Our institution is the tertiary referral center for a large geographic area comprising much of Vermont and New Hampshire. Cardiac interventional cases number approximately 1,200 – 1,400 per year. Although the basics of coronary intervention can be mastered in one year, we believe that a two-year experience is optimal to allow full development of an academic and research portfolio and/or an adequate experience in peripheral or structural heart disease interventional procedures.
The ACGME-certified component of the experience consists of a full year whose primary focus is the mastery of basic coronary intervention skills in the cardiac catheterization laboratory and management of interventional patients, supplemented by one half-day per week in the ambulatory care clinic and a full spectrum of didactic and clinical conferences. Protected time for research is also available during this year of training. Fellows who successfully complete this component of the training experience will be eligible to sit the ABIM exam for certification in Interventional Cardiology. We accept up to two fellows per year for this ACGME-certified training.
The structure of the second year of experience can be tailored to meet the goals of the individual fellow. A significant research project forms a major component of the work undertaken during this year, with mastery of and contribution to the literature in the area of research expected. Full training in peripheral vascular intervention (except carotids) is available, providing eligibility for both parts of the Vascular Medicine Board Exam. Some of the experience in peripheral intervention will be in collaboration with Vascular Surgery and Interventional Radiology faculty at DHMC. Fellows may also use this year to develop expertise in more specialized cardiac procedures such as ASD/PFO closure, CTO PCI, and valvuloplasty. Clinical skills can be polished through a part-time junior faculty position during this year as well. The latter can be used for funding support in the second year, though research grant support is strongly encouraged.
On-call experience provides ample training in acute care and emergency cases such that graduates are poised and competent in these situations. We provide primary PCI for STEMI in a coordinated and well developed regional effort, resulting in a volume of > 200 emergency cases annually. The call schedule structure is flexible, but extends through the two years and is typically one weeknight per week and one weekend in three or four.
The Cardiac Catheterization Laboratories comprise four rooms, all of which are equipped with state-of-the-art Philips digital flat plate detector x-ray systems. One of the rooms has bi-plane capability, and one has an FD 20 flat plate detector for use in peripheral interventions. Table-mounted integrated IVUS and FFR systems are installed in all four rooms. Training in coronary procedures includes diagnostic angiography, pressure wire assessment, intravascular ultrasound (IVUS), balloon angioplasty, stenting, rotational atherectomy, and the use of distal protection devices. Valvular procedures include aortic and mitral valvuloplasty. Other cardiac procedures include transseptal catheterization, endomyocardial biopsy, alcohol septal ablation, PFO and ASD closure, and use of vascular access closure devices. Exposure to invasive evaluation and treatment of congenital heart disease can be gained by scrubbing with an interventional pediatric cardiologist, who typically works in our cath lab one day per week. Peripheral interventions include renal, subclavian and both supra and infra-inguinal lower extremity revascularizations.
Research opportunities include access to an extensive procedure and outcomes data base of more than 35,000 in-house cases, collaboration within the Northern New England Cardiovascular Disease Study Group, stent and coronary device trials, pharmaceutical trials, and animal lab-based projects.