In October 2023, the American Board of Anesthesiology (ABA) administered the first-ever Adult Cardiac Anesthesiology (ACA) board examination, marking a historic milestone in subspecialty certification. This credential formally recognizes anesthesiologists with advanced training in the perioperative care of patients undergoing complex cardiac surgery and transcatheter interventions.

To meet this new national standard, candidates must complete an ACGME-accredited fellowship and demonstrate advanced clinical expertise in cardiopulmonary bypass, transesophageal echocardiography (TEE), and cardiovascular physiology.

In response, Montefiore’s Adult Cardiothoracic Anesthesiology Fellowship Program launched a strategic curriculum overhaul to ensure graduates are equipped for board success and long-term clinical excellence. The Montefiore Adult Cardiothoracic Anesthesiology Fellowship is a one-year, ACGME-accredited program that accepts four fellows annually. Fellows are immersed in high-volume, high-acuity care, with exposure to open-heart and complex valve surgeries, heart transplantation, structural heart interventions, mechanical circulatory support, and complex aortic procedures.

Led by Drs. Kumar Vivek and Claire Joseph, fellowship program director and associate program director, respectively, with leadership from Cardiac Anesthesia Division Director Dr. Peter Von Homeyer, the Adult Cardiothoracic Anesthesiology Fellowship at Montefiore continues to grow in both scope and depth. The program offers an exceptional training experience rooted in clinical excellence, advanced technology, and multidisciplinary collaboration.

Curriculum Innovations: Focused, Multidisciplinary, Exam-Driven

In 2023, Montefiore’s Cardiac Anesthesiology Division faculty were among the first anesthesiologists in the country to sit for the inaugural ACA board exam. In redesigning the curriculum for the ACTA Fellowship Program, faculty aimed to ensure that both didactics and bedside learning prepared fellows for exam success.

“I am proud of how our fellowship curriculum has evolved over the last year, thanks in large part to the efforts of Dr. Claire Joseph,” Dr. Vivek said. “By involving Cardiothoracic Surgery, Interventional Cardiology, Electrophysiology, and Critical Care Medicine in our fellows’ lectures, we are able to more effectively prepare them for their futures as attending cardiac anesthesiologists.”

In 2025, the Division of Cardiothoracic Anesthesiology introduced a new didactic curriculum aligned with the ACA exam blueprint. Weekly lectures feature cardiothoracic anesthesiology faculty and multidisciplinary experts covering topics such as mechanical circulatory support, interventional cardiology, electrophysiology, coronary revascularization, and pediatric and congenital cardiac surgery. This cross-specialty collaboration ensures fellows gain not only anesthesia-specific knowledge, but also broader procedural and clinical decision-making insight.

“Cardiology procedures can be quite complex, and we are serving an often severely ill population with advanced age, which makes it crucial to have a strong understanding of the procedures performed,” Dr. Von Homeyer explained. “Our cardiology faculty’s input into the didactics is invaluable as these procedures become increasingly common in cardiac anesthesia practice.”

Fellows also receive comprehensive preparation for the Advanced Perioperative TEE Examination administered by the National Board of Echocardiography (NBE). Through extensive intraoperative exposure, image review sessions, and formal instruction, fellows graduate confident and qualified in perioperative echocardiography.

“The attendings take pride in teaching us and are very approachable, especially with learning echocardiography,” said current fellow Dr. Patrick Kiendrebeogo. “They take time to answer our questions and create a supportive learning atmosphere.”

Additionally, the Division of Cardiac Anesthesia has launched a new initiative to expand training in electrophysiology anesthesia for procedures such as the Watchman device. This initiative includes comprehensive instruction in patient management and the development of quality improvement projects aimed at long-term enhancements in patient care.

Expanded Clinical Exposure: Innovation, Complexity, and the Future

The demand for fellowship-trained cardiac anesthesiologists is expected to rise steadily, driven by demographic shifts and rapid innovation in cardiovascular medicine. As life expectancy increases, so does the population of patients with chronic cardiac conditions, multiple comorbidities, and complex surgical histories.

A notable shift is the growing adult congenital heart disease (ACHD) population, resulting from improved survival into adulthood for patients with previously fatal cardiac anomalies. These patients require highly individualized perioperative care involving re-operations, complex physiology, and multidisciplinary planning, areas in which cardiac anesthesiologists play a critical role.

The proliferation of transcatheter and hybrid cardiovascular procedures, including TAVR, MitraClip, left atrial appendage occlusion, and percutaneous ventricular assist devices, has introduced a new level of procedural complexity. Cardiac anesthesiologists trained in perioperative echocardiography, hemodynamic modulation, and mechanical support are uniquely equipped to manage this evolving landscape.

To reflect these changes, Montefiore Einstein’s ACTA Fellowship has expanded its clinical portfolio and rotation structure. Fellows now receive training in left atrial appendage occlusion device placement with real-time TEE guidance and manage a wide spectrum of mechanical circulatory support, including ECMO, Impella, and novel devices such as the BrioVAD.

Fellows also complete a thoracic anesthesia rotation at Weiler Hospital, focusing on cases requiring one-lung ventilation, including pulmonary resections and lung transplants. Additional elective opportunities include perfusion, advanced TEE, and pediatric cardiac surgery. As the Children’s Hospital at Montefiore’s Pediatric Cardiac Surgery Program expands, fellows gain extensive experience caring for the growing ACHD population.

The ACTA Fellowship Program also emphasizes immersive, hands-on multidisciplinary education beyond the operating room. Fellows participate in joint wet labs with cardiothoracic surgery fellows, including porcine heart dissections, as well as high-fidelity simulation workshops focused on vascular access, intraoperative crisis management, and temporary pacemaker and ICD placement. These sessions strengthen technical skills, team communication, and preparedness for complex perioperative scenarios.

Meet the Fellowship Class of 2026

The ACTA Fellowship Class of 2026 exemplifies the diversity, clinical excellence, and commitment to patient care that define the program. Fellows come from leading institutions around the world and bring unique perspectives to the Division of Cardiothoracic Anesthesiology.

“No matter where you go for fellowship, you will learn cardiac anesthesia,” said Dr. Emily Chung. “What I appreciate about Montefiore is that I am learning while also enjoying my time here. The people I work with truly make the difference.”

Looking Ahead

As interest in the program continues to grow, the Division of Cardiothoracic Anesthesiology proudly announces that for the Class of 2027, three outstanding internal candidates successfully matched: Dr. Danielle Nogoy, Dr. Yair Miller, and Dr. Yitzchak Dayan. This strong internal match reflects the quality of training, mentorship culture, and inspiration provided by current fellows.

In addition, Dr. Shaopeng Huang, a graduate of the 2025 ACTA Fellowship class, joined the Montefiore Einstein Department of Anesthesiology as a faculty member in August 2025.

Montefiore Einstein remains at the forefront of adult cardiac anesthesiology training. Through faculty leadership, multidisciplinary collaboration, and expanding clinical offerings, the Department of Anesthesiology continues to prepare the next generation of board-certified cardiac anesthesiologists to meet the demands of modern cardiothoracic care.