Cardiac Fellowship

[biddi45]

Look all over this thread and was wondering if anyone could tell me about these Cardiac Anesthesia fellowships. I received interviews to these places:

UMDNJ - RWJ
Montefiore/Albert Einstein
Mount Sinai

Any information would be helpful. Thanks

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[Mista Suprane]

mt. sinai is one of the best fellowships in the country. not sure about the others.

 

[ssmallz]

UMDNJ - Seems solid from what I hear. We have a coresident going there next year and he seemed very happy to go

 

[proman]

mt. sinai is one of the best fellowships in the country. not sure about the others.

I'm not sure I'd agree with that.

 

[biddi45]

What is wrong with the fellowship in your opinion? I am going there next week for an interview

 

[biddi45]

UMDNJ - Seems solid from what I hear. We have a coresident going there next year and he seemed very happy to go

I went there this week for an interview, seems like a good program with a great mix of cases. The attendings there seem cool

 

[pushthesux]

mt. sinai is one of the best fellowships in the country. not sure about the others.

Umm, Mt. Sinai may be the best cardiac fellowship on the upper east side. That's about it. If you're going to NYC for cardiac...you go to Columbia.

 

[Bertelman]

umm, mt. Sinai may be the best cardiac fellowship on the upper east side. That's about it. If you're going to nyc for cardiac...you go to columbia.

+1

 

[proman]

UMDNJ is an excellent fellowship, giving the fellow exposure to every cardiac case available. The only things they don't do are liver and lung transplants. They also are one of the 11 teaching centers in the country for minimally invasive port access cases.

Only 11? Who else does it? An active minimally invasive center is important because it means a wide variety of mitral valve pathology to hone the echo skills on.

 

[urge]

An active minimally invasive center is important because it means a wide variety of mitral valve pathology to hone the echo skills on.

You seem to assume that most mitral valve surgery is done via minimally invasive access. I disagree. I think maximally invasive mitral surgery is more common.

 

[proman]

You seem to assume that most mitral valve surgery is done via minimally invasive access. I disagree. I think maximally invasive mitral surgery is more common.

I'd agree with your disagreement (but not your assumption that I'm assuming). Especially if only 11 centers are doing minimally invasive surgery. But I know that having a minimally invasive surgeon drives a lot of business (even if they end up being done open). Got any numbers?

 

[Mista Suprane]

Umm, Mt. Sinai may be the best cardiac fellowship on the upper east side. That's about it. If you're going to NYC for cardiac...you go to Columbia.

i didn't say columbia wasn't one of the best as well.

as far as mt. sinai:

influential faculty:
-david reich and steven konstadt are there - associate editors of kaplan's;
-reich is also editor in chief of SCVA.
-konstadt is president of SCA.
-kaplan himself was the chair there for 15-20 years.

clinical experience:
-1300 pump cases a year
-unique case exposure - david adams has invented multiple types of mitral and tricuspid valve annuloplasty rings and performs more mitral valve repairs than anyone else in the country. not to mention a active minimally invasive center (mini thoracotomies and 4 inch sternotomies). probably the pinnacle center of reconstructive valve surgery. go ahead, look it up.

what more are you looking for, except for maybe more research pedigree and an ivy league caliber name?

if you want to live in the northeast you'd be a fool to blow off mt. sinai.

 

[nycitygas]

I thought Konstadt was the chairman at Maimo now?

 

[urge]

SCVA

What is that?

How do you know so much about Sinai? I'm getting suspicious of self promotion.

 

[biddi45]

Thanks everyone for your input. Any info about Montefiore/ Albert Einstein cardiac anesthesia program?

 

[smgilles]

What is that?

How do you know so much about Sinai? I'm getting suspicious of self promotion.

Society of Cardiovascular Anesthesia (SCVA)

I believe that is the old acronym before becoming (SCA) http://www.scahq.org/

Correct me if I am wrong Mista - by the way Mista I signed up to do both Fellowships (CV/CCU).

 

[bobg504]

Society of Cardiovascular Anesthesia (SCVA)

I believe that is the old acronym before becoming (SCA) http://www.scahq.org/

Correct me if I am wrong Mista - by the way Mista I signed up to do both Fellowships (CV/CCU).

Where are you headed for fellowship man? I will have you know that your classmate Mista totally looked out for me this year (my CA1[ year)....You ROCK Mista!!

 

[smgilles]

Where are you headed for fellowship man? I will have you know that your classmate Mista totally looked out for me this year (my CA1[ year)....You ROCK Mista!!

I am staying at Mayo and then coming on as staff.

 

[bobg504]

I am staying at Mayo and then coming on as staff.

That's outstanding!

 

[Bertelman]

Only 11? Who else does it? An active minimally invasive center is important because it means a wide variety of mitral valve pathology to hone the echo skills on.

I think he's saying UMDNJ is a teaching center for minimally invasive procedures, as in other providers can travel there to learn how to do it. One of our surgeons has done several in the last month, and one of the centers they visited to observe was UMDNJ.

We do it in my little corner of the world, and I'm pretty sure we're not one of eleven. UT's group does it, I believe. It's done in Rochester, too. I think the cannula rep probably goes to 5 or 6 centers in the Northeast alone.

 

[proman]

I think he's saying UMDNJ is a teaching center for minimally invasive procedures, as in other providers can travel there to learn how to do it.

That makes much more sense. Our mitral valve surgeon doesn't think it can be taught, he just learned it on his own. None of the cardiac surgery fellows know how to do it. I asked his for some numbers, he states there are about 40,000 mitral valve cases in the country, and roughly 8,000 of those are minimally invasive. There's a greater tendency to repair valves when done minimally invasive (probably has to do with patient selection).

 

[Bertelman]

That makes much more sense. Our mitral valve surgeon doesn't think it can be taught, he just learned it on his own. None of the cardiac surgery fellows know how to do it. I asked his for some numbers, he states there are about 40,000 mitral valve cases in the country, and roughly 8,000 of those are minimally invasive. There's a greater tendency to repair valves when done minimally invasive (probably has to do with patient selection).

Wow. 20% done MIS? I would have thought less than 10. We've got a pretty high volume cardiac center, and we've only just started doing them. That means for the last 10 years, someone's been doing like 50% MIS.

I can understand his thought that a surgeon can't be taught, but at the very least the team needs to understand how these cases are done. That takes teaching.

 

[urge]

Could someone define Minimally Invasive Surgery? Some surgeons are making 11.9cm sternotomies and billing themselves as MIS. According to the STS 12cm is the threshold. Seems like PR to me.

 

[smgilles]

Could someone define Minimally Invasive Surgery? Some surgeons are making 11.9cm sternotomies and billing themselves as MIS. According to the STS 12cm is the threshold. Seems like PR to me.

Here's a dumbed down version of how we do them.

http://www.mayoclinic.org/medicalprofs/robotic-mitral-valve-repair.html

 

[urge]

Here's a dumbed down version of how we do them.

http://www.mayoclinic.org/medicalprofs/robotic-mitral-valve-repair.html

That's cool.

How do they cannulate for bypass?- The big honker that we put in RIJ? Femoral?

Are they doing recetions & rings with those, or Alfieri's?

Is it just for garden variety p2 prolapse, as your website suggests?

 

[ProRealDoc]

That's cool.

How do they cannulate for bypass?- The big honker that we put in RIJ? Femoral?

Are they doing recetions & rings with those, or Alfieri's?

Is it just for garden variety p2 prolapse, as your website suggests?

I'll make it easy for you. Just check out the link below. As the anesthesiologist for these types of cases, you'll be placing a coronary sinus catheter. Your central access is typically via left IJ or SC.

http://www.cme.umn.edu/prod/groups/med/@pub/@med/@cme/documents/content/med_content_177866.pdf

 

[smgilles]

I'll make it easy for you. Just check out the link below. As the anesthesiologist for these types of cases, you'll be placing a coronary sinus catheter.

http://www.cme.umn.edu/prod/groups/med/@pub/@med/@cme/documents/content/med_content_177866.pdf

Thanks ProRealDoc...makes it easier to answer

 

[hondamts]

I think a bunch of centers are doing the minimally invasive procedure. In Southern California I know three centers that are doing them. I do about 3-5 a week and place retrograde catheters in about 4 and if it's a good week in all 5. Our surgeons do a mitral or aortic via minimal procedure in about three hours tops from start to finish so we can do 4 a day at times if all goes smooth.

Hope this helps. I think a CT fellowship is also about what you want to do "after" your fellowship. Some places are great for private practice and some places are great for academic. It's what you want to get out of it.

Goodluck

 

[proman]

Many ways to do the bypass circuit. Currently, the surgeon places a 2 stage femoral venous cannula that we help with echo to position the tip in the SVC. He uses a variety of aortic cannulas, some are transthoracic:

He also uses a flexible aortic cross clamp:

Now that the Endoaortic Clamp catheter is back he also uses this:

For the patients he doesn't want to cross clamp, we just fibrillate. I've never placed a coronary sinus catheter.

 

[ProRealDoc]

Many ways to do the bypass circuit. Currently, the surgeon places a 2 stage femoral venous cannula that we help with echo to position the tip in the SVC. He uses a variety of aortic cannulas, some are transthoracic:

He also uses a flexible aortic cross clamp:

For the patients he doesn't want to cross clamp, we just fibrillate. I've never placed a coronary sinus catheter.

CS catheters are part of our standard lines for minimally invasive MV repairs. Everyone gets one with few exceptions (i.e., prominent thebesian valve obstructing CS ostium).