Adult Cardiothoracic Anesthesia Rotation

The Adult Cardiothoracic Anesthesiology (ACTA) rotation is an exciting and important component of the residency program. During their ACTA rotation, anesthesiology residents are exposed to a wide variety of cardiac, thoracic, and major aortic cases. Cardiac surgery exposure ranges from common procedures (such as coronary revascularization surgery, valve repair, and replacement) to more complex surgeries (such as repair of aortic dissection or aneurysm and surgery for adult congenital heart disease). In addition, residents gain extensive experience in the perioperative care of patients requiring assist devices ranging from intra-aortic balloon pumps to ventricular-assist devices. Time in the cardiac catheterization lab provides residents with experience in interventional therapeutic cardiology procedures (such as transfemoral or transapical aortic valve replacement) and electrophysiology laboratory procedures. Residents also care for patients undergoing a wide variety of thoracic surgical procedures, including lung-volume reduction surgery, tracheal surgery, and esophageal surgery. In addition, residents gain experience with heart and lung transplantation surgery.

Residents rotate through ACTA starting in the second half of their CA-1 year and all residents complete three months of cardiothoracic anesthesia by the end of their CA-3 year. Additional time on the service may be arranged for those interested. Because of the large number of procedures performed, both residents and fellows are able to personally perform the majority of their own cases.

During the ACTA rotation, residents become proficient in the placement of arterial, central venous, and pulmonary artery catheters, double lumen endotracheal tubes, bronchial blockers, and thoracic epidurals. Transesophageal echocardiography (TEE) skills are developed with intraoperative hands-on experience and with the use of the TEE simulator in the Margaret Wood Center for Simulation and Education.

In addition to the rich and exciting clinical experience, the ACTA rotation includes a structured Resident Lecture Series program, providing a combination of didactic teaching by faculty, resident-led journal club discussions, and ACTA fellow-led lectures. Residents’ performance at the end of their rotation is done by direct faculty evaluation, as well as by an objective structure clinical examination relevant to the practice of cardiothoracic anesthesiology.

During their ACTA rotation, residents are encouraged to participate in academic projects. Our residents regularly attend, alongside ACTA faculty, regional and national meetings with challenging cases and poster abstract presentations, as well as case report submissions.