Cardiothoracic Anaesthesia Fellowship

The consultant led cardiothoracic anaesthesia (CTA) service at Fiona Stanley Hospital deals with a wide range of adult heart and lung diseases and an overall annual workload exceeding 1,000 cases. This is a high-risk patient population with a significant number of emergency cases. We are active in clinical and preclinical research including work on organ preservation as well as perioperative coagulopathy.

The goal of the one-year fellowship program is to provide structured training in CTA, giving fellows the knowledge and skills to pursue a career in the discipline in comparable units around the world.

During their attachment, the fellow is expected to become competent delivering anaesthesia with minimal supervision in all but the most difficult cardiothoracic cases. In addition to general cardiac anaesthesia, they will be exposed to cardiac and lung transplantation, ventricular assist device insertion and develop an understanding of the anaesthetic difficulties encountered with these procedures. Similarly, expertise will be acquired for general and more specialised anaesthesia for thoracic surgery.

The service covers 2 cardiothoracic theatres daily and 2 structural heart (TAVI/mitral clip), and 2 electrophysiology lists per week. Generally, 2 consultants and either a JR or fellow are attached to each cardiothoracic theatre, which can have a mix of cardiac, thoracic, and occasionally cardiology cases each day. In addition, the interventional cardiology TAV and electrophysiology lists have one consultant and one registrar assigned. There are plans for expansion of both the cardiothoracic and cardiology services over the next 12 months.

Clinical work

The cardiac workload includes the surgical management of:

• coronary, valvular, aortic and myocardial diseases
• adult congenital heart disease
• ventricular assist devices
• heart transplantation.

CTA supports the FSH interventional cardiology, structural heart (TAVI/mitral clip) and electrophysiology programs.

Our thoracic workload includes the cardiothoracic (CT) surgical management of pleural, pulmonary, and mediastinal diseases, bronchoscopy and, in collaboration with the advanced lung failure service, lung transplantation.

In conjunction with CT surgery, Intensive Care Medicine, and Clinical Perfusion we also support the Extra Corporeal Membrane Oxygenation (ECMO) service for respiratory and cardiac failure. There is also the opportunity to interact with our clinical perfusionists who provide in-theatre cardiopulmonary bypass and ECMO services.

Our team contributes to local and remote organ retrieval.

Preoperative assessment includes both ward and clinic-based assessments and coordination with the surgical teams for preoperative optimisation for cardiac, thoracic, and structural heart cases and assessment of transplant recipients.

Within the staffing allocations as outlined above there is the expectation of increasing autonomy during the fellowship, subject to assessment, and dependent on the individual case, surgeon, and consultant anaesthetist preferences.

Echo

There is extensive exposure to transoesophageal echocardiography (TOE) during the placement.

Fellows are expected to train in TOE and attain a formal qualification at Diploma level or above from an Australian or New Zealand university, the US National Board of Echocardiography. (i.e., Examination of Special Competence in Adult Echocardiography or Examination of Special Competence in Advanced Perioperative Transesophageal Echocardiography) or European EACVI certification in Adult TOE.

The fellow is expected to conduct regular TOE case review meetings with the CTA team.

Non-clinical

Research

• We partner with the Heart and Lung Research Institute of WA (HLRI WA) which is involved in ongoing clinical and pre-clinical research. Self-initiated research with HLRI WA, is also encouraged.
• Contribution to the Cardiothoracic service Audits, at least one/year.
• Presentation at scientific meetings or conferences is encouraged.
• Contribution to regular departmental meetings, cardiothoracic surgical unit M&M meetings
• Multidisciplinary clinics (CTS planning meeting, Thoracic MDT, , heart and lung transplant and TAVI MDT meetings), general cardiology and cardiology echo meetings.
• Teaching of anaesthesia trainees; - regular structured teaching and informal in theatre teaching.
• Coordination of the CTA eJournal club.
• Contribution to the development of the CTA service policies and procedures.
• Attendance at a local CALS course

Rostering

February start date

The cardio-thoracic anaesthesia fellow will work as part of the team of consultants and junior anaesthetic trainees. The Fellowship is a full-time cardio-thoracic allocation equating to 4 days per week.

There is regular, allocated, non-clinical time, on average one day per week.

Additionally, there is on-call from home, for out-of-hours cardiac/thoracic anaesthesia, on a 1-in-4 basis including weekday nights, weekends, and public holidays.

Further information

Cardiothoracic Anaesthesia Fellowship supervisor: Dr Jay Bruce