Training in structural heart disease: a fellow’s perspective

When Andreas Gruentzig started an interventional cardiology fellowship in 1980, it is unlikely that he fully anticipated the exponential growth of the field over the next several decades. The spark that he created with the first coronary balloon angioplasty in 1977 ignited a wildfire which has led to the development of myriad catheter-based technologies for cardiac conditions that traditionally require open-heart surgery. Alain Cribier added fuel to the fire when he performed the first transcatheter aortic valve replacement (TAVR) in 2002, triggering the arms race to develop the technology to treat valvular and structural heart defects with catheter-based systems. In the last decade, the burgeoning field of structural heart disease (SHD) has necessitated the development of formal training programs to provide adequate exposure and ensure competence for fellows-in-training. However, as the field of SHD grows at an exponential pace, there continues to be a lack of standardization across training programs. Additionally, for the fellow-in-training, there are a number of factors to consider when deciding whether to pursue a dedicated year of SHD training.