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Adult Cardiothoracic Anesthesiology Fellowship

Message from the Program Director

‌The goal of the Adult Cardiothoracic Anesthesiology Fellowship at the University of Maryland is to train leaders in perioperative cardiovascular care. Our cardiac surgery program is currently the largest in the state of Maryland and offers a complex case mix that allows fellows to grow tremendously in their skills and confidence. Fellows in our program are exposed to the full gamut of contemporary cardiothoracic surgery procedures including: complex mitral valve repairs, major aortic surgery, coronary revascularizations (both robotic and on-pump), pulmonary embolectomies and thromboendarterectomies, transcatheter aortic valve replacements, heart and lung transplantations, and LVAD implantations. ‌

Our center also has one of the largest adult ECMO programs in the country and many cardiac surgery patients are bridged to operations or recovery with ECMO. In addition to training outstanding clinicians, we are committed to our fellows’ professional growth and achieving the highest possible levels in all ACGME competencies including communication, teamwork, professionalism, and systems based practice. Our diverse faculty provides fellows with the opportunity to learn from a variety of past experiences and recent graduates have had great success in both academic medicine and private practice. Our division offers unique research opportunities with nationally recognized faculty in areas that include bleeding/coagulation, epidemiology, and outcomes research for cardiac surgery patients.

We welcome your interest in our training program and look forward to meeting you.

Michael Mazzeffi, MD, Associate Professor, Program Director View Profile

Learn More about the Adult Cardiothoracic Fellowship Program

Overview

The Department of Anesthesiology at the University of Maryland School of Medicine has three ACGME-approved cardiothoracic anesthesia fellowship positions. Given our current surgical volume (over 1400 cases), CT anesthesia fellows receive ample opportunity to gain both personal and supervisory experience in managing the most interesting and challenging cases in anesthesia. Each cardiothoracic anesthesia fellow will participate in a total of six months in the cardiovascular operating rooms where he or she will both supervise and individually perform CT anesthesia cases (approximately 1/3 and 2/3). Fellows take approximately four weekday calls and one weekend of call coverage per month and have a guaranteed post call day free of clinical duties after every call period. In addition to the cardiac operating rooms fellows spend one month in the CSICU, have two months of elective time, two months of dedicated TEE time, and one month of thoracic anesthesia experience.

The CT anesthesia fellows are allotted ample time to pursue scholarly activities and the faculty are highly supportive of these endeavors. The fellows have a professional development/education fund that can be used to attend meetings or to purchase educational materials. The department pays for attendance of the SCA Perioperative TEE meeting in Atlanta, GA and fellows have the opportunity to attend other local and national meetings such as the Society for Cardiovascular Anesthesiologists Annual Meeting.

Clinical Curriculum

Fellows gain proficiency in and exposure to the perioperative evaluation and intraoperative management of cardiac surgical patients including:

  • elective and emergency revascularization procedures
  • complex valve repairs and replacements including a high volume of endocarditis cases
  • pericardial procedures
  • neoplastic procedures
  • heart and lung transplants and combined procedures
  • thoracic aortic surgery including ascending, transverse and descending aortic surgery with and without circulatory arrest
  • thoracic endovascular aortic repair
  • ventricular assist device implantation
  • minimally invasive cardiac surgery including MitraClip, TAVR, and repair of congenital defects including: ASDs, anomalous pulmonary veins, etc.
  • robotic CABGs
  • pulmonary embolectomies and thromboendarterectomies

In addition, fellows will gain experience with thoracic surgery including:

  • thoracoscopic and open lung resections
  • bronchopulmonary lavage
  • bronchoscopy and related procedures
  • radical pleurectomy for mesothelioma
  • esophageal surgery and resection
  • robotic lung resection

Echocardiography Training

Our fellows gain competence in TEE training with two months of dedicated echo time in both the cardiology echo lab as well as operating rooms. They receive training in TEE, TTE, epiaortic and 3D technologies.  We currently have five Phillips IE33 machines and Phillips Xcelera acrchiving, which allows for easy review of previous echoes outside of the operating room.  All IE33 machines have 3D capability.

Our fellows perform well over the required number of TEE examinations each year for the advanced PTE certification.  We offer and pay for our fellows to attend the echo week course offered by the Society of Cardiovascular Anesthesiologists in preparation for taking the Advanced PTE exam. The department has four echo technicians that are themselves skilled practitioners who support the technical aspects of the echo service, so that our fellows can concentrate on learning the techniques of echocardiography. 

Research Training

Each fellow will have an assigned mentor who is usually a member of the Cardiothoracic Anesthesiology faculty. The cardiac anesthesia fellow will have a defined project and will be expected to submit findings for presentation at a national meeting, typically the SCA annual meeting. Areas of active investigation in the division include coagulation and hemostasis, outcomes research in cardiac surgery, ECMO related bleeding, disseminated intravascular coagulation, intracardiac thrombosis, and infectious complications of transfusion.  Members of the division have received recent grant funding from both industry and foundations including the SCA and APSF.

Recent Publications

Abuelkasem, E., Hasan, S., Mazzeffi, M. A., Planinsic, R. M., Sakai, T., & Tanaka, K. A. (2017). Reduced Requirement for Prothrombin Complex Concentrate for the Restoration of Thrombin Generation in Plasma from Liver Transplant Recipients. Anesthesia and Analgesia, 125(2), 609–615. https://doi.org/10.1213/ANE.0000000000002106

Henderson, R. S., Jr., Deshpande, S., Williams, B., Taylor, B. S., & Tanaka, K. A. (2017). Idarucizumab for Dabigatran Reversal in Emergency Type-A Aortic Dissection. Journal of Cardiothoracic and Vascular Anesthesia, 31(6), e80–e81. https://doi.org/10.1053/j.jvca.2016.04.027

Mazzeffi, M. A., Lee, K., Taylor, B., & Tanaka, K. A. (2017). Perioperative management and monitoring of antiplatelet agents: A focused review on aspirin and P2Y12 inhibitors. Korean Journal of Anesthesiology, 70(4), 379–389. https://doi.org/10.4097/kjae.2017.70.4.379

Mazzeffi, M., Abuelkasem, E., Drucker, C. B., Kalsi, R., Toursavadkohi, S., Harris, D. G., … Crawford, R. (2018). Contemporary Single-Center Experience With Prophylactic Cerebrospinal Fluid Drainage for Thoracic Endovascular Aortic Repair in Patients at High Risk for Ischemic Spinal Cord Injury. Journal of Cardiothoracic and Vascular Anesthesia, 32(2), 883–889. https://doi.org/10.1053/j.jvca.2017.12.002

Mazzeffi, M., Tanaka, K., & Galvagno, S. (2017). Red Blood Cell Transfusion and Surgical Site Infection after Colon Resection Surgery: A Cohort Study. Anesthesia and Analgesia, 125(4), 1316–1321. https://doi.org/10.1213/ANE.0000000000002099

Odonkor, P., Srinivas, A., Strauss, E., Williams, B., Mazzeffi, M., & Tanaka, K. A. (2017). Perioperative Coagulation Management of a Hemophilia A Patient During Cardiac Surgery. Seminars in Cardiothoracic and Vascular Anesthesia, 21(4), 312–320. https://doi.org/10.1177/1089253217702747

Plurad, D. S., Chiu, W., Raja, A. S., Galvagno, S. M., Khan, U., Kim, D. Y., … Robinson, B. (2018). Monitoring modalities and assessment of fluid status: A practice management guideline from the Eastern Association for the Surgery of Trauma. The Journal of Trauma and Acute Care Surgery, 84(1), 37–49. https://doi.org/10.1097/TA.0000000000001719

Tanaka, K., Moser, K., Abraham, D., Sniecinski, R., & Mazzeffi, M. (2017). Off-Label Prothrombin Complex Concentrates: Buyer Be Careful! Journal of Cardiothoracic and Vascular Anesthesia, 31(6), e91–e92. https://doi.org/10.1053/j.jvca.2017.01.004

Williams, B., Wehman, B., Mazzeffi, M. A., Odonkor, P., Harris, R. L., Kon, Z., & Tanaka, K. A. (2017). Acute Intracardiac Thrombosis and Pulmonary Thromboembolism After Cardiopulmonary Bypass: A Systematic Review of Reported Cases. Anesthesia and Analgesia. https://doi.org/10.1213/ANE.0000000000002259

Wipfli, C., Fitzpatrick, M. V., Fitzpatrick, J. K., Taylor, B. S., & Tanaka, K. A. (2017). Assessment of Fibrin Polymerization During Bivalirudin Anticoagulation for Transcatheter Aortic Valve Replacement. Journal of Cardiothoracic and Vascular Anesthesia, 31(4), e65–e66. https://doi.org/10.1053/j.jvca.2017.02.178

How to Apply

Applicants who have successfully completed their anesthesiology residency in an ACGME accredited program with an interested in Critical Care Anesthesiology are encouraged to apply.  Applicants should register with the San Francisco Match at www.sfmatch.org.  For fellowship positions for 2020-2021, we start accepting applications in December 2018.  Selected applicants will be invited for a formal interview between December 2018 and April 2019.

Your file is complete when we receive:

  • A completed Central Application Service (CAS) form from SFMatch.org
  • Current curriculum vitae
  • Personal statement
  • Copy of medical school transcript
  • USMLE I, II, & III/COMLEX scores
  • Anesthesiology In-Training Exam or board scores
  • Three letters of reference, one of which should be from the chariman or program director of your training program

Interested applicants should inquire with Dr. Michel Mazzeffi (mmazzeffi@som.umaryland.edu).