Training in structural heart interventions.

O ver the last decade, there have been tremendous advances in our ability to treat valvular heart disease and anatomic cardiac defects utilizing catheter-based approaches. At the same time, the number of patients with acquired valvular heart disease or adult congenital heart disease who may benefit from these procedures has grown at a rapid pace—and will continue to grow with the aging population. These rapidly progressing structural heart interventions include transcatheter aortic valve replacement, percutaneous mitral valve repair, septal defect closures, shunt interventions, paravalvular leak closures, balloon aortic valvuloplasty, and left atrial appendage closure. As a result, there is an immediate and growing need for operators trained in these highly complex procedures. Although the curriculum for Accreditation Council for Graduate Medical Education (ACGME) programs, providing training in coronary and peripheral interventions, is well defined with set expectations, there are no ACGMEaccredited training programs for structural heart disease in the country. Therefore, there are unique challenges and opportunities facing both the trainees seeking structural heart disease training as well as the programs establishing dedicated structural interventional fellowships. Some of the challenges currently facing those seeking structural heart disease training include variable volume of the procedures performed; senior operators with limited experience with novel technologies and procedures; new devices being limited to patients enrolled in clinical trials, and therefore, restrictions on who can implant those devices; and a small number of centers experienced enough in these procedures to provide adequate training (1,2).