Clinical training serves as the cornerstone of the Interventional Cardiology Fellowship. Trainees serve as the primary assisted operator during procedures and work one-on-one with faculty. The program strives to provide the proper balance between autonomy and supervision. Emphasis is placed on procedural indications, appropriate use criteria, fundamental and advanced procedural skills, techniques, decision-making, and post-procedural care. In addition to cath lab-based training, Fellows also spend one-half day per week in the outpatient clinic, which provides the opportunity to evaluate patients prior to and following procedures.
Coronary Artery Disease
The University of Rochester is a high-volume PCI center where both “routine” and complex interventions are performed. As an urban medical center with a busy emergency room, there is an active primary PCI program for the management of acute MI. The University of Rochester is also a tertiary referral center serving a large portion of New York State. The vast majority of our coronary procedures are performed via the radial artery approach, allowing Fellows to obtain expertise in this technique. Advanced coronary therapeutic and diagnostic modalities are available, including optical coherence tomography (OCT), intravascular ultrasound (IVUS), Fractional Flow Reserve (FFR), as well as atheterectomy, thrombectomy, and lithoplasty. We emphasize a Heart Team approach to patient management, and complex high-risk indicated PCI procedures (CHIP) are undertaken in our lab.
Peripheral Vascular Disease
Patients with peripheral vascular conditions are evaluated and undergo treatment in the catheterization laboratory. During training, particular emphasis is placed on knowledge of indications, therapeutic alternatives (medical, endovascular, and surgical), and technical skills for performance of angiography and percutaneous revascularization.
Structural Heart Disease
Endovascular management of structural heart disease represents a key component of the training program at U of R. Fellows currently participate in a variety of cath lab-based procedures for the treatment of structural heart disease, including:
- Transcatheter Aortic Valve Replacement (TAVR)
- Mitral Transcatheter Edge-to-Edge Repair (TEER)
- ASD/PFO closure
- Aortic, mitral and pulmonic balloon valvuloplasty
- Embolization procedures for acquired and congenital cardiac anomalies
- Left atrial appendage closure
- Debulking therapy for right heart endocarditis and thrombosis
Alcohol septal ablation is integral to the management of hypertrophic cardiomyopathy. Our institution has a busy alcohol septal ablation program, and Interventional Fellows actively evaluate patients with hypertrophic cardiomyopathy and participate in these procedures.
Cardiogenic Shock and Advanced Heart Failure
The University of Rochester serves as the sole cardiac transplant center in Central and Western New York, runs a high-volume ventricular assist device (VAD) program, and has a busy mechanical circulatory support (MCS) program for patients with acute cardiogenic shock. Interventional fellows actively participate in percutaneous LVAD, RVAD, and ECMO implantation.
The University of Rochester has an established Pulmonary Embolism Response Team (PERT), and invasive therapies for acute pulmonary embolism, including aspiration thrombectomy, and catheter-directed thrombolysis are performed in the catheterization laboratory when indicated.