Program Structure

The Cardiothoracic Transplantation Surgery Fellowship provides advanced training in lung transplant; heart transplant; mechanical circulatory support; extracorporeal membrane oxygenation (ECMO); management of patients with end stage lung and heart failure to senior level cardiothoracic surgery trainees as well as graduates of cardiovascular and thoracic surgery residency programs.

The fellowship provides broad, extensive experience in all aspects of transplantation surgery. While there are a handful of programs that can provide an adequate experience in one of these fields, Duke is unique in providing a large clinical experience in all of these disciplines. We perform over 70 heart transplants, 100 lung transplant, 150 ventricular assist devices, and 250 ECMO procedures every year. In addition to gaining operative experience, fellows will participate in both outpatient clinic and as well as all aspects of inpatient care. Fellows will be involved from initial patient diagnosis, work-up, and pre-surgical evaluation to both short-term and long-term follow-up. At all times, trainee will function under the supervision and direction of the program faculty. The trainees will not be independent providers.

In this role, the fellow will train alongside residents enrolled in the accredited Thoracic Surgery and General Surgery programs at Duke University, as well as with advanced practice providers in both the inpatient and outpatient setting. The fellow will actively participate in all educational conferences and activities. The fellows are also encouraged to participate in a full range of research opportunities, including both basic science and clinical research. The fellow will be able to work with several faculty who have formal training in clinical research and can provide mentorship as well as guidance in statistical analysis. Through these faculty, the fellow will have access to a large intuitional database as well as national and international registries in order to perform both hypothesis testing and hypothesis generating research. The fellow will have approximately 10% of the fellowship protected in order to pursue a research interest.

It is expected that at the completion of one year of training, the fellow will have participated in 30 lung transplants implants, 20 heart transplant implants, 30 ventricular assist device implants, 40 ECMO cases, and 20 heart and/or lung procurement procedures. This will include the preoperative assessment of these patients, the operative procedure, and the inpatient and outpatient postoperative care of these patients.

The fellow will participate in the following educational conferences:

  • Case Conference (Weekly)
  • Morbidity and Mortality (Monthly)
  • Grand Rounds (Weekly)
  • ECMO Seminar (Weekly)
  • ECMO Simulation (Quarterly)
  • Lung Transplant Listing Conference (Weekly)
  • Heart Transplant Listing Conference (Weekly)
  • Lung Transplant Pathology Rounds (Quarterly)
  • Heart Transplant Pathology Rounds (Weekly)
  • Transplant Core Curriculum Lecture Series (Monthly)

While the core program is one year in duration, some trainees can elect to spend a second year of training. This is most appropriate for fully trained cardiothoracic surgeons who intend to function as the Surgical Director of a program immediately upon completion of the fellowship. This second year will provide continued broad clinical exposure with an emphasis on program development and program management.

Supervision and Evaluation

All trainees function under the supervision of the program faculty at all times. They will not be functioning as independent providers during this fellowship. Over the course of the year, there is graduated responsibility as appropriate based on the trainee’s clinical skill and needs. The trainees are informally evaluated by the faculty with which they are working at the time and point of contact. They are formally evaluated by the faculty monthly and by the program director quarterly. These formal evaluations are written in nature and directly address the components of care: preoperative evaluation, donor evaluation, recipient selection, intraoperative skills, critical care, and postoperative care.