Comparison of modified Del Nido and Custodiol® cardioplegia in minimally invasive mitral valve surgery

Objectives: In this study, we evaluated if modified Del Nido cardioplegia delivers comparable cardiac protection in comparison to Custodiol® in patients undergoing isolated minimally invasive mitral valve repair.

Methods: From January 2018 to October 2021, all patients undergoing non-emergent isolated minimally invasive mitral valve repair were included in this study. The cardioplegia was chosen at the surgeons’ discretion. The primary end points of this study were peak postoperative cardiac enzyme levels. Secondary end points were in-hospital mortality, hospital stay, occurrence of cardiac arrhythmias, pacemaker implantations, postoperative lactate and sodium levels and postoperative incidence of renal failure requiring dialysis.

Results: A total of 355 patients were included in this study. The mean age of patients was 57. After propensity score matching, a total of 156 pairs were identified. There was no difference in cross-clamp time between both groups. Postoperative creatine kinase levels were higher in patients receiving Custodiol on the 1st and 2nd postoperative days. Creatine kinase isoenzyme MB levels were higher in patients receiving Custodiol on the 2nd postoperative day (0.5 ± 0.2 vs 0.4 ± 0.1 µmol/l s; P < 0.001). Postoperative Troponin T concentrations were similar between both groups. Maximum lactate concentrations were higher in patients receiving Custodiol on the day of surgery (2.4 ± 1.9 vs 2.0 ± 1.1 mmol/l; P = 0.04). The overall hospital stay was longer in patients receiving Del Nido cardioplegia (10.6 ± 3.2 vs 8 ± 4.1 days; P < 0.01).

Conclusions: Modified Del Nido cardioplegia based on Ionosteril® solution offers equivalent protection compared to Custodiol for isolated minimally invasive mitral valve repair.

Extrapleural pneumonectomy for sarcoma: Outcomes of adult patients at a specialized center

Background: Extrapleural pneumonectomy (EPP) is a complex surgical procedure involving en-bloc resection of the parietal and visceral pleura, lung, pericardium, and ipsilateral diaphragm. Small case series of pleural-based sarcoma of predominantly pediatric patients suggest EPP may be a life-prolonging surgical option. We aimed to describe the characteristics and outcomes of adults who underwent EPP at a specialized sarcoma center.

Methods: Clinicopathologic variables, surgical details, and follow-up information were extracted for patients undergoing EPP for pleural-based sarcoma between August 2017 and December 2020. Primary outcomes were event-free survival (EFS) and overall survival (OS) from the date of EPP. Secondary outcomes were disease-free interval (DFI) prior to EPP, and early and late postoperative complications.

Results: Eight patients were identified, seven with soft tissue sarcoma and one with bone sarcoma. Patients had either localized disease with a primary thoracic sarcoma, sarcoma recurrent to the thorax, or de novo metastatic disease. All patients underwent resection of their pleural-based sarcoma by an experienced cardiothoracic surgeon, and some patients had pre or postoperative treatment. The perioperative morbidity was comparable with previously published reports of EPP performed in mesothelioma patients. At median follow-up of 22.5 months, median EFS was 6.0 months and OS was 20.7 months. Six patients (75%) had disease recurrence; five (62.5%) died of progressive disease. Two patients (25%) had not recurred: one died of a radiation-related esophageal rupture, and one was alive with no evidence of disease at 37.0 months. Characteristics of those with the longest EFS included low-grade histology and achieving a metabolic response to preoperative chemotherapy.

Conclusions: In adults with pleural-based sarcoma, EPP is rarely curative but appears to be a feasible salvage procedure when performed at specialized centers. Patient selection is critical with strong consideration given to multimodal therapy to optimize patient outcomes. In the absence of a confirmed response to neoadjuvant treatment, long term survival is poor and EPP should not be recommended

Early and long-term outcomes following redo mitral valve surgery in patients with prior minimally invasive mitral valve surgery

Objectives: The frequency of minimally invasive mitral valve surgery (MVS) has steadily increased over the last decades and therefore surgeons are now encountering an increasing number of patients requiring mitral valve (MV) reoperations post-minimally invasive MVS. The aim of this study was to analyse the early postoperative outcomes and the long-term survival in patients who undergo reoperative MVS following previous minimally invasive surgery.

Methods: Patients who underwent redo MVS following prior minimally invasive MVS between January 2002 and December 2021 were included in our analysis. Study data were prospectively collected and retrospectively analysed. The primary outcomes were 30-day mortality and long-term survival.

Results: Among the 187 included patients, 34 (18.2%) underwent repeat MV repair and 153 (81.8%) MV replacement. The median age was 66 years (interquartile range 56-74) and 80 (42.8%) patients were female. Redo MVS was performed through median sternotomy in 169 patients (90.4%). A total of 77 (41.2%) patients had additional concomitant procedures. The median intensive care unit stay was 1 day (1-5). The 30-day mortality was 6.4% (12/187). Estimated survival at 5 and 12 years was 61.8% and 38.3%, respectively. Preoperative stroke (hazard ratio 3.28, 95% confidence interval 1.37-7.85, P = 0.007) as well as infective endocarditis (hazard ratio 1.85; 95% confidence interval 1.09-3.11, P = 0.021) were independent predictors of long-term mortality.

Conclusions: Redo MVS following prior minimally invasive MVS can be performed safely with low early perioperative mortality and acceptable long-term survival. Preoperative stroke, infective endocarditis and concomitant tricuspid valve surgery are independent predictors of long-term mortality.

Pacemaker implantation after concomitant tricuspid valve repair in patients undergoing minimally invasive mitral valve surgery: Results from the Mini-Mitral International Registry

Objective: Randomized evidence suggests a high risk of pacemaker implantation for patients undergoing mitral valve (MV) surgery with concomitant tricuspid valve repair (cTVR). We investigated the impact of cTVR on outcomes in the Mini-Mitral International Registry.

Methods: From 2015 to 2021, 7513 patients underwent minimally invasive MV with or without cTVR in 17 international centers (MV: n = 5609, cTVR: n = 1113). Propensity matching generated 1110 well-balanced pairs. Multivariable analysis was applied.

Results: Patients with cTVR were older and had more comorbidities. Propensity matching eliminated most differences except for more TR in patients who underwent cTVR (77.2% vs 22.1% MV, P < .001). Mean matched age was 71 years, and 45% were male. European System for Cardiac Operative Risk Evaluation II was still 2.68% (interquartile range [IQR], 0.80-2.63) vs 1.9% (IQR, 1.12-3.9) in matched MV (P < .001). MV replacement (30%) and atrial fibrillation surgery (32%) were similar in both groups. Cardiopulmonary bypass (161 minutes [IQR, 133-203] vs MV: 130 minutes [IQR, 103-166]; P < .001) and crossclamp times (93 minutes [IQR, 66-123] vs MV: 83 minutes [IQR, 64-107]; P < .001) were longer with cTVR. Although in-hospital mortality was similar (cTVR: 3.3% vs MV: 2.2%; P = .5), postoperative pacemaker implantations (9% vs MV: 5.8%; P = .02), low cardiac output syndrome (7.7% vs MV: 4.4%; P = .02), and acute kidney injury (13.8% vs MV: 10%; P = .01) were more frequent with cTVR. cTVR eliminated relevant TR in most patients (greater-than-moderate TR: 6.8%). Multivariable analysis identified MV replacement, atrial fibrillation, and cTVR as risk factors of postoperative pacemaker implantation.

Conclusions: cTVR in minimally invasive MV surgery is an independent risk factor for pacemaker implantation in this international registry. It is also associated with more bleeding, low output syndrome, and acute kidney injury. It remains unclear whether technical or patient factors (or both) explain these differences.

Risk of Bias in Randomized Clinical Trials Comparing Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-analysis

Importance: Recent European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines highlighted some concerns about the randomized clinical trials (RCTs) comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for aortic stenosis. Quantification of these biases has not been previously performed.

Objective: To assess whether randomization protects RCTs comparing TAVI and SAVR from biases other than nonrandom allocation.

Data sources: A systematic review of the literature between January 1, 2007, and June 6, 2022, on MEDLINE, Embase, and Cochrane Central Register of Controlled Trials was performed. Specialist websites were also checked for unpublished data.

Study selection: The study included RCTs with random allocation to TAVI or SAVR with a maximum 5-year follow-up.

Data extraction and synthesis: Data extraction was performed by 2 independent investigators following the PRISMA guidelines. A random-effects meta-analysis was used for quantifying pooled rates and differential rates between treatments of deviation from random assigned treatment (DAT), loss to follow-up, and receipt of additional treatments.

Main outcomes and measures: The primary outcomes were the proportion of DAT, loss to follow-up, and patients who were provided additional treatments and myocardial revascularization, together with their ratio between treatments. The measures were the pooled overall proportion of the primary outcomes and the risk ratio (RR) in the TAVI vs SAVR groups.

Results: The search identified 8 eligible trials including 8849 participants randomly assigned to undergo TAVI (n = 4458) or SAVR (n = 4391). The pooled proportion of DAT among the sample was 4.2% (95% CI, 3.0%-5.6%), favoring TAVI (pooled RR vs SAVR, 0.16; 95% CI, 0.08-0.36; P < .001). The pooled proportion of loss to follow-up was 4.8% (95% CI, 2.7%-7.3%). Meta-regression showed a significant association between the proportion of participants lost to follow-up and follow-up time (slope, 0.042; 95% CI, 0.017-0.066; P < .001). There was an imbalance of loss to follow-up favoring TAVI (RR, 0.39; 95% CI, 0.28-0.55; P < .001). The pooled proportion of patients who had additional procedures was 10.4% (95% CI, 4.4%-18.5%): 4.6% (95% CI, 1.5%-9.3%) in the TAVI group and 16.5% (95% CI, 7.5%-28.1%) in the SAVR group (RR, 0.27; 95% CI, 0.15-0.50; P < .001). The imbalance between groups also favored TAVI for additional myocardial revascularization (RR, 0.40; 95% CI, 0.24-0.68; P < .001).

Conclusions and relevance: This study suggests that, in RCTs comparing TAVI vs SAVR, there are substantial proportions of DAT, loss to follow-up, and additional procedures together with systematic selective imbalance in the same direction characterized by significantly lower proportions of patients undergoing TAVI that might affect internal validity.

Incidence and outcomes of emergency intraprocedural surgical conversion during transcatheter aortic valve implantation: Insights from a large tertiary care centre

Objective: During a transcatheter aortic valve implant (TAVI) procedure, intraprocedural complications that are manageable only by conversion to emergency open-heart surgery (E-OHS) occasionally occur. Contemporary data on the incidence and outcome of TAVI patients undergoing E-OHS are scarce. This study aimed to evaluate early and midterm outcomes following E-OHS of patients undergoing TAVI in a large tertiary care centre with immediate surgical backup availability for all TAVI procedures over a 15-year period.

Methods: Data from all patients undergoing transfemoral TAVI between 2006 and 2020 at the Heart Centre Leipzig were analysed. The study time was divided into 3 periods: 2006-2010 (P1), 2011-2015 (P2) and 2016-2020 (P3). Patients were grouped according to their surgical risk (high risk: EuroSCORE II ≥ 6%; low/intermediate risk: EuroSCORE II <6%). Primary outcomes were intraprocedural and in-hospital death and 1-year survival.

Results: During the study period, a total of 6903 patients underwent transfemoral TAVI. Among them, 74 (1.1%) required E-OHS [high risk, n = 66 (89.2%); low/intermediate risk, n = 8 (10.8%)]. The rate of patients requiring E-OHS was 3.5% (20/577 patients), 1.8% (35/1967 patients) and 0.4% (19/4359 patients) in study periods P1 to P3, respectively (P < 0.001). The proportion of patients who had E-OHS who were low/intermediate risk increased considerably over time (P1:0%; P28.6%; P3:26.3%; P = 0.077). Intraprocedural deaths occurred in 10 patients (13.5%), all of whom were high-risk. In-hospital mortality was 62.1% in high-risk patients and 12.5% in low/intermediate risk patients (P = 0.007). One-year survival was 37.8% in all patients undergoing E-OHS, 31.8% in high-risk patients and 87.5% in low/intermediate risk patients (log-rank P = 0.002).

Conclusions: In-hospital and 1-year survival rates following E-OHS are higher in low/intermediate risk than in high-risk patients undergoing TAVI. An on-site cardiac surgical department with immediately available E-OHS capabilities is an important component of the TAVI team.

Blood versus crystalloid cardioplegia during triple valve surgery: A single center experience

Background: The efficacy of different cardioplegia solutions on outcomes of complex cardiac operations such as triple valve surgery (TVS) is scarce. Here we compared the outcomes in TVS patients receiving either crystalloid (Bretschneider) or blood (Calafiore) cardioplegia.

Methods: Screening of our institutional database with prospectively entered data identified 471 consecutive patients (mean age 70.3 ± 9.2 years; 50.9% male), who underwent TVS (replacement or repair of aortic, mitral and tricuspid valve) between December 1994 and January 2013. In 277 patients, cardiac arrest was induced with HTK-Bretschneider solution (HTK, n = 277, 58.8%), whereas 194 received cold blood cardioplegia (BCP) according to Calafiore (n = 194, 41.2%). Comparisons of perioperative and follow up outcomes were made between cardioplegia groups.

Results: Preoperative patient characteristics and comorbidities were equally balanced between groups. 30-days mortality was similar between groups (HTK: 16.2%; BCP: 18.2%; p = 0.619). Incidence of the cumulative endpoint (30days mortality, myocardial infarction (MI), arrhythmia, low cardiac output syndrome or need for permanent pacemaker implantation) was also comparable (HTK: 47.6%; BCP: 54.8%, p = 0.149). In patients with reduced left ventricular ejection fraction (LVEF <40%), 30days mortality was higher in the HTK group (HTK 18/71 22.5%; BCP 5/50 10%; p = 0.037). Five-year survival was similar between groups (52 ± 6% for HTK and 55 ± 5% for BCP patients). In-Hospital mortality was best predicted by length of surgery and reperfusion ratio. Decreased age, shorter bypass time, preserved LVEF and concomitant surgical procedures have been found to be protective from long-term mortality.

Conclusions: Myocardial protection with HTK shows equivalent outcomes compared to BCP during TVS. Patients with reduced left ventricular function may benefit from BCP during TVS.

The Feasibility of Less-Invasive Bentall Surgery: A Real-World Analysis

Objective: Minimally invasive approaches are being used increasingly in cardiac surgery and applied in a wider range of operations, including complex aortic procedures. The aim of this study was to examine the safety and feasibility of a partial upper sternotomy approach for isolated elective aortic root replacement (a modified Bentall procedure).

Methods: We performed a retrospective analysis of 768 consecutive patients who had undergone isolated Bentall surgery between January 2000 and January 2021 at our institution, with the exclusion of re-operations, endocarditis, acute aortic dissections, and root replacement with major concomitant procedures such as multi-valve or coronary bypass surgery. A total of 98 patients were operated on via partial sternotomy (PS) and were matched 2:1 to 196 patients operated on via full sternotomy (FS).

Results: The procedure time was 12 min longer in the PS group (205 min vs. 192.5 min in the FS group, p = 0.002), however, cardiopulmonary bypass and aortic cross-clamp times were comparable between groups. Eight PS-procedures were converted to full sternotomy, predominantly for bleeding complications (n = 6). Re-exploration for acute bleeding was necessary in 11% of the PS group and 4.1% of the FS group (p = 0.02). Five FS patients and none in the PS group required emergency coronary bypass grafting for postoperative coronary obstruction (p = 0.2). PS patients were hospitalized for a significantly shorter period (9.5 days vs. 10.5 days in the FS group, respectively). There were no significant differences regarding in-hospital (p = 0.4) and mid-term mortality (p = 0.73), as well as for other perioperative complications.

Conclusions: Performing Bentall operations via partial upper sternotomy is associated with similar perfusion and cross-clamp times, as well as overall mortality, when compared to a full sternotomy approach. A low threshold for conversion to full sternotomy should be accepted if limited access proves insufficient for the handling of intraoperative complications, particularly bleeding.

Rationale of the PAPAartis trial

Surgical and interventional repair of thoracoabdominal aortic aneurysms improve survival significantly compared to the natural history of the disease. However, both strategies are associated with a substantial risk of spinal cord ischemia, which has been reported to occur-even in contemporary series by expert centers-in up to 12% of patients, depending on the extent of the disease. Following improved neurological outcomes after staged approaches in extensive clinical and long-term large animal studies, and the description of the “collateral network”, the concept of “Minimally Invasive Staged Segmental Artery Coil Embolization” (MIS2ACE) was introduced by Etz et al. This concept of priming the collateral network in order to improve spinal cord blood supply showed promising experimental and early clinical outcomes, and consequently led to the initiation of the randomized controlled multicenter PAPAartis trial (Paraplegia Prevention in Aortic Aneurysm Repair by Thoracoabdominal Staging). This Keynote Lecture describes the background and rationale for this trial and gives an update on the current status.

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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.