Sub-Specialty Cardiology Fellowships

Cardiac Electrophysiology

The goal of the Jackson Memorial Hospital (JMH)/University of Miami Miller School of Medicine Fellowship Program in Clinical Cardiac Electrophysiology is the additional subspecialty training of cardiology fellows in the diagnosis and management of patients with cardiac arrhythmias including all appropriate invasive and noninvasive methods for evaluation and drug, device and ablative forms of therapy.

The Clinical Cardiac Electrophysiology Fellowship Program is an ACGME accredited two year training program with complex ablation and/or specialized laboratory or animal research and a two year program starting in 2017. Our fellows are an integral part of the Cardiology Division and assist in all aspects of consultative and interventional electrophysiology. The training program is based at Jackson Memorial Hospital, but the fellows spend time at the University of Miami Hospital & Clinics – Uhealth Tower, and the Miami VA Hospital as well.

Program Director:

  • Raul Mitrani, MD
    Program Director, Clinical Cardiac Electrophysiology Fellowship Program
    Associate Professor of Medicine, University of Miami Miller School of Medicine

Core Faculty:

Program Coordinator:

ACGME Accredited: Yes
Residents or Fellows per year: 1
Duration: 2 Years
Postgraduate Training Required: Internal Medicine Residency and Cardiovascular Fellowship
U.S. Citizenship Required: US Citizen, Permanent Residents/Green Card Holder, and J1 Visa

For further information about the application process and requirements, interested applicants can go to:
https://jacksonhealth.org/graduate/clinical-cardiac-electrophysiology/

Advanced Heart Failure & Cardiac Transplantation

The goal of the Jackson Health System / Jackson Memorial Hospital (JMH) Fellowship Program in Advanced Heart Failure and Transplantation, in affiliation with the University of Miami Miller School of Medicine is the training of fourth year cardiology fellows in the diagnosis and management of patients with heart failure.

Educational Program

The Advanced Heart Failure and Transplantation Fellowship Program in the University of Miami/Jackson Memorial Hospital is primarily located at Jackson Memorial Hospital, and directly affiliated as a subspecialty fellowship under the UM/JMH Cardiovascular Disease (CVD) Fellowship Program.

As the only Advanced Heart Failure and Transplant Program in South Florida, our fellows have access to the University of Miami Hospital and Jackson Memorial Hospital. Both hospitals serve as major referral centers for advanced heart failure and transplantation for the state of Florida. The fellow gains experience in medical management of advanced heart failure, evaluation of heart transplantation candidates, and pre-, peri- and post-transplant care. The fellow also gains experience from ventricular assist devices, both approved and investigational, which are implanted for both bridging to other forms of therapy and for destination therapy. The JMH/UM Cardiac Transplant Program has been in continuous operation for over 20 years and the clinical outcomes have consistently placed it among the top tier of centers nationally. We perform approximately 35-40 heart transplantations per year.

Heart Failure Training Education

  • Management of Heart Failure
  1. To be able to institute an effective plan for the diagnostic evaluation of patients with new onset HF
  2. Understand the role of non-pharmacologic interventions including diet and education
  3. To have a full understanding of the multiple pharmacologic treatment options now available, and to recognize the appropriate indications for each therapy
  4. Understand the treatment options for the management of arrhythmias in HF
  5. Be aware of treatment options for the management of specific cardiomyopathies including cardiac amyloidosis, sarcoidosis, Fabry’s disease etc.
  6. Understand the indications for device therapy including implantable cardiac defibrillators and biventricular pacing devices
  7. To understand the indications for heart transplant consideration
  8. Understand the concepts of disease management and health care delivery
  • Management of decompensated patients:
  1. To recognize the role of hemodynamic monitoring including pulmonary arterial catheters
  2. To understand the role of inotropes, vasopressors and vasodilators
  3. To be able to manage volume overload using standard therapies including diuretics, and the role of ultrafiltration and hemodialysis in appropriate patients
  4. To be able to recognize the need for mechanical circulatory support in patients with advanced or refractory disease, and to understand the various options now available including percutaneous support devices, temporary and permanent implantable assist devices
  5. Be able to contribute to discharge planning, longitudinal care and prevention of readmission

End Stage Heart Failure/Palliative Care: To understand the role of palliative care in end-stage HF, and to be able to participate in discussions on end-of-life issues with patients, family members and other providers

HEART TRANSPLANTATION EDUCATION

  • To be aware of the scope, trends and outcomes of heart transplantation in the United States. To understand the role of the United Network for Organ Sharing (UNOS) and local organ procurement organizations (OPOs).
  • To be aware of the indications for heart transplantation
  • To understand the pre-transplant work-up process, psychological and social considerations, exclusion criteria, listing procedure and status, individual issues, HLA sensitization and techniques for desensitization, the place of retransplantation, use of inotropes and assisted circulation as a bridge to transplant.
  • Understand transplant listing criteria and the prioritization of recipients for donor offers.
  • To understand the indications for using inotropes and vasodilators, the place of hemodynamic monitoring using pulmonary arterial catheters and the indications for short and long term mechanical circulatory support.
  • Understand the management of donor candidates, evaluation of donor offers and the procurement of organs (‘donor runs’). Be familiar with donor and recipient surgical procedures including organ preservation, biatrial technique vs bicaval. Be aware of early and medium term complications of heart transplantation.
  • To understand and differentiate the pathophysiology of acute antibody mediated and cellular rejection as well as chronic rejection (see below). Be aware of typical clinical and pathological findings, the classification system for grading rejection and appropriate treatment strategies for each grade of rejection. To be familiar with surveillance strategies including endomyocardial biopsies, drug level monitoring, gene expression profiling and genomic markers of rejection, echocardiography and cardiac MR, immune function assays and antibody monitoring.
  • Immunosuppression: have a firm grasp of strategies for induction therapy, drugs used for chronic immunosuppression and their side effects, and therapies used for treatment of acute rejection.
  • Long term post-transplant care
    I. Complications: to be familiar with early and late complications of transplantation.
    II. Transplant vasculopathy: Late graft failure, immune and non-immune causes/factors, histopathological and clinical difference compared to atherosclerosis, treatment
    III. Chronic kidney disease: role of calcineurin inhibitors, induction therapy in preserving renal function
    IV. Infections: Early vs. late infection, opportunistic infections and activation of latent infections, prophylaxis
    V. Malignancy: leading cause of late death equaling vasculopathy, post-transplant lymphoproliferative disorders and skin cancers, role of viral factors (EBV etc.)

Program Director:

  • E. Joseph Bauerlein III, M.D. FACC   
    Program Director, Advanced Heart Failure/Transplant Fellowship Program
    Associate Professor of Clinical Medicine, University of Miami Miller School of Medicine

Core Faculty:

  • Joshua Hare, MD 
    Louis Lemberg Professor of Medicine
    Director, Interdisciplinary Stem Cell Institute
    University of Miami Miller School of Medicine
  • Nina Thakkar Rivera, DO
    Site Supervisor, UMH Advanced Heart Failure/Transplant Fellowship Program 
    Associate Professor of Clinical Medicine, University of Miami Miller School of Medicine

Program Coordinator:

ACGME Accredited: Yes
Residents or Fellows per year: 1-2
Duration: 1 Year
Postgraduate Training Required: Internal Medicine Residency and Cardiovascular Fellowship
U.S. Citizenship Required: US Citizen, Permanent Residents/Green Card Holder, and J1 Visa

For further information about the application process and requirements, interested applicants can go to:
https://jacksonhealth.org/graduate/advanced-heart-failure/

 

Interventional Cardiology


The Interventional Cardiovascular Training Program at Jackson Memorial Hospital in affiliation with Miami VA Medical Center and University of Miami Hospital has been designed according to the specifications of the Accreditation Council for Graduate Medical Education- Special Requirements for Training Programs in Interventional Cardiovascular Diseases.

Educational Program

The educational goal of this 12-month fellowship program is to prepare its trainees to function at a high level of clinical performance in interventional cardiology. This includes the development of appropriate clinical judgment in selecting patients for cardiac interventional procedures and a high level of technical skill in performing them. This overall goal has four components:

  • To understand the effectiveness and limitations of coronary interventional procedures in order to select patients and procedure types appropriately
  • To achieve the appropriate cognitive knowledge and technical skills needed to perform interventional cardiac procedures at the level of quality attainable through the present state of the art
  • To foster an attitude of life-long learning and critical thinking skills needed to gain from experience and incorporate new developments
  • To understand and commit to quality assessment and improvement in procedure performance

To achieve these goals, the clinical training program is competency-based, and follows all ACGME rules and guidelines. The educational program is directed towards and fulfills all of the ACGME Program Requirements for Fellowship Education in the Subspecialties of Internal Medicine and the Program for Added Qualifications in Interventional Cardiovascular Disease. Fellows are expected to participate in clinical, basic, or health services research.

Faculty

There are at least 6 key interventional Cardiology faculty members who come in contact with the three interventional fellows throughout their training. They are led by Dr. Alexandre Ferreira, Director of the Interventional Program. The additional faculty the fellows will rotate with include:

Program Director:

  • Alexandre C. Ferreira, MD
    Director, Interventional Fellowship Program
    Site Supervisor, Jackson Memorial Hospital
    Voluntary Professor of Medicine, University of Miami Miller School of Medicine

Core Faculty:

  • Eduardo de Marchena, MD
    Site Supervisor, Interventional Program at the University of Miami Hospital
    Director, UM Interventional Cardiology
    Professor of Medicine and Surgery
  • Alan Schob, MD
    Site Supervisor, Interventional Program at the VA Medical Center
    Professor of Medicine, University of Miami Miller School of Medicine
  • Carlos E. Alfonso, MD
    Director, Cardiovascular Fellowship Program
    Associate Professor of Clinical Medicine, University of Miami
  • Mauricio G Cohen, MD
    Professor of Clinical Medicine
    Director, University of Miami Hospital & Clinics, UHealth Towers Cardiac Catheterization Lab University of Miami Miller School of Medicine
  • Michael D Dyal, MD
    Assistant Professor of Clinical Medicine, University of Miami
  • Claudia Martinez, MD
    Associate Professor of Clinical Medicine
    University of Miami Miller School of Medicine
  • Cesar Mendoza, MD
    Medical Director, JHS Cardiology
    Jackson Health System, Jackson Main Hospital

Program Coordinator:

ACGME Accredited: Yes
Residents or Fellows per year: Three
Duration: One Year
Postgraduate Training Required: Internal Medicine Residency and Cardiovascular Fellowship
U.S. Citizenship Required: No

For further information about the application process and requirements, interested applicants can go to:
https://jacksonhealth.org/graduate/interventional-cardiology/

Interventional Cardiology (Structural Heart disease) – (non-ACGME accredited)

The International Interventional Structural Heart Disease Fellowship Program at the University of Miami/Jackson Memorial Hospital (UM/JMH) is directed by Eduardo de Marchena, MD with the support of Drs. Mauricio Cohen, Carlos Alfonso, Michael Dyal, Alan Schob, Cesar Mendoza, and Alexander Ferreira. The fellowship is comprised of a one-year program, which functions as an integral component of the subspecialty programs in cardiology, interventional cardiology and the categorical residency program in internal medicine. The program is designed to provide training in structural heart disease procedures for fellows with prior cardiac catheterization and interventional cardiology experience. Candidates for the International Interventional International Interventional Structural Heart Disease Fellowship Program should be highly qualified physicians with a minimum of 12 months’ experience in cardiac catheterization and coronary angiography find out more about air conditioning installation ashland va. Training focuses on the comprehensive acute, chronic and preventive care of adults, with adults with heart disease being defined as anyone over the age of sixteen. The goal of training in structural heart disease Interventions is to provide physicians with a broad perspective in the care of the adult patient with complex structural heart disease.

During the year of interventional structural heart disease training, fellows are expected to master the risks, techniques and indications of structural heart disease practice. They will be expected to develop the judgment and experience necessary to select patients and function as independent operators during interventional procedures in patients with a wide variety of structural heart disease including adults with congenital heart disease.

It is our anticipation that the number of structural heart disease interventions performed by each fellow will be sufficient to achieve expertise and procedural independence while in the program. Fellows’ will be primary operators in the majority of these cases.

A major component of the fellowship will involve the performance of procedures in the adult cardiac catheterization laboratories. The UM/JMH comprise two centers with state-of-the-art high-resolution digital fluoroscopy units, which are networked throughout the hospital. A wide variety of diagnostic and interventional procedures are performed in these laboratories.

The fellow will be expected to master the risks, techniques and indications of the following procedures:

  • Transseptal left heart catheterization
  • ASD/PFO closure
  • Alcohol septal ablation
  • LAA exclusion
  • Interventions in congenital heart diseases
  • Percutaneous aortic balloon valvuloplasty
  • Percutaneous aortic valve replacement
  • Percutaneous mitral balloon Valvuloplasty
  • Percutaneous mitral valve repair
  • Percutaneous paravalvular leak closure
  • Miscellaneous (pericardial window, LV punctures, snares)

ACGME Accredited: No
Residents or Fellows per year: 1
Duration: 1 Year
Postgraduate Training Required:
1. Graduate of an ACGME-accredited Interventional Cardiology Fellowship Program
2. Graduate of an ACGME-accredited Cardiovascular Disease Fellowship Program
3. Graduate of an ACGME-accredited Internal Medicine Residency Program
U.S. Citizenship Required: US citizen, US Permanent Resident/Green Card Holder, and J-1 visa

For further information about the application process and requirements, interested applicants can go to:
https://jacksonhealth.org/graduate/international-interventional-structural-heart-disease/