Operative Case Criteria for Two-Year Fellowships

As of 2023, all candidates for Congenital Cardiac Surgery subspecialty certification are 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 are effective for congenital fellows 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 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):

Index Cases

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 Fellowships

The Board’s operative experience requirements include performance of a minimum of seventy-five (75) major pediatric congenital cardiac open operative procedures as primary surgeon during each 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 per year of the specified number for the following cases for credit toward the requirement of 75 major congenital cases each year:

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 RC-TS protects the patient, for whom the faculty surgeon has the ultimate responsibility. This supervised experience optimally prepares the candidate to begin the independent practice of Congenital Cardiac Surgery after the completion of fellowship training. The evaluation of the candidate by the surgical faculty validates such preparation.

The ABTS Congenital Cardiac Surgery (CCS) Credentials Committee is authorized by the Board to reject a candidate if the operative experience during the Congenital Cardiac Surgery fellowship is considered inadequate in volume and/or distribution. The candidate, the Program Director, and the RRC will be notified if such action is taken. If the CCS Credentials Committee finds the applicant’s operative experience inadequate and additional training is required, any such additional training must be approved by the Board in advance of undertaking such training. If the Program Director determines that a fellow needs additional training beyond the ACGME-approved period before a candidate’s application is submitted, this additional training must also be approved in advance by the Board.

Even though emphasis on one or another facet of Congenital Cardiac Surgery may have characterized a candidate’s fellowship experience, the candidate is nevertheless held accountable for knowledge concerning all areas and 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 setting. This requires an understanding of cardiorespiratory physiology, respirators, blood gases, metabolic alterations, cardiac output, extracorporeal membrane oxygenation, hyperalimentation, and many other areas. By virtue of the fellowship training in Congenital Cardiac Surgery, the candidate is expected to be knowledgeable in the surgical care of critically ill pediatric and adult patients and the critical care of surgical patients.

For the full details of the Congenital Initial Certification process, refer to the Congenital Cardiac Surgery Booklet of Information.