Adult Cardiothoracic Anesthesiology

Our Adult Cardiothoracic Anesthesiology (ACTA) Fellowship Program is designed to develop advanced clinical skills in cardiovascular and thoracic anesthesiology and prepare graduates for National Board of Echocardiography certification in Advanced Perioperative Transesophageal Echocardiography, as well as the ABA certification exam in Adult Cardiac Anesthesiology. Our department's ACTA service provides anesthetic care for over 2,000 adult cardiac surgical procedures annually. Four ACGME-accredited one-year positions are available each year.

Clinical Experience

Cases encountered on the ACTA service span the entire range of cardiothoracic and thoracic surgical practice. UPMC is a world leader in heart and lung transplantation, and fellows gain substantial expertise in the management of these challenging procedures, in addition to removal of ventricular assist devices as a bridge to transplantation and the use of extracorporeal membrane oxygenation for short-term support after lung transplantation. ACTA fellows also develop expertise in the management of common cardiac surgical procedures such as coronary bypass (including a variety of minimally-invasive techniques), valve replacement and repair, thoracic aortic reconstruction, surgical management of atrial fibrillation and other arrhythmias, and pulmonary thromboendarterectomy.

A busy thoracic anesthesia service is staffed by a closely-related group of UPMC faculty who offer a rich resource for fellows who wish to enhance their experience managing patients undergoing thoracic surgery.

Fellows also gain exposure to procedures in the electrophysiology and cardiac catheterization laboratories, including laser lead extractions, percutaneous mitral valve repair, left atrial appendage occlusion procedures, catheter-based arrhythmia ablations, and placement of cardiac implantable electronic devices.

Fellows are encouraged to take advantage of the opportunity to gain expertise in pediatric cardiothoracic anesthesia during a one- to two-month rotation at UPMC Children's Hospital of Pittsburgh (CHP). Fellows interested in this option should make it known at the time of their application, so that they may visit CHP during their visit to Pittsburgh.

Educational Program

The ACTA Service supports a monthly subspecialty conference and an Interdisciplinary Echocardiography Conference (IDEC), in addition to the department’s very full schedule of didactic lectures, journal clubs, case conferences, research conferences, and grand rounds.

Didactic Program

Protected time each Wednesday permits a robust didactic program consisting of lectures, case conferences, and echo rounds. Fellows lead a monthly IDEC with their peers from cardiology and cardiothoracic surgery. Workshops on basic perioperative transthoracic echocardiography, lung ultrasonography, extracorporeal perfusion, and high frequency jet ventilation are included. A pig heart dissection lab, co-taught with cardiothoracic surgery faculty, enhance fellows’ 3-D understanding of cardiac anatomy with echocardiographic correlation.

Quality and Safety

Fellows are integrally involved in two important quality improvement initiatives: 1) reducing avoidable waste of blood products in the operating rooms, and 2) implementation of a structured OR-to-ICU handoff tool improve patient safety during transitions of care.

Research Opportunities

Our ACTA faculty have a national profile in research. Foci of special expertise include mechanisms of myocardial ischemia and functional properties of ischemic myocardium; intraoperative transesophageal echocardiography; anesthesia for lung transplantation; anesthesia for endovascular cardiac surgery; muscle relaxants; and mechanisms of anesthetic action.

For those looking to pursue research further, we offer an anesthesiology-focused NIH T32 postdoctoral research fellowship for physician-scientists (PI: Yan Xu, PhD).

Ongoing Studies

Title	Principal Investigator	Site(s)	Funding Agency
Sensydia - Echocardiogram and Cardiac Performance System  Ejection Fraction Validation Study	Stephen A. Esper, MD, MBA	UPMC Presbyterian	n/a
Sensydia - Cardiac Performance System Evaluation Study	Kimberly Howard-Quijano, MD, MS, FASE	UPMC Presbyterian and UPMC Passavant	n/a
Cleveland Clinic - The Effect of Continuous Low Tidal Volume Ventilation and Hyperoxia Avoidance During Cardiopulmonary Bypass (sub-study)	Kimberly Howard-Quijano, MD, MS, FASE	UPMC Presbyterian and UPMC Passavant	Society of Cardiovascular Anesthesiologists (SCA) Multi-Institutional Collaborative Clinical/ Translational Research Grant
A Randomized, Double-Blinded, Controlled, Parallel Group, Non-Inferiority, Phase III Study to Evaluate the Efficacy and Safety of the INTERCEPT Blood System for Red Blood Cells in Patients Undergoing Complex Cardiac Surgery Procedures (ReCePI study)	Alesia Kaplan, MD (Pitt Pathology)	UPMC Shadyside and UPMC Presbyterian	Cerus Corporation
PANDORA: Schedules Prophylactic Six Hourly Intravenous Acetaminophen or Placebo to Prevent Postoperative Delirium in Older Cardiac Surgical Patients	Kathirvel Subramaniam, MD, MPH, FASE	UPMC Presbyterian, UPMC Shadyside, and UPMC Passavant	National Institutes of Health
An Observational Trial To Assess the Performance of the TEG® 6s Diagnostic System with the Citrated K, KH, RTH, FFH Cartridge (Cardiac)	Kathirvel Subramaniam, MD, MPH, FASE	UPMC Presbyterian	Haemonetics Corporation
An Observational Trial to Assess the Performance of the TEG® 6s Diagnostic System with the Citrated K, KH, RTH, FFH Cartridge (Liver)	Tetsuro Sakai, MD, PhD, MHA, FASA	UPMC Montefiore	Haemonetics Corporation

Fellow Scholarly Projects

Fellow Name	Title	Presentation/Publication Info
Amanda Cole Bernardi	Use of Transesophageal Echocardiography in Management of Bioprosthetic Valve Endocarditis with Gerbode Defect	SCA Meeting 2020
Adam Hill	Increased Vasoactive-Inotropic Score and Hypoxia is Associated with the Development of Acute Kidney Injury after Double Lung Transplantation	SCA Meeting 2020
Adam Hill	Complex Thoracoabdominal Aneurysm Repair in a Patient with Loeys-Dietz Syndrome	SCA Meeting 2020
Alexandra Nicholas	Missing Flap? A Unique Case of Type A Aortic Dissection	SCA Meeting 2020
Alexandra Nicholas	Local Anesthetic Systemic Toxicity	Emory University Anesthesia Pain Management Subspecialty Conference
Harikesh Subramanian	Ex-Vivo ECMO Pharmacokinetics Study	SCA Meeting 2020
Harikesh Subramanian	Echo Corner	SCA Meeting 2020
Harikesh Subramanian	Hemostasis in Heart Transplantation	Journal of Cardiothoracic and Vascular Anesthesia (JCVA)
Harikesh Subramanian	The Year in Anesthesia for Cardiothoracic Transplantation	JCVA
Michael Gemma	Virtual Reality Preparation for the Cardiac Anesthesia Rotation	Society for Education in Anesthesia 2021 Meeting
Michael Gemma	Perioperative Risk Assessment: Supporting Literature and Updates to Current Guidelines	CME Info Evidence-Based Medicine Review
Michael Gemma	Single Lung Ventilation: Review of Indications, Techniques and Lung Protective Strategies	CME Info Evidence-Based Medicine Review
Michael Gemma	Perioperative Risk Assessment: Supporting Literature and Updates to Current Guidelines	CME Info
Michael Gemma	Single Lung Ventilation: Review of Indications, Techniques and Lung Protective Strategies	CME Info
Luca La Colla	Anesthesia for Patients with Pulmonary Hypertension	Oakstone Publishing 2020
Luca La Colla	Point of Care Ultrasound (POCUS)	Oakstone Publishing 2020
Luca La Colla	The Influence of Socioeconomic Deprivation on Outcomes in Lung Transplantation	SCA Meeting 2021
Luca La Colla	Highlights in Thoracic Anesthesia, 2020	JCVA
Luca La Colla	Out-of-Plane Versus in-Plane Radial Artery Cannulation in Adult Cardiac Surgical Patients: One Size Does Not Fit All. Time to Use a Combined Approach for Radial Artery Cannulation?	JCVA
Luca La Colla	Echo Corner Case #1	SCA Newsletter
Luca La Colla	Size Matching in Adult Lung Transplantation – (Still) an Open Question?	Society for the Advancement of Transplant Anesthesia Meeting
Joshua McAnulty	A Retrospective Review of Association of Perioperative Red Blood Cell Transfusion on Mortality After Orthotopic Heart Transplantation	SCA Meeting 2021
Joshua McAnulty	Exercise Prehabilitation	CME Info
Joshua McAnulty	Protective One Lung Ventilation	CME Info
Adam McIntyre-Smith	Intraoperative Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery	SCA Meeting 2021
Adam McIntyre-Smith	OR to CTICU Handoff Improvement	Multidisciplinary, Multisite Improvement Project
Adam McIntyre-Smith	Prolonged Ventilation Workgroup	Coincidental with ERACS project
Adam McIntyre-Smith	Mechanical Ventilation	Oakstone Publishing 2020
Adam McIntyre-Smith	Acute Kidney Injury	Oakstone Publishing 2020
Ezeldeen Abuelkasem	Portopulmonary Hypertension in End Stage Liver Disease: Taking the Preoperative TEE and RHC with a Grain of Salt!	Mediterranean Transplantation Anesthesiology and Simulation Symposium 2022
Ezeldeen Abuelkasem	The Safety and Outcomes of Isolated Portal-to-Jugular Venovenous Bypass in Liver Transplant Recipients: A Contemporary Single Center Experience	International Liver Transplantation Society (ILTS) Congress on Liver Transplantation 2022
Ezeldeen Abuelkasem	Prognostic Value of Intraoperative Global Longitudinal Strain in Liver Transplant Recipients	ILTS Congress on Liver Transplantation 2022
Ezeldeen Abuelkasem	Prognostic Value of Intraoperative Global Longitudinal Strain in Liver Transplant Recipients	SCA Annual Meeting
Ezeldeen Abuelkasem	Liver Failure	Book chapter in 2021 textbook Trauma Induced Coagulopathy
Ezeldeen Abuelkasem	Roles of Four-Factor Prothrombin Complex Concentrate in the Management of Critical Bleeding	Transfusion Medicine Reviews
Samuel Goldstein	Association of Post-Procedural Extubation at Time of Impella 5.5® Insertion And Improved Survival	SCA Meeting 2022
Juan Rango	Tracheal Injury after Sternotomy: When Saw Guard Lets its Guard Down	SCA Annual Meeting
Chad Spencer	Hyperbaric Effects on Cold Stored Whole Blood Following a Military Dive Mission Profile	Transfusion

Application Process

Qualifications for our ACTA Fellowship Program are completion of an AGCME-accredited anesthesiology residency program by the start of the fellowship. Upon completion of an application and submission of documentation, the submission will be reviewed for an interview by the Program Director and selection committee. A minimum of three letters of recommendation from senior faculty, preferably those who have worked with the trainee performing cardiac anesthesiology, are required.

This program participates in the San Francisco (SF) Match. Please register, complete the application, and upload the following documents to the SF Match site for a complete application.

• Copies of USMLE/COMLEX steps 1, 2, and 3
• Copy of ECFMG certification (if applicable)
• Three letters of recommendation

After submitting your SF Match application, please email the following documents to benvenutiam@upmc.edu:

• Copy of medical school transcript and dean’s letter (Medical School Performance Evaluation)
• Copy of board certification/most recent In-Training Examination report/ ABA Basic Exam letter

For further information about the ACTA Fellowship, please contact Angela Schultz at 412-692-4528 or benvenutiam@upmc.edu.