Adult Cardiothoracic Anesthesiology (ACTA) Fellowship

Clinical instruction is provided in the cardiothoracic operating rooms under one-to-one supervision of cardiothoracic anesthesia faculty members. Fellow responsibilities include:

• Provide comprehensive anesthetic and perioperative care to complex procedures in high acuity patient populations.
• Supervise and educate Stanford Anesthesiology residents on the cardiothoracic anesthesiology and TEE rotations.
• Role: 75% Direct Provider; 25% Supervisory.

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 Stanford CVICU is a closed surgical unit, staffed by 75% cardiothoracic anesthesiology-trained intensivists and designed on the model of the Perioperative Surgical Home.  On this rotation, fellows will interact with a multidisciplinary care team and work collaboratively with multiple specialty consult services.

Elective rotations are offered at Stanford Health Care (SHC), Santa Clara Kaiser Permanente Medical Center (SCKPMC) and Stanford Children’s Health, Lucile Packard Children’s Hospital (LPCH) and include the following:

• Advanced CTOR Supervisory Experience
• Advanced CVICU
• Advanced Cardiac Imaging
• Electrophysiology
• General OR Experience
• Global Health Experience
• Life Flight Patient Transport
• Liver Transplant
• Pediatric/Adult Congenital Heart Surgery
• Perfusion/Mechanical Circulatory Support
• Regional Anesthesia
• Research
• Structural Heart Echocardiography
• Thoracic Surgery
• Transfusion Medicine
• Transthoracic Echocardiography

Echocardiography training includes a period of formal instruction in perioperative transesophageal echocardiography (TEE) which includes:

• Hands-on training and direct clinical performance, interpretation, and application of intraoperative echocardiography in surgical decision-making. 
• Formulate, generate, and archive a formal report of the comprehensive intraoperative TEE examination.
• Gaining experience with 3-D echocardiography, transthoracic echocardiography and the application of echocardiography in the management of critically ill patients.
   

In addition to time allotted for the pursuit of scholarship projects, fellows are given two dedicated weeks of protected independent academic time to prepare for board exams and/or additional academic endeavors.

Perioperative Echocardiography

• Transesophageal echocardiography (2-D and 3-D)
• Transthoracic echocardiography

Cardiac and Lung Transplantation

• Heart Transplants (80 cases/year), Lung Transplants (50 cases/year)
• Combined Organ Transplants (20 cases/year): Heart/Lung, Heart/Liver, Heart/Kidney, Lung/Liver

Mechanical Circulatory Support

• LVADs, RVADs, BiVADS, Axillary IABPs

Aortic Surgery

• Open Aortic surgery approx. 270 cases/yr
  
• Ascending aorta/aortic arch repair
  
• Descending Thoracoabdominal aortic repair
  
• Endovascular Aortic Repair (TEVAR, EVAR)
• Exposure to spinal cord protection techniques (lumbar CSF drain placement/management, intraoperative neuromonitoring)
  

Cardiac Valve Surgery

• AVR (including Ross procedures)
• MVR
• TVR
• Combined multivalvular repairs and replacements

Cardiac Revascularization

• CABG: approx. 160 cases/yr
• Off-pump CABG, Myocardial Bridge unroofing
• Robotic-Assisted CABG

Minimally Invasive Cardiac Surgical Procedures with Lung Isolation Techniques

• For AVR, MVR, TVR, CABG, Myocardial Bridge Unroofing, and LVADs

Catheter-based Valve Procedures

• TAVR  TMVR, TTVR
• Mitral Transcatheter Edge-To-Edge Repair
• LA Appendage Exclusion

Specialty procedures

• Pericardectomy
• Myotomy/Myectomy
• Pulmonary Thromboendarterectomy

Electrophysiology/Cardiac Catheterization

• Epicardial VT Ablation

Thoracic Surgical Procedures

• Experience with a variety of lung isolation techniques

High Risk Surgical Patients

• Severe Pulmonary Hypertension, ACHD, MCS patients undergoing a variety of surgical procedures

Regional Anesthesiology for Cardiac Surgery

• Serratus Anterior Plane blocks, Thoracic epidurals, Erector spinae catheters, and chest wall blocks for cardiac surgical patients

Cardiothoracic Surgical Intensive Care Unit

• Closed unit, Staffed with >80% cardiothoracic anesthesiology trained intensivists

The didactic curriculum is meticulously crafted to provide 100 hours of protected time for fellows to gain a deep understanding of cardiac anesthesia, encompassing both theoretical knowledge and practical skills. It is designed to be learner-focused and comprehensive to equip fellows with the knowledge, skills, and professionalism needed to excel in the challenging and rewarding field of cardiac anesthesia. This is accomplished through a combination of lectures, hands-on experiences, and collaborative learning modules. The educational lecture curriculum includes:

• Weekly ACTA Core Didactic Lecture Series
• Orientation Bootcamp
• Introduction to TEE with simulator training
• Advanced 3D TEE Workshops
• Daily TEE reviews with dedicated faculty
• One-on-one mentoring
• Career-development and well-being workshops
• Weekly Department Grand Rounds
• M&M Conferences
• Journal Clubs
• Interdisciplinary Case Planning Rounds (High Risk ACHD and PH, High Risk Ob, Structural Heart Interventions, Endovascular Catheter Case Planning)
• Opportunity to attending CCM lectures and journal club conferences

Our program values individuality and fosters fellows’ unique professional aspirations by offering diverse scholarship pathways. These personalized pathways allow fellows to explore areas they are interested in to shape their fellowship journey as well-rounded clinicians and scholars. The structured pathways are designed to accommodate fellows’ unique interests and offer flexibility and support to shape their learning journey within the fellowship. Through these pathways, we hope our fellowship prepares you not just for a career, but for a transformative journey in healthcare. Available pathways include:

Funds and Reimbursements provided by the Division/Dept.

• One-time housing stipend from anesthesia department of $3,600 per *+
• Educational fund reimbursement supporting board dues, memberships, books, workshops, courses, etc. of $1,000
• Fully sponsored attendance at SCA ECHO Week and SCA Annual Meeting (up to $6,500)
• ACLS recertification 
• SCA membership
• Other educational reimbursements provided by division

Funds & Reimbursements provided by the SHC GME Office

• Please visit the SHC GME Website

Vacation:

Fellows receive 15 days of vacation that can be taken in increments of 1-week or taken as various days throughout the year.

Away Conferences:

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 Society of Cardiovascular Anesthesiologists Annual Meeting. In addition, fellows are given an educational stipend if they choose to present at ASA or another national society meeting (e.g. SOCCA, etc.).