|Observe and interpret CPX||5 (observe)|
|Perform and interpret right heart catheterization||50 (of which at least 30 should be pretransplantation)|
|Perform and interpret pulmonary vasodilator challenge in pulmonary hypertension†||5|
|Interrogate ICDs and CRT devices||20/20 (or document comparable training during general cardiology fellowship and review 3 ICD and 3 CRT interrogations with an EP attending who attests to the competency expected of AHFTC physicians)|
|Observe implantation of VADs||3|
|Perform and interpret VAD interrogation||10|
|Oversee the medical care, including anticoagulation and VAD speed setting, of LVAD recipients||15 (of which 5 must be during index hospitalization of LVAD implantation)|
|Perform and interpret LVAD ramp procedures†||10|
|Observe procurement of donor organs||3|
|Observe cardiac transplant surgery||3|
|Oversee the medical care, including immunosuppressive regimen, of a cardiac transplant recipient||30 (of which 5 must be during index transplant hospitalization)|
|Perform endomyocardial biopsies, femoral access||5|
|Perform endomyocardial biopsies, internal jugular access||45|
|Review endomyocardial specimens, with a range of pathology, in collaboration with a pathologist||20|
|Interpret the severity of CAV from a coronary angiogram utilizing the ISHLT Cardiac Allograft Vasculopathy Grading scale||10|
|Participate in end-of-life and/or palliative care discussions||10|
AHFTC = advanced heart failure and transplant cardiology; CAV = cardiac allograft vasculopathy; CPX = cardiopulmonary exercise testing; CRT = cardiac resynchronization therapy; EP = electrophysiology; ICD = implantable cardioverter-defibrillator; ISHLT = International Society for Heart & Lung Transplantation; LVAD = left ventricular assist device; and VAD = ventricular assist device.
↵∗ Recommendations for number of procedures required are based on consensus recommendations and indicate numbers that should be performed and/or interpreted successfully to achieve competence. These numbers are intended as general guidance, based on the educational needs and progress of typical AHFTC trainees. Competency to perform each procedure must be based on evaluation by the supervising physician and may exceed or be below the threshold number shown in Table 2.
↵† Acquired during additional months beyond a dedicated 12-month advanced heart failure/transplant fellowship.