Research at The Baird Institute continues to make a difference to every patient our surgeons treat; due to clinical and laboratory research in collaboration with our key researchers. Over the last year we have seen seven key areas of focus come together to help surgeons and researchers use technology and skilful surgery to improve patient survival and quality of life. Surviving cardiac disease, genetic issues and blood vessel problems in heart and lung patients has been directly improved with the support of our donors. Here are updates on major research and highlights of recent research publications, demonstrating how that support has helped patients.
Professor Paul Bannon MB BS, FRACS, PhD
Chair, The Baird Institute
Dr Liu from The Centenary Institute with her Baird Institute colleagues published in Circulatory Research, 2017: ‘ARHGAP18 protects against thoracic aortic aneurysms formation by mitigating the synthetic and proinflammatory smooth muscle phenotype’. This leading paper looks at the gene responsible for building our blood vessels. Understanding how genes influence aortic aneurysm development will help identify a cure for this devastating blood vessel anomaly.
Dr Sherrah, a recipient of The Baird Institute Medtronic Research Scholarship, published a pivotal paper in the Journal of American Cardiology 2016: ‘Nonsyndromic thoracic aortic aneurysm and dissection outcomes with Marfan Syndrome versus bicuspid aortic valve aneurysm’. This exacting review identified the significant differences in disease processes that affect the Aorta and require surgery. Surgeons and researchers globally have used this analysis to examine their own results to ensure better patient outcomes.
Surgeon and Professor Paul Bannon (chair of The Baird Institute), and fellow board member and surgeon, Richmond Jeremy are working with Professor Grieve (a scientist and Radiologist) at The Charles Perkins Centre to investigate blood flow in the abnormal ascending thoracic aorta, with the assistance of a National Health and Medical Research Council (NHMRC) grant. This research blends with studies made possible due to the establishment of an Aortic Tissue Bank and Database at Royal Prince Alfred Hospital; allowing research into cardiac disease processes and surgical care.
Coronary Artery Work
In our work with patients who suffer heart disease from atherosclerosis (hardening of the arteries and the formation of fatty plaques) and heart attacks (a myocardial infarction), our surgeons and researchers are currently investigating the long-term benefits of performing beating-heart surgery, instead of the traditional approach where the heart was stopped and complications from stroke could occur; especially in patients with known risk factors for stroke. Professor Michael Vallely and colleagues published a landmark study of their experience using a ‘no-touch’ technique (anOPCAB) based upon their experience with 37, 720 patients that showed a reduction in stroke of 78% compared to traditional bypass surgery, reduced mortality (50%), less kidney failure (53%), 48% less bleeding problems and a reduction in ICU length of stay. The website has an ABC produced video clip of Professor Vallely operating on a patient using this technique. See: Journal of the American College of Cardiologists, 2017 ‘Coronary artery bypass grafting with and without manipulation of the ascending aorta’.
The Baird Institute is working with researchers at The Charles Perkins Centre to better understand operative challenges for heart and lung surgery and are using the Hybrid Operating Theatre to simulate these challenges. Dr Hugh Paterson recently published a study within this area in Journal of Thoracic Cardiovascular Surgery 2017: ‘Competitive flow in coronary bypass surgery: The roles of fractional flow reserve and arterial graft configuration’.
Clinical Trials, supported by The Baird Institute, at RPAH are contributing to findings nationally and globally to ensure that improved techniques and technology will help patient survival. One such trial is the VISION study, conducted with The St George Institute and Abbott – Diagnostics to investigate blood levels of Troponin, a protein, that might signal early heart muscle damage in surgery.
Exciting new research continues in the field of developing synthetic materials that mimic blood vessels. Dr Wise and colleagues published in Nanomedicine, 2017 ’Plasma activated coating immobilizes apolipoprotein A-I to stainless steel surfaces in its bioactive form and enhances biocompatibility’, recent results from their work in establishing artificial blood vessels that reduce the risk of clotting and act like normal blood vessels. This approach will help surgeons use ‘fake’ blood vessels when the patient’s own vessels are too damaged for use.
ECMO and Heart Failure Work
Outside-the-body blood oxygenation (ECMO) in the treatment of heart failure continues to be an area of research that provides important practice changes to help patients recover better from major heart and lung surgery. This machine was used extensively in non-heart/non-surgical patients during the 2009 infamous swine flu pandemic. Dr Michael Stevens from The Charles Perkins Centre is working with The Baird Institute and recently published in the Journal of Biomechanics, 2017: ‘Flow mixing during peripheral veno-arterial extra corporeal membrane oxygenation – A simulation study’. Michael’s work involves studying how blood is returned from the ECMO machine and mixes with the patient’s residual blood. These effects cannot be seen with current imaging in theatre, so Michael has been using computer simulation of these effects in a wide-range of patient-specific conditions and scenarios, to provide feedback to the surgeon and the wider research community on these effects.
In contrast to this approach, a systematic review undertaken by Dr Michael Seco and The Baird Institute researchers has analysed a large series of published papers on the use of Left ventricular Assist Devices (LVADs) that help the heart function until a heart transplant is performed. Published in the International Journal of Cardiology, 2017: ‘Long-term prognosis and cost-effectiveness of left ventricular assist device as bridge to transplantation: A systematic review’, the overall analysis of data from these papers provides certainty that the use of LVADs continues to provide reliable care and continuing improved outcomes for patients beyond the initial surgical period.
Continuing work is being done with Professor John Fraser and the National Health and Medical Research Council of Australia in the ACTIONS (Advanced Cardio-respiratory Therapies Improving OrgaN Support) study, conducted with the Centre for Research Excellence.
Hypertrophic Obstructive Cardiomyopathy (HOCM) Work
Our Baird Institute affiliate researcher, Dr Passage, in collaboration with Fred Mohr’s group in the internationally recognized Leipzig Heart Centre (Germany), recently published on a new surgical approach to repair the Mitral valve in patients suffering from an enlarged heart muscle (particularly the left ventricle). The journal paper features a video, demonstrating the innovative surgical approach that improves patient outcomes after the surgery. Annals of Cardiothoracic Surgery, 2016: ‘Transmitral myectomy and how to deal with systolic anterior motion (SAM) in hypertrophic obstructive cardiomyopathy’. These researchers are renowned for their work and a continued collaboration will contribute to an incredibly important learning relationship.
Other work within the area of HOCM is looking at genetic factors contributing to valve and ventricular disease and the establishment of a Heart Muscle Tissue Bank with the Anatomy Department to further research and interventions into cardiomyopathy.
Along with research into aortic surgery, valve research explores the surgical repair, non-invasive repair or replacement of valves within the heart. Valves help hold and push blood through the four ventricles of the heart and into/out of the lungs. Professors Wilson and Vallely, along with Professor Ng from the Heart Research Institute, have a continuing commitment to research into valve disease with a focus being the elderly patient and transcatheter aortic valve implantation (TAVI). The area of research has some crossover with aortic root reconstruction surgery and approaches to these types of surgery involves understanding patient risk factors, types of surgery best suited to that patient and perfecting surgical skills.
Repair or replacement of the mitral valve has changed so much over the years and research continues to inform best practice. A new approach for patients too unwell to have surgery, is the endovascular (through the blood vessel) placement of a clip to reduce valve leakage. Results from ‘Mitraclip’ surgery are constantly being reviewed over the long term to improve patient survival and longevity. This is further supported through animal model research and surgical training conducted in the Charles Perkins Centre laboratories.
Lung Cancer Work
Dr Michael Seco and Dr Matheus Carelli are currently developing a comprehensive lung and thoracic surgery database at Royal Prince Alfred Hospital. This will involve the collection of data on patients undergoing lung cancer resections and other major chest operations. Databases for these patients provide invaluable information about surgical practices, patient recovery and outcome, and quality control. The cardiac surgery database at Royal Prince Alfred Hospital has been in use for over a decade and continues to stem multiple analyses and publications each year, and it is hoped the thoracic database will have a similar impact. This work will also form the basis of a comparable nation-wide database.
An imaging approach known as Neural Connectivity, is being undertaken by Professor Grieve and colleagues, to explore imaging processes to better understand brain injury after cardiac surgery. New imaging technologies using MRI are now able to identify subtle brain injury not seen using other imaging technology. This is exciting, ground breaking work, recently published in British Journal of Anaesthesia, 2017: ‘Neural network imaging to characterize brain injury in cardiac procedures: the emerging utility of connectomics’.
In addition to this form of imaging, the use of computational modelling and augmented reality for surgical planning and teaching is now becoming part of tertiary-level practice. 3-D printing and bio-printing are proving to be important to research as is the understanding and production of biomaterials, currently being explored with our affiliate researcher, Dr Steve Wise.
Robotic training and its uses are being researched through the Institute of Academic Surgery and the Surgical Robotic Program. The use of artificial intelligence and nano-robotics makes this an exciting field to explore for their practical and research-based uses in heart and lung surgery.
For a full list of all research publications of The Baird Institute, please click here