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Training Program
THORACIC SURGERY

Goals and Objectives
Adult Cardiac Rotation

Overall Objective: Understand the anatomy, physiology, and pathophysiology of the disease processes outlined in the TSDA Curriculum Section VIII (Acquired Heart Disease), Section IX (Thoracic Trauma), X (Transplantation), and XI (Extracorporeal Bypass and Coagulation). Develop clinical skills to diagnose and determine the most appropriate treatment plan for patients with these specific disease processes. Develop clinical / technical skills for intraoperative treatment, specifically to include preparation for, and completion of coronary artery bypass, valve repair/replacement, aortic repair/replacement, and heart transplantation. Develop patient care skills for intensive care, elective postoperative care, and outpatient follow-up of patients undergoing cardiac surgical procedures.

Specific Clinical Skills by Year of Training

Year 1
  1. Develop knowledge sufficient to be an effective first assistant. The importance of first assisting cannot be overemphasized since it is not possible to be an effective operative adult cardiac surgeon without being able to first assist.
  2. Understand conduct of cardiac surgical operations to include:
    1. Basic fundamentals of cardiopulmonary bypass
    2. Anesthesia issues during post-bypass period
    3. Understand intraoperative decision-making – i.e., which vessels to bypass, valve repair/replacement, extent of aortic resection for aneurysm/dissection
    4. Understand myocardial protection
    5. Understand weaning from cardiopulmonary bypass
    6. Understand pharmacologic manipulation in postoperative period
  3. Develop independent skills in progression to include:
    1. Sternotomy
    2. Chest closure
    3. Mammary artery takedown
    4. Cannulation
      1. Single-stage venous
      2. Dual-stage venous
      3. Arterial cannulation
        1. Aortic
        2. Femoral
        3. Axillary
      4. Cannulation for cardioplegia
        1. antegrade
        2. retrograde
    5. Proximal anastomosis
    6. Distal anastomosis
    7. Tricuspid valve repair
    8. Placement of Intraaortic Balloon Pump
    9. Donor Cardiectomy for Heart Transplantation
  4. Understand techniques for reoperative coronary and valve surgery
  5. Understand progression of operations for valve replacement and intraoperative decision making
  6. Understand exposure and cannulation techniques for aortic replacement:
    1. Ascending aorta
    2. Descending aorta
    3. Thoracoabdominal aorta
Year 2
  1. Develop ability to direct the conduct of cardiac surgical operations to include:
    1. Control of cardiopulmonary bypass
    2. Interact with anesthesia during post-bypass period
    3. Guide intraoperative decision-making – i.e., which vessels to bypass, valve repair/replacement, extent of aortic resection for aneurysm/dissection
    4. Guide myocardial protection
    5. Guide weaning from cardiopulmonary bypass
    6. Guide pharmacologic manipulation in postoperative period
  2. Develop independent skills in progression to include:
    1. Refine year 1 clinical skills to progress towards safe, independent practice
    2. Aortic valve replacement
      1. Mechanical valve
      2. Bioprosthetic valve
    3. Mitral valve replacement
      1. Mechanical valve
      2. Bioprosthetic valve
    4. Mitral valve repair
      1. Posterior leaflet
      2. Anterior leaflet
    5. Complex operations for ischemic complications
      1. Chronic VSD
      2. Acute VSD
      3. Papillary muscle rupture
    6. Aortic Repair/Replacement
      1. Root
      2. Ascending (Aneurysm/Dissection)
      3. Descending
      4. Thoracoabdominal
    7. Placement of temporary mechanical LV and RV support
    8. Heart Transplantation
    9. Endovascular Skills for Thoracic Aortic Stents
    10. Reoperative Coronary and Valve Surgery
  3. Understand exposure and cannulation techniques for aortic arch replacement
  4. Understand techniques for permanent mechanical LV and RV support
  5. Exposure/understand technique for minimally invasive cardiac surgery (mitral and aortic valve)
  6. Endovascular Thoracic Aortic Stents
  7. Heart/Lung Transplantation
  8. Lung transplantation:
    1. Recipient selection
    2. Donor selection
    3. Indications for single vs. double lung transplantation
    4. Immunotherapy and postoperative care
    5. Selection and application of varying lung preservation techniques
 

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