As residents, we have the opportunity to rotate at the renowned Texas Heart Institute for several months, beginning as early as our CA-1 year. Here, you will be involved in cases ranging from AV fistulas and EP cases in the cath lab, to more involved cases such as CABGs, robotic and open valve repairs, LVADs and placement of other mechanical circulatory support devices, kidney/liver/lung/heart transplants, and aortic procedures requiring deep hypothermic circulatory arrest, to name a few. The array of cases is diverse, and you will be granted an appropriate level of autonomy and access to increasingly complex cases as you progress through your training.
On a typical day, I wake up around 5:30 a.m. and aim to arrive at the hospital between 6 to 6:30 a.m., depending on how long it will take to set up for my case. Today, my first case is a “straightforward” CABG. I perform a basic OR set-up as per usual, draw up drugs, and set up any drips that we may need. Our anesthesia techs are invaluable and assist with setting up our monitors, transducers, fluid bags, ultrasound, and ensuring we have all the supplies we need. At around 7:00, I meet my patient in pre-op, obtain consent, and discuss the anesthetic plan with my attending. Once everything is ready, I roll my patient into the OR by 7:30 a.m. For this case, I obtain a pre-induction arterial line before proceeding with induction of general anesthesia, intubation, and placement of a central line and pulmonary artery catheter. We place a TEE probe and perform a quick exam with the CV anesthesia fellows on their “echo month” before I take my morning break. Fortunately, the remainder of the case progresses uneventfully. At this institution, we perform our own blocks and epidurals if needed for the case. Today, we perform a parasternal block at the end of the case and then transport our patient to the ICU.
Depending on the schedule for the day, I may be assigned to another case, asked to relieve another resident/fellow, or dismissed home. There is a daily release order for the residents and fellows that takes into account how late we stayed the day before and any upcoming calls that we have. Overall, the system is fair and well-balanced. We take a handful of in-house calls every month, which involves arriving at noon, finishing up the cases for the day, and then covering any emergent cases or airways that occur overnight. The hours for the rotation are reasonable, and there is an appropriate balance between being occupied with complex cases at work and having enough time to relax and decompress outside of the hospital.
This rotation provides excellent exposure to high-acuity cases and trains us to become comfortable with managing extremely sick patients in the operating room. I consider this rotation to be one of the best aspects of our training here at Baylor. I personally enjoyed my experience so much that I will be staying next year and pursing a cardiac anesthesia fellowship at THI.
