Cardiothoracic Hands-on Clinical Experience
The strength of the Massachusetts General Hospital Adult Cardiothoracic Anesthesia Fellowship is the clinical experience in the operating room, cardiac catheterization suite, electrophysiology suite, and Cardiac Surgical Intensive Care Unit (CSICU).
The Cardiac Anesthesia Group (CAG) covers four dedicated cardiac operating rooms. More than 1200 cases are performed each year, including revascularization, valve replacement, adult congenital heart repairs, heart transplantation, ventricular assist device placement, thoracic aortic repair, ECMO, and excision of cardiac masses. The more challenging cases are generally performed by the fellow. Although supervision of junior residents in integral to training, most fellows perform their cases with a single attending physician.
Care of the patient presenting for non-cardiac thoracic surgery is a major requirement of the fellowship. All fellows rotate for a one-month intensive experience in the care of these patients. The role of the fellow rotating on the MGH thoracic anesthesia service is primarily to become familiar with and perform anesthetic management of patients with lung diseases undergoing surgical procedures. The fellow works under the guidance of an attending anesthesiologist who is trained in adult thoracic anesthesia. Cases include lung transplantation and airway surgery. Fellows perform pre- and post-operative evaluation of patients receiving thoracic surgery, and perform thoracic anesthesia under the supervison of an attending anesthesiologist with expertise in thoracic anesthesia.
Transthoracic Echocardiography (TTE)
The MGH cardiology department provides echocardiography services throughout the hospital. Elective echo exams are performed between 8am-4pm. Emergency services are available 24 hours a day. A total of 18 cardiologists and 30 sonographers are involved in providing these services. The Cardiac Anesthesia fellow will observe the sonographer performance of transthoracic echocardiograms during the morning hours in the outpatient laboratory. Some directed scanning experience will be provided. During the afternoon, the fellow will read exams with the cardiologists in the echo reading room.
Electrophysiology and Catheterization
The CAG provides anesthesia coverage in the Knight Center for Interventional Cardiovascular Therapy. The fellow will have a change to provide anesthetic coverage for percutaneous closure of atrial and ventricular defects and percutaneous aortic and mitral valvuloplasty. We are one of the leading centers for transcatheter aortic valve replacement.
The Electrophysiology Suite places nearly 1000 devices for pacing and defibrillation a year in addition to the performance of pulmonary vein isolation, ablation of ventricular tachycardia, and placement of devices to exclude the atrial appendage. The CAG provides coverage seven days a week for these often critically ill patients.
Cardiac ICU (CSICU)
All fellows rotate through the Mass General Cardiothoracic Surgical Intensive Care Unit (CSICU) for a one-month experience in the perioperative care of heart patients. The Blake 8 Cardiac Surgical Intensive Care Unit is an 18-bed unit devoted to the pre- and post-operative care of cardiac surgical patients. More than 1000 patients are admitted annually. The patient population includes patients who have undergone coronary artery bypass grafting, valve repair/replacement, thoracic aortic repair, heart transplantation, ventricular assist device placement, repair of adult congenital heart defects, surgical management of endocarditis, and surgical management of traumatic injury of the heart.
Expertise in echocardiography is key to the success of a cardiothoracic anesthesiologist. Dr. Scott Streckenbach is the Director of Perioperative Echocardiography. His role included acting as director of the acquisition, interpretation, and reporting of the nearly 800 perioperative examinations that occur each year. Echo is being used more and more frequently for non-cardiac cases, including organ transplantation, vascular surgery and trauma. Fellows easily meet the 300 examinations interpreted and 150 examinations performed as required by the National Board of Echocardiography.
The ACGME encourages fellows to pursue additional expertise in other disciplines of heart surgery. We have established electives in Extracorporeal Technology, Pediatric Cardiac Surgery at the Boston Children's Hospital, Electrophysiology, Research, and Interventional Cardiology. Other electives may be arranged.