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Travelling Fellowship:
A year in Sunnybrook Bao Nguyen PhD FRCS, Clinical Fellow in Cardiac Surgery and Transcatheter Therapy - Toronto, Canada
“Y
ou are accepted” was how the correspondence reply began in April 2016. Of course, I was delighted to accept! And with that, the process of navigating College licensing and credentialing began in earnest with medicals for work permits and obligatory criminal record checks as one would anticipate for an international posting. I went out on my fellowship experience prior to obtaining CCT and the position was prospectively approved by the GMC, with support from the JCST. The administration was completed a year later in the summer of 2017 and I was ready to travel to Canada’s most populous city, Toronto, in the province of Ontario, to join the division of Cardiac Surgery at Sunnybrook Hospital. This is a large tertiary-referral centre located in the leafy suburbs of mid-town Toronto and is a major teaching hospital of the University of Toronto. Sunnybrook is Canada’s largest trauma centre with 1300 beds and is an established veteran’s hospital and home to the Schulich heart centre. The Cardiac Surgery division within is productive and active, staffed by 4 surgeons, and is home to the largest TAVI program in Ontario run in conjunction with an excellent structural heart Cardiology service.
During the latter years of my training in the United Kingdom I developed an interest in aortic surgery and the management of valvular heart disease. This Cardiac surgery and Transcatheter Therapy Fellowship allowed the opportunity to pursue a rounded operative experience complemented by training in structural heart disease. Whilst working in the surgical division, I provided a 1:4 on-call
From a clinical perspective, I undertook this fellowship to develop specialisation in an area of cardiac surgery that I believe the United Kingdom will need in the long term: collaborative expertise in the totality of management of aortic and complex valvular heart disease. Surgical training needs additional focus on and the ability to deliver percutaneous treatment with both practical experience in the catheterisation lab as well as in the operating theatre - a clinician with experience and common convergence of knowledge and skills. To date, at Sunnybrook under supervision, I have performed 92 open-heart procedures as the primary operator. This has included conventional as well as sutureless AVRs; on- and off-pump coronary artery surgical revascularisation as well as combined valve and grafts. In addition I have received training in a good range of more complex adult cardiac surgery with surgery for endocarditis; resection of cardiac tumours; redo cardiac surgery; major aortic procedures including aortic root and arch replacements; emergency surgery for aortic dissection; emergency surgery for trauma and ECMO support. From an interventional perspective I have participated and performed all aspects of the TAVI procedure alongside two highly-
“To date, at Sunnybrook under supervision, I have performed 92 open-heart procedures as the primary operator.” service with 2-3 days in the operating room and 1-2 days per week in the intervention suite, depending on service requirements and arrangements. The surgical expertise was provided by Professor Stephen Fremes who is the co-lead on TAVI with Dr Sam Radhakrishanan, cardiologist and director of the Cardiac Catheterisation Labs, alongside training with Dr Harindra Wijeysundera, interventional cardiologist with a specific interest in transcatheter aortic valve implantation and coronary chronic total occlusions.
