During the one-year fellowship, the fellow will perform 20 heart transplants and 20 mechanical circulatory support implants. They will focus on learning clinical and medical management for these patients, gradually taking on more decision-making responsibilities.
Heart Transplant
The Pre-heart transplant patients undergo evaluation by the Cardiothoracic Transplant team, followed by presentation at a weekly cardiothoracic transplant selection committee meeting for approval. The committee includes transplant surgeons, cardiologists, pulmonologists, social workers, transplant coordinators, and other consultants. After transplantation, the patient's care is primarily managed by the transplant cardiologist, encompassing all aspects of their medical needs.
The management principles that the fellow will participate in:
- Intensive care unit management
- Fluid management
- Basic medical management
- Surgical management
- Immunosuppression management
- IV access management
- Diagnosis and management of surgical complications
- Evaluation and admission of the pre cardiothoracic transplant recipients
- Evaluation of post cardiothoracic transplant patients with potential surgical complications
- Taking call for the post cardiothoracic transplant in-patients in ICU
For complex medical issues, specialist consultation will be sought, with the fellow and attending surgeons maintaining close communication with consultants. This collaborative approach ensures optimal medical care for cardiothoracic transplant recipients.
Surgical responsibilities of the fellows with regards to cardiothoracic transplantation:
- Completing heart transplant as primary surgeon
- Participating in or performing deceased cardiac harvest
- Becoming familiar with the use of heart perfusion pumps
- Operative management and workup of post heart transplant complications
- Surgical management of non-transplant surgical issues in post heart transplant recipients
Mechanical Circulatory support
The End-stage heart recipient candidates undergo evaluation by the cardiology/VAD service, and fellows participate in pre-transplant assessments alongside attending surgeons. Once evaluated, patients are discussed at weekly transplant selection committee meetings. The transplant fellow is responsible for admitting and preparing patients for implantation, providing both medical and surgical care throughout the process. They participate in various levels of implantation under attending surgeon supervision and are actively involved in ICU management, including fluid and device management, ventilator care, and medical interventions. Floor management includes tasks such as fluid and diuretic management, device care, and management of antibiotics. Fellows are involved in floor management until patient discharge, under the supervision of attending surgeons.
Surgical Responsibilities:
- Completion of LVAD, RVAD, TAH, PVAD & ECMO
- Post-transplant ICU medical and surgical management
- Diagnosis and management of surgical complications after implantation
- Diagnosis and management of surgical complications (non-transplant related) after implantation
Organ and tissue procurement and preservation
All deceased donor harvests are completed by fellows and a staff transplant surgeon. The fellow is expected to start as an assistant and become the primary surgeon on the harvest. All donor harvests are staffed by attending surgeons to ensure the quality of harvested organs.
The fellow will achieve the mastery of:
- Deceased donor heart harvests
- The knowledge of preservation solution types
- Management of the unstable donor
