Since it's inception in the 1970s, it has been the intent of our Cardiothoracic Anesthesiology Fellowship to prepare the fellow to practice cardiothoracic anesthesiology independently and competently through a program organized to ensure optimal patient care while 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.
On an annual basis, our division provides anesthetic care to approximately 2250 cardiac and thoracic surgical patients. We routinely perform over 1000 cardiac surgical procedures utilizing cardiopulmonary bypass each year. Of these, one-third are coronary revascularizations and one-third are valve procedures (approximately half of which are mitral valve repairs). The remaining one-third of the bypass cases annually include approximately 150 major aortic reconstructions, 150 major pediatric congenital procedures, implantation of a growing number of mechanical circulatory support devices (VADs), adult and pediatric heart transplantation, and adult congenital heart procedures. Non-bypass procedures annually include approximately 700-800 major intrathoracic, non-cardiac procedures, including video-assisted and open procedures on the lungs, esophagectomies and adult lung transplantation. Additionally, we routinely provide care to approximately 175 - 200 pediatric patients undergoing diagnostic and therapeutic interventional cardiology procedures as well as both pediatric and adult patients undergoing percutaneous electrophysiologic studies and interventions.
Approximately 1400 Transesophageal Echocardiographic (TEE) examinations are performed by our division each year, and it is a major focus of our training program to prepare the fellow to perform perioperative TEE competently. 100% of our cardiac anesthesia attending staff is board certified by the National Board of Echocardiography to perform perioperative TEE, and the vast majority of our previous fellows who took the perioperative TEE exam passed on the first attempt.
Our CT anesthesia fellowship has been ACGME-accredited to train 5 fellows since July, 2006. Fellow duty hours and conditions of work are in compliance with ACGME guidelines as well as with those of the Bell Commission of New York State. The maximum number of on-duty hours is 80 hours per week, though a typical work week is in the range of 50-55 hours. All fellows are guaranteed 24 hours off-duty following a day on which they were "on-call". A minimum of 10 hours off between duty shifts is strictly enforced. All weekend and night "on-call" duties are from home by beeper and there is no elective operating schedule at the Mount Sinai Hospital on weekends, national or major religious holidays.
Didactics
Complimenting the varied and busy clinical experience of our fellowship is a comprehensive series of didactic lectures covering topics pertinent to the practice of cardiac and thoracic anesthesiology as well as transesophageal echocardiography. These 41 talks are based on the recommended teaching curriculum of both the ACGME-accredited fellowship in cardiothoracic anesthesiology as well as the core teaching curriculum of the American Society of Echocardiography. In addition to these scheduled sessions, an abundance of teaching will take 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, one month will be spent rotating through the 24-bed Cardiac Surgical Intensive Care Unit, and two months will be spent on focused rotations through the pediatric cath lab, the electrophysiology lab and the pediatric cardiac OR (the 12th month is comprised of 4 weeks of paid vacation that can be taken throughout the year).
Scholarly Activity
The Division of Cardiothoracic Anesthesiology at the Mount Sinai Hospital is very academically involved in both national and international professional societies and symposia, and our attendings have authored numerous definitive 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 monitoring technologies. Fellows are encouraged to participate in research projects that are of interest to them, to present abstracts and interesting case series at major meeting and to write articles for publication, and book chapters.
