Index Case Requirements for Two-Year Residencies

Beginning in 2023, all candidates for Congenital Heart Surgery subspecialty certification will be required to complete 2 consecutive years of ACGME training in a single program and complete 150 major cases, with a minimum of 50 major cases in the first year of training. These requirements will be effective for congenital residents who started their training on or after July 1, 2023. 
The Board’s operative experience requirements include performance of a minimum of 150 major pediatric congenital cardiac open operative procedures over a 2-year period, with a minimum of fifty (50) cases as primary surgeon in the first year (the first 12-month period) of fellowship. 

Operative experience must include at least the following minimum numbers of index cases during the total course of fellowship training (within 2 years):

10  Ventricular septal defect repairs
  8  Atrioventricular septal defect repairs (minimum of 4 complete required)
  8  Tetralogy of Fallot repairs
  8  Aortic arch reconstruction/coarctation repair (minimum of 3 via median sternotomy)
  3  Systemic-to-pulmonary artery shunt procedures
  8  Arterial switch, Norwood, Damus-Kaye-Stansel, common arterial trunk repairs [any combination to a total of at least 8]
  5  Bidirectional Glenn/hemi-Fontan procedures
  5  Fontan procedures
  4  Anomalous pulmonary venous connection (minimum of 1 Total Anomalous Pulmonary Venous Connection repair) procedures 
  3  Pulmonary artery banding procedures
  3  Vascular ring procedures
  3  Coronary artery procedures
  8  Re-operative procedures in patients older than 5 years of age (independent of the above index cases)

In order to ensure an appropriately diverse distribution of cases, the applicant’s case log cannot exceed a maximum of the specified number for the following cases for credit toward the requirement of 150 cases in a 2-year timeframe:
10  Secundum atrial septal defect and/or patent foramen ovale closure procedures
  5  Patent ductus arteriosus ligation and/or division procedures
  8  Right ventricle-to-pulmonary artery conduit replacement procedures
  8  Pulmonary valve repair/replacement procedures (w/ or w/o transannular patch)
  8  Other valve repair/replacement procedures (patients 18 years of age or under, only) 

Index Case Requirements for One-Year Residencies

The Board’s operative experience requirements for applicants in a one-year residency include the performance of a minimum of seventy-five (75) major pediatric congenital cardiac open operative procedures as primary sur­geon during the twelve (12) month period of fellowship training. Operative experience must include at least the following minimum numbers of index cases:

5 Ventricular septal defect repairs
5 Atrioventricular septal defect repairs
4 Tetralogy of Fallot repairs
4 Aortic arch reconstruction (including coarctation) procedures
3 Systemic-to-pulmonary artery shunt procedures
5 Arterial switch, Norwood, Damus-Kaye-Stansel, truncus arteriosus repairs [any combination to a total of at least 5] 
5 Bidirectional Glenn/hemi-Fontan and/or Fontan procedures [any combination to a total of at least 5]
5 Reoperative procedures (includes adult congenital disease reoperation)


In order to ensure an appropriately diverse distribution of cases, the applicant’s case log cannot exceed a maximum of the specified number for the following cases for credit among the 75 major congenital cases:

5 Secundum atrial septal defect and/or patent foramen ovale closure procedures 
5 Patent ductus arteriosus ligation and/or division procedures
5 Pulmonary artery banding procedures
5 Right ventricle-to-pulmonary artery conduit insertion/replacement procedures
5 Pulmonary valve replacement procedures
5 Other valve repair or replacement (patients 18 years of age or under, only)

Instructions: 

All residents are required to use the application and operative logs forms on the Board application. Operative case logs required for application for certification by the ABTS must be entered in the ABTS format; ACGME logs do not satisfy this requirement. You will be asked to enter the following information directly into the ABTS database:Hospital/Institution Name

  • Procedure Date
  • Patient Age (and units)
  • Institution Case ID (your non-PII identifier)
  • Diagnosis
  • Faculty Supervisor
  • Outcomes (30-day)
  • Operation or Procedure (you will select from the ABTS dropdown list)
The application of a candidate whose operative experience does not include the required number of index cases as listed will be sent to the CHS Credentials Committee for review. Additional training time may be necessary for the candidate to meet the surgical case distribution requirement.


The Board recognizes that supervised operative experience in a well-organized teaching setting that is approved by the RRC protects the patient, who is the ultimate responsibility of a faculty surgeon. This supervised experience optimally prepares the candidate to begin the independent practice of congenital heart surgery after the completion of residency training. The evaluation of the candidate by the surgical faculty validates such preparation.

The ABTS CHS Credentials Committee is authorized by the Board to reject a candidate if the operative experience during the congenital heart surgery residency is considered to be inadequate in volume and/or intensity depth and/or breadth. The candidate, the Program Director, and the RRC will be notified if such action is taken. If the Credentials Committee finds the applicant's operative experience inadequate and additional training is required, the additional training must be approved by the Board in advance of undertaking such training. Should the Program Director determine that a resident needs additional training beyond the twelve (12) months that has been approved by the ACGME and the RRC-TS before submitting a candidate’s application, this additional training must also be approved by the Board in advance.

Even though emphasis on one or another facet of congenital heart surgery may have characterized a candidate's residency experience, the candidate is nevertheless held accountable for knowledge concerning all phases of the field. The candidate should also have an in depth knowledge of the management of acutely ill patients age 18 and under in an intensive care unit. This requires an understanding of cardiorespiratory physiology, respirators, blood gases, metabolic alterations, cardiac output, hyperalimentation, and many other areas. By virtue of the residency training in congenital heart surgery, the candidate is expected to be knowledgeable in the surgical care of critically ill patients and the critical care of surgical patients.

For the full details of the Congenital Initial Certification process, refer to the Congenital Booklet of Information on the ABTS homepage at www.abts.org.