Adult Cardiothoracic Anesthesiology

Our goal is to train individuals to be:

• Highly competent in anesthesia and perioperative care for cardiothoracic and vascular patients.
• Proficient in advanced perioperative echocardiography.
• Qualified to provide consultant advice.
• Dedicated to leading and advancing excellent cardiothoracic anesthesiology practice.

Education 

Didactic education 

Our weekly CTA fellow seminars provide didactic education in anesthesia and perioperative/periprocedural management of the cardiothoracic/cardiovascular patient, as well as in advanced perioperative echocardiography. This perspective is supplemented and enhanced by attending relevant didactic lectures and seminars of the UW Cardiology, Cardiothoracic Surgery, and Critical Care Medicine fellowship training programs. 

Conferences 

Our conference program includes weekly CTA didactics and transesophageal echocardiography (TEE) rounds, weekly Cardiology/Cardiac Surgery/CTA Interdisciplinary Case Conferences, weekly Anesthesiology & Pain Medicine Grand Rounds, a quarterly CTA Journal Club, and quarterly CTA Quality Assurance and Improvement seminars. 

Clinical experience

Cardiac OR (35 weeks) 

Approximately 700-800 highly complex cardiac surgical cases requiring cardiopulmonary bypass are performed at UW Medical Center – Montlake annually. Here is a sample of our surgical case distribution:

• CABG (isolated): 20% 
• Heart transplantation: 12% 
• Thoracic aortic surgery (open – excluding TEVAR): 16% 
• Valve surgery (including combined CABG & valve surgery): 40% 
• Ventricular assist device / total artificial heart: 6% 
• Other (including congenital): 6% 

Fellow responsibilities in the Cardiac ORs balance personal delivery of anesthesia and perioperative care with supervision and instruction of anesthesiology residents under appropriate – frequently one-to-one – supervision by CTA faculty. 

We integrated hands-on perioperative TEE training into the Cardiac OR rotation experience and utilize this imaging modality in nearly all cardiac surgical cases, complex transcatheter structural heart procedures, and other cardiovascular interventions performed under general anesthesia. Our fellows personally perform most perioperative/periprocedural TEE studies under direct supervision and guidance by CTA faculty who are either National Board of Echocardiography (NBE) certified in, or testamurs of, Advanced Perioperative transesophageal echocardiography.

The Division of Cardiothoracic Anesthesiology also provides anesthesia and periprocedural care for all patients undergoing transcatheter therapies for structural heart disease, electrophysiological procedures, and percutaneous coronary interventions. Many complex transcatheter aortic valve implantation/replacement procedures and percutaneous therapies (e.g., valvular edge-to-edge repair, transcatheter mitral valve replacement, left atrial appendage occluder device implantation, perivalvular regurgitation occlusion, etc.) involve intra-procedural TEE evaluation and guidance provided by CTA faculty.

Cardiothoracic Intensive Care Unit (4 weeks) 

Through a combination of clinical experience, bedside teaching, didactic lectures and conferences, and directed reading, the critical care rotation in the Cardiothoracic Intensive Care Unit teaches our fellows a systematic approach to caring for critically ill adult cardiothoracic surgical patients after cardiac, complex thoracic, and major vascular surgery.

Adult Echocardiography Lab (3 weeks) 

All of our fellows complete an elective rotation in the UW Medical Center – Montlake Echocardiography Lab, where they gain experience in 2D- and 3D-transthoracic and transesophageal echocardiography.  Fellows progress from observing echocardiographic examinations to performing them under the supervision of senior cardiac sonographers. They also conduct offline interpretation and reporting of echocardiographic studies under the supervision of UW Cardiology faculty.

Thoracic OR (4 weeks) 

UW Medical Center – Montlake consistently places in the top 20% of US transplant programs by volume. Our thoracic surgery program provides a full range of contemporary thoracic surgical practice, including lung transplantation, open, video- and robotic-assisted lung resection, whole lung lavage, tracheal resection/reconstruction, pulmonary thromboendarterectomy, esophageal resection, and numerous endoscopic airway interventions. Our Thoracic OR rotation teaches fellows to become proficient in thoracic epidural catheter placement, management of one-lung ventilation, and anesthesia management for airway interventions.

Electives (three 2-week rotations) 

We offer elective rotations in: 

• Adult Congenital Heart Disease Clinic 
• Cardiopulmonary Perfusion 
• Cardiac Care Unit (Cardiology critical care) 
• Cardiothoracic Intensive Care Unit (in addition to the required 1-month cardiothoracic surgical critical care rotation) 
• Cardiac Implanted Electronic Device (aka pacemaker and ICD) Management 
• Echocardiography Lab (subject to availability and in addition to the “required” 3-week rotation) 
• Pediatric Cardiac Anesthesiology (based at Seattle Children’s Hospital 
• Interventional Echocardiography 
• Transfusion Medicine 
• Research (subject to availability of funding) 

Please refer to UW GME for updated stipend information, insurance and retirement benefits, policies, procedures, and other available resources. 

Financial support 

Annual Stipend: The UW CTA Fellowship salary is based on the UW GME schedule and may change from year to year. 

Academic Allowance: Subject to available funding, fellows will receive an academic allowance each academic year as “all inclusive” support for their general expenses incurred during their time training.

PTO and leave 

Please refer to the UW Resident and Fellow Physician Union – Northwest Contract for institutional PTO and leave allowance, and note that all leave of absence during training is subject to policies set by the American Board of Anesthesiology, which states: “The total of any and all absences during a subspecialty fellowship may not exceed the equivalent of 20 working days (four weeks) per year. Attendance at scientific meetings, not to exceed five working days during the year of training, shall be considered part of the training program. Absences in excess of those specified will require lengthening of the total training time to the extent of the additional absence.” 

Program Director: Richard Sheu, MD, FASE  

Associate Program Director: Dominik Steck, MD

Program Administrator: Nicole Sullivan, actanes@uw.edu 

See a complete list of our cardiothoracic anesthesiology faculty and fellows.

SF Match 

Our program participates in the nationwide Adult Cardiothoracic Anesthesiology Fellowship Match organized by SF Match. 

SF Match provides a Centralized Application Service for Adult Cardiothoracic Anesthesiology fellowships, where applicants must complete an online application form and submit three (3) letters of recommendation. Instructions can be found on the SF Match website.

Application documents 

In addition to SF Match requirements, applicants must also submit these supporting documents directly to our program: 

• Official medical or osteopathic school transcript will be requested upon invitation to interview. Transcript will need to be sent prior to rank deadline

• ABA BASIC Examination status 
• ECFMG certificate (if applicable) 
• Information about visa status (if applicable) 

Please send completed applications and/or questions to actanes@uw.edu 

Interviews 

All interviews for UW GME training positions will continue to be conducted remotely through Zoom or another appropriate video conferencing platform until further notice per UW GME administration policy. Interview dates will be provided upon invitation. 

To learn more about life and training in Seattle, visit our GME’s website for Prospective Residents and Fellows.