Cardiovascular Anesthesia and Critical Care (TGH)

Toronto General Hospital

(7-8 positions per year)

Clinical Curriculum 

The core 8-9 month rotation will be spent in cardiovascular OR. It is the expectation that fellows are able to complete a minimum of 120 cases per year involving CPB of which a minimum 50% will be valve repair or replacement, revision of a complex congenital repair, root repair or replacement, LVAD insertion or TEVAR. Home call for LVAD insertion, heart transplant and aortic dissection is one week in 6 to 8 weeks. 

An elective cardioversion list is scheduled weekly. Arrhythmia ablation as well as pacemaker insertion including biventricular, epicardial systems, insertion of aortic stents (coarctation), device closure of ASD, VSD, and perivavular leak, percutaneous valve repair and replacement have become an obligation of the department of cardiovascular anaesthesias. The fellow can expect to be assigned to one of diagnostic, therapeutic or device insertion lists each week. 

Heart transplant and ventricular assist devices are managed under the heart failure program. The centre performs an average of 30-35 heart transplants per year and is funded for 40 ventricular assist devices. The fellow will participate in either the intra-operative management or the post operative care in the CVICU. 

The CVICU is a 20-bed unit that is managed by the department of cardiovascular anaesthesia in conjunction with the department of cardiovascular surgery. The anaesthesia fellows alternate with the surgical fellows for weekday coverage Monday to Friday and the evening and overnight call alternates with the CV surgical fellows. During their time in the CVICU, which cumulatively will account for 12 weeks in a one-year fellowship, the fellow will become proficient in the management of post operative cardiac surgical patients.

A fellow will have a minimum of 30 dedicated TEE days during a 12 month fellowship that are considered a core clinical skill and not an academic activity. 

Call duties

Fellows will participate in one-week every 6-8 weeks of home call for heart transplant, aortic dissection and LVAD insertion. Should these cases occur late at night the fellow would be relieved of clinical duties the following day. The anesthesia CVICU fellows alternate with the surgical fellows for the night coverage and each weekend day. A fellow can expect four to five overnight calls in the CVICU in a two month call cycle. They may be assigned one weekday per month OR call on occasions with the next day off.

Education Curriculum

TEE reading sessions are mandatory for fellows. Wednesdays comprise formal didactic TEE topic followed by relevant clinical cases. Thursdays have a formal reading session where challenging or illustrative cases forms the previous week are reviewed.  

There are several multi-disciplinary rounds in the hospital that are weekly and which fellows are strongly encouraged to attend if there is no conflict with their clinical duties. These rounds include cardiovascular didactic and triage rounds, cardiology echo rounds, congenital heart rounds, and heart transplant rounds.  

Research

Research is integrated into the fellowship with an average of one academic day per week throughout the year. Academic days can be clustered to accommodate research projects and presentation preparation. There are ongoing trials in which they may participate or they may embark on their own individual research projects. Participation and presentation in academic conferences is encouraged.

Applications and Enquires

Please send an updated Curriculum Vitae and Letter of Intent to:

Dr. Coimbatore Srinivas 
Director, Fellowship Program 
Toronto General Hospital 
200 Elizabeth Street, EN3-438 
Toronto, ON Canada M5G 2C4 
coimbatore.srinivas@uhn.ca

Note: Due to high volume of applications, only shortlisted candidates will be receive a response.

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