The training program at CHI St. Luke’s Health/Texas Heart Institute is well suited to train physicians who specialize in heart failure and cardiac transplantation. The program enjoys a large transplant volume, the largest assist device and artificial circulation program in the region and many research endeavors in heart failure and transplantation.
Congestive heart failure is the leading cause of hospitalization in the United States in the medicare age population and has been for the past decade. Despite fairly substantial advancements in the therapy for other types of cardiovascular disease, heart failure continues to have a substantial morbidity and mortality associated with it. In the past 30 years, the use of ventricular assist devices and cardiac transplantation has proven to be a very acceptable method for treating patients with end stage heart failure. Currently there is a shortage of physicians who specialize in heart failure and cardiac transplantation. The training program at St. Luke’s/Texas Heart Institute is well suited to train physicians in this discipline. The program enjoys a large transplant volume, the largest assist device and artificial circulation program in the region and many research endeavors in heart failure and transplantation.
Transplant and heart failure physicians are trained in cardiology and cardiovascular disease and, in addition, have completed an extra year of training in transplantation and heart failure medicine. The physicians successfully completing this training year and also completing their cardiology fellowship training would be eligible by the United Network of Organ Sharing (UNOS) to be medical directors of a cardiac transplant and heart failure program.
SELECTION OF TRAINEES:
Individuals having completed training in internal medicine who have demonstrated an interest in the subspecialty of cardiovascular diseases would be acceptable candidates for a transplantation and heart failure year. Physicians having been enrolled in, or successfully completing, a cardiology fellowship would be ideal. This added year could be prior to a fellowship in cardiovascular disease since transplantation medicine involves a great deal of internal medicine practice.
This training program, while fulfilling qualifications for the United Network of Organ Sharing, would not be ACGME accredited, as there is currently no recognized ABIM subspecialty board for transplantation and heart failure medicine. The Fellow must be able to be licensed in the State of Texas with either a permanent or an institutional license.
One fellow each year will be trained in the St. Luke’s/Texas Heart Institute program. The trainee would spend a twelve-month period on a clinical and clinical research rotation that will be described in the forthcoming sections. The candidate who successfully completes such training will have a working knowledge of cardiac transplantation and, in particular, patient selection, patient management in the pre and postoperative period, as well as what patients are candidates for left ventricular assist systems and various ionotropic drugs.
Trainees will participate in inpatient rounds, which at the St. Luke’s Episcopal Hospital/Texas Heart Institute typically involve direct patient care of approximately 12-15 patients with severe advanced heart failure who are in need of cardiac transplantation or who have recently undergone transplantation. In addition, transplant complications such as infections, rejection, post transplant neoplasms, and transplant coronary artery disease are all managed by this transplant service. Transplant rounds consist of rounds with a faculty attending, a heart failure nurse coordinator, a transplant nurse coordinator, and adhoc pharmacy personnel. In addition, members of the surgical team also round and clinical decisions involve the coordination of both surgical and medical efforts.
Fellows who participate in the program will gain extensive experience in the right heart catheterization and interpretation of this data. In addition, fellows will be exposed to cardiac magnetic resonance imaging and positron emission tomography primarily for the assessment of viability and structural abnormalities. There will be the opportunity to participate in left heart catheterizations, however this is not a primary focus of this fellowship as the trainees will receive more than adequate cardiac catheterization skills in general cardiology fellowship training. Fellows will be trained extensively in endomyocardial biopsies and will be very comfortable in right ventricular endomyocardial biopsy at the completion of their fellowship.
The fellow will be expected to complete a project during the training year and will be strongly encouraged to present this data at a national meeting. Appendix A details a list of the current research topics. Progress on these projects is reviewed bi monthly at a team meeting. Extensive editorial support is provided to help in manuscript preparation and grant preparation.