Next year, the VCU College of Health Professions’ Department of Nurse Anesthesia will launch a graduate program in Cardiovascular Perfusion – the first of its kind in Virginia and one of just 22 nationwide.

The 20-month program will prepare students for one of the most specialized and critical roles in cardiac care: the cardiovascular perfusionist, who is responsible for operating the heart-lung machine during open-heart surgeries. The program has been approved by the State Council of Higher Education and the Southern Association of Colleges and Schools Commission on Colleges.

“Most people have no idea what a perfusionist does,” said Keith Pelletier, Ph.D., a certified clinical perfusionist with 15 years of experience and the newly appointed director of the program. “We’re the ones who take over the function of the heart and lungs when a patient’s heart is safely stopped during surgery. We keep them alive while the surgeon repairs a patient’s heart.”

As vital members of cardiac surgical teams, perfusionists not only control the flow of a patient’s blood and oxygen using a heart-lung machine, they also administer what’s known as cardioplegia. It’s a specialized potassium-heavy solution that safely stops the heart – and then following the completion of an often lifesaving surgery, helps the heart begin to pump blood again.

“There’s a lot of responsibility. We’re the only ones who can’t leave the room,” said Pelletier, noting the busy environment of operating rooms – as well as the rewards in caring for patients at critical moments. “If you're on bypass duty for 10 hours, you’re right there at the machine for 10 hours.”

In addition to cardiac surgery, perfusionists can manage ECMO (extracorporeal membrane oxygenation), a form of life support used in cases of severe heart or lung failure. Use of ECMO surged during the COVID-19 pandemic and remains in high demand.

Rigorous, real-world curriculum

VCU’s five-semester program will blend classroom instruction, simulation-based training and clinical experience. Students will work with state-of-the-art equipment, including the Califia Perfusion Simulator, as well as real heart-lung machines.

In the first year, students will observe surgeries weekly and participate in intensive simulations. “Before you can operate the equipment in a real case, you need to get your hands on it in a safe environment,” said Pelletier, who brings extensive experience in simulated perfusion practice.  “That’s what we’re building with our lab and sim training.”

By the third semester, students begin hands-on clinical rotations at partner hospitals, including VCU Medical Center. There, they’ll perform perfusion under the supervision of experienced clinicians.

To graduate, students must complete at least 75 clinical cases under professional supervision. VCU aims for students to participate in more than 100 cases, a standard found in most programs. After graduation, students complete an additional 40 supervised clinical cases before they can pursue the required certification by the American Board of Cardiovascular Perfusion.

“There’s a lot of pressure in this job,” Pelletier said. “You need to be calm under stress, think fast and be absolutely sure of what you're doing. Because if you’re unsure, it might be too late.”

Stepping up to fill a need in Virginia 

Perfusion is a small-but-growing field. Today, only around 4,000 perfusionists practice nationwide, leading to increased demand for trained professionals, especially in states like Virginia, which currently has no in-state education pathway. At the same time, heart surgeries and procedures are getting more complex, adding to the need for more perfusionists.

“VCU saw the need and stepped up,” Pelletier said. “Right now, anyone from Virginia who wants to become a perfusionist has to go out of state. And often they stay in those states to work. This program will help keep talent in Virginia.”

The program’s placement within Nurse Anesthesia, while unique compared to some schools, is intentional. “We work alongside CRNAs and anesthesiologists in the OR every day,” he said. “Sharing sim labs and training side-by-side will prepare all students for the teamwork the job demands.”

The Cardiovascular Perfusion program began as a request from VCU Health System leadership, where cardiac surgeons and perfusion teams had long recognized the need for in-state training. The effort, led by Vigneshwar Kasirajan, M.D., FACS, chair of the VCU Health Department of Surgery, and Patricia Nicolato, D.O., cardiac surgeon and medical director of the new program, involved years of foundational work.

“There was a group of stakeholders that was really committed,” said Nickie Damico, Ph.D., CRNA, associate professor and Herbert T. Watson Endowed Chair of the Department of Nurse Anesthesia. “They had done years of preliminary work to try to make this come to be.”

Support came from both adult and pediatric perfusion leaders at VCU Health and Children’s Hospital of Richmond at VCU, alongside faculty in the School of Medicine and the College of Health Professions. Funding tied to the Pauley Heart Center helped move the project forward, and Health Administration students contributed an early prospectus outlining its feasibility.

“Just considering the types of simulation, the environments we work in, and the training we do — there’s a lot of alignment with nurse anesthesia,” Damico said. “We’ve supported high-quality, high-fidelity simulation for years, and we’re simply shifting the content. This program builds on a foundation we already have in place.”

Attracting the inaugural class

Ideal applicants bring backgrounds in science or health care, often coming from work as nurses, respiratory therapists or first responders. They also must complete a significant shadowing experience in cardiac surgery. Beyond academics, Pelletier emphasized character traits such as emotional resilience, adaptability and composure under pressure.

“This field isn’t for everyone,” said Pelletier, noting that the practice is a good fit for individuals who want a career with a blend of clinical and technical applications. “You’re making life-and-death decisions in a high-stress environment, and you have to be able to work within a tight surgical team. We’re looking for students who know exactly what they’re getting into and are ready to commit.”

VCU will enroll its first cohort of 10 students in early 2026, with future cohorts expanding to 12.

“When I heard VCU was starting a program, I knew I had to be part of it,” Pelletier said. “We’re training the next generation of perfusionists right here in Virginia.”

Prospective students can learn more and apply through VCU’s Graduate Admissions website.

By Kyra Newman