Table 2

Recommendations for Minimum Procedural Volume or Technical Experience to Achieve and Demonstrate Competence in AHFTC

Procedure/Technical SkillNumbers
Observe and interpret CPX5 (observe)
20 (interpret)
Perform and interpret right heart catheterization50 (of which at least 30 should be pretransplantation)
Perform and interpret pulmonary vasodilator challenge in pulmonary hypertension5
Interrogate ICDs and CRT devices20/20 (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 VADs3
Perform and interpret VAD interrogation10
Oversee the medical care, including anticoagulation and VAD speed setting, of LVAD recipients15 (of which 5 must be during index hospitalization of LVAD implantation)
Perform and interpret LVAD ramp procedures10
Observe procurement of donor organs3
Observe cardiac transplant surgery3
Oversee the medical care, including immunosuppressive regimen, of a cardiac transplant recipient30 (of which 5 must be during index transplant hospitalization)
Perform endomyocardial biopsies, femoral access5
Perform endomyocardial biopsies, internal jugular access45
Review endomyocardial specimens, with a range of pathology, in collaboration with a pathologist20
Interpret the severity of CAV from a coronary angiogram utilizing the ISHLT Cardiac Allograft Vasculopathy Grading scale10
Participate in end-of-life and/or palliative care discussions10

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.