Familial Aortopathies – State of the Art Review

Zentner D, James P, Bannon P, Jeremy R

Heart Lung Circ 2020 Apr;29(4):607-618

PMID: 32067919


Aortopathies are conditions that result in aortic dilatation, aneurysm formation and dissection. Familial aortopathies (perhaps better known as heritable thoracic aortic aneurysm and dissection, h-TAAD, as not all have a positive family history) are recognised to have an underlying genetic cause and affect the aorta, predisposing it to the above pathologies. These conditions can also affect the extra-aortic vasculature, particularly large elastic arteries and other body systems. Mutations in a number of genes have been associated with h-TAAD. However, not all affected families have a pathogenic gene variant identified-highlighting the importance of a three-generational family history and the likely role of both environmental factors and future gene discoveries in furthering knowledge. Survival has improved over the last few decades, essentially due to surgical intervention. The benefit of identifying affected individuals depends upon a regular surveillance program and timely referral for surgery before complications such as dissection. Further research is required to appreciate fully the effects of individual gene variants and improve evidence for prophylactic medical therapy, as well as to understand the effect of h-TAAD on quality of life and life choices, particularly around exercise and pregnancy, for affected individuals. This will be complemented by laboratory-based research that seeks to understand the tissue pathways that underlie development of arterial pathology, ideally providing targets for novel medical therapies and a means of non-invasively identifying individuals at increased vascular risk to reduce dissection, which remains a devastating life-threatening event.

Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial

Myles PS, Smith JA, Kasza J, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, McGuinness S, Byrne K, Chan MTV, Landoni G, Wallace S, Forbes A,

J. Thorac. Cardiovasc. Surg. 2019 02;157(2):644-652.e9

PMID: 30459103


BACKGROUND: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.

METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.

RESULTS: The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053).

CONCLUSIONS: In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

Age-related changes of shape and flow dynamics in healthy adult aortas: A 4D flow MRI study

Callaghan FM, Bannon P, Barin E, Celemajer D, Jeremy R, Figtree G, Grieve SM

J Magn Reson Imaging 2019 01;49(1):90-100

PMID: 30102443


BACKGROUND: Abnormal flow dynamics play an early and causative role in pathologic changes of the ascending aorta.

PURPOSE: To identify: 1) the changes in flow, shape, and size that occur in the ascending aorta with normal human ageing and 2) the influence of these factors on aortic flow dynamics.

STUDY TYPE: Retrospective.

SUBJECTS: In all, 247 subjects (age range 19-86 years, mean 49 ± 17.7, 169 males) free of aortic or aortic valve pathology were included in this study. Subjects were stratified by youngest (18-33 years; n = 64), highest (>60 years, n = 67), and the middle two quartiles (34-60 years, n = 116).

FIELD STRENGTH/SEQUENCE: Subjects underwent a cardiac MRI (3T) exam including 4D-flow MRI of the aorta.

ASSESSMENT: Aortic curvature, arch shape, ascending aortic angle, ascending aortic diameter, and the stroke volume normalized by the aortic volume (nSV) were measured. Velocity, vorticity, and helicity were quantified across the thoracic aorta.

STATISTICAL TESTS: Univariate and multivariate regressions were used to quantify continuous relationships between variables.

RESULTS: Aortic diameter, ascending aortic angle, shape, and curvature all increased across age while nSV decreased (all P < 0.0001). Systolic vorticity in the mid arch decreased by 50% across the age range (P < 0.0001), while peak helicity decreased by 80% (P < 0.0001). Curvature tightly governs optimal flow in the youngest quartile, with an effect size 1.5 to 4 times larger than other parameters in the descending aorta, but had a minimal influence with advancing age. In the upper quartile of age, flow dynamics were almost completely determined by nSV, exerting an effect size on velocity and vorticity >10 times that of diameter and other shape factors.

DATA CONCLUSION: Aortic shape influences flow dynamics in younger subjects. Flow conditions become increasingly disturbed with advancing age, and in these conditions nSV has a more dominant effect on flow patterns than shape factors.

LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:90-100.

Rugby Player’s Aorta: Alarming Prevalence of Ascending Aortic Dilatation and Effacement in Elite Rugby Players

Kay S, Moore BM, Moore L, Seco M, Barnes C, Marshman D, Grieve SM, Celermajer DS

Heart Lung Circ 2020 Feb;29(2):196-201

PMID: 31494040


BACKGROUND: Prompted by a cluster of observations concerning ascending aortic pathology in elite rugby players, we assessed over 150 asymptomatic predominantly retired players with echocardiography, aiming to document the prevalence and severity of ascending aortic dilatation and/or anterior aortic effacement, both ‘risk factors’ for potentially catastrophic aortic complications.

METHODS: Rugby players (at least 5 years of high level competitive rugby) were classified as elite (national, state or first grade representatives) or non-elite. A total of 152 asymptomatic players with a mean age of 45 ± 13 years (range 21-65) underwent transthoracic echocardiography. Z-scores (number of standard deviations from a population mean) were calculated for aortic root and ascending aortic size.

RESULTS: Regarding the aortic root, a Z-score of >2 was seen in 24% (expected prevalence 2.3%, p < 0.001) and a Z-score >3 was seen in 4% (expected prevalence 0..1%, p < 0.001). Sixty-two (62) players (41%) had an aortic root greater than 40 mm diameter. Ascending aortic Z-scores were >2 in 53% of players and >3 in 22% (p < 0.001). Abnormal anterior aortic effacement at the sinotubular junction (STJ) was seen in 88 players (58%). Abnormal aortic dilatation and effacement were associated with a longer duration of competitive rugby participation and elite status, respectively.

CONCLUSIONS: Ascending aortic dilatation with abnormal anterior effacement is exceedingly common in asymptomatic retired elite rugby players. This warrants increased surveillance in retired players until the clinical significance of these findings can be further investigated.

Extracorporeal membrane oxygenation support in refractory perioperative anaphylactic shock to rocuronium: a report of two cases

Carelli M, Seco M, Forrest P, Wilson MK, Vallely MP, Ramponi F

Perfusion 2019 11;34(8):717-720

PMID: 31046596


In recent years, extracorporeal membrane oxygenation has become increasingly common in the treatment of in-hospital cardiac arrest in non-cardiac surgery patients. This includes cardiac arrest secondary to perioperative anaphylactic shock refractory to standard advanced life support protocols, which is a rare but catastrophic event associated with significant mortality. Neuromuscular blocking drugs are most commonly implicated in perioperative anaphylaxis, with rocuronium playing a major role. In this article, we report two cases of young and otherwise fit and well patients who experienced a perioperative arrest secondary to rocuronium anaphylaxis before elective surgery; both patients did not respond to conventional advanced life support, but survived neurologically intact after institution of urgent veno-arterial extracorporeal membrane oxygenation.

Ex-vivo lung perfusion versus standard protocol lung transplantation-mid-term survival and meta-analysis

Chakos A, Ferret P, Muston B, Yan TD, Tian DH

Ann Cardiothorac Surg 2020 Jan;9(1):1-9

PMID: 32175234


Background: While extended criteria lung donation has helped expand the lung donor pool, utilization of lungs from donors of at least one other solid organ is still limited to around 15-30%. Ex-vivo lung perfusion (EVLP) offers the ability to expand the number of useable lung grafts through assessment and reconditioning of explanted lungs, particularly those not initially meeting criteria for transplantation. This meta-analysis aimed to examine the mid- to long-term survival and other short-term outcomes of patients transplanted with EVLP-treated lungs versus standard/cold-storage protocol lungs.

Methods: Literature search of ten medical databases was conducted for original studies involving “ex-vivo lung perfusion” and “EVLP”. Included articles were assessed by two independent researchers, survival data from Kaplan-Meier curves digitized, and individual patient data imputed to conduct aggregated survival analysis. Meta-analyses of suitably reported outcomes were conducted using a random-effects model.

Results: Thirteen studies met inclusion criteria, with a total of 407 EVLP lung transplants and 1,765 as per standard/cold storage protocol. One study was a randomized controlled trial while the remainder were single-institution cohort series of varying design. The majority of donor lungs were from brain death donors, with EVLP lungs having significantly worse PaO/FiO ratio and significantly greater rate of abnormal chest X-ray. Aggregated survival analysis of all included studies revealed no significant survival difference for EVLP or standard protocol lungs (hazard ratio 1.00; 95% confidence interval: 0.79-1.27, P=0.981). Survival at 12, 24, and 36 months for the EVLP cohort was 84%, 79%, and 74%, respectively. Survival at 12, 24, and 36 months for the standard protocol cohort was 85%, 79%, and 73%, respectively. Meta-analysis did not find a significant difference in risk of 30-day mortality or primary graft dysfunction grade 3 at 72 hours between cohorts.

Conclusions: There was no significant difference in mid- to long-term survival of EVLP lung transplant patients when compared to standard protocol donor lungs. The incidence of 30-day mortality and primary graft dysfunction grade 3 at 72 hours did not differ significantly between groups. EVLP offers the potential to increase lung donor utilization while providing similar short-term outcomes and mid- to long-term survival.

Single versus double lung transplantation for fibrotic disease-systematic review

Wilson-Smith AR, Kim YS, Evans GE, Yan TD

Ann Cardiothorac Surg 2020 Jan;9(1):10-19

PMID: 32175235


Background: Lung transplantation has long been the accepted therapy for end-stage pulmonary fibrotic disease. Presently, there is an ongoing debate over whether single or bilateral transplantation is the most appropriate treatment for end-stage disease, with a paucity of high-quality evidence comparing the two approaches head-to-head.

Methods: This review was performed in accordance with PRISMA recommendations and guidance. Searches were performed on PubMed Central, Scopus and Medline from dates of database inception to September 2019. For the assessed papers, data was extracted from the reviewed text, tables and figures, by two independent authors. Estimated survival was analyzed using the Kaplan-Meier method for studies where time-to-event data was provided.

Results: Overall, 4,212 unique records were identified from the literature search. Following initial screening and the addition of reference list findings, 83 full-text articles were assessed for eligibility, of which 17 were included in the final analysis, with a total of 5,601 patients. Kaplan-Meier survival analysis illustrated improved survival in patients receiving bilateral lung transplantation (BLTx) than in those receiving unilateral transplantation for idiopathic pulmonary fibrosis at all time intervals, with aggregated survival for BLTx at 57%, 35.3% and 24% at 5-, 10- and 15-year follow-up, respectively. Survival rates for SLTx were 50%, 27.8% and 13.9%, respectively.

Conclusions: Whilst a number of studies present conflicting results with respect to short-term transplantation outcomes, BLTx confers improved long-term survival over SLTx, with large-scale registries supporting findings from single- and multi-center studies. Through an aggregation of published survival data, this meta-analysis identified improved survival in patients receiving BLTx versus SLTx at all time intervals.

Unilateral Versus Bilateral Antegrade Cerebral Perfusion: A Meta-Analysis of Comparative Studies

Tian DH, Wilson-Smith A, Koo SK, Forrest P, Kiat H, Yan TD

Heart Lung Circ 2019 Jun;28(6):844-849

PMID: 30773323


BACKGROUND: Antegrade cerebral perfusion (ACP) is an essential adjunct for prolonged hypothermic circulatory arrest (HCA) during aortic arch surgery. However, it has yet to be established whether ACP should be delivered unilaterally or bilaterally. The aim of the present meta-analysis is to investigate outcomes of unilateral ACP (uACP) compared to bilateral ACP (bACP) in comparative studies.

METHODS: Electronic searches were performed using four databases from their inception to February 2017. Relevant comparative studies with adult patients who underwent aortic arch surgery using unilateral or bilateral ACP were included. Data was extracted by two independent researchers and analysed according to predefined endpoints using a random-effects model. Meta-regression was used to identify predictors of primary outcomes.

RESULTS: Nine comparative studies were identified, comprising 967 uACP patients and 879 bACP patients. No significant differences in age, sex, or proportion of total arch replacements were identified. The uACP cohort had a greater proportion of acute dissections (86% vs 75%, p = 0.04). Hypothermic circulatory arrest and cerebral perfusion times were similar between both groups. No significant differences were seen between unilateral and bilateral groups in terms of mortality (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.64-1.48; p = 0.90; I = 0%), permanent neurological deficit (PND) (OR 1.04; 95% CI 0.74-1.45; p = 0.85; I = 0%), temporary neurological deficit (p = 0.74), acute kidney injury (p = 0.36) or reoperation for bleeding (p = 0.65). No factors affecting mortality or PND were identified on meta-regression.

CONCLUSION: For patients undergoing aortic arch surgery, the available evidence supports either uACP or bACP as an adjunct to HCA. However, there is insufficient comparative evidence available to determine the benefit of either modalities in patients with longer durations of circulatory arrest.

Temperature Selection in Antegrade Cerebral Perfusion for Aortic Arch Surgery: A Meta-Analysis

Tian DH, Weller J, Hasmat S, Preventza O, Forrest P, Kiat H, Yan TD

Ann. Thorac. Surg. 2019 07;108(1):283-291

PMID: 30682350


BACKGROUND: The increasing use of antegrade cerebral perfusion (ACP) during aortic arch surgery has corresponded with a trend toward warmer target temperatures for hypothermic circulatory arrest. This meta-analysis examined the clinical outcomes using colder or warmer circulatory arrest targets with ACP.

METHODS: Electronic searches were performed using four databases from their inception to February 2017. Comparative studies of adult patients who underwent aortic arch operations using ACP at different circulatory arrest temperatures were included. Data were extracted by 2 independent researchers and analyzed according to predefined end points using a random-effects model.

RESULTS: The literature search identified 18 comparative studies, with 1,215 patients in the “cold” cohort and 1,417 in the “warm” cohort. Mean hypothermic circulatory arrest temperatures were 20.3°C and 26.5°C in the cold and warm groups, respectively. A trend existed for increased permanent neurologic deficit overall when colder targets were used (odds ratio, 1.45; 95% confidence interval, 0.98 to 2.13; p = 0.06); this became significant when adjusted estimates were aggregated (odds ratio, 1.65; 95% confidence interval, 1.06 to 2.55; p = 0.03). No difference in the mortality rate was seen when adjusted effects were aggregated. Temporary neurologic deficit, postoperative dialysis, ventilator time, and intensive care unit stay were significantly reduced in the warm cohort overall. No significant differences in reexploration for bleeding were found.

CONCLUSIONS: ACP with warmer circulatory arrest temperatures may reduce the incidence of permanent neurologic deficit as well as potentially other clinical outcomes. Further studies are required to determine the safe circulatory arrest durations for visceral organs at warmer temperatures.

Endovascular versus medical management of type B intramural hematoma: a meta-analysis

Chakos A, Twindyawardhani T, Evangelista A, Maldonado G, Piffaretti G, Yan TD, Tian DH

Ann Cardiothorac Surg 2019 Jul;8(4):447-455

PMID: 31463207


Background: Aortic intramural hematoma constitutes one of the three classifications of acute aortic syndrome (AAS). Type B intramural hematoma (IMH-B) is localized to the descending thoracic aorta and can be managed through medical, endovascular or surgical means. Data comparing contemporary management with thoracic endovascular aortic repair (TEVAR) versus traditional medical management (MM) is sparse and only moderate strength recommendations for TEVAR are provided in guidelines. This meta-analysis aimed to pool available data from comparative studies between TEVAR and MM and examine differences in outcomes.

Methods: Literature search of electronic medical databases was conducted to identify studies comparing TEVAR and MM for management of IMH-B. Data extraction from studies fulfilling the inclusion criteria was performed by two authors and meta-analysis using a random-effects model applied to pool baseline data and examine risk ratios (RR) for management outcomes.

Results: Of the initial 2,349 studies, nine studies were identified for analysis. There were 161 TEVAR patients and 166 who were medically managed. The mean age of the cohort was 62.2 years [95% confidence interval (CI): 55.8-68.7 years]. Patients with complicating features of IMH-B at presentation were more likely to appear in the TEVAR group, with more penetrating atheromatous ulcer (PAU) [risk difference (RD), 0.565, 95% CI: 0.240-0.889, P=0.001], ulcer-like projection (ULP) (RD 0.240, 95% CI: 0.965-0.384, P=0.001), and greater IMH size (mean difference, MD 5.47 mm, 95% CI: 0.320-10.6, P=0.037). There was no statistical difference between TEVAR and MM for the primary endpoints of aortic-related death (RR 0.535, 95% CI: 0.191-1.5, P=0.234) or IMH-B regression (RR 1.25, 95% CI: 0.859-1.81, P=0.246). Of the secondary endpoints, TEVAR had both significantly less dissection during follow-up (RR 0.295, 95% CI: 0.0881-0.989, P=0.048) and less rupture during follow-up (RR 0.206, 95% CI: 0.0462-0.921, P=0.039).

Conclusions: A small number of series comparing TEVAR and MM for management of IMH-B are available and random-effects meta-analysis did not reveal any statistically significant difference between treatments for aortic related death or IMH-B regression at a mean follow-up of 37 months. TEVAR was found to be associated with lower risk of dissection and lower risk of rupture during follow-up. Baseline data meta-analysis showed patients with complicating features of PAU, ULP, and larger IMH size were more likely to be managed with TEVAR.

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Ms. Jivani Murugan


Jivani is a Policy Officer employed at the Aboriginal Health and Medical Research Council of NSW. She is a Criminal Justice graduate from Macquarie University and is passionate about reducing health inequities for all communities. Jivani was born with a congenital heart condition and has had three open heart surgeries since her first at 10 days old. Her most recent, at age 23, introduced her to The Baird Institute and Professor Bannon.

Jivani campaigned for our 2021 Mid-year Appeal to fundraise and spread awareness of cardiothoracic surgery. She is an advocate for heart health and uses her position as a patient to raise awareness in the community and continues to showcase how surgery has saved her life. Jivani has enrolled in a Master of Public Health at Macquarie University commencing in 2023.

Mr. Ross Saunders

Ross is a business leader based in Sydney and originating from the United Kingdom. He currently runs the Australia & New Zealand operation for a global manufacturer with specialisation in business transformation, governance & compliance, program management, and strategic planning.

With particular interest in organisational transformation, Ross has led business and digital transformation programs across several global and national organisations including RS Group plc, Wesfarmers Industrial & Safety and Essentra plc.

Notably, Ross is also a post-operative recipient of valve-sparing aortic root replacement surgery, provided by Prof. Bannon and his team at Royal Prince Alfred Hospital, Sydney.

Associate Professor Christopher Cao

BSc (Med), MBBS (1st Hon), PhD, FRACS

Associate Professor Christopher Cao is a Consultant Cardiothoracic Surgeon at Royal Prince Alfred Hospital, Concord Hospital, Chris O’Brien Lifehouse, Macquarie University Hospital, and Sydney Adventist Hospital.

Christopher graduated with First Class Honours from the University of New South Wales and scored 99/99 in both steps of the United States Medical Licensing Exam. This was followed by a pre-internship at Yale University, USA. After his cardiothoracic surgical training with the Royal Australasian College of Surgeons in Sydney, his specialist Fellowship training was completed at the Memorial Sloan Kettering Cancer Center in New York, USA, the world’s oldest and largest private cancer center. He was then invited to be a Faculty Member in the Department of Cardiothoracic Surgery at New York University Medical Center, where he gained additional experience in minimally invasive cardiac surgery as well as heart and lung transplantation.

Associate Professor Cao has authored or co-authored more than 100 articles in high-impact international scientific journals and textbooks. His PhD with Sydney University was focused on the surgical management of pleural and lung cancers. He is the first author in one of the largest international registries on robotic surgery to date. His clinical interests include minimally invasive and robotic thoracic and cardiac surgery.

Dr Sean Lal

BMedSci(Hons), MBBS(Hons), MPhil(Med), PhD(Med), FRACP

Dr Sean Lal is an Academic in the Faculty of Medicine and Health at the University of Sydney and a Consultant Cardiologist at Royal Prince Alfred Hospital, sub-specialising in heart failure and cardiac MRI. He is also the Chair of the Heart Failure Council for the Cardiac Society of Australia and New Zealand.

Sean completed his undergraduate degree in Medical Science with first class honours at the University of Sydney, receiving full academic scholarship. He pursued his graduate Medical Degree (MBBS) and a Master of Medicine by research (MPhil) at the University of Sydney, where he was awarded the Dean’s Scholarship, the Medical Foundation Scholarship and the University of Sydney Bercovici Medal. As a medical doctor, Sean completed all of his general and specialty clinical training at Royal Prince Alfred Hospital. During his cardiology training, he was awarded a National Churchill Fellowship to study mechanisms of cardiac regeneration at Harvard Medical School.

Sean has a clinical and research interest in heart failure. For his PhD in this field, he was awarded a combined National Health and Medical Research Council (NHMRC) and National Heart Foundation (NHF) Scholarship, as well as the NHMRC and Royal Australasian College of Physicians (RACP) scholarship for research excellence.

He was also awarded a Commonwealth Endeavour Postgraduate Fellowship to Harvard University and Massachusetts Institute of Technology (MIT), where he undertook proof of concept studies demonstrating the intrinsic regenerative capacity of the human heart following myocardial infarction; whilst also gaining clinical experience in acute heart failure management in the cardiac ICU at the Brigham and Women’s Hospital.

Sean is the Director of the Sydney Heart Bank at the University of Sydney, which is one of the largest biorepositories of cryopreserved human heart tissue in the world. He is the Head of the Cardiac Research Laboratory in the School of Medical Sciences at the Charles Perkins Centre, which focuses on basic science and translational research into human heart failure.

Dr Brian Plunkett

Dr Brian Plunkett is an Australian-trained Cardiothoracic Surgeon with a special interest in transcatheter valve procedures and minimally invasive cardiac surgery.

Following the completion of his Royal Australasian College of Surgeons training, he undertook a Mitral Valve Repair fellowship in Edmonton, Canada, followed by dual Harvard Fellowships in Advanced Cardiac Surgery and Transcatheter Structural Heart Procedures.

He was awarded the inaugural Michael Davidson Structural Heart Fellowship by the American Thoracic Surgery Foundation, making him one of only a handful of surgeons formally trained in Transcatheter Structural Heart procedures.

He is the surgical lead of the Royal Prince Alfred Hospital transcatheter valve program, supervisor of cardiothoracic surgical training, and surgical director of the ECMO program. Dr. Plunkett’s areas of specialisation include all transcatheter valve procedures (MitraClip, TriClip, TAVI, TMVI, paravalvular leak closure), aortic valve replacement, mitral and tricuspid valve repair, all-arterial coronary bypass surgery, atrial fibrillation surgery, and pacemaker, cardiac defibrillator and resynchronisation device implantation.

He has been involved in several first-in-man procedures since his return from the USA, and is a champion of novel technologies to improve patient safety in cardiac procedures at Sydney Adventist Hospital.

Dr Benjamin Robinson

Mr Benjamin Robinson is an adult cardiothoracic surgeon with a long association with The Baird Institute. Whilst a medical student, he completed honours research with the Baird on outcomes in early-stage non-small cell lung cancer, under the supervision of Professor Brian McCaughan. He was awarded a Baird Institute Fellowship for this work. He subsequently trained in cardiothoracic surgery at Royal Prince Alfred Hospital and was the inaugural Baird Institute – Stanford University exchange scholar. Mr Robinson later completed a cardiac surgery clinical fellowship at Bart’s Heart Centre in London. He then worked as a consultant cardiothoracic surgeon at St. James’s Hospital in Dublin, before returning to Sydney to take up appointments at Royal Prince Alfred, Concord Repatriation General and Strathfield Private Hospitals.

Mr Robinson has experience in the spectrum of adult cardiac surgery, including coronary, valvular and aortic disease, as well as in general thoracic surgery. He has specific clinical interest in minimal access aortic valve surgery, arterial coronary grafting and aortic surgery. He has completed postgraduate study at Cambridge University and has academic interests in surgical outcomes research and epidemiology.

Professor Tristan Yan

Dr Tristan Yan is the Head of Department of Thoracic Surgery at Chris O’Brien Lifehouse. Professor Yan graduated from the University of New South Wales (UNSW) with Bachelor of Science (Medicine), Bachelor of Medicine and Bachelor of Surgery. He also completed three postgraduate higher degrees, Master of Surgery (USyd), Doctor of Medicine (UNSW) and Doctor of Philosophy (UNSW). He was trained at Royal Prince Alfred Hospital and St Vincent’s Hospital in Sydney and then obtained Cardiothoracic Surgery Fellowship from the Royal Australasian College of Surgeons. Following advanced specialty fellowships in the United States, England, Scotland and Germany, he specializes in minimally invasive cardiovascular surgery, and minimally invasive thoracic surgery.

Professor Tristan Yan is dedicated to surgical innovations. He applies the latest pioneering techniques to minimize surgical trauma and access sites and thus achieves a more rapid and comfortable recovery for his patients. He first completed his general surgical fellowship with Paul Sugarbaker in the United States, one of the most prominent surgeons in the world. He was then closely trained by the pioneer of Minimally Invasive Thoracic Surgery, Mr. William Walker, in Edinburgh, where he mastered the technical expertise of video-assisted thoracoscopic surgery (VATS) to perform complex lung resections, such as lobectomy and segmentectomy.

Associate Professor Chris Cao

After completing his medical degree at the University of New South Wales with First Class Honours, Christopher attended his pre-internship at Yale University, USA. He scored 99/99 for his United States Medical Licensing Exam, and completed his Cardiothoracic surgical training in Sydney. Concurrently, Christopher completed his PhD degree with Sydney University, focusing on the surgical management of lung and pleural diseases.

After completing his surgical training with the Royal Australasian College of Surgeons, Christopher was invited to a Fellowship at the Memorial Sloan Kettering Cancer Centre in New York City, one of the largest cancer centres in the world. This was followed by a Fellowship in New York University, where he was asked to join the Faculty in the Department of Cardiothoracic Surgery. His fellowship was focused on robotic and minimally invasive thoracic surgery, treating lung cancers, mediastinal tumours, mesothelioma, and other lung-related diseases. During his 18-month Fellowship at MSKCC and NYU, Christopher was fortunate to work with some of the leading international surgeons, gaining invaluable clinical and academic experience.

With over 100 publications in international peer-reviewed journal articles and book chapters, A/Prof Cao has a keen interest in thoracic surgery, particularly the treatment of lung cancers through minimally invasive surgery. He has made more than 50 presentations in international meetings as a Faculty Member in Paris, New York, Edinburgh, Taipei, Sydney, and Guangzhou. Christopher has personally supervised students and residents from Sydney University, University of New South Wales, Cornell University and New York University.

He is a member of the Australian and New Zealand Society of Cardiac and Thoracic Surgery, and works as a Consultant Surgeon at Lifehouse, Royal Prince Alfred Hospital, Concord Hospital, Sydney Adventist Hospital, and Macquarie University Hospital.

Dr Mike Byrom

Dr Michael Byrom is a modern, innovative cardiothoracic surgeon with training and experience in New Zealand, Australia, the United Kingdom, and Italy. Particular areas of expertise include:

  • Truly minimally-invasive surgery to the aortic valve that avoids complete division of the breast bone (hemi-sternotomy, right anterior mini-thoracotomy); allowing faster recovery and return to normal activities
  • Mitral valve repair with excellent repair rates and outcomes – resulting from diverse training in France, Italy, and the United Kingdom
  • Avoidance of the need for anticoagulation through valve selection, valve repair, and surgical treatment of atrial fibrillation
  • Minimally-invasive lung resection, avoiding a large thoracotomy wound and enabling faster recovery and return to normal activities with reduced pain and discomfort
  • Sternal and rib titanium plate fixation of chronic non-united fractures
  • Performing these procedures while minimising risk of complications, allowing Dr Byrom to achieve world-class results for his patients

Dr Matthew Bayfield

Dr Matthew Bayfield is an extremely experienced cardiothoracic surgeon with a broad range of skills and special interests within his field. He has performed more than 6000 heart and lung procedures. Dr Bayfield has hospital appointments at Strathfield Private Hospital, Royal Prince Alfred Hospital and Concord Hospital. His surgical interests include:

  • Coronary artery surgery: Dr Bayfield is one of Australia’s busiest coronary surgeons; with particular focus on minimal access incisions, and use of in-situ bilateral internal mammary artery grafts for enhanced longevity of the benefit of coronary revascularization.
  • Aortic root and arch surgery: Dr Bayfield has been performing aortic root and arch surgery since 1995, when he completed a Cardiovascular Fellowship at the University of Virginia in the USA. His focus is on o minimal access incisions, short cardiopulmonary bypass times, and for arch surgery antegrade cerebral perfusion with cerebral oxygen saturation monitoring.
  • Surgery for emphysema / CAL: Dr Bayfield was trained in open lung reduction surgery whilst doing a fellowship at the University of Virginia in 1995. Since that time he has developed thoracoscopic techniques for the procedure, and since 2003 been an implanter of endobronchial valves as a minimally invasive alternative to surgery. With over 100 endobronchial valve case experience, and long term follow-up of these patients, he is one of Australia’s most experienced endobronchial valve proceduralist.
  • Correction of pectus defects: Dr Bayfield has a special interest in correction of both pectus and carinatum defects, with techniques including implantation of Nuss bar under video-assisted control, and open radical sternochondroplasty.Lung cancer surgery: Dr Bayfield has been in surgical partnershio with Professor Brian McCaughan since 1996, and was trained by him as a registrar. Prof McCaughan is Australia’s most experienced and prolific lung cancer surgeon, has published widely on many aspects of its treatment, and has been awarded Medal of the Order of Australia (AM) for services to health in respect to his work on malignant mesothelioma.
  • Pacemaker and defibrillator implantation: Dr Bayfield was trained in device implantation as a young surgeon in the 1980’s and has developed skills to ensure that a device can be safely and reliably implanted even in the most difficult case with minimal risk. He was trained in cardiac resynchronzation therapy techniques at the introduction of that technology. He has regular pacemaker and defibrillator implantation lists at Royal Prince Alfred Hospital, Strathfield Private Hospital, and Concord Hospital.
  • Surgical treatment for ischaemic cardiomyopathy: Dr Bayfield trained in heart and lung transplantation whilst at the University of Virginia. With this skill base he has been able to develop a multi-faceted approach to treat patients whose hearts have been damaged by coronary artery disease (heart attack). These therapies include coronary artery bypass, mitral valve repair, and implantation of CRT defibrillators.

Professor Paul Bannon

Professor Paul Bannon is an adult cardiothoracic surgeon of international standing with clinical appointments at Royal Prince Alfred Hospital, Concord and Strathfield Private Hospital. At Royal Prince Alfred Hospital Professor Bannon is the Head of Department of Cardiothoracic Surgery, Co-Chair of the Institute for Academic Surgery, Director of the Robotic Training Institute and the current President of the Medical Officers Association. At the University of Sydney, he holds the inaugural Professorial Chair of Cardiothoracic Surgery and the Bosch Chair of Surgery. He is also the current Head of the Discipline of Surgery for the Sydney Medical School and the Academic Director of the newly opened Translational Research Facility or Hybrid Theatre at the Charles Perkins Centre. He is the Chair of The Baird Institute for Applied Heart and Lung Surgical Research. Professionally he is the Past President of the Australian and New Zealand Society of Cardiothoracic Surgeons (ANZSCTS) and in that role serves on the steering Committee for the ANZSCTS National Cardiac Surgical Database, the National TAVI Accreditation Committee and is the Cardiac Surgical Chair of the Medical Benefits Schedule review program. For the Ministry of Health NSW he has been in the role of Co-Chair of the Cardiac Devices Committee for the Agency of Clinical Innovation.

Professor Bannon graduated from the University of Sydney in 1987, completed a PhD from the same institution in 1998 and was awarded a FRACS (CTh) in 1998. He has a particular passion for translational research in the areas of congenital aortic and mitral valve disease, biomaterials and biocompatibility, limitation of blood product usage in cardiac surgery, the inflammatory response to bypass and the development of academic surgical careers. He has authored or co-authored more than 120 scientific papers, published in peer-reviewed journals. He is co-editor-in-chief of the Annals of Cardiothoracic Surgery, a Medline listed multimedia journal of cardiothoracic surgery. Professor Bannon has a reputation as the ‘surgeons surgeon’ and has particular expertise in surgery of the aortic root and arch, high-risk re-do surgery, total-arterial coronary artery bypass grafting and surgery for hypertrophic cardiomyopathy.

Professor Richmond W. Jeremy


Professor Richmond Jeremy’s medical and cardiology training were at the University of Sydney and Royal Prince Alfred Hospital.

His clinical research career includes a PhD on coronary physiology and a post doctoral research Fellowship at Johns Hopkins Hospital, Baltimore before returning to the University of Sydney and Royal Prince Alfred Hospital.

University of Sydney responsibilities have included service as Associate Dean Sydney, Medical School, Head of Central Clinical School and Pro Vice-Chancellor, Campus Infrastructure and Services.

Professional responsibilities have included service as Editor-in-Chief of Heart Lung and Circulation, membership of Boards on National Heart Foundation (NSW), Royal Australasian College of Physicians (Adult Medicine Division) and Cardiac Society of Australia and New Zealand.

Mr. Shaun Clyne

MA LLM (Syd)

Shaun is a corporate lawyer based in Sydney. He is the Australian Head of the Mergers & Acquisitions practice. He regularly advises on a wide range of corporate and securities law issues for public listed companies including takeovers, schemes of arrangement and capital raisings. He advises on Australian Stock Exchange compliance matters and regularly acts for both bidders and targets in connection with takeover bids and schemes of arrangement (hostile and friendly) for ASX-listed companies.

A leading practitioner in equity capital markets, Shaun has also advised numerous companies on their initial public offerings and capital raisings (rights issues, AREO’s, placements, employee share and options plans).

Shaun has presented at a variety of seminars and conferences and published several papers in his areas of specialisation.

His areas of expertise are mergers and acquisitions, corporate advisory and capital markets.

Ms. Joanne Wade


Joanne Wade has been a plaintiff lawyer since her admission to the Supreme Court of NSW in 1996 and has worked in asbestos litigation for well over 18 years. Joanne is an Accredited Specialist in Personal Injury Law and prides herself on her communication with her clients and, on many occasions, her clients’ families. She understands the importance and need to handle all her cases with the utmost diligence and compassion. Joanne has acted for hundreds of people suffering from mesothelioma, lung cancer, asbestosis and asbestos related pleural disease. Her clients are everyday people who have worked hard all their lives and deserve justice. Joanne acted for Steven Dunning in his claim against BHP Billiton Limited in the Dust Diseases Tribunal of NSW (Dunning vBHP Billiton Limited [2014] NSWDDT 3). Mr Dunning suffered from malignant pleural mesothelioma and in a landmark decision; the court awarded Mr Dunning the highest amount for damages for pain and suffering in NSW. Joanne went on to represent Mr Dunning in the Appeal before the NSW Court ofAppeal where BHP’s appeal was unanimously dismissed (BHPBilliton Limited v Dunning [2015] NSWCA 55). Joanne has also successfully acted for the late Bevan McGrath in his claim against Allianz Australia Insurance Limited, for his condition of asbestos related pleural disease and ensured that case was resolved on a provisional damages basis. Mr McGrath went on to develop mesothelioma, one of only a small number of cases where he then brought a second claim for further damages because his first claim was resolved on a provisional basis. Joanne successfully acted for Mr McGrath in both his claims and the late Mr McGrath successfully received further damages in a judgment by the court (McGrath v Allianz AustraliaInsurance Limited [2011] NSWDDT). The judgement was upheld on appeal (Allianz Australia Insurance Limited v McGrath [2011]NSWCA 153).

“It is with great privilege to work with people suffering from asbestos illnesses, and the greatest satisfaction formed is securing a result for those people to help ease their suffering, and to know their families will be looked after.”Joanne takes great pride in the work Slater and Gordon have undertaken in representing victims of asbestos disease, unions and asbestos support groups, including the work of Ken Fowlie in 2004 who acted for the ACTU and asbestos support groups in negotiations with James Hardie to secure an agreement which will ensure current and future victims of asbestos –related diseases would be fully compensated for years to come.Joanne is a passionate advocate and one thing that separatesJoanne from other lawyers is perspective, with her own father being exposed to asbestos working at Cockatoo IslandDockyard, she is in the unique position of seeing it from both angles.“My clients are generally people who have worked hard all their lives, and are lovely people who deserve justice. I am glad to fight for that justice and to make a difference to their lives.”


  • Asbestos Claims
  • Dust Disease Board Appeals
  • Dust Diseases Claims
  • Compensation Claims

Career History

  • Slater and Gordon since 2008 (practice group leader)
  • 2000-2007 Watkins Tapsell (partner)
  • 1996-2000 Watkins Tapsell (lawyer)
  • 1992-1995 NSW Crown Solicitors Office (paralegal clerk)

Professor Clifford F. Hughes


Professor Cliff Hughes is President of the International Society for Quality in Health Care. Until March 2015 he was the Chief Executive Officer of the Clinical Excellence Commission, a statutory health corporation established in 2004 to build capacity and design programs to promote and support improvement in quality and safety for health services across NSW. He has been chairman or member of numerous Australian state and federal committees associated with quality, safety and research in clinical practice for health care services. He has held various positions in the Royal Australasian College of Surgeons, including Senior Examiner in Cardiothoracic Surgery and member of the College Council. In November 2015 the College bestowed upon him the highest award given to a Fellow in his lifetime, the Sir Hugh Devine Medal. He has received awards for his national and international work including an Alumni Award from the University of NSW. He has led five medical teams to China and has performed cardiac surgery in Hong Kong, Singapore, Malaysia, India and Bangladesh. In 1998, he was made an Officer in the Order of Australia (AO) in recognition of his contributions and “service to cardiac surgery, international relationships and the community”. In June 2014, the University of NSW conferred upon him the degree of Doctor of Science, its peak academic award.

Professor Jeffrey Braithwaite


Professor Jeffrey Braithwaite, BA, MIR (Hons), MBA, DipLR, PhD, FIML, FCHSM, FFPHRCP (UK), FAcSS (UK), Hon FRACMA, FAHMS is Founding Director, Australian Institute of Health Innovation, Director, Centre for Healthcare Resilience and Implementation Science, and Professor of Health Systems Research, Faculty of Medicine and Health Sciences, Macquarie University. His research examines the changing nature of health systems, attracting funding of more than AUD$131 million (EUR€81.8 million, GBP£70.8 million).

He has contributed over 470 peer-reviewed publications presented at international and national conferences on more than 915 occasions, including 97 keynote addresses. His research appears in journals such as JAMA, British Medical Journal, The Lancet, BMC Medicine, BMJ Quality & Safety, and International Journal for Quality in Health Care. He has received numerous national and international awards for his teaching and research.

He is interested in the Anthropocene and the impact of human activity on human and species’ health, population and climate. He blogs at

Further details are available at his Wikipedia entry:

Ms. Michelle Sloane


Michelle’s background is in psychology and human resources working for many years in senior executive positions at Westpac, IBM and Unilever. Twenty years ago she established a human resources management consulting practice, Diversity Management, and led that organisation for 16 years. Michelle has worked extensively in the areas of change management, organisational analysis and design, human resource management, program management, stakeholder engagement as well as leadership development and training.

Michelle has a Master of Business Administration from the University of Technology, a Master of Arts (Psychology) from the University of Sydney and a Bachelor of Arts from the University of New South Wales. In addition Michelle is a Graduate of the Institute of Company Directors (GAICD).

Michelle has also been a Councillor for the City of Willoughby in Sydney. During her time as Councillor and Deputy Mayor, she has worked tirelessly with the local community advocating across a range of local and state-wide issues. Her interest in local government was developed over many years as a very active volunteer in her local community.

Professor Paul G. Bannon


Professor Paul Bannon is the Chair of The Baird Institute for Applied Heart and Lung Surgical Research, a not-for-profit medical research institute established in 2001, to improve the outcomes and better the lives of those undergoing heart and lung surgery.

He is Head of Department, Cardiothoracic Surgery at Royal Prince Alfred Hospital, Sydney and holds the Chair of Cardiothoracic Surgery and the Bosch Chair of Surgery, University of Sydney. He has performed over 2500 adult cardiac surgical procedures ranging from coronary artery bypass to complex aortic root and arch reconstructions. He is President of the Australia and New Zealand Society of Cardiac and Thoracic Surgeons and is the Society representative to the Cardiac Surgery National Database. He is the Co-Chair of the Institute of Academic Surgery at RPAH where he also oversees the robotic surgical program. He heads the National MBS Taskforce Review for Cardiac Surgery and has held various positions in the Royal Australasian College of Surgeons and Royal Prince Alfred Hospital.

Professor Bannon’s teaching responsibilities are currently to all years of the Graduate Medical Program at Sydney Medical School, University of Sydney. He supervises local and international Doctorate, Masters and Honours students as well as international elective students. He is the Co Editor-in-Chief of The Annals of Cardiothoracic Surgery and a Director of the CORE Group for International Collaborative Research. Professor Bannon has published widely in books, journals and conference proceedings on cardiothoracic surgery, basic science and evidence based medicine.

He has a particular passion for translational research in the areas of congenital aortic and mitral valve disease, hypertrophic cardiomyopathy, biomaterials and biocompatibility, limitation of blood product usage in cardiac surgery, the inflammatory response to bypass and the development of academic surgical careers. He is a current Chief Investigator on NHMRC and NHF grants for biomaterials and congenital heart disease research as well as a current NHMRC CRE grant on mechanical circulatory support. His role in the CRE is to produce NHMRC Clinical Practice Guidelines and measure their dissemination, adoption and outcomes. He personally oversees more than $500,000 worth of research funding annually. His Department currently runs 16 clinical trials amongst many other laboratory and clinically based projects.