This one-year fellowship is offered to those who have completed a general cardiology fellowship (PGY7 level or greater) and are seeking advanced training in the subspecialty of heart failure, cardiac transplantation and mechanical circulatory support leading to American Board of Internal Medicine subspecialty certification.

The fellowship includes assignments in the subspecialty outpatient clinic, the inpatient service and the biopsy suite. The inpatient rotation takes place in the Heart Transplant ICU, a dedicated 20 bed in-patient ICU supervised by the heart failure attendings.

As fellows gain experience and demonstrate growth in their ability to care of patients, they will assume roles that permit graded and progressive responsibility. By the completion of training, fellows will be experts in the areas below.

Advanced Heart Failure Cardiology

Perform efficient initial assessment of heart failure including:

  • Etiology and contributing factors
  • Hemodynamic status at rest and cardiac reserve
  • Adequacy of current therapy to relieve symptoms, prevent disease progression, and prevent mortality
  • Potential need for surgical intervention including cardiac transplantation and mechanical circulatory support (short term and long term)
  • Individualize medication regimens for heart failure at every stage from asymptomatic left ventricular dysfunction through advanced heart failure
  • Describe components of decision making regarding hospital admission for patient with chronic heart failure
  • Understand, evaluate and manage patients with many forms of cardiomyopathy
  • Understand major multi-center clinical trials in heart failure
  • Participate in initiatives of quality improvement and understand performance metrics       

Transplantation Cardiology

  • Understand the evaluation process and patient selection criteria for heart transplantation
  • Participate in documentation and communication with multi-disciplinary team.
  • Identify and manage pulmonary hypertension in patients listed for cardiac transplantation
  • Understand allosensitization and approaches to the sensitized patient
  • Understand  listing status and know the roles of the United Network of Organ Sharing (UNOS) and Organ Procurement Organizations (OPO)
  • Synthesize information necessary to decide suitability of a donor heart for transplantation
  • Participate in procurement of a donor organ and observe implantation surgery
  • Manage early post-operative transplant patients, including initiation of immunosuppression
  • Manage outpatient  immunosuppression including minimization of immunosuppression and corticosteroid tapering
  • Perform endomyocardial biopsies
  • Interpret endomyocardial biopsies
  • Understand treatment of rejection including primary graft dysfunction, acute cellular, antibody mediated and late acute rejection
  • Decrease risk of complications following transplantation including use of prophylactic medical regimens
  • Recognize and manage common complications following transplantation
  • Evaluate and select candidates for re-transplantation
  • Identify and communicate compassionately with patients at end-of-life for referral to palliative care team
  • Understand major multi-center clinical trials in cardiac transplantation
  • Participate in initiatives of quality improvement and understand performance metrics       

Mechanical Circulatory Support (MCS)

  • Evaluate of patients and select appropriate candidates for MCS
  • Document and communicate with multi-disciplinary team
  • Understand MCS indications such as bridge to transplant (BTT), destination therapy (DT)
  • Select appropriate device types for given indications
  • Understand basic mechanical components of currently available ventricular assist devices
  • Recognize and respond to common device alarms
  • Understand need for and methods of pre-operative medical optimization
  • Manage patients in the post operative period including pump speed adjustment, anticoagulation initiation and medication optimization
  • Manage outpatients on durable MCS including routine care, complications, and pump speed adjustments
  • Manage patient readmitted with MCS for device and non-device related complications
  • Understand device end-of-life manifestations
  • Collaborate with palliative care to manage end of life MCS patients
  • Understand major multi-center clinical trials in MCS
  • Participate in initiatives of quality improvement and understand performance metrics

Pulmonary Vascular Disease

In addition, fellows will receive training in the field of Pulmonary Arterial Hypertension including evaluation of patients with possible PAH, hemodynamic assessment with right heart catheterization, selection of pulmonary vasodilator therapy and long term management utilizing goal-directed therapy.

Apply to Fellowship

Salpy Pamboukian, MD, MSPHSalpy Pamboukian, MD, MSPH
Fellowship Director