The initial rate of troponin I release post-reperfusion reflects the effectiveness of myocardial protection during cardiac allograft preservation

Ryan JB, Hicks M, Cropper JR, Garlick SR, Kesteven SH, Wilson MK, Feneley MP, Macdonald PS

Eur J Cardiothorac Surg 2003 Jun;23(6):898-906

PMID: 12829065


OBJECTIVE: To determine if the initial rate of troponin I release post-reperfusion reflects the effectiveness of myocardial protection during cardiac allograft preservation.

METHODS: A porcine model of orthotopic heart transplantation was used. Data from two control groups (CON(4) and CON(14)) and two treatment groups (CAR(4) and CAR(14)) were analysed. Hearts in CON(4) (n=6) and CAR(4) (n=6) were subjected to 4 h of ischaemia while hearts in CON(14) (n=3) and CAR(14) (n=6) were subjected to 14 h of ischaemia. All hearts were arrested and stored in the same extracellular preservation solution. Both donor and recipient animals in the CAR(4) and CAR(14) groups received a single intravenous dose of cariporide (2 mg/kg), prior to explantation and reperfusion, respectively.

RESULTS: Mean (SEM) plasma troponin I levels (microg/ml) 3 h post-reperfusion were: CON(4) 210+/-52, CAR(4) 68+/-21, CON(14) 633+/-177, CAR(14) 346+/-93. On multiple linear regression analysis, the rate of troponin I release over the first 3 h post-reperfusion was significantly lower in hearts stored for 4 h compared to hearts stored for 14 h (P<0.0001) and in hearts treated with cariporide compared to control hearts (P=0.0017). Early graft function was superior in hearts treated with cariporide, when compared to control hearts stored for the same period of time. All of the CAR(14) hearts could be weaned from cardiopulmonary bypass whereas none of the CON(14) could be weaned (6/6 vs. 0/3; P=0.012). While all hearts stored for 4 h could be weaned, contractility, as measured by the preload recruitable stroke work (PRSW) relationship, was significantly better preserved in CAR(4) hearts than in CON(4) hearts (P<0.0001).

CONCLUSIONS: The initial rate of troponin I release post-reperfusion is determined by the duration of cardiac allograft ischaemia. Altering the myocardial preservation strategy can reduce the rate of release. Such reductions are associated with improvements in early graft function. These findings validate the initial rate of troponin I release post-reperfusion as an end-point when comparing cardiac allograft preservation strategies. In addition, the present study provides indirect evidence that troponin I degradation during ischaemia-reperfusion is related to the accumulation of intracellular calcium.

Haptoglobin elutes from human atherosclerotic coronary arteries–a potential marker of arterial pathology

Matuszek MA, Aristoteli LP, Bannon PG, Hendel PN, Hughes CF, Jessup W, Dean RT, Kritharides L

Atherosclerosis 2003 Jun;168(2):389-96

PMID: 12801624


BACKGROUND: Molecules which egress from atherosclerotic arteries may function as plasma markers of arterial pathology, but such egress has not been proven with living human coronary arteries. We hypothesised that proteins eluting from the arterial wall may discriminate between atherosclerotic and non-atherosclerotic coronary arteries.

METHODS AND RESULTS: During cardiac bypass surgery, 155 sequential fractions of antegradely flushed coronary cardioplegia solution were collected by balloon-cuffed catheter from the coronary sinus in subjects with angiographically extensive (n=30) or minor (n=7) coronary disease. Although plasma was the major source of protein in heavily blood-contaminated samples, under conditions of low blood contamination (<0.5 mg/ml red cell Haemoglobin) coronary circulation-derived protein was detected. N-terminal sequencing of a major 40 kDa band detected by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) demonstrated 100% homology with beta chain of Haptoglobin (Hpt). Comparison of perfusates from patients with and without significant coronary disease found that the concentration of Hpt was markedly increased in perfusates from atherosclerotic coronary arteries (0.099+/-0.017 microg Hpt/microg Hb) relative to controls (0.016+/-0.008 microg Hpt/microg Hb, P=0.0027). Analysis of peripheral plasma samples of the same subjects, and of a separate cohort of patients, confirmed greater Hpt in those with angiographic coronary disease than in those without disease.

CONCLUSIONS: Proteins such as Hpt elute from the human coronary vascular bed and may differentiate between arteries with minor or extensive atherosclerosis. Although the suitability of Hpt as a circulating plasma marker for atherosclerosis remains to be established, the approach used in the present study may permit identification of diverse plasma-detectable markers of atherosclerosis, and the subsequent non-invasive evaluation of in vivo arterial pathology.

Emergency surgery after unsuccessful coronary angioplasty: a review of 15 years’ experience

Barakate MS, Bannon PG, Hughes CF, Horton MD, Callaway A, Hurst T

Ann. Thorac. Surg. 2003 May;75(5):1400-5

PMID: 12735553


BACKGROUND: Emergency coronary artery bypass grafting (CABG) is occasionally necessary for failed percutaneous transluminal coronary angioplasty (PTCA). The aim of this study was to assess the outcome of patients receiving emergency CABG after unsuccessful PTCA over a 15-year study period.

METHODS: From January 1982 through December 1996, 74 patients underwent emergency CABG after unsuccessful PTCA (crash group). This group was compared with a matched group of 74 patients having primary elective CABG (control group).

RESULTS: All 74 crash group patients were to have PTCA of one coronary system. After PTCA failure, 58 patients (78.3%) developed electrocardiographic changes of evolving acute myocardial infarction (AMI). The overall rate of AMI was 8.1% for the crash group and 2.7% for the control group. Two patients in the crash group died, with no deaths in the control group. There was no significant difference between mean in-hospital length of stay.

CONCLUSIONS: With prompt, aggressive, and complete myocardial revascularization, patients who required emergency CABG after PTCA failure had an outcome not significantly different from that of patients having elective CABG.

Cariporide (HOE-642) improves cardiac allograft preservation in a porcine model of orthotopic heart transplantation

Ryan JB, Hicks M, Cropper JR, Garlick SR, Kesteven SH, Wilson MK, Feneley MP, Macdonald PS

Transplantation 2003 Mar;75(5):625-31

PMID: 12640300


BACKGROUND: Acute graft dysfunction caused by ischemia-reperfusion injury is recognized as a major source of morbidity and mortality following adult heart transplantation. The aim of this study was to determine whether treating the donor and recipient with cariporide, an inhibitor of the sodium-hydrogen exchanger, could reduce ischemia-reperfusion injury.

METHODS: A porcine model of donor brain death, hypothermic ischemic preservation, and orthotopic cardiac transplantation was used. Allografts in both the control group (CON, n=6) and treatment group (CAR, n=6) were arrested and stored for 4 hours in the extracellular crystalloid cardioplegia currently used in the clinical transplantation program at our institution. In addition, both the donor and recipient animals in the CAR group received a single intravenous dose of cariporide (2 mg/kg) 15 minutes before harvesting and reperfusion, respectively.

RESULTS: The initial rate of troponin I release was significantly lower in recipients of CAR hearts than in recipients of CON hearts (P =0.020). All hearts were weaned successfully from bypass. More CAR hearts were weaned successfully at the first attempt, at 1 hour post-reperfusion, than CON hearts (6 of 6 vs 3 of 6), but this did not achieve statistical significance. Left ventricular contractility (preload recruitable stroke-work relationship) and left ventricular compliance (end-diastolic pressure-volume relationship) were significantly better preserved in CAR hearts than CON hearts (both P <0.0001).

CONCLUSIONS: Myocardial injury was reduced, and contractile function was better preserved in allografts that received cariporide, compared with allografts that received conventional preservation alone.

Lazaroid (U74389G)-supplemented cardioplegia: results of a double-blind, randomized, controlled trial in a porcine model of orthotopic heart transplantation

Ryan JB, Hicks M, Cropper JR, Nicholson A, Kesteven SH, Wilson MK, Feneley MP, Macdonald PS

J. Heart Lung Transplant. 2003 Mar;22(3):347-56

PMID: 12633703


BACKGROUND: U74389G (16-desmethyl tirilazad), a 21-aminosteroid or “lazaroid,” inhibits lipid peroxidation, which is an important element of ischemia-reperfusion injury. The aim of this study was to determine whether the addition of U74389G to the cardioplegic preservation solution could improve early cardiac allograft function.

METHODS: A porcine model of donor brain death and orthotopic cardiac transplantation was used. Hearts were arrested and preserved for 6 hours in an aspartate-enriched extracellular cardioplegia that had been supplemented with either U74389G and its carrier (n = 7) or the carrier alone (n = 9). Epicardial sonomicrometry and transmyocardial micromanometry were used to obtain pressure-volume loops before and after transplantation. Left ventricular wall volume was measured by volume displacement.

RESULTS: A higher proportion of U74389G-treated hearts were weaned successfully from cardiopulmonary bypass, but this difference did not achieve statistical significance (86% [6 of 7] vs 56% [5 of 9]; p = 0.308). In the hearts that were weaned successfully, preservation of left ventricular contractility, as judged by the pre-load recruitable stroke work relationship, was significantly better in the U74389G-treated hearts (p = 0.0271). In contrast, left ventricular compliance, as judged by the end-diastolic pressure-volume relationship, was significantly better preserved in the control group (p < 0.0001). U74389G-treated hearts developed less myocardial edema, as judged by the post-transplant left ventricular wall volume/baseline steady-state epicardial end-diastolic volume ratio (64 +/- 9% vs 76 +/- 11%; p = 0.045).

CONCLUSIONS: The benefit obtained from U74389G-supplemented cardioplegic preservation solution was marginal for hearts stored for 6 hours. After longer ischemic times, the benefit may be clearer.

An unusual cause of hemolysis in a patient with an aortic valved conduit replacement

Allman C, Rajaratnam R, Kachwalla H, Hughes CF, Bannon P, Leung DY

J Am Soc Echocardiogr 2003 Feb;16(2):188-90

PMID: 12574748


Hemolytic anemia is a well-known but uncommon complication in patients with prosthetic heart valves. It is most commonly a result of prosthetic valve dysfunction, periprosthetic valvular regurgitation, or both. We report a case of a 41-year-old man who had a previous aortic valve and root replacement for acute proximal aortic dissection, now presenting with hemolytic anemia. This was a result of flow obstruction at the distal anastomosis of the aortic conduit by the presence of multiple dissection flaps resulting in severe flow turbulence. Although the pathology was at the blind spot for transesophageal echocardiography, the dissection flaps, the flow turbulence, and the degree of obstruction were well-demonstrated by this technique after careful manipulation of the probe and a high index of suspicion.

Coronary artery bypass grafting (CABG) after initially successful percutaneous transluminal coronary angioplasty (PTCA): a review of 17 years experience

Barakate MS, Hemli JM, Hughes CF, Bannon PG, Horton MD

Eur J Cardiothorac Surg 2003 Feb;23(2):179-86

PMID: 12559340


OBJECTIVE: Patients who undergo successful percutaneous transluminal coronary angioplasty (PTCA) may subsequently require operative myocardial revascularization. This review examines whether prior successful PTCA alters outcomes following subsequent coronary artery bypass grafting (CABG). The costs of interventional cardiology procedures and definitive surgery were also examined.

METHODS: From January 1981 through December 1997, 361 patients underwent CABG following initially successful PTCA (interval group). This group was compared with 11,909 patients who underwent CABG as the primary intervention for coronary artery disease (control group).

RESULTS: The average time interval to CABG following initial PTCA was 13.7 months. The post-CABG myocardial infarction rate was 4% for patients in the interval group and 3% for patients in the control group. The 30-day mortality was similar for both patient groups (2%). For the interval group, the average cost of total interventional management was 24,220 dollars per patient. This included average costs of 13,873 dollars for CABG and 10,347 dollars for all preoperative interventional cardiology procedures.

CONCLUSION: There is little doubt that PTCA procedures may provide successful myocardial revascularization. However, these procedures often need to be repeated over time and may serve only to delay coronary surgery, at substantial financial and personal cost.

The preload recruitable stroke work relationship as a measure of left ventricular contractile dysfunction in porcine cardiac allografts

Ryan JB, Hicks M, Cropper JR, Garlick SR, Kesteven SH, Wilson MK, Macdonald PS, Feneley MP

Eur J Cardiothorac Surg 2002 Nov;22(5):738-45

PMID: 12414040


OBJECTIVE: Paradoxically, it has been reported that after 1.5-4 h of hypothermic ischaemic preservation there is complete recovery of contractile function in canine cardiac allografts, as assessed by the preload recruitable stroke work (PRSW) relationship. This raises questions about the suitability of the canine heart as a model for preservation research and the PRSW relationship as an end-point. The aim of the present study was to evaluate the PRSW relationship as an index of left ventricular contractility in porcine cardiac allografts.

METHODS: Eighteen orthotopic heart transplants were performed in inbred Westran pigs. Brain death was induced in the donor pigs 1 h prior to explantation. The donor hearts were arrested with extracellular cardioplegia, which was stored in ice prior to administration. On explantation, the donor hearts were immersed in cardioplegia and stored in ice. The donor hearts were subjected to either 4 (IT4, n = 6), 6 (IT6, n = 9) or 14 (IT14, n = 3) h of ischaemia. Post-transplant, all hearts were supported with dobutamine (10 mcg/kg per min). The PRSW relationship was derived from pressure-volume loops obtained by epicardial sonomicrometry and transmyocardial micromanometry. Multiple linear regression was used to describe and compare the PRSW relationship before brain death in the donor and after weaning from bypass in the recipient.

RESULTS: Eleven hearts were weaned successfully from cardiopulmonary bypass: IT4 100% (6/6), IT6 56% (5/9) and IT14 0% (0/3) (IT4 versus IT14: P = 0.012). Analysis of the PRSW relationship revealed a reduction in contractility in both the IT4 and IT6 groups (both P < 0.0001), but a greater reduction in the IT6 group (P < 0.0001). Notably, the volume-axis intercept of the PRSW relationship was found to be a better discriminator of post-preservation contractile dysfunction than the slope of the PRSW relationship.

CONCLUSIONS: The porcine heart’s susceptibility to ischaemic injury makes it ideal for evaluating the effect of different preservation strategies on contractile recovery. The PRSW relationship can be used to evaluate the differences in contractile recovery, though the nature of the effect of ischaemic preservation necessitates analysis by multiple linear regression.

Endothelial expression of intercellular adhesion molecule 1 and vascular cell adhesion molecule 1 is suppressed by postbypass plasma containing increased soluble intercellular adhesion molecule 1 and vascular cell adhesion molecule 1

Vallely MP, Bannon PG, Hughes CF, Kritharides L

J. Thorac. Cardiovasc. Surg. 2002 Oct;124(4):758-67

PMID: 12324734


OBJECTIVE: Endothelial cell dysfunction has been implicated in the inflammatory response to cardiopulmonary bypass, and the upregulation of endothelial cell expression of adhesion molecules might promote leukocyte extravasation in vivo. Soluble endothelial cell adhesion molecules are increased after bypass. The aim of this study was to investigate the relationship between endothelial cell-surface expression of adhesion molecules and their concentration in plasma after coronary artery bypass grafting.

METHODS: Ten patients undergoing coronary artery bypass with cardiopulmonary bypass had 5 plasma samples taken at defined intervals before, during, and after cardiopulmonary bypass. Plasma was incubated with human umbilical vein endothelial cell monolayers, and expression of E-selectin, intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 on the surface of human umbilical vein endothelial cell monolayers was measured by means of enzyme-linked immunosorbent assay. Plasma soluble adhesion molecules, C-reactive protein, interleukin 8, interleukin 10, transforming growth factor beta1, and neutrophil counts were determined for each patient.

RESULTS: Markers typical of acute inflammation (ie, interleukin 8, neutrophils, and C-reactive protein) were all increased after bypass. Soluble plasma intercellular and vascular cell adhesion molecule 1 (but not E-selectin) were increased after bypass. However, endothelial cell expression of vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 (but not E-selectin) were significantly decreased by exposure to postbypass plasma. Additionally, postbypass plasma inhibited interleukin 1beta-stimulated endothelial cell expression of vascular cell and intercellular adhesion molecule 1. Interleukin 10 and transforming growth factor beta1, both of which are known to inhibit endothelial cell adhesion molecule expression, were respectively increased 10-fold and 3-fold (P <.05) after bypass.

CONCLUSIONS: Despite containing increased soluble intercellular and vascular cell adhesion molecule 1, postbypass plasma inhibits endothelial cell expression of intercellular and vascular cell adhesion molecule 1. Upregulated vascular expression of adhesion molecules might not be essential for endothelial activation after bypass.

Risk of reoperation for structural failure of aortic and mitral tissue valves

Dalrymple-Hay MJ, Crook T, Bannon PG, Ohri SK, Haw MP, Bayfield MS, Hendel NP, Livesey SA, Hughes CF, Monro JL

J. Heart Valve Dis. 2002 May;11(3):419-23

PMID: 12056737


BACKGROUND AND AIM OF THE STUDY: The study aim was to assess the risk of reoperation for patients with a failing stented tissue valve.

METHODS: Between 1980 and 1999, 259 patients (118 males, 141 females; mean age 60.1+/-15.4 years) underwent redo valve replacement to replace a failing stented tissue valve. Of these patients, 94 (36.3%) underwent redo aortic valve replacement (AVR), 105 (40.5%) redo mitral valve replacement (MVR), and 60 (23.2%) redo aortic and mitral valve replacement (DVR). Twenty patients (7.7%) had previous coronary artery bypass grafting (CABG); further CABG were performed in 32 cases (12.4%). Preoperatively, 216 patients (83.3%) were in NYHA functional class III or IV.

RESULTS: The early mortality was (6.5%; n = 17), including three patients who had AVR, five DVR, and nine MVR. A higher preoperative NHYA status (p <0.0004) and emergency surgery (p <0.0001) were significantly associated with an increased risk of operative death (univariate analysis). Age at surgery (p = 0.45), previous CABG (p = 0.45), position of the valve replaced (p = 0.2), type of implant (p = 0.06) and presence of coronary artery disease (p = 0.51) were not associated with a significant risk of operative mortality. Including those patients who died, 88 (34.0%) experienced a peri- or postoperative complication, seven of which (2.7%) were permanent.

CONCLUSION: A failing tissue valve can be replaced, with acceptable operative mortality and morbidity. The choice of valve is a balance of its advantages and disadvantages, and these must be discussed with the patient. It appears, however, that the trend towards reducing the age at which tissue valve implantation is performed may be justified.

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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

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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.