Medical College of Wisconsin Advanced Heart Failure and Transplant Cardiology Fellowship

Advanced Heart Failure and Transplant Cardiology is a highly specialized field. The Froedtert-MCW Advanced Heart Failure/Transplant Cardiology Fellowship Program is a 12-month training program where fellows who have completed training in Adult Cardiovascular Medicine will learn to become successful specialists in the field of advanced heart failure and cardiac transplant. Fellow trainees who complete this experience will be proficient in the evaluation, treatment and management of patients with advanced heart failure, mechanical circulatory support, and cardiac transplantation and will be eligible to sit for the ABIM Advanced Heart Failure/Transplant Cardiology Board examination.

The objectives of this fellowship have been set at a high level with a rigorous agenda: to develop first-rate skills in the management of highly complex advanced heart failure and cardiac transplant patients, and to partake in a formal project of supervised cardiac research. Fellows will learn to deal effectively with the patient selection process for mechanical circulatory support and cardiac transplantation and will also learn pre-operative and post-operative management skills in the outpatient and inpatient settings.

Fellows will be taught to critically appraise the current literature in heart failure, ventricular assist devices and cardiac transplantation and will be expected to lead a journal club monthly on his/her selected topic facilitated by a staff member within the department.

The clinical experience for each fellow is dictated by the requirements set forth by the ACGME. The minimal specific numbers of procedures that will be performed are as dictated by the ACGME as well. During the 12-month training period, the Advanced Heart Failure fellow will master the following:

• Evaluation of advanced & end stage heart failure in the acute inpatient and ambulatory settings
• Evaluation and management of pulmonary hypertension and pulmonary vascular diseases
• Evaluation and diagnosis of various non-ischemic cardiomyopathies (e.g. autoimmune, infiltrative, drug/toxin induced, viral, hereditary, etc.)
• Evaluation of patients for ICD and cardiac resynchronization therapies
• Medical management of advanced heart failure with use of IV inotropic agents as palliative or bridge therapy
• Indications/contraindications for surgical advanced heart failure therapies (transplant, ventricular assist device, and other forms of mechanical circulatory support)
• Pre-, peri-, and post-op management of patients undergoing cardiac transplantation and ventricular assist devices implantation
• Management of mechanical circulatory support devices (e.g. Impella, balloon pump, VAD (HVAD, HMII and HMIII, ECMO…)
• Invasive hemodynamic monitoring with standard right heart catheterization as well as indications for and implementation of various provocative testing during the RHC procedure (e.g. vasodilator studies, exercise testing)
• Indications for and how to safely perform endomyocardial biopsy on the native heart and cardiac allograft
• Review of endomyocardial biopsies for post-transplant surveillance of rejection and evaluation of native heart diseases (myocarditis, infiltrative disease, etc.)
• Supervision and interpretation of Cardiopulmonary Exercise Testing

Advanced Heart Failure and Transplant Cardiology Fellows are expected to do at least one month of research during their training. We have a very well established Cardiovascular Research Center where fellows will have the opportunity to work with basic and clinical scientists around campus, visit the Cardiovascular Research Center website to find out more information.

To this end, at the beginning of training, the fellow will meet with faculty members to discuss potential projects. Once a project is chosen, the fellow will be expected to work towards the goal of publication or presentation at a national conference. The fellow will also be given sufficient time over the course of his/her fellowship to do so. To facilitate meeting the goal of publication and/or presentation, the fellow will participate in monthly Department of Medicine fellow conferences which include lectures regarding construction and implementation of research protocols and seminars on biostatistics. The Medical College of Wisconsin also provides resources to assist with data collection and analysis.