During the first year, a fellow’s time will be divided between the adult cardiac service and the general thoracic service.
The adult cardiac surgery service will teach the fellow the indications for surgery of ischemic and valvular heart disease and the medical management of these patients. The fellow will be responsible for the preoperative evaluation of patients and will learn the risks of the operations and how to counsel patients appropriately. The fellow will perioperatively manage the patients following complicated cardiac and general thoracic procedures, including ICU care which involves ventilator management, nutritional support, inotropic management, and management of intra-aortic balloon pumps. The fellows will acquire graded responsibilities as primary surgeon to perform operations for coronary revascularization, valve repair and replacement, and aortic disease, as well as for heart and lung procurements for transplantation.
The fellow will evaluate and manage thoracic malignancies including lung, esophageal, and mediastinal tumors, as well as surgical lung infections. The resident will stage thoracic malignancies, utilize appropriate adjunctive protocols for chemotherapy
and radiation therapy, and provide intraoperative airway management and planning of major airway resections. The fellow will also evaluate, manage, and provide operative treatment of patients undergoing lung transplantation and will acquire
graded intraoperative responsibility as surgeon for operations on the lung, chest wall, mediastinum, and esophagus
In the first year, the fellow will also acquire a working knowledge of echocardiography, nuclear cardiology, cardiac stress tests, pulmonary function studies, chest imaging (CT and MRI), and esophageal motility. The fellow will become sufficiently familiar with these tests to be able to independently interpret them.
By the end of the first year, it is the expected that the fellow is fully capable of performing straightforward cardiac surgery with minimal assistance. Virtually all general thoracic cases are performed by the fellow with faculty assistance.
The second year is devoted to the practice of adult cardiac surgery at the University of Colorado Hospital and the VA Medical Center, as well as gaining exposure to pediatric cardiac surgery at Children’s Hospital Colorado. It is expected during the second year that fellows will develop an increased understanding of the medical management of heart failure, the indications and contraindications for heart transplantation, the management of heart transplant recipients, and the indications for ventricular assist devices.
The fellows will continue to assume more responsibility as primary surgeon for operations for myocardial revascularization, valvular heart disease, and heart procurements. The fellow will also assume graded responsibility as primary surgeon in the placement of ventricular assist devices.
The fellow will learn the pathophysiology of the common congenital heart anomalies as well as the fundamentals of cardiopulmonary bypass in infants and children. The fellow will also learn the perioperative hemodynamic management of pediatric cardiac surgical patients and will acquire graded intraoperative responsibility as surgeon for operations to correct atrial septal defects, ventricular defects, patent ductus arteriosus, and coarctation of the aorta.
By the beginning of the third year, the fellow is expected to have made a decision regarding his/her ultimate career goals and sub-specialization. Once this decision has been made and the fellow has demonstrated skills to be ABTS eligible, the fellow’s experience is focused in the chosen area. This is typically for the final six to nine months of the fellowship. Such areas might include esophageal surgery, minimally invasive thoracic surgery, valve repair, etc. In addition, all fellows will assume responsibility as primary surgeon on heart and lung transplants as well as insertion of ventricular assist devices.