- What "CHS" Actually Means
- Who a CHS Candidate Is
- The Two-Part Certification Pathway
- Eligibility Before You Apply
- The 11 Content Categories
- Fees and Testing Windows
- Exam Format and Question Style
- Building a Study Timeline Around the Domains
- After You Pass: Continuing Certification
- Why Surgeons Pursue a CHS
- Frequently Asked Questions
- CHS is the American Board of Thoracic Surgery's Congenital Cardiac Surgery subspecialty certification, not a nursing or public-health credential.
- Total initial fees are $4,900: $650 application, $1,750 written exam, $2,500 oral exam.
- The 2026 written window runs December 7-11, 2026; the oral exam follows June 4-5, 2027 in Dallas.
- Written questions moved to a three-option multiple-choice format starting in 2025.
What "CHS" Actually Means
On this site, CHS refers specifically to the Certification in Congenital Cardiac Surgery issued by the American Board of Thoracic Surgery (ABTS). ABTS also calls it "Congenital Heart Surgery" certification on its own website, which is why you'll see both phrasings used interchangeably in official materials. This is a subspecialty certification layered on top of an existing, primary ABTS certification in general thoracic surgery - it is not an entry-level license and it is not related to any other credential that happens to share the same three letters.
If you're asking What Is CHS? or searching for a plain-language CHS meaning, the short answer is this: it's the board-recognized way a cardiothoracic surgeon demonstrates advanced, verified competence specifically in operating on congenital heart disease, from infants through adult congenital patients. For a deeper dive into the terminology itself, see What Does CHS Stand For? and What Does CHS Mean?
Who a CHS Candidate Is
A candidate for this certification is already a practicing cardiothoracic surgeon who holds primary ABTS certification and has completed dedicated congenital cardiac surgery training beyond general thoracic residency. This is not a credential a medical student, nurse, or physician assistant sits for - it's a subspecialty board exam for surgeons who operate on septal defects, conotruncal anomalies, and single-ventricle physiology as their primary practice.
Hospitals and academic congenital heart programs use this certification as a hiring and privileging benchmark. If you're researching CHS jobs or trying to understand how the credential affects hiring at pediatric and congenital heart centers, understand that the certification functions less like a "nice to have" line on a CV and more like a gatekeeping requirement for staff-surgeon roles in many programs.
The Two-Part Certification Pathway
The initial certification pathway has two sequential components:
- Part I - Written Examination: A multiple-choice exam administered at Pearson Professional Testing Centers. You must pass this before you're permitted to sit for Part II.
- Part II - Oral Examination: An in-person case-based oral exam held at a designated ABTS site.
This article and the broader CHS Certification content on this site focus primarily on Part I written preparation, with complementary attention to Part II oral case discussion - not on the separate continuing-certification assessment that follows after you're already certified. Details on the specific eligibility gate before Part I are covered in the next section, and a full breakdown of the multi-step process lives in CHS Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Eligibility Before You Apply
ABTS requires several things to be in place before you can even sit for Part I:
- Current primary ABTS certification (general thoracic surgery board certification)
- Unrestricted medical licensure
- Qualifying thoracic and congenital cardiac surgery training
- Verified operative experience in congenital cases
- Formal endorsement from your training program
Fellows who began training on or after July 1, 2023 face a more specific bar: two consecutive years in a single ACGME-accredited congenital cardiac surgery program, plus a minimum of 150 major congenital cases logged during fellowship, with at least 50 of those cases completed in the first year alone. This case-volume and continuity requirement is designed to ensure trainees get sustained, concentrated exposure rather than fragmented rotations.
Key Takeaway
Confirm your training program's accreditation status and case log totals early - the 150-case / 50-first-year threshold is a hard eligibility gate, not a suggestion, for anyone starting fellowship in July 2023 or later.
The 11 Content Categories
Part I written preparation is organized around 11 content categories drawn from the ABTS Booklet of Information. These categories are unweighted - ABTS does not publish a percentage breakdown telling you how many questions come from each area, so treat every domain as fair game rather than assuming a handful of "big" topics will dominate the exam.
Domain 1: Septal Defects
Atrial and ventricular septal defects, including anatomic variants, surgical timing, and closure techniques.
- Distinguishing defect types and their associated conduction risks
Domain 2: Anomalies of Venous Connection
Systemic and pulmonary venous return anomalies, including total and partial anomalous pulmonary venous connection.
- Surgical repair strategy tied to specific anatomic variant
Domain 3: Anomalies of the Aorta, Aortic Arch, and Coronary Arteries
Coarctation, interrupted arch, vascular rings, and congenital coronary anomalies.
- Arch reconstruction approaches by lesion complexity
Domain 4: Anomalies of the Tricuspid and Mitral Valves
Ebstein anomaly, mitral valve dysplasia, and atrioventricular valve repair strategy.
- Valve-sparing versus replacement decision points
Domain 5: Anomalies of the Aortic Valve and Left Ventricular Outflow Tract
Aortic stenosis, subvalvar and supravalvar obstruction, and Ross procedure indications.
- Staged versus single-stage LVOT strategies
Domain 6: Anomalies of the Pulmonary Valve and Right Ventricular Outflow Tract
Pulmonary stenosis/atresia and RVOT reconstruction techniques.
- Conduit selection and long-term durability tradeoffs
Domain 7: Conotruncal Anomalies
Tetralogy of Fallot, truncus arteriosus, and transposition physiology.
- Arterial switch versus Rastelli-type repair logic
Domain 8: Anomalies of Atrioventricular Connection, Univentricular Heart, and Atrial/Visceral Situs
AV canal defects, single-ventricle palliation pathways, and situs abnormalities.
- Fontan pathway staging and candidacy criteria
Domain 9: Diseases of the Myocardium
Cardiomyopathies and myocardial disease processes relevant to surgical decision-making.
- Surgical versus medical/transplant pathway triggers
Domain 10: Pre-, Intra-, and Post-Operative Evaluation and Management of Congenital Cardiac Disease
Perioperative planning, intraoperative decision-making, and postoperative care across the congenital spectrum.
- Recognizing and managing common postoperative complications
Domain 11: Acquired Cardiovascular Diseases in Infants and Children
Non-congenital cardiovascular disease processes that present in pediatric patients.
- Differentiating acquired disease from congenital presentation
For a category-by-category deep dive with more granular subtopics and sample reasoning patterns, see CHS Exam Domains 2026: Complete Guide to All 11 Content Areas.
Fees and Testing Windows
Initial certification carries a total cost of $4,900, broken into three separate payments:
| Fee Component | Amount |
|---|---|
| Application Fee | $650 |
| Written Examination (Part I) | $1,750 |
| Oral Examination (Part II) | $2,500 |
| Total | $4,900 |
These figures do not include travel, lodging, or preparation materials for the in-person oral exam. A full cost breakdown, including how to budget around the two-exam structure, is available in CHS Certification Cost 2026: Complete Pricing Breakdown.
The 2026 written examination window is December 7-11, 2026, administered at Pearson Professional Testing Centers. The associated oral examination is scheduled for June 4-5, 2027 in Dallas. Because the oral exam only follows a passing written score, candidates are effectively planning on a roughly six-month cycle between the two exams. See CHS Exam Dates 2026: Testing Windows, Deadlines & Scheduling for registration deadline planning around this window.
Exam Format and Question Style
Part I is a written, multiple-choice exam. Starting in 2025, ABTS moved to a three-option answer format rather than the traditional four- or five-option layout - a meaningful change for anyone who trained on older question banks, since it narrows the guessing margin but also demands sharper discrimination between plausible answer choices rather than obvious distractors.
A passing written score is required before you're eligible to schedule Part II. The oral exam is case-based and conducted in person, testing not just recall but real-time surgical judgment across the same content categories. If you're trying to gauge how demanding this two-stage structure really is relative to other board pathways, How Hard Is the CHS Exam? Complete Difficulty Guide 2026 unpacks that in more depth, and CHS Passing Score 2026: Exactly What You Need to Pass covers what "passing" actually requires.
Building a Study Timeline Around the Domains
Because the 11 categories are unweighted, an effective prep schedule spreads deep review across every domain rather than over-indexing on the ones that feel most familiar from daily practice. Surgeons who operate heavily in conotruncal repair, for example, often under-review myocardial disease or acquired cardiovascular disease topics simply because those cases appear less often on their own service.
High-complexity anatomic domains
- Conotruncal Anomalies and Atrioventricular Connection/Univentricular Heart - the domains with the most branching decision trees
Valve and outflow tract domains
- Tricuspid/Mitral Valve anomalies and Aortic Valve/LVOT anomalies, paired for comparison since both hinge on repair-versus-replacement logic
Vascular and venous domains
- Aorta/Arch/Coronary Anomalies and Venous Connection anomalies, with attention to less-frequently-tested anatomic variants
Perioperative management and less-familiar categories
- Pre/Intra/Post-Operative Management, Diseases of the Myocardium, and Acquired Cardiovascular Diseases in Infants and Children
This kind of domain-anchored scheduling is more useful than generic weekly study templates because it forces review time toward categories that are easy to neglect in daily practice. For a complete week-by-week plan built specifically around all 11 categories, see CHS Study Guide 2026: How to Pass on Your First Attempt, and for a compact final-review resource, CHS Cheat Sheet 2026: One-Page Review of Must-Know Facts condenses must-know points across every domain.
After You Pass: Continuing Certification
Passing Part I and Part II doesn't end your relationship with ABTS. Since January 2024, ABTS has used non-time-limited certificates for this subspecialty, conditional on meeting five-year milestone requirements rather than a hard recertification exam every fixed number of years. Existing time-limited certificates transition to this model at their expiration.
To stay in compliance, certified surgeons must maintain unrestricted licensure, hold hospital privileges, provide professional references, complete 150 Category 1 CME credits per five-year period (at least 75 of which must relate to thoracic surgery specifically), document qualifying congenital case activity, complete an online continuing-certification assessment, and meet patient-safety/improvement requirements. This continuing-certification assessment is a distinct process from the initial Part I/Part II pathway and isn't the focus of this site's exam-prep content, but it's worth knowing it exists as you plan your long-term certification lifecycle.
Why Surgeons Pursue a CHS
For most candidates, the driver isn't curiosity - it's career gatekeeping. Congenital heart programs increasingly expect this subspecialty certification as a condition of staff privileges, and it signals to hiring committees, referring physicians, and hospital credentialing bodies that a surgeon has met a board-verified standard specific to congenital cases rather than general thoracic practice. If you're weighing whether the time, case-volume requirements, and $4,900 in fees are worth it relative to your career trajectory, Is the CHS Certification Worth It? Complete ROI Analysis 2026 and CHS Salary Guide 2026: Complete Earnings Analysis both examine that question in more detail.
If your training pathway is still in progress, understanding the training-side expectations - case logs, program accreditation, fellowship continuity - is just as important as exam content. See CHS Training for how programs structure that experience, and browse practice questions organized by domain on the main practice test site to see how these categories translate into actual exam-style items.
Key Takeaway
Certification is a career requirement in many congenital programs, not an optional credential - plan your fellowship case logs and CME tracking with that reality in mind from day one.
Frequently Asked Questions
In this context, CHS refers to the Certification in Congenital Cardiac Surgery (sometimes called Congenital Heart Surgery certification) issued by the American Board of Thoracic Surgery. It is unrelated to other credentials that share the same abbreviation in different fields.
Yes. Current primary ABTS certification in general thoracic surgery is one of the baseline eligibility requirements, alongside unrestricted licensure, qualifying training, verified operative experience, and program endorsement.
Initial certification totals $4,900, split into a $650 application fee, a $1,750 written examination fee, and a $2,500 oral examination fee, not including travel or study materials.
Part I is a written, multiple-choice exam administered at Pearson Professional Testing Centers using a three-option format introduced in 2025. Part II is an in-person, case-based oral examination that can only be scheduled after passing Part I.
No. ABTS treats them as unweighted coverage categories in its Booklet of Information, so candidates should prepare across all 11 domains rather than prioritizing a subset based on assumed exam weight.