Training & Curriculum

The one-year clinical fellowship includes experience in inpatient care (intensive care, step-down and consultative services), outpatient clinics, and time in the endomyocardial biopsy suite.

The Advanced Heart Failure and Heart Transplantation Fellowship training is outlined below:


Heart Failure

  • Inpatient care services for:
    • Patients with heart failure after cardiothoracic surgery
    • Patients for whom specialized heart failure management is requested
    • Patients admitted for heart transplant evaluation
    • Patients actively listed for heart transplantation admitted with cardiac or non-cardiac diagnoses
  • Inpatient management of patients with advanced heart failure, including:
    • Managing acute decompensated heart failure
    • Managing cardiogenic shock, including inotropic therapy
    • Indicating, placing and interpreting right heart catheterization
    • Indicating, placing and troubleshooting intra-aortic balloon pumps
    • Indicating emergent mechanical circulatory support
    • Managing end-of-life care and hospice
  • Outpatient management of patients with advanced heart failure, including:
    • Optimizing the heart failure medication regimen
    • Diagnosing, interpreting and managing arrhythmias in heart failure
    • Identifying candidates for defibrillator and cardiac resynchronization therapy
    • Interpreting noninvasive tests, such as echocardiography and cardiopulmonary stress testing
    • Managing patients after hospital discharge
    • Managing outpatient inotropic therapy
    • Managing end-of-life care
  • Evaluation of patients for heart transplantation, including:
    • Identifying candidates for transplantation (indications, contraindications and evaluation process)
    • Identifying candidates for mechanical circulatory support
    • Evaluating and managing patients with anti-HLA antibodies awaiting transplantation


Heart Transplantation

  • Inpatient management of heart transplantation, including:
    • Evaluation of the potential transplant donor
    • Understanding the process of organ procurement and harvesting
    • Assistance/observation of cardiac transplant surgery
    • Immediate postoperative management of heart transplant recipients
    • Understanding the role of induction therapy
    • Management of post-transplant arrhythmias
    • Diagnosis and management of hemodynamically compromised rejection
    • Treatment of heart transplant recipients re-admitted with cardiac or non-cardiac diagnoses
  • Outpatient management of heart transplantation, including:
    • Appreciation of the role of the heart transplant coordinator in the heart transplant clinic
    • Understanding the tailored approach to interpretation and management of immunosuppression
    • Interpretation of echocardiograms post heart transplantation
    • Performance and interpretation of endomyocardial biopsies
    • Indications for and interpretation of anti-HLA antibody assessment
    • Diagnosis and management of acute cellular and humoral rejection
    • Performance and interpretation of coronary angiograms for diagnosis and management of transplant vasculopathy
    • Management of non-cardiac complications, including nephropathy, infections and malignancy


Mechanical Circulatory Support

  • Evaluation of patients for mechanical circulatory support, including:
    • Identifying indications (bridge to recovery, bridge to transplant, or destination therapy)
    • Identifying devices (percutaneous vs. implanted; biventricular vs. left-ventricular)
    • Consulting with cardiothoracic surgery regarding indications, timing and device selection
  • Device management, including:
    • Working closely with cardiothoracic surgery for immediate and long-term management
    • Managing postoperative complications
    • Troubleshooting device complications
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