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Cardiac Anesthesia Fellowship

Program Director, Dr. Hilda Alfaro

The Department of Anesthesia and Perioperative Medicine at Western University offers a one-year, Clinical Cardiac Anesthesia Fellowship based at London Health Sciences Centre in London Ontario Canada. 

We offer 5 cardiac anesthesia fellowship positions each year.

Our Cardiac Anesthesia Fellowship prepares fellows for independent practice by providing an opportunity to develop skills in clinical care, judgment, teaching, and research. The strength of our educational program results from a highly motivated team of cardiac anesthetists, a comprehensive didactic teaching program, and a very busy cardiac surgery service.

Each year, we perform approximately 1,400 cardiac surgical procedures utilizing cardiopulmonary bypass.

Our center is a national leader in minimally invasive/robotic coronary artery bypass grafting and mitral valve repair surgery. We were the 1st center in North America to have a hybrid operating room. Our list of minimally invasive procedures includes:

We also offer a broad based clinical experience including:

Our division performs transesophageal echocardiograms (TEE) for almost all cardiac cases performed, and our training program emphasizes training of fellows in this procedure. All of our cardiac anesthesia attending staff are certified by the National Board of Echocardiography to perform perioperative TEE. All of our previous fellows who have completed our cardiac anesthesia fellowship program have passed the perioperative TEE exam on the first attempt.

Our goal for the fellowship is to train and mentor future cardiac anesthetists to excel clinically, and in the fields of education and research.  We are committed to providing the highest quality experience and education for each of our fellows.

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Fellowship Structure

Eligibility for Canadian and Foreign Medical Graduates

Educational Activities

The fellow will be required to attend and participate in the following formal educational events:


The fellow will be required to participate in the following teaching activities:

Goals and Objectives

Medical Expert

  • The Cardiac Anesthesiologist must have developed an appreciation of all aspects of perioperative medical management for cardiac surgery patients. This includes an understanding of cardiac physiology, influence of anesthetic agents and techniques on the cardiac and vascular systems, and the impact of cardiac pathology on physiology and pharmacology.
  • By the end of the fellowship the fellow will be able to:
    • Describe and independently manage the physiologic changes occurring during cardiac surgery and cardiopulmonary bypass.
    • Interpret
      • Invasive and non-invasive cardiac diagnostic tests
      • Cardiac catheterization studies
      • Arterial and venous blood gases
      • Data from intravascular monitoring devices
    • Perform and interpret TEE in accordance with the guidelines of the National Board of Echocardiography
    • Perform preoperative patient assessments and develop management strategies with a view to risk stratification and management, medical optimization, anesthetic and postoperative planning.
    • Manage high-risk surgical patients in the intraoperative and immediate postoperative period.
    • Provide in-hospital anesthetic consultation for high risk patients.
    • Describe the options available for postoperative analgesia, their advantages and disadvantages, including multimodal analgesia and select appropriate therapies for individual patients.
    • Identify, investigate and manage important postoperative complications occurring in the cardiac ICU or step-down.
    • Provide pharmacologic and non-pharmacologic support of the circulation
    • Provide mechanical support of ventilation in the OR and in the ICU.
    • Achieve and manage lung isolation using a variety of techniques, including fibre optic bronchoscopy.
    • Manage patients and populations with the following specific conditions, taking into account the epidemiology, clinical presentation and physiology:
      • Ischemic heart disease
      • Cardiomyopathies
      • Cardiac masses
      • Pericardial disease
      • Tamponade
      • Heart transplantation
      • Thoracic aortic disease
    • Independently manage patients with the following devices and procedures for initiation and for ongoing care
      • Cardiac pacing and cardioversion and defibrillators
      • Cardiac assist devices
      • Minimally invasive cardiac procedures
      • Transcatheter aortic valve
      • Intraortic balloon counterpulsation
      • ECMO
      • Deep Hypothermic circulatory arrest


  • The cardiac anesthesiologist must work in a team environment, communicating and cooperating with surgeons, nurses, perfusionists, pharmacists, and others.
  • By the end of the fellowship the fellow will be able to:
    • Appreciate the roles of other members of the care team.
    • Communicate clearly in a collegial manner that facilitates the achievement of care goals.
    • Promote the sharing of important perioperative information with the medical team to enhance the care of, and identify high-risk patients at various stages of the perioperative course.
    • Hand over the care of a patient to other health care professionals to ensure the continuity of safe patient care.


  • The cardiac anesthesiologist must possess an awareness of the logistical constraints of delivery of health care and be able to propose useful and creative solutions to optimize care. The financial impact of perioperative management strategies must be understood.
  • By the end of the fellowship the fellow will be able to:
    • Contribute to the improvement of health care delivery within the team and organization.
    • Outline the structure of perioperative medical care, and how it fits in the administrative structure of the care setting.
    • Discuss the advantages and disadvantages of alternative models of care.
    • Explain the costs incurred by perioperative management strategies.
    • Discuss the potential savings in health care expenditure offered by perioperative medical interventions.

Health Advocate

  • The Cardiac anesthesiologist must respond to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment. They must also understand both the benefits and deficiencies of care at the system level such that they can contribute maximally to patient care.
  • By the end of the fellowship the fellow will be able to:
    • Identify the potential costs and benefits of new and existing strategies
    • Delineate the obstacles to delivery of perioperative medical care
    • Contribute to the development of solutions to the obstacles, and to the expansion of the perioperative options in the care setting
    • Discuss the societal impact of the medical intervention and the perioperative period


  • The Cardiac anesthesiologist must engage in the continuous learning regarding ongoing developments in the literature on perioperative cardiac care, and be able to appropriately incorporate them into practice. The conduct of perioperative medical research, and in particular outcomes based research, must be understood. They must also engage in teaching of students, residents, other health care professionals and the public.
  • By the end of the fellowship the fellow will be able to:
    • Read and critique publications about perioperative medicine.
    • Integrate best available evidence into practice
    • Contribute to the creation and dissemination of knowledge and practices applicable to perioperative care
    • Contribute to the design of studies on perioperative outcomes and management.


  • The Cardiac anesthesiologist must continuously conduct the practice of medicine with integrity, honesty, and accountability
  • Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards
  • Demonstrate a commitment to ethical principles in providing care, obtaining informed consent, and maintaining patient confidentiality
  • Demonstrate a commitment to society by recognizing and responding to societal expectations in health care
  • Demonstrate a commitment to the profession by adhering to standards and participating in physician-based regulation


The Fellowship Director for Cardiac Anesthesia will provide face-to-face feedback to fellows at 3 month intervals. The feedback will be based on:

    1. Cardiac anesthesia cases performed
    2. TEEs performed and interpreted

The fellow in Cardiac Anesthesia is expected to successfully complete the National Board of Echocardiography Advanced PTeXAM and acquire certification at the end of their fellowship year.

Click here to view recent publications from the cardiac team

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