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Organization
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| The fellowship program is organized and directed by the local head of Cardiovascular Anesthesia Division (Dr. Caetano Nigro Neto, Ph.D., M.D., Brazilian European Association of Cardiothoracic Anesthesiology (EACTA) representative), in conjunction with the heads of Surgery, Congenital Heart Diseases, Cardiovascular Diagnostic Methods and Interventional Cardiology Departments, as program collaborators. |
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Program duration
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| The CTVA - IDPC is offered for anesthesiologists worldwide for one or two year-option programs. The program starts on March and finishes on February of next year. |
| The second-year training program is optional and can be done in one of the following areas: Advanced Perioperative Echocardiography and Advanced Anesthesia for Congenital Heart Disease, lasting 12 months each. |
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Program structure
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| During the first year, the fellow gets a 1:1 supervision with a senior cardiac consultant. |
| The pragmatic content of the fellowship is divided in: |
| Theoretical and Scientific Program |
| Clinical Practice Program |
| Theoretical and Scientific Program (approximately 280 h): continuous medical education in the field of cardiac (adults and pediatric) and vascular anesthesia is offered. It will be based on lectures emphasizing the conduction of anesthesia, clinical cases and protocols. In addition, a theoretical course of Perioperative Echocardiography with simulation practice will be offered. The fellow will be motivated to develop his/her research skills by participating in clinical trials, multicentre studies and helping on writing papers. Moreover, he/she is encouraged to participate of cardiothoracic conferences. Fellows are required to perform the Advanced Cardiovascular Life Support (ACLS) course within the fellowship. |
| Clinical Practice Program (approximately 2100 h): The trainee will follow all ICUs activities under supervision of senior specialists and will participate of intensive care ward rounds. Cardiovascular anesthesia clinical practice enrolls different rotations, as follows: |
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1st month
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| Introduction to clinical cardiovascular anesthesia section mentored by the program directors or division heads. Presentation of institutional assistance protocols. |
| Anesthesia management for standard cardiac procedures. |
| Participation of intensive care ward rounds and preoperative anesthesia clinic. |
| Participation in continuous in-house educational activities and clinical case conferences, as well as in research activities. |
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2nd to 12th months
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| Hybrid Room (2 months): clinical duties as a member of the heart team for standard and advanced interventional cardiac procedures, including transcatheter aortic valve implantation (TAVI) (transapical/transfemoral), aortic valve bypass and anterolateral mitral valve repairs/replacements, interventions for congenital heart diseases. |
| Congenital Heart Disease Surgery (1 month): clinical duties for standard and complex congenital heart diseases procedures. |
| Cardiothoracic Adult Surgery (4 months): clinical duties for standard cardiac procedures (isolated CABG, aortic and mitral valve replacement, aortic reconstruction requiring deep hypothermic arrest, thoracic aortic aneurysm repair and aortic dissection repair). |
| Vascular Surgery (1 months): clinical duties for different kinds of vascular surgeries and endovascular procedures. |
| Transesophageal echocardiography (1 month): acquisition of basic TEE skills to obtain standard views with simulation, perioperative and ambulatory exams, under supervision. Moreover, during the whole program the fellow will perform perioperative exams and have books, lectures and teaching in the operating theater, and should be able to perform a self-consistent TEE examination at the end of the program. |
| Electrophysiology Unit (1 month): clinical duties for procedures in patients with different types of arrhythmias. Management of adult patients for cardiac pacemaker and automatic implantable cardiac defibrillator placement and surgical treatment of cardiac arrhythmias. |
| Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) Section (1 month): the fellows will be involved in the management of patients treated with VV- and VA-ECMO and will have training for cardiopulmonary bypass skills with the CPB team, under supervision of experienced perfusionists. |
| Intensive Care Unit (1 month): rotation in the Department of Intensive Care Medicine (optional), depending on pre-fellowship ICU qualifications and experience. The goal of this rotation is to focus on the post-operative care of cardiovascular patients and pain management. |
| During the last 30 days of the first year, the fellow should be working independently, under remote supervision. A senior faculty member is immediately available. |
| At the end of the first year period, the fellow will be able to: |
| Understand normal cardiovascular anatomy and physiology. |
| Perform a comprehensive preoperative evaluation of cardiovascular patients, interpreting the cardiovascular function tests in a rational way. |
| Understand pathophysiological changes of the aortic, coronary, valvular diseases and their anesthetic implications. Moreover, he/she will should understand the pathophysiology of main congenital cardiopathies and their anesthetic implication. |
| Provide rational perioperative use of the following drugs: antiarrhythmic, inotropic, chronotropic, vasopressors, vasodilators, beta blockers, diuretics, anticoagulants. |
| Understand fundamentals of extracorporeal circulation (CPB and ECMO) and circulatory assistance devices (intra-aortic balloon counterpulsation, ventricular assist device). |
| Understand the principles of myocardial and brain protection, as well as changes in physiology associated with hypothermia. |
| Know the physiology of coagulation and adequately interpret coagulation tests, as well as critically manage perioperative bleeding using drugs and transfusion therapy. |
| Plan and perform anesthesia for vascular procedures. |
| Basic knowledge of how to install, interpret and handle an external pacemaker. |
| To develop an anesthetic strategy for the cardiac patient for non-cardiac surgery and for procedures performed outside the surgical block. |
| Demonstrate ability to install and interpret data from arterial, central venous and pulmonary artery catheters. |
| Perform basic and intermediate perioperative transesophageal and transthoracic echocardiography - TEE/TTE. |
| Respond to stress and emergency situations, as well as coordinate actions with other professionals and units involved in patient care. |
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Fellows are expected to act in a respectful, courteous, civil and ethical manner in the best interests of their patients.
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| Participate actively of research activities; acquire the ability to critically interpret published literature and to make significant contributions to research projects. |
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Evaluation of the fellow
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| Fellow's progress will be evaluated and discussed every 3 months by the program's director and consultants. His/her professional attitude, knowledge, and clinical judgment will be assessed, as well as practical skills, social competence, efficiency of patient management and performance in critical clinical scenarios. |
