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Cardiac and Thoracic Anesthesia

The cardiothoracic anesthesia service typifies the multidisciplinary approach to the treatment of ischemic heart disease, valvular repair and replacement, complex aortic reconstruction, and off-pump interventions such as Transcatheter Aortic Valve Replacement (TAVR), Lariat, percutaneous closure device, laser lead extraction and, coming soon, MitraClip procedures. In addition to cardiac procedures, the service covers the operative arm of the comprehensive thoracic oncology program doing pulmonary, esophageal and mediastinal mass resections utilizing open, thoracoscopic, and robotic techniques. We are beginning the first phase of our Extracorporeal Membrane Oxygenation (ECMO) program for post-cardiotomy support, with a plan to expand to Veno-Venous (V-V) ECMO in 2015. Additionally, we have added a cardiac anesthesia intensivist to the Cardiovascular Critical Care Unit (CVCC) for daily coverage of unit patients..

Significant changes have occurred in the structure and composition as well as referral patterns to DHMC. As Dartmouth-Hitchcock continues to partner with smaller regional hospitals, our referral volume has increased and is forecast for continued growth in the future. The cardiac surgery and thoracic surgery divisions have separated and now have new chiefs: Dr. Jock McCullough from Hackensack now leads the Cardiac Surgery Service and Dr. David Finley from Sloan Kettering heads the Thoracic Surgery service. Likewise, Anesthesia split these two divisions appointing Dr. Jessica Hathaway and Dr. Aaron Mancuso as the respective Division Directors. Dr. Jeff Clark remains the Resident Rotation Director and Dr. Adrienne Williams is the Director of Peri-operative Tranesophageal Echocardiography (TEE).

In addition to intraoperative anesthesia, multiple members of the cardiothoracic team have specialty certification in critical care. Their involvement provides continuity between the immediate intraoperative and postoperative care of cardiothoracic surgical patients and allowed us to seamlessly integrate into the CVCC. Drs. Athos Rassias, Steve Surgenor, and Jessica Hathaway manage the CVCC Monday through Friday.

Education

  • OR: CA-1 and CA-2 residents participate in the cardiac service on two, four-week rotations. The service covers two heart rooms daily and a third room devoted to thoracic procedures providing them with exposure to a wide variety of cardiothoracic surgical procedures. Residents become proficient at invasive monitoring techniques, the management of cardiopulmonary bypass, the use of vasoactive infusions, and the diagnosis and treatment of coagulopathies. All residents receive a tutorial in central venous access which includes a simulation and didactic session prior to their first day on the cardiac rotation. This assures both uniform instruction and ample time for practice prior to performance of this invasive procedure in the operating room.
  • TEE: As TEE is a standard cardiopulmonary bypass procedure at DHMC, residents receive four weeks of dedicated TEE time, 2 weeks each in PGY-1 and PGY-2 years. Senior residents can elect additional TEE time in their CA-3 year. This exposure, in addition to twice monthly TEE conferences, and access to Heartworks® computer-mannequin based simulator more than adequately prepares residents for the Basic Perioperative TEE exam and subsequent certification.
  • ICU: CBY residents rotate on this service for 2 weeks and as CA-3s will have the opportunity to spend elective time in the CVCC.

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