Terumo Aortic Fellow

INTRODUCTION The Thoracic Aortic Aneurysm Service at Liverpool Heart and Chest Hospital is one of the busiest specialist thoracic aortic services in the UK providing comprehensive care for patients with complex aortic disease. Six cardiac surgeons with a specialist interest in thoracic aortic surgery operate on more than 300 patients per year. At the centre of the service is the Aneurysm Clinic which has well over 3000 operated patients under follow-up and another 1000 under surveillance. Patients are discussed at a weekly multidisciplinary team (MDT) meeting which includes cardiac surgeons, vascular surgeons, intensivists and physicians ensuring appropriate bespoke patient centred care.

Facilities include a specialist hybrid theatre allowing hybrid procedures using stents and conventional surgery. A 24/7 specialist aortic on-call service is available 365 days per year. The service is integrated with Vascular Surgery in the form of Liverpool Cardiovascular Surgery (LCS) with weekly open and endovascular intervention by vascular surgeons. Joint weekly clinics are scheduled for complex intervention.

The service is supported by two Aortic ANPs and Aortic Administrator. We are also involved in research and innovation through collaboration with The University of Liverpool. Training is important to us and we have had a succession of aortic fellows from around the UK and the world, with both cardiac and vascular backgrounds, who have spent time with our team. In a recent review of the last 5 years of training, Type A dissection repairs were done by trainees.

Patients are supported by a specialist Aortic Nurse Practitioner. We have a Proximal Aortic Fellow and a Distal Aortic Fellow, one supported by Terumo and one by Artivion. If possible new fellows start as a Proximal Fellow focusing on root and arch surgery, then transitioning to the Distal Fellowship, for thoracoabdominal aortic surgery experience. The distal fellow works closely with our Vascular colleagues.

The post is initially for 6 months extendable to 12 months after review and mutual agreement. There is no commitment to general cardiac / thoracic surgical duties or to the on call rota for middle grade surgeons. The focus will be on complex proximal aortic surgery from root to total arch, and where opportunity allows, thoracoabdominal intervention. Funding: The Fellowship is funded by Terumo at £35K per year and an additional supplement by LHCH.

There will be a deduction of basic rate of income tax from this amount at source. Experience offered dependent on background: Operating: To provide: 1) First operator experience of proximal thoracic aortic surgery including root replacement, proximal arch and total arch surgery, including emergencies 2) Experience of the management of thoracoabdominal aortic disease, and dependent on experience, duration of fellowship and opportunity, progression to operative experience. Critical Care: 1) Experience of managing patients in the critical area including MEP and spinal drains Ward Care: 1) Experience of managing aortic patients on the ward Outpatient: 1) Experience of assessing new patients including patients undergoing staged procedures as well as surveillance and post operative follow-up. MDT: 1) Experience of presenting and discussing complex aortic cases in a multidisciplinary forum.

**On-call dependent on background**: 1) First on-call experience for all urgent and emergency referrals. No commitment to general junior on-call system. The exact arrangements depend on experience and background on the two fellows. Audit and research: 1) Opportunities to engage in routine audit of clinical practice and be involved in research projects.

**Commitments and responsibilities (Example)**: Monday All Day Theatre including TAAA list Tuesday All Day Theatre including TAAA list Wednesday 0815-0900 Weekly Regional MDT (Distal Fellow) Presentation of cases and provisional plans. 0800-1200 (Proximal Fellow) 1) Clinic scrutiny for following week including a patient-by-patient review confirming imaging and a plan. 2) Admin / Discharge paperwork / database completion. 0800-1200 (Distal Fellow) 1) Liverpool Cardiovascular Service Clinic.

**Priorities in theatre**: Where possible the aortic fellow will have priority over in-house SpRs as operating surgeon or first assistant however compromise may be required to meet the needs of our SpRs with some cases performed by SpRs in part or whole. Learning agreements: At the start of the fellowship a formal learning agreement will be written up based on experience and interests Contacts Mr Field and Mr Kuduvalli Liverpool Heart and Chest Hospital NHS Trust Thomas Drive Liverpool, L14 3PE Telephone (0151) 228 1616 The Trust is committed to approaching the control of risks in a strategic and organised manner. The postholder must be aware of their individual responsibilities as detailed in the Trusts Risk Management, Health & Safety and Incident policies, and those under the Health and S