Adult cardiac anesthesiology certification requires completion of a one-year fellowship in adult cardiothoracic anesthesia and passing the adult cardiac anesthesiology exam. Browse or search the content outline below.
A. Foundations of Adult Cardiac Anesthesiology
1. Anatomy
a.
Embryological development (Primitive heart structures, Timing of development, Blood flow to the fetus and newborn)
b. Cardiac Anatomy
c. Thoracic anatomy
2. Physiology
b. Cardiac cycle
c. Ventricular function
d. Regulation of circulation and blood volume
i.
Arterial pressure
B. Preoperative Evaluation of the Patient for Cardiac Surgery
1. Non-invasive cardiovascular evaluation & interpretation
c. Evaluation of cardiac ischemia
2. Cardiac catheterization procedures and diagnostic interpretation
a. Left-sided tracings
b. Right-sided tracings
3. Oral Medications – pharmacology and perioperative management
a. Blood pressure
f. Anti-platelet agents
C. Intraoperative Monitoring of the Patient Undergoing Cardiac Surgery
2. Arterial pressure monitoring
3. Central venous (CVP) monitoring
4. Pulmonary arterial catheterization
6. Transesophageal echocardiography
D. Management of Cardiopulmonary Bypass (CPB)
1. Anticoagulation issues
c. Heparin-induced thrombocytopenia
2. The CPB circuit
a. Cannulation considerations
3. Temperature management
4. Physiological disturbances of CPB
5. Separation from CPB
a. Resuming cardio-respiratory function
6. Complications after CPB
E. Mechanical Circulatory Support
1. Intra-aortic balloon pump
2. Temporary ventricular assist devices
b. Intraoperative management
3. Durable ventricular assist devices
F. Cardiac Diseases
1. Cardiomyopathy
a. Types
b. Medical/interventional management
2. Chronic heart failure
a. Systolic (Heart Failure with Reduced Ejection Fraction, [HFrEF])
b. Diastolic (Heart Failure with Preserved Ejection Fraction [HFpEF])
c. Medical/interventional management
3. Pericardial disease
a. Cardiac Tamponade
4. Ischemic heart disease
d. Acute coronary syndrome
e. Treatment
3.
Alternate surgical techniques and anesthetic implications (e.g., off-pump, minimally invasive, robotic)
5. Rare cardiac diseases
a. Neoplastic disease
G. Valvular Heart Disease
1. Aortic stenosis
a. Etiologies
b. Diagnosis and severity assessment
c. Treatment
2. Aortic regurgitation
b. Diagnosis and severity assessment
3. Mitral stenosis
b. Diagnosis and severity assessment
4. Mitral regurgitation
a. Mechanisms of MR
c. Diagnosis and severity assessment
d. Treatment
5. Tricuspid regurgitation
b. Diagnosis and severity assessment
6. Tricuspid stenosis
b. Diagnosis and severity assessment
7. Prosthetic heart valves
H. Adult Congenital Heart Disease
1. General considerations
2. Pulmonary valve disease
I. Thoracic Aortic Disease
1. Acute aortic syndromes (e.g., dissection, intramural hematoma, penetrating aortic ulcer, trauma)
e. Surgical management
2. Ascending / Arch aneurysms
3. Descending aortic aneurysms
b. Open repair
iii.
Complications (e.g., spinal cord ischemia, renal failure, recurrent laryngeal nerve injury)
J. Electrophysiology Procedures
2. Pacemaker insertion
b. Types of PPM
3. Ablations: Anesthetic considerations
K. Postoperative Considerations
1. Pulmonary
2. Cardiac
4. Pain control
L. Other Topics
1. Research methodology/statistical analysis
2. Practice management
a. Costs of medical/anesthesia care
b. Efficient OR staffing and scheduling
c. Population health: perioperative surgical home and enhanced recovery
d. Clinical informatics
3. Quality Improvement and patient safety
a. Definitions
b. Medication errors: assessment and prevention
c. Crisis management and teamwork
d. Quality Improvement (QI) basics
e. Performance assessment
4. Diversity, Equity and Inclusion (DEI) in health care
b. Barriers
i.
Systematic racism, colorism/shadeism, sexism, discrimination against orientation, gender identity, language, national origin, ethnicity, religion, immigration/citizenship status, age, familial status, and disability
c.
Approaches to improvement; interventions at individual, inter-personal, community, organizational and policy levels; cultural and gender competency, upstander vs. bystander, allyship vs. performative action, tokenism vs representation, assortativity vs. homophily
5. Healthcare disparities
a.
Social determinants of health considerations in assessment and management of patients – race, language, education status, religion, housing, nutrition, geographic location, rural vs. urban, access to and quality of care, health coverage
6. Ethics and medico-legal issues
a. Professionalism: definitions and teaching
ii.
Professional behavior: honesty, integrity, compassion, respect, altruism, conflicts of interest, response to marketing
b. Patient autonomy and decision making
ii.
Advance directives, Do Not Resuscitate (DNR) orders, medical orders for life-sustaining treatment
c. Legal and regulatory issues
ii.
Legal actions and consequences, National Practitioner Data Bank, Closed Claims findings, professional liability insurance
iv.
Patient privacy issues: principles of confidentiality, access to records, protected health information
d.
Primary certification, recertification, maintenance of certification and related issues (Professional Standing, Lifelong Learning, Cognitive Knowledge, Clinical Practice Assessment, Systems-Based Practice)
e. Research ethics
ii.
Ethical standards in research design: scientific validity, fair subject selection, favorable risk-benefit profile
TEE Certification
Certification in Basic and Advanced Perioperative Transesophageal Echocardiography is awarded by the National Board of Echocardiography.
The Basic certification is intended for non-diagnostic monitoring within the customary practice of anesthesiology. It is not sufficient for making diagnoses that require cardiac surgical intervention. Diplomates must:
- Complete 150 basic perioperative TEE examinations, 50 of which must be personally performed and interpreted under supervision
- Pass the Basic PTEeXAM
The Advanced certification is intended for full diagnostic use, including direction of the perioperative surgical decision-making process. Diplomates must:
- Complete a 12-month ACGME-accredited cardiac anesthesiology fellowship.
- Complete 300 comprehensive perioperative TEE examinations, 150 of which must be personally performed and interpreted under supervision
- Pass the Advanced PTEeXAM
Study Resources
Virtual TEE simulator from the Toronto General Hospital Department of Anesthesia
Online lecture series and question bank from the University of Utah
OpenAnesthesia Basic Course in TEE
American Society of Echocardiography and Canadian Society of Echocardiography
Commercial Echo Board Review Courses
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