Author + information
- Bharath Rajagopalan, MBBS∗ (, )
- Jonathan Buber, MD,
- Pradeep K. Yadav, MD and
- Michael W. Cullen, MD
- ↵∗Division of Cardiovascular Medicine, University at Buffalo, 875 Ellicott Street 7th Floor, Buffalo, New York 14203
The field of adult and pediatric interventional cardiology (PIC) has expanded considerably over the last decade. Given the recent advances like transcatheter aortic valve replacement, percutaneous mitral valve repair, and left atrial appendage closure, many cardiology training programs are offering dedicated fellowship for training in structural heart interventions.
In 2011, the Society of Cardiovascular Angiography and Interventions found significant deficiencies in a survey of structural heart disease (SHD) interventional training programs. These included the lack of structured training curriculum, low case volumes, limited number of training positions, and lack of a unified application process (1). Similar problems related to small case numbers, limited training opportunities, and absence of a uniform application process were also present in PIC. Lack of a comprehensive list of interventional training programs and varying application requirements among existing programs makes finding fellowships difficult for prospective applicants in these specialties. Therefore, the American College of Cardiology’s Fellows-in-Training Section Leadership Council sought to study the current state of fellowship training in adult SHD and congenital interventional cardiology. Here we present our initial survey results and use them to assess the current landscape of training programs in structural and congenital heart disease interventions.
Surveys (Online Tables 1 and 2) focusing on the availability of a dedicated structural interventions fellowship, duration of the fellowship, and application requirements were sent to adult interventional and pediatric cardiology training program directors within the United States and Canada. The survey was initially sent in April 2015 with a reminder email in 2 weeks. After 1 month, follow-up emails were sent to the program coordinators of the programs that had not responded to the initial survey. If needed, personalized emails were sent to the program directors encouraging survey completion. Finally, the websites of the nonresponding programs were reviewed to determine if they offered dedicated training in structural interventions.
The survey was sent to 150 adult interventional cardiology programs, of which 104 (69%) responded. Of these, 36 interventional cardiology programs (Online Table 3) offered additional training in adult SHD. Of these 36 programs, 26 (72%) provided complete responses to survey questions. Ninety-four percent of programs required prior training in interventional cardiology. Two programs (6%) offered a combined 2-year program including interventional cardiology and SHD training. Three programs (8%) also accepted trainees with prior training in cardiothoracic surgery. The duration of training for SHD was universally 1 year. The number of training positions in each program varied from 1 to 3. The Northeast (36%) offered the highest number of training programs relative to other regions.
A similar survey was sent to 65 pediatric cardiology programs. Thirty-two pediatric cardiology programs responded to the survey (49%) of which 9 programs (Online Table 4) offered training in congenital interventions. Of these, 8 programs offered training in PIC, and 1 program also offered training in adult congenital heart disease interventional cardiology. All PIC programs accepted candidates with pediatric cardiology training. Only 4 programs (50%) accepted candidates with combined internal medicine/pediatric cardiology training. The single program offering adult congenital heart disease interventional cardiology training required either formal adult congenital heart disease training or combined internal medicine/pediatric cardiology with additional training in PIC. The duration of training for congenital interventions was 1 year in most programs (78%). Two programs (22%) required 2 years of training. The number of training positions in each program varied from 1 (in 89%) to 2 (in 11%). Geographically, the West (44%) offered the greatest number of training programs in congenital interventions. A detailed list of all programs with their contact information is available at www.ACC.org (2).
Our survey describes the current landscape of adult structural and congenital interventional cardiology fellowship training in the United States and Canada. Compared with the 2011 survey by Society of Cardiovascular Angiography and Interventions, the number of adult SHD training programs has increased from 9 to 36 programs (1). This could be due to a comparatively higher response rate to our survey and also to opening of newer programs. Prior data on congenital interventional cardiology training programs have not been published.
Limitations of our study include the survey response rate and lack of detailed information about the breadth of training at these programs. Nevertheless, we are confident that these results offer valuable resources for fellows interested in the burgeoning field of structural and congenital heart interventions.
Ultimately, our data suggest that the number of adult structural and congenital interventional programs is growing. This recent growth heightens the need for alignment across training programs. We therefore advocate that professional societies collaborate to unify and streamline adult SHD and congenital interventional cardiology training program curricula and application processes.
The authors are extremely thankful to Dr. Robert Beekman III for his critical review of this manuscript. We also thank Ms. Kristin West and Mr. Stefan Lefebvre, Staff Liaisons to ACC FIT Section Leadership Council, for providing logistical support for this project.
For supplemental tables, please see the online version of this article.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2016 American College of Cardiology Foundation
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- ↵Structural Heart Disease Fellowship Programs Database. Available at: http://www.acc.org/membership/sections-and-councils/fellows-in-training-section/training-resources/structural-heart-disease-and-congenital-interventional-fellowship-programs. Accessed June 12, 2016.