Structural Heart Disease Fellowship at Princeton Baptist Medical Center 2018 Updated – An Overview
“The structural heart disease fellowship at Princeton Baptist Medical Center is amongst the most hands on fellowships in the United States with all cases performed by the attending and the single structural fellow. The structural fellow is considered a center-point of the heart team. There is a strong emphasis placed on proficiency in structural imaging”
The goal of the structural heart disease fellowship at Princeton Baptist Medical Center is not only to learn hands on proficiency in the technical aspects of advanced structural heart procedures with high volume, but also to learn the skills required to sustain, differentiate and grow a structural heart program from the ground up. This is key as the majority of those completing a structural heart disease fellowship will never perform structural heart procedures and have limited access to bread and butter structural heart procedures. This is typically due to obtaining positions where there saturation of operators or there is not infrastructure to develop a program.
This structural heart disease fellowship differs from the majority of structural heart disease fellowships in multiple key aspects. The aim is not simply to learn technical proficiency in complex structural heart procedures but to gain proficiency in all aspects of a busy structural heart program. This includes familiarity with the entire evaluation from patient referral, to imaging, to procedure and procedural imaging to inpatient management to discharge to follow up. Importantly the fellow will be trained in the set up and follow-through of a busy structural heart operation including a full appreciation of the infrastructure required from office staff, to registry requirements, to procedural equipment needs and facility, to follow up. Critically, the fellows going through the structural heart disease fellowship at Princeton Baptist Medical center will be trained in heart team infrastructure and critically the growth and marketing of a successful statewide and beyond program.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Procedures and Volume
- Complex Structural Patient Evaluations > 1000
Imaging Procedures Performed
- 3D Transesophageal Echocardiography > 750
Interventional Structural Procedures
Procedure numbers will of course fluctuate however based on current projections the following can provide a rough outline.
- Balloon Aortic Valvuloplasty > 200 (i.e includes TAVR)
- TAVR transcatheter aortic valve replacement > 200
- Aortic Paravalvular Leak Repair > 20
- Pulmonary Valvuloplasty < 5
- Mitraclip > 100
- Mitral Paravalvular Leak Repair > 20
- Mitral valve in valve / valve in ring / valve in MAC >25
- Atrial Septal Defects > 40
- Ventricular Septal Defects > 5
- Transseptal Heart Catheterization > 250
- Superior Vena Cava Intervention – 5
- Catheter Directed Treatment of Pulmonary Embolism > 50
- Cardiac / Aortic Pseudoaneurysm – 5
- Coronary Artery Fistulas – 5
- Alcohol Septal Ablation >25
- Left Atrial Appendage Occlusion >100
- ECMO/Impella/Protek >50
- Large Bore Sheath Management > 400
- Angiovac thrombus removal – variable (5-10)
Thoracic And Abdominal Endografting
- TEVAR / EVAR > 30-50
Emerging Technology With Access This Year
- Transcatheter Mitral Valve Replacement (Starting in next 2 months, part of ongoing Trials)
- Transcatheter Tricuspid Valve Repair
Other Interventional Procedures With High Volumes
- Coronary interventions > 750 performed / year
- Carotid artery stenting > 50 performed / year
- Peripheral Interventions > 200 performed per year
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Some Cases of Note from 2015-2016
- Catheter directed treatment of massive pulmonary embolism and large right atrial thrombus using ultrasound-assisted thrombolysis, a case series.
- Percutaneous Repair of Severe Paravalvular Prosthetic Mitral Regurgitation for Pre-Operative Optimization of a High Risk Patient Requiring Redo Mitral Valve Replacement.
- Percutaneous coiling of massive cardiac pseudoaneurysm and concomitant occlusion of aorta-left ventricular fistula.
- Percutaneous repair of severe aortic paravalvular leak followed by Mitraclip procedure in a high-risk patient with severe heart failure.
- Percutaneous repair of iatrogenic perimembranous ventricular septal defect with an Amplatz Ductal Occluder 3 device.
- Percutaneous repair of massive atrial septal defect in a patient with severe pulmonary hypertension with a self fenestrated septal occluder device.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Structural Heart Clinic
Diagnosis and management of complex structural heart disease from referral to management plan development is key. The structural program has a dedicated twice-weekly structural heart clinic that encompasses patient initial visit, relevant imaging and diagnostic studies. Over 1000 patients are evaluated per year for structural heart disease evaluations at Princeton Baptist Medical Center. The structural heart fellow will be responsible for initial evaluation, supervision of complex 2d echocardiography, performing 3D-echocardiography, provocative testing, and invasive testing such as right, left and trans-septal heart catheterization. A dedicated nurse practitioner is present for the structural heart and valve clinic at Princeton Baptist to help run the above.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center –Inpatient Structural Heart Service
Up to 15 inpatients (typically 5-10) at any one time on the structural heart disease service including ICU and floor care. Will be responsible for daily evaluations; plan formation and transition to disposition. A strong emphasis is placed on care pathway optimization and outcomes. The fellow will be involved in emergent care including involvement in overnight coverage for emergencies and emergency procedures. There is a inpatient structural heart consult service, and the fellow will be responsible for new patient evaluations and follow up. There is dedicated nurse practitioner helping with this.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Imaging Proficiency
The structural heart fellow is expected to become proficient in high level advanced structural heart echocardiography. Will learn to be able to tease out the intricacies of multi faceted structural heart defects through 2D and 3D TTE and TEE. Importantly the fellow will learn live real time 3D guidance of structural heart procedures and the use of echocardiography to guide pre procedural technical aspects such as device sizing. Use of CT imaging will also be taught, particularly with regard to TAVR intervention and other complex intervention as related to structural heart disease. Independent interpretation and reporting of these scans from a structural aspect will be learned.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – TAVR meeting
The structural heart fellow will be involved in the heart team at the TAVR meeting and be integrally involved in decision making regarding patient suitability, prosthesis type and access route. This is typically every Friday morning.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Structural Heart Meeting
Typically every week on Tuesday morning there is a dedicated structural team meeting where all intake of structural patients is triaged appropriately, schedules for procedures and clinics aligned, and typically non-TAVR patients are discussed. All staff that works in the structural heart and valve clinic set up attend.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Pulmonary Embolism Service
Princeton Baptist Medical Center is a busy referral center for the evaluation and treatment of pulmonary embolism. The pulmonary embolism service is a multidisciplinary approach to pulmonary embolism, particularly centered on massive and submassive pulmonary embolism. This includes risk stratification and determination of suitability for interventional treatment with catheter directed therapy.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Device Courses
The structural heart fellow will have opportunity to attend courses and training that is deemed to be suitable for ongoing credentialing regarding devices. Obtaining these will be critical when it comes to credentialing in any jobs taken.
Structural Heart Disease Fellowship at Princeton Baptist Medical Center – Contact Points
Director of the Structural Heart Program – Mustafa Ahmed MD
Manager of Structural Heart Operations – Laura Raye Byrd
For further information or to ask questions please contact
Laura Raye Byrd
Manager, Structural Heart & Valve Clinic
Baptist Medical Center-Princeton
701 Princeton Ave. SW, Ste. 206
Birmingham, AL 35211