Welcome

The Transcatheter Aortic Valve Program at Hamilton Health Sciences is a multidisciplinary program including cardiac anesthesia, nursing, interventional cardiology, cardiac surgery, vascular surgery, echocardiography, and cardiac CT imaging. The primary procedural strategy is percutaneous transfemoral access with conscious sedation and local anaesthesia. The preferred alternate access is axillary (both percutaneous and cutdown). All patients considered for aortic valve intervention are seen in a regional valve clinic with attending physicians from interventional cardiology and cardiac surgery. The program features full integration of cardiac CT imaging with TAVR. All TAVR planning CTs are interpreted by the implanting physician team on dedicated image processing software located in the cath lab and all TAVR fellows obtain advanced CT interpretation skills as a core component of their fellowship.

Certification Outcome

The successful completion of the fellowship will grant a Fellowship McMaster Certification.

Entry Requirements

Training is offered to interventional cardiologists and cardiac surgeons with strong clinical and technical skills. Interventional cardiology candidates should have successfully completed a core interventional fellowship and possess the ability to independently perform diagnostic angiography and percutaneous coronary intervention. Cardiac surgical candidates should have successfully completed core cardiac surgical residency training with an expressed interest or advanced competence in aortic valve surgery.

Recent graduates are required to submit an application form and comply with McMaster University Postgraduate Medical Education requirements for residents and fellows.

Application Deadline

Trainees may start the fellowship in July or January. Applicants should contact the program director at least one year prior to the anticipated start date.

Goals of Training

The TAVR CT Structural Fellowship at HHS teaches a unique combination of knowledge and skills from multiple disciplines including interventional cardiology, cardiac surgery, and radiology. Upon completion of training, the fellow is expected to be able to function as an independent TAVR operator who will perform procedures in the context of a multidisciplinary heart team.

Length of Training

1 year

Funding

One funded position is available on a competitive basis.  Alternatively, fellows may be funded by their home university.  Successful applicants are provided with letters of support for grant applications upon request.

Curriculum Highlights

Fellowship Structure and Expectations

The fellowship program is 12 months in duration with 10 months spent on the TAVR service and 2 months available for electives. While on the TAVR service, the fellow’s weekly schedule will be as follows:

• 1 day TAVR procedure (typically 5 cases per day)
• 1 day Cardiac CT image acquisition and reporting (>20 CTs per day)
• 1 day TAVR Clinic, image review (cath/CT/echo), patient workup, and procedural planning
• 1 day Academic time
• 1 day to maintain and develop discipline-specific TAVR related procedural skills (Cath/PCI for Interventional cardiology, Cardiac ORs for cardiac surgery)

For interventional cardiologists, electives provide the opportunity for exposure to percutaneous mitral (both mitral clip and mitral valvuloplasty), left atrial appendage closure, and open aortic and mitral procedures. For cardiac surgeons, elective time will be spent in cardiac catheterization and coronary angiography.

Training Requirements

Upon completion of the TAVR CT structural fellowship, the fellow will have fulfilled the following training requirements:

1. Involvement in clinical and imaging evaluation of >200 TAVR candidates
2. Participate as an operator in at least 100 TAVI procedures. Procedural responsibility will be graduated with the goal of having the fellow obtain access for the delivery sheath and deliver the valve in 25 procedures
3. A minimum of Level 2 cardiac CT training. Level 3 cardiac CT training will also be possible depending on trainee interests.

Supervision & Feedback

The fellow assessment will involve a combination of direct workplace-based assessment & in-training evaluation of performance in the cath lab, CT, clinic, and academic work. A case log book must be submitted, reviewed and signed off by the program committee for fellowship completion.

Associated Programs