Fellowship Director
Ravi V. Joshi, M.D.

A comprehensive 12-month specialized training experience in the perioperative care of patients undergoing cardiac, thoracic, advanced vascular, and transplantation surgery. UTSW fellows will be taking care of high-risk and complex patient populations at a variety of clinical settings including the modern Clements University Hospital, Baylor University Medical Center, Dallas Children’s Medical Center, and the North Dallas Veterans Affairs Hospital. As a major transplant center in North Texas, our fellows will have experience in the management of Heart/Lung Transplantation, implantation of extracorporeal devices (LVAD), and new minimally invasive procedures such as TAVR.

Goals and Objectives
Fellows in our Cardiothoracic Anesthesiology training program will:
• Develop expertise in advanced cardiopulmonary physiology and pathophysiology
• Understand the fundamentals of cardiopulmonary bypass and extracorporeal circulation
• Learn the perioperative care of management of the cardiac surgical patient
• Manage patients supported on extracorporeal mechanical devices (LVAD, ECMO, Impella)
• Provide perioperative care of adult patients for heart and lung transplantation
• Become familiarized with Transthoracic Echocardiography (TTE)
• Train in minimally invasive cardiac and vascular procedures (TEVAR, TAVR)
• Pursue academic or scholarly activity towards journal publication or national presentation
• Supervise the training of CA-2 and CA-3 residents in cardiac anesthesia
• Develop expertise in Transesophageal Echocardiography (TEE) with the intent to obtain Certification in Advanced Perioperative Transesophageal Echocardiography (PTEeXAM)

Clinical Sites
UTSW William P. Clements, Jr. University Hospital
Baylor University Medical Center
Children’s Medical Center Dallas
Parkland Hospital System
Dallas VA Medical Center

Site Rotations
William P. Clements, Jr. University Hospital (CUH) is the primary training site for our fellows, replete with 3 Cardiac operating rooms, 2 Thoracic operating roomss and 2 fully functional Hybrid suites. With a high-risk and complex patient population, fellows training at CUH will be exposed to adult cardiac surgery cases including CABG and valve replacement, aortic surgery with DHCA, heart/lung transplantation, and mechanical circulatory device implantation. Fellows will also experience cases involving minimally invasive cardiac surgery, TAVR, TEVARs, and robotic thoracic surgery. Fellows should expect to perform their own cases and supervise residents.

Baylor University Medical Center - Clinical training in adult cardiac surgery cases including valve and CABG procedures. Experience in heart transplantation is also possible. Fellows will perform their own cases.

Children’s Medical Center Dallas (Elective) - This site offers clinical experience in pediatric cardiac surgery. Fellows may work with the anesthesiology team in the perioperative care of patients with complex congenital lesions.

Parkland Hospital System - Spend elective time with cardiology in the echocardiography lab.

Dallas VA Medical Center - One of the nation’s largest VA Hospitals on an 85-acre campus acts as the secondary training site for our fellows. Clinical training involves the perioperative care of adult cardiac surgery in our veteran population. Elective time in the cardiology echocardiography lab is also possible.

Echocardiography Experience
90% of cardiac cases have TEE exams performed
Philips Healthcare Epic 3DTEE machines in all cardiac rooms
Epiaortic ultrasound performed routinely
Robotic Thoracic Surgery
Coronary Sinus Catheter and Pulmonary Vent Placement (Mini-thoracotomy)
Transvenous Pacing Catheter placement
Anesthesia for Transcutaneous Aortic Valvular Replacement (TAVR)
Strain Analysis and Myocardial Mechanic Capabilities
Cerebral oximetry (INVOS 5100)
FloTrac and Clear Site (continuous CO, systolic pressure variability)
Intrathecal pressure monitoring and CSF drainage (“spinal drains”)
ROTEM analysis for hemostasis

Research
Mentored projects and funding for ALL poster presentations
Outcomes-based quality improvement and clinical research
Co-Participants in institutional/national STS database
Active projects include SCAF FOCUS/CSTS initiative
TRICS-III trial center for blood conservation research
RECESS trial center (Steiner, et al., NEJM 2015)
APART: Pilot Design for pre-operative anemia management
Enhanced Communication for Handovers from the OR (ECHO)

Didactics
Weekly conferences (TEE didactics, Topics in CT anesthesiology, case conference, journal club)