Structural/Endovascular Training

[astropilot]

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I am looking for further training to supplement my IV cardiology fellowship (2013). Though I will get well versed in all things coronary, some PFO, peripheral (below knee too), and TAVI during my IV training, I am looking for more training in balloon valvuloplasty, watchman, ASA, pfo, carotid, and endovascular repair.

I know Mass Gen, Ruch and Mayo have formal prorgrams. Fogarty also started up something this year. Maybe Lennox Hill?

Anyone hear of any other programs.

Thanks.

ap

 

[indiamacbean]

I am also interested in structural training. I know that Columbia has a second year for structural training. I have heard that at Mayo you are probably wiping a lot of wires without doing a lot yourself. Not sure if is actually try. I imagine that Cleveland is good but probably hard to get in as an outsider.

 

[astropilot]

I am also interested in structural training. I know that Columbia has a second year for structural training. I have heard that at Mayo you are probably wiping a lot of wires without doing a lot yourself. Not sure if is actually try. I imagine that Cleveland is good but probably hard to get in as an outsider.

The formal programs I've found include Mayo and MGH (obviously, they have websites). I have called Cleveland Clinic - they didn't know what I was talking about, same with University of Miami, Nortwestern, and Chicago. Cedars Siani said they are not sure if they will have funding but encouraged an application.

 

[Myostatin]

I am looking for further training to supplement my IV cardiology fellowship (2013). Though I will get well versed in all things coronary, some PFO, peripheral (below knee too), and TAVI during my IV training, I am looking for more training in balloon valvuloplasty, watchman, ASA, pfo, carotid, and endovascular repair.

I know Mass Gen, Ruch and Mayo have formal prorgrams. Fogarty also started up something this year. Maybe Lennox Hill?

Anyone hear of any other programs.

Thanks.

ap

Columbia offers dedicated structural training and is the place to be, IMO. Lenox Hill is a good bet, though not sure if they would offer a dedicated year for this - Carlos Ruiz there does some incredible things. Mayo has a dedicated year but I've also heard from fellows there that autonomy is lacking - this may have changed in recent years. Things may be changing substantially in your timeframe as TAVI exands out from the PARTNER / CorveValve sites. Another option is going international - if any of the faculty at your current institution have connections in Canada / England / Germany / Netherlands this may be your best bet as interventionalists in these countries have years more experience for the interventions you mention - though you might have to fund yourself.

 

[joejabjab]

just a note. . .I think the OP meant Rush instead of "Ruch". they have a dedicated structural year following the interventional year

 

[hookaman]

Thinking about pursuing an IC fellowship but not sure yet...biggest reason I want to do it is to have more variety once I am an attending (variety = seeing patients inpatient and outpatient, imaging (nuc, TTE, TEE), cath/interventions)

Question: In private practice, if you are an interventionalist, will you be reading echos, nuc, doing TEEs or will you be a cath jockey?

My idea job would be a couple days of cath, and the rest split between imaging and seeing patients

 

[badasshairday]

Thinking about pursuing an IC fellowship but not sure yet...biggest reason I want to do it is to have more variety once I am an attending (variety = seeing patients inpatient and outpatient, imaging (nuc, TTE, TEE), cath/interventions)

Question: In private practice, if you are an interventionalist, will you be reading echos, nuc, doing TEEs or will you be a cath jockey?

My idea job would be a couple days of cath, and the rest split between imaging and seeing patients

Check your PM.

 

[joejabjab]

I have similar questions on scope of a diverse practice. if you have interesting info, can you PM me too? Thanks.

 

[ucladukes]

I am looking for further training to supplement my IV cardiology fellowship (2013). Though I will get well versed in all things coronary, some PFO, peripheral (below knee too), and TAVI during my IV training, I am looking for more training in balloon valvuloplasty, watchman, ASA, pfo, carotid, and endovascular repair.

I know Mass Gen, Ruch and Mayo have formal prorgrams. Fogarty also started up something this year. Maybe Lennox Hill?

Anyone hear of any other programs.

Thanks.

ap

At the risk of sounding like a troll, I too am interested in advanced fellowship, but I couldn't help but notice the post above was a fellow claiming to be "well versed" in TAVI. Personally, I am not aware of a center that allows the fellows to actually perform (not assist) in the procedure, such that they will be able to function independently and get credentialled. I get the feeing a lot of fellows are going to misrepresent that they can do TAVI, am I wrong? Opinions? Maybe my program is the only one not letting fellows perform protocol procedures that are part of a clinical trial.

 

[joejabjab]

Our interventional fellows don't do the TAVIs either.

At the risk of sounding like a troll, I too am interested in advanced fellowship, but I couldn't help but notice the post above was a fellow claiming to be "well versed" in TAVI. Personally, I am not aware of a center that allows the fellows to actually perform (not assist) in the procedure, such that they will be able to function independently and get credentialled. I get the feeing a lot of fellows are going to misrepresent that they can do TAVI, am I wrong? Opinions? Maybe my program is the only one not letting fellows perform protocol procedures that are part of a clinical trial.

 

[HarryGary]

There's a recent grad from my home institution who I believe is credentialed in it. It is rare.

 

[OptimusPrime]

My 2 cents for fellows interested in structural/peripheral additional training.

I recently looked into this as it became quickly a relevant issue for me.

The question one must ask himself (or herself) is more regarding what the plan is after interventional fellowship.

If you are planning on joining an academic center where TAVR is not well established and your long term plan is to help bring TAVR to that tertiary academic hospital. Then I would suggest an additional year of training just to boost your resume and help you start things going at your new institution. Even though I agree most TAVR additional year teaching fellows don't quite get the 1st hand experience (more details below) its still better than showing up to a program with no experience and want to start a TAVR program there.

If the academic institution you plan to join already has a TAVR program its more complex picture and has to do with how open will the faculty performing the TAVR be in allowing a new assistant professor in interventional cardiology to join the TAVR program and willing to help you get on the job training (obviously more ideal). One way you can look at it is by the age of the attendings involved. If they are older in the years they may be more open into developing a protégé to take over for them in few years when they cut back on their involvement/hours. But again this is just a theory and not applicable in all situations.

As was mentioned earlier posts (and I agree) "most" places that would take on a fellow after their 1 year interventional training to teach you TAVR still are hesitant to have you be the first operator (you'll be 2nd or 3rd in line) which is still good experience to have. The issue is TAVR is still a relatively new procedure that the so called instructors are still learning themselves and would like as many numbers as 1st operator to boost their own resume. Maybe not so much the case in institutions with high TAVR volume (ie Dr. Makkar @ Cedars... but then again at that point perhaps they would not want their morbidity/mortality numbers messed up by having a novice operators position/deploy the valve). This may change as years pass.

Going along with that theory the more high volume places for TAVR (example Scripps) allow their fellows more hands on experience (usually during 2nd year, it's a 2 year program). I was told by recent graduate he was 1st operator on number of cases but he may just wanted to impress me on his program).

If you plan on joining private practice I can not see a benefit in doing an additional year of TAVR training at this point. Although after FDA approval TAVR is now available at more centers its still technically limited to the super sick nonsurgical patients and requires a relatively strict screening process and committees and so fort. No private interventionalist will get into the TAVR business for the next few years until they perfect it more (ie more US experience/outcomes data for FDA).

Hopefully at some point in the near future it will get more broader approval for performing TAVR on surgical patients (ie younger/healthier) and by the next 5 years we should have access to now more obsolete (hand me down if you will) TAVR devices from Europe (ie smaller sheaths/catheters and no surgical cut down). By that point and if billing (almighty CMS) for it becomes well established the private guys may become more interested. Also by that point we will have more newer valves on the market (hopefully) and as a private interventionalist in the community you probably will go to a training conferences/courses put on by whatever valve company and sent back to your home program with a proctor for the first few cases.

So hope this helps. I also have a few things to say about peripheral teaching and interventional fellowship but I'll save it for another post (this one already went way too long. Sorry about that).

OP

 

[Myostatin]

There's a recent grad from my home institution who I believe is credentialed in it. It is rare.

I've looked at almost all the well known strucutral programs on some level. Columbia is the only program where I'm sure the dedicated structural fellows perform cases as 1st operator and come out independently competent in TAVI. This is because they've been doing it longer than anywhere else in the US and have absurd volume. It is conceivable that other very high volume / experienced centers may get stuctural fellows in as 1st operator toward the end of their 2nd year of training - however, you most definitely have to ask the PDs or heads of the TAVI program this question up front, and if they're not willing to promise this without reservation, I would walk. I'm skeptical of most structural programs.