Dublin – Ireland

Interventional Fellowship – St James’s Hospital & Trinity College Dublin

Supervising Consultants: Dr P Crean (creansec@stjames.ie), Dr N Mulvihill

Overview

St James’s Hospital is a large university tertiary centre cardiology department associated with Trinity College Dublin.  It has a well established fellowship program with very experienced and internationally renowned interventionalists as trainers.  It also has a well established interventional educational programme and an active research output.  Dr Peter Crean is the Cath lab director and runs the interventional fellowship program with Dr Niall Mulvihill.

Interventional fellows can expect to perform a high volume of procedures (300-500 as first or solo operator) using a full range of interventional devices for managing complex patients.  Multiple interventional research projects are underway including single and multi-centre centre projects.  The successful applicant will be expected to undertake research projects during his/her time in Dublin leading to presentation and publication.

The cardiology department at St. James’s hospital comprises 5 full time consultants, 4 of whom are interventionalists. There are 5 Specialists registrars and 1 Interventional fellow, 3 SHOs and 2 HOs. The department has a full range of adult cardiac diagnostic and therapeutic services. The non invasive imaging includes stress echo, CT angiography and a dedicated research 3 Tesla MR scanner. There a 2 cath labs in the department.

We offer a 24 hour primary PCI service which is currently expanding to give access to regional referring hospitals. The majority of diagnostic and invasive procedures are performed by the transradial route. We use and integrated Volcano IVUS system in each lab and also use RADI pressure wire frequently. Our DES usage is in excess of 90%. We are a supra-regional referral centre for complex PCI.

In 2009 we commenced a TAVI program using the Medtronic Corevalve and are currently performing 2-3 cases per month, mostly transfemorally (occasional subclavian access) using light sedation only. We offer aortic and mitral balloon valvuloplasty in selected patients. We also treat PFOs and ASD percutaneously. There is a regional EP and device service.

The successful candidate will be in the cath lab 3 ½ days per week with one day spent in the cardiac research department. There is also a requirement to be involved in the registrar on call rota 2-3 nights per month.

Applications are invited form UK and Irish SpR in their final 2 years of training who are undertaking subspecialty training in Intervention.

Testimonial

Author & previous fellow: Dr Simon Hetherington (Simon.hetherington@kgh.nhs.uk)

St James’s Hospital is one of the largest tertiary referral centres in Ireland, and is based in the centre of Dublin, only a short distance from the St James’s Gate Guinness Brewery. There are five Interventional Cardiologists (including one visiting Cardiologist) working within the cardiology department, and EP, imaging and device implantation services are also provided to the region.

There are two cath labs running five days a week, and over 1500 PCI procedures are performed each year. You are the only Interventional Fellow, although there is always a clinical registrar timetabled to the other cath lab.

My weekly timetable consists of at least three and a half days in the lab each week (up to four and a half days), with my remaining time allocated to overseeing the department’s, and my own, clinical research activities. Your basic salary is supplemented by participation in the registrar oncall rota (at most 1 in 7 resident oncall rota, after 5 pm). You do not have any fixed in-patient or clinic commitments.

In the first six months of my fellowship I have performed over 200 first operator procedures and thus I expect to have performed over 400 cases by the end of the twelve months. The majority of procedures undertaken will be either first or solo operator, although there is ample supervision available if required, meaning the training is of high quality. You work with all the Interventionists and so are exposed to a wide variety of different practices and techniques. The majority of procedures are performed via transradial access.

As the department is a regional referral centre, a high proportion of cases are complex such as multivessel PCI, LMS intervention and CTO. In addition, you will have the opportunity to gain experience with novel devices and emerging technologies in PCI (for example, I was lucky enough to implant the first Capella Sideguard side branch protection stent in Ireland).

The hospital has an established CoreValve TAVI programme, with 25 devices implanted last year, and you can expect to be closely involved, gaining valuable experience in this technique. Primary PCI is provided on a 24 hour basis to the local population with rescue PCI provided to the regions.

The Dublin Interventional Fellowship thus provides excellent training opportunities in a wide range of practical skills that could be deemed essential to the aspiring Interventional Cardiologist. Your colleagues and staff are friendly and supportive, ensuring the whole Dublin experience can be enjoyed to its fullest. Ireland itself is a fantastic place to live, with ample countryside to explore, and culture to become immersed in. I cannot recommend it highly enough.