IABP, LVAD, RVAD, BIVAD, TAH)
  • Extracorporeal membrane oxygenation (ECMO)
  • Catheter-based aortic valve replacement (TAVR)
  • Catheter-based mitral valve repair (Mitral Clip)
  • Catheter-based pulmonic valve replacement (Melody Valve)
  • Endovascular aortic repair (TEVAR, EVAR, and fenestrated grafts)
  • Port-access and minimally invasive cardiac operations
  • Robotic lung resection
  • Surgical and catheter ablation for arrhythmias
  • Electrophysiology and cardiac catheterization laboratory procedures
  • Adult congenital heart disease
  • Pediatric congenital heart disease
  • Anesthesia for patients with pulmonary hypertension and other high-risk patients undergoing non-cardiac operations
  • Cardiovascular surgical critical care medicine

The educational curriculum of the fellowship also includes:

  • Introduction to Intraoperative TEE Course
  • Weekly Adult Cardiothoracic Anesthesiology Core Didactic Series
  • Weekly Combined Cardiology, Cardiothoracic Surgery, Cardiac Anesthesia, and Radiology Case Conference
  • Monthly multidisciplinary Cardiothoracic Surgery, Anesthesiology, Nursing, and Perfusion Quality and Education Conference
  • Monthly Cardiac Surgical Morbidity and Mortality Conference
  • A Bi-Weekly Adult Cardiothoracic Anesthesiology Journal Club
  • Monthly Critical Care Medicine Journal Club
  • Monthly ICU Echo Rounds
  • Weekly Cardiovascular ICU and Critical Care Medicine Didactic Series
  • Weekly Department of Anesthesiology, Perioperative, and Pain Medicine Grand Rounds
  • Daily TEE Review Sessions

Fellows are also encouraged to take advantage of the rich collaborative and entrepreneurial environment that the Stanford community has to offer. Opportunities include open lectures at the business, law, and engineering schools as well as seminars and workshops in grant writing and professional development.

During the year, the fellow will prepare one Problem-Based Learning Discussion (PBLD) presentation for the Department of Anesthesiology Grand Rounds; two PBLD presentations for the Combined Cardiology, CT surgery, CT Anesthesiology and Radiology Case Conference; and participate in a multidisciplinary Quality Improvement project. In addition, ACTA fellows will receive an educational stipend that provides funding to attend the Society of Cardiovascular Anesthesiologists (SCA) Annual Comprehensive Review & Update of Perioperative Echo as well as funding to attend and present a case at the Fellows’ Component of the Annual Meeting of the SCA.

Clinical and basic science investigation is an important mission of the Stanford Medical School, and the ACTA fellowship program welcomes and strongly supports candidates planning careers in academic practice. An effort is made to engage fellows in ongoing clinical or laboratory research projects, and opportunities exist for fellows to initiate and carry out independent investigations with established researchers. Academic time and support is provided to fellows based on their individual career objectives and areas of investigation.

Clinical Case Volume

Number of Cardiac Procedures with CPB Per Year:

  • Stanford Hospital: 800
  • Valley Medical Center: 180
  • Kaiser Permanente - Santa Clara: 600
  • Lucile Packard Children's Hospital (pediatric and adult congenital): 380

Distribution of on-pump cases:

  • Stanford: CABG (25%), Open and Minimally Invasive Valve Surgery (35%), Open Aortic Surgery (30%), Ventricular Assist Device and Mechanical Circulatory Support (10%)
  • Valley Medical Center: Mixture of mostly CABG and Valve Surgery, small percentage of Open Aortic Surgery
  • Kaiser Permanente - Santa Clara: CABG (30%), Open and Minimally Invasive Valve Surgery (60%), Open Aortic Surgery (10%)
  • Lucile Packard Children's Hospital: Varied

Average Number of CPB Procedures Per Trainee Per Year: 150

Number of Cardiac Procedures off-CPB Per Year:

  • Stanford: 130
  • Valley Medical Center: 5
  • Kaiser Permanente – Santa Clara: 130

Distribution of off-pump cases:

  • Stanford: Transcatheter Aortic Valve procedures (90%), CABG (5%), Other (5%)
  • Valley Medical Center: CABG (100%)
  • Kaiser Permanente - Santa Clara: CABG (100%)

Average Number of off-CPB Procedures Per Trainee Per Year: 30

Number of Non-Cardiac Thoracic Cases Per Year: 400

Number of Heart, Lung and Heart/Lung Transplants Per Year: 70

Number of Major Vascular Cases Per Year: 400

Faculty

  • Daryl Oakes, M.D. (Fellowship Program Director)
  • Ronald Pearl, M.D., PhD. (Department Chairman)
  • Jessica Brodt, M.D.
  • Albert T. Cheung, M.D. 
  • Igor Feinstein, M.D.
  • Linda Foppiano, M.D.
  • Charles Hill, M.D.
  • Thuan Ho, M.D.
  • Ethan Jackson, M.D.
  • Max Kanevsky, M.D., Ph.D.
  • Worasak Keeyapaj, M.D.
  • Natalia Martinez Acero, M.D.
  • Marie McHenry, M.D.
  • Christina Mora Mangano, M.D.
  • Sheela Pai Cole, M.D.
  • Ashley Peterson, M.D.
  • Vidya Rao, M.D., M.B.A.
  • Kirsten Steffner, M.D
  • Albert Tsai, M.D.

ACGME Fellowship Application Eligibility

Applicants must be:

  • A graduate of an ACGME-accredited Anesthesiology Residency Program
  • Eligible for Medical Board of California License

International Medical Graduates can contact the program directly regarding eligibility requirements.

ACGME Fellowship Application Process

APPLICATION DEADLINE, FRIDAY, FEBRUARY 14, 2020

INTERVIEW DATES FOR THE ADULT CARDIOTHORACIC ANESTHESIOLOGY (ACTA) FELLOWSHIP WILL BE HELD ON A FRIDAY OR SATURDAY IN MARCH (DATES TBD)

All applicants must apply through SF Match and submit a Common Application through the SF Match Central Application Service (CAS)

Additional documents, please read below:

  • Applicants invited to interview may be asked to provide additional documents which can include CV and color photo. 
  • Applicants accepted into the program will be required to submit other documentation as part of the registration process.

Please do not email supplemental materials unless asked to do so.

ACGME fellows are appointed through the Graduate Medical Education (GME) office, which is part of Stanford Health Care (SHC) and are not subject to the same registration requirements as the School of Medicine (SoM) fellows/postdocs. Please visit the GME website for further information.

Anesthesiology CCM (ACCM)

APPLICATION DEADLINE AND INTERVIEW DATES FOR COMBINED 2-YEAR ACTA/ACCM FELLOWSHIP FOLLOW THE ACCM TIMELINE (VISIT ACCM WEBSITE FOR FURTHER DETAILS, SEE BELOW)

Dual 2-year combined ACCM and Adult Cardiothoracic Anesthesiology (ACTA) Fellowships:  This fellowship track involves two years of training after completing your CA3 year at an approved ACGME anesthesia residency program. Both ACCM and ACTA fellowships are completed over a two-year consecutive time frame.  If applying and you want to be considered for the 2-year combined program at SHC, it is imperative you carefully read the instructions below.

Both the ACTA and ACCM fellowships require use of the SF Match Central Application Service (CAS) system.  To ensure applicants applying to our dual 2-year fellowship have a seamless experience, we have outlined the below application process:

The 2-year dual ACCM and ACTA fellowship at SHC is considered two separate ACGME programs.  Therefore within the SF Match system, it is NOT currently an option to apply and submit 1 application for the combined program.  We ask that all applicants interested in completing the combined fellowship at SHC apply through SF Match under the ACCM program ONLY and not apply to both ACTA and ACCM due to SF Match application costs associated with applying to multiple programs.  

Once you have applied for the combined fellowship, please EMAIL letting us know you have submitted your application through the ACCM SF Match program and wish to be considered for both fellowships. 

For detailed information regarding the ACCM interview and ranking/match process for applicants applying to both SHC programs, please visit the ACCM WEBSITE to review the timeline and instructions.

Further questions about the application process or program may be directed to:

  • Bernadett Mahanay (Fellowship Program Supervisor)
    Stanford University Medical Center
    Department of Anesthesiology, Perioperative and Pain Medicine
    300 Pasteur Drive, H3578
    Stanford, CA 94305-5640
    Email: bromo@stanford.edu
    Tel: 650-723-6415
  • Daryl Oakes, M.D. (ACTA Fellowship Program Director)
    Stanford University Medical Center
    Department of Anesthesiology, Perioperative and Pain Medicine
    300 Pasteur Drive, H3578
    Stanford, CA 94305-5640
    Email: doakes@stanford.edu