Welcome

Certification Outcome

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

Entry Requirements

• Must have completed Cardiology Residency training prior to start of fellowship
• Recent graduates are required to submit an application form and comply with McMaster University Postgraduate Medical Education requirements for residents and fellows.

Application Deadline

• A general deadline of November 30 each year.  Program will accept a July 1 start date

Goals of Training

Transcatheter Mitral and Tricuspid Fellowship Goals – June 2020

The Transcatheter Mitral and Tricuspid Fellowship at HHS teaches a unique combination of knowledge and skills from multiple disciplines including interventional cardiology, cardiac surgery, and echocardiography. Upon completion of training, the fellow is expected to be able to function as an independent transcatheter mitral/tricuspid operator who will perform procedures with the support of a multidisciplinary heart team. At the completion of training, the fellow will have acquired the following competencies:

Medical Expert:

Clinical Evaluation

• demonstrate knowledge of mitral and tricuspid valvular heart disease including natural history of disease, hemodynamics, appropriate diagnostic imaging (especially echocardiography), grading of severity, optimal medical therapy, application and outcomes of transcatheter mitral and tricuspid valve repair
• conduct a comprehensive clinical assessment to identify and frame risks, benefits and alternatives to structural intervention
• conduct appropriate and thorough workup for patients referred for mitral and tricuspid valve intervention including appropriate use of coronary angiography, hemodynamic studies, echocardiography, and advanced non-invasive testing
• have an approach to frailty evaluation and an appreciation for futility as it pertains to mitral/tricuspid case selection

Echocardiography

• understand echocardiographic evaluation of mitral and tricuspid valve disease, identify severity using quantitative measures, characterize etiology, evaluate mitral/tricuspid valve leaflets, annulus, subvalvular apparatus, left/right ventricle and left/right atrium,

• interventricular septum and their impact on transcatheter mitral/tricuspid intervention candidacy

• appropriately order and integrate additional noninvasive testing into the assessment of disease including use of exercise echocardiography

Catheter and Wire Skills

• interventional cardiologists are expected to have proficiency in this area prior to starting transcatheter mitral/tricuspid training having completed a minimum of 2 years cath/PCI fellowship and will acquire wire skills specific to the this procedure

Transeptal Puncture

• Fellows will learn basic and advanced trans-septal puncture under trans-esophageal echocardiography and fluoroscopy guidance
• Understand and identify risks associated with trans-septal puncture
• Identify when iatrogenic atrial septal defect requires closure

Transcatheter mitral and tricuspid Procedural Skills

• demonstrate the ability to interpret real time trans-esophageal echocardiography of the mitral and tricuspid valves and surrounding structures

• able to perform large bore vascular access, including anatomic landmarking, ultrasound guidance, and closure techniques (percutaneous or figure of 8 suture)

• demonstrate understanding of left and right atrial anatomy and the ability to navigate this complex anatomy under TEE and fluoroscopy guidance

• demonstrate understanding of optimal orientation of the mitraclip or triclip with respect to the line of coaptation of leaflets
• demonstrate ability to safety grasp leaflets with mitraclip or triclip

• demonstrate understanding of risks, including identification of single leaflet detachment, perforation and cardiac tamponade, embolization of clip

• identify and manage vascular access site complications

Post procedure evaluation and follow-up

• evaluate patients for post procedural complications including bleeding, stroke, single leaflet detachment

• interpret post procedural echocardiogram to assess stability of mitraclip or triclip and degree of regurgitation

• understand and implement appropriate post procedural medical therapy, including anticoagulation, and heart failure thearpies, including diuretic dosage.

Communicator and Collaborator:

• communicate and collaborate with specialists in other disciplines to clarify competing prognostic concerns among patients referred for structural intervention

• collaborate with cardiac anesthesia to establish optimal sedation approach for high-risk patients
• communicate with patients, family members and referring physicians to enable patient centered decision making, incorporating discussion of the natural history of disease and intervention, any modifiers or mitigators of risk

• collaborate with nurse practitioners and allied healthcare workers in the clinical evaluation of patients

• collaborate in a multidisciplinary team including presentation of cases at heart team rounds and interdisciplinary team presentations

Professional, Leadership, Manager, and Health Advocate:

• demonstrate a high degree of professionalism including but not limited to high ethical standards, excellent team relationships, punctuality and sense of responsibility during preprocedural clinics, lab cases, and post procedural ward and elective care understand radiation safety and use of contrast agents

• direct team pre-procedural planning and heart team review discussions
• contribute to wait-list management and co-ordinate inpatient access to percutaneous mitral/tricuspid valve interventions and transfers of care
• obtain informed consent
• maintain a log and perform a periodic audit of complication rates of mitral/tricuspid interventional procedures

Scholar:

• conduct or contribute to mitral/Tricuspid related research project or related scholarly activity
• access and interpret evidence relevant to mitral/tricuspid interventional procedures
• educate other physicians and health professionals about aspects of mitral/tricuspid interventional procedures (i.e. HIU interventional rounds, cardiology regional rounds, Heart Team Rounds, journal clubs, etc)

Length of Training

Funding

Curriculum Overview

Curriculum highlights

Supervision & Feedback

Trainees will be assessed by formal written evaluation via a Work Based Assessment form every 3 months along with daily verbal feedback

Associated Programs

All Programs

More opportunities

• https://healthsci.mcmaster.ca/medicine/division/cardiology/education/transcatheter-mitra-tricuspid-fellowship