Mechanical Versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

Zhao DF, Seco M, Wu JJ, Edelman JB, Wilson MK, Vallely MP, Byrom MJ, Bannon PG

Ann. Thorac. Surg. 2016 Jan;

PMID: 26794881


The choice of a bioprosthetic valve (BV) or mechanical valve (MV) in middle-aged adults undergoing aortic valve replacement is a complex decision that must account for numerous prosthesis and patient factors. A systematic review and meta-analysis was performed to compare long-term survival, major adverse prosthesis-related events, anticoagulant-related events, major bleeding, reoperation, and structural valve degeneration in middle-aged patients receiving a BV or MV. A comprehensive search from six electronic databases was performed from their inception to February 2016. Results from patients aged less than 70 years undergoing aortic valve replacement with a BV or MV were included. There were 12 studies involving 8,661 patients. Baseline characteristics were similar. There was no significant difference in long-term survival among patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs had significantly fewer long-term anticoagulant-related events (hazard ratio [HR] 0.54, p = 0.006) and bleeding (HR 0.48, p < 0.00001) but significantly greater major adverse prosthesis-related events (HR 1.82, p = 0.02), including reoperation (HR 2.19, p < 0.00001). The present meta-analysis found no significant difference in survival between BVs and MVs in patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs have reduced risk of major bleeding and anticoagulant-related events but increased risk of structural valve degeneration and reoperation. However, the mortality consequences of reoperation appear lower than that of major bleeding, and recent advances may further lower the reoperation rate for BV. Therefore, this review supports the current trend of using BVs in patients more than 60 years of age.

Equivalent outcomes after coronary artery bypass graft surgery performed by consultant versus trainee surgeons: A systematic review and meta-analysis

Virk SA, Bowman SR, Chan L, Bannon PG, Aty W, French BG, Saxena A

J. Thorac. Cardiovasc. Surg. 2016 Mar;151(3):647-654.e1

PMID: 26707761


OBJECTIVE: In recent years, concerns have been raised about the learning opportunities available to cardiac surgical trainees. This meta-analysis was conducted to assess the impact of trainee operator status on clinical outcomes after coronary artery bypass graft (CABG) surgery.

METHODS: Medline, EMBASE, and the Cochrane Library were systematically searched for studies that reported CABG outcomes according to the training status of the primary operator (consultant vs trainee). Data were independently extracted by 2 investigators; a meta-analysis was conducted according to predefined clinical endpoints.

RESULTS: Sixteen observational studies (n = 52,966) met criteria for inclusion, with 8 studies (n = 36,479) reporting propensity-adjusted analyses. Trainee cases were associated with increased aortic crossclamp duration (mean difference: 4.80; 95% confidence interval [CI], 0.76-8.83) and cardiopulmonary bypass duration (mean difference: 4.24; 95% CI, 0.00-8.47). Perioperative mortality was similar for CABG performed primarily by trainees versus consultants (odds ratio 0.98; 95% CI, 0.81-1.18). No significant difference was found in the incidence of perioperative stroke, myocardial infarction, acute renal failure, reoperation for bleeding, or wound infection. Trainee operator status was not associated with increased midterm mortality (hazard ratio 1.00; 95% CI, 0.90-1.11). In subgroup analysis that included 5 studies and 8025 patients, off-pump CABG trainee cases were not associated with increased perioperative mortality or morbidity.

CONCLUSIONS: With appropriate supervision, conventional CABG can be performed by trainee surgeons without an adverse impact on perioperative outcomes or midterm survival. Data regarding off-pump CABG are limited, and further research is warranted to ascertain the impact of trainee operator status on long-term outcomes after off-pump CABG.

The Freestyle Aortic Bioprosthesis: A Systematic Review

Sherrah AG, Edelman JJ, Thomas SR, Brady PW, Wilson MK, Jeremy RW, Bannon PG, Vallely MP

Heart Lung Circ 2014 Dec;23(12):1110-1117

PMID: 25047283


BACKGROUND: The Medtronic Freestyle bioprosthesis (FSB) provides an alternative to other prostheses for both aortic valve and aortic root surgery. This paper is a systematic review of the post-operative outcomes in patients with aortic valve and/or aortic root disease following FSB implantation.

METHODS: Electronic databases were searched for primary analysis, prospective randomised studies comparing the FSB with an alternative aortic prosthesis were included. Additionally, case series that included data for at least 100 individual operated patients were used for secondary analysis.

RESULTS: Among three identified randomised studies, 199 FSB cases were compared with homografts, and stented and an alternative stentless bioprosthesis. The FSB showed comparable hospital mortality (4.5% vs 5.3%) and eight-year actuarial survival (80±5.0% versus 77±6.0%) with the homograft (respectively) and comparable reduction in left ventricular mass index relative to other prosthesis types. Over 6000 individual patients were included in the selected 15 case series. Weighted mean operative mortality, neurological event rate and five-year actuarial survival was 5.2%, 5.5% and 77.8%, respectively.

CONCLUSION: The FSB performed comparably against alternative prostheses regarding in-hospital mortality, long-term survival and reduction in left ventricular mass index. Included case series demonstrated robust post-operative outcomes in both the short and long term.

Should clopidogrel be discontinued before coronary artery bypass grafting for patients with acute coronary syndrome? A systematic review and meta-analysis

Cao C, Indraratna P, Ang SC, Manganas C, Park J, Bannon PG, Yan TD

J. Thorac. Cardiovasc. Surg. 2014 Dec;148(6):3092-8

PMID: 24954178


OBJECTIVE: Patients presenting with acute coronary syndrome (ACS) are treated with dual antiplatelet agents, including aspirin and clopidogrel, to prevent mortality and recurrent ischemia. However, those who require coronary artery bypass grafting (CABG) could have increased postoperative bleeding and bleeding-related adverse outcomes. The current guidelines on clinical management differ significantly. The present meta-analysis examined the evidence for clopidogrel in the treatment of patients presenting with ACS requiring CABG, with a focus on the timing of medication cessation before surgery.

METHODS: A systematic review of 9 electronic databases was performed to identify all relevant studies with comparable outcomes for patients with ACS treated with clopidogrel before CABG. The endpoints included reoperation, major bleeding, mortality, and a composite endpoint of mortality and recurrent myocardial infarction.

RESULTS: Five relevant studies were identified according to the predefined selection criteria. Patients who had received clopidogrel had a significantly lower incidence of composite endpoints than those who had not. However, patients who underwent CABG < 5 days after the last dose of clopidogrel had a significantly greater incidence of reoperation, major bleeding, and combined adverse outcomes than those who had had a washout period >5 days.

CONCLUSIONS: The results from the present meta-analysis suggest that patients who present with ACS should be treated with dual antiplatelet therapy, including clopidogrel. However, for patients subsequently referred for CABG, a minimum washout period of 5 days should be observed to minimize perioperative bleeding and bleeding-related complications, unless emergency indications exist. These results differ from those of previous studies and guidelines.

A meta-analysis of endoscopic versus conventional open radial artery harvesting for coronary artery bypass graft surgery

Cao C, Tian DH, Ang SC, Peeceeyen S, Allan J, Fu B, Yan TD

Innovations (Phila) 2014 Jul-Aug;9(4):269-75

PMID: 25084252


OBJECTIVE: The radial artery has been demonstrated to provide superior long-term patency outcomes compared with saphenous veins for selected patients who undergo coronary artery bypass graft surgery. Recently, endoscopic radial artery harvesting has been popularized to improve cosmetic and perioperative outcomes. However, concerns have been raised regarding the effects on long-term survival and graft patency of this relatively novel technique. The present meta-analysis aimed to assess the safety and the efficacy of endoscopic radial artery harvesting versus the conventional open approach.

METHODS: A systematic review of the current literature was performed on five electronic databases. All comparative studies on endoscopic versus open radial artery harvesting were included for analysis. Primary endpoints included mortality and recurrent myocardial infarction. Secondary endpoints included graft patency, wound infection, hematoma formation, and paresthesia.

RESULTS: Twelve studies involving 3314 patients were included for meta-analysis according to predefined selection criteria. There were no statistically significant differences in overall mortality, recurrent myocardial infarction, or graft patency between the two surgical techniques. However, patients who underwent endoscopic harvesting were found to have significantly lower incidences of wound infection, hematoma formation, and paresthesia.

CONCLUSIONS: Current literature on endoscopic harvesting of the radial artery for coronary artery bypass graft surgery is limited by relatively short follow-up periods as well as differences in patient selection and surgical techniques. In addition, there are currently no randomized controlled trials to provide robust clinical data. However, the available evidence suggests that the endoscopic approach is associated with superior perioperative outcomes without clear evidence demonstrating compromised patency or survival outcomes.

Systematic review of the cost-effectiveness of transcatheter aortic valve implantation

Indraratna P, Ang SC, Gada H, Yan TD, Manganas C, Bannon P, Cao C

J. Thorac. Cardiovasc. Surg. 2014 Aug;148(2):509-14

PMID: 24280719


OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to aortic valve replacement (AVR) for selected patients with severe aortic stenosis. The present systematic review was conducted to analyze the cost-effectiveness of this novel technique within reimbursed healthcare systems.

METHODS: Two reviewers used 7 electronic databases from January 2000 to November 2012 to identify relevant cost-effectiveness studies of TAVI versus AVR or medical therapy. The primary endpoints were the incremental cost-effectiveness ratio (ICER) and the probability of cost-effectiveness. The eligible studies for the present systematic review included those in which the cost-effectiveness data were measured or projected for TAVI and either medical therapy or AVR. All forms of TAVI were included, and all retrieved publications were limited to the English language.

RESULTS: Eight studies were included for quantitative assessment. The ICER for TAVI compared with medical therapy for surgically inoperable patients ranged from US$26,302 to US$61,889 per quality-adjusted life year gained. The probability of TAVI being cost-effective compared with medical therapy ranged from 0.03 to 1.00. The ICER values for TAVI compared with AVR for high-risk surgical candidates ranged from US$32,000 to US$975,697 per quality-adjusted life year gained. The probability of TAVI being cost-effective in this cohort ranged from 0.116 to 0.709.

CONCLUSIONS: Depending on the ICER threshold selected, TAVI is potentially justified on both medical and economic grounds compared with medical therapy for patients deemed to be surgically inoperable. However, in the high-risk surgical patient cohort, the evidence is currently insufficient to economically justify the use of TAVI in preference to AVR.

A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma

Cao C, Tian D, Park J, Allan J, Pataky KA, Yan TD

Lung Cancer 2014 Feb;83(2):240-5

PMID: 24360321


BACKGROUND: Malignant pleural mesothelioma (MPM) is an aggressive disease of the pleural lining with a dismal prognosis. Surgical treatments of MPM with a curative intent include extrapleural pneumonectomy and extended pleurectomy/decortication (P/D). This meta-analysis aimed to compare the perioperative and long-term outcomes of EPP and extended P/D for selected surgical candidates.

METHODS: A systematic review of the literature was performed on six electronic databases to identify all relevant data on comparative outcomes of extended P/D and EPP in a multimodality setting. Endpoints included perioperative mortality and morbidity, as well as long-term overall survival.

RESULTS: Seven relevant studies with comparative data on EPP (n=632) versus extended P/D (n=513) were identified from the current literature. Comparison of these two groups demonstrated significantly lower perioperative mortality (2.9% vs. 6.8%, p=0.02) and morbidity (27.9% vs. 62.0%, p<0.0001) for patients who underwent extended P/D compared to EPP. Median overall survival ranged between 13-29 months for extended P/D and 12-22 months for EPP, with a trend favouring extended P/D.

CONCLUSIONS: Although it must be emphasized that patient selection and treatment strategies differ between EPP and extended P/D, a number of comparative studies have recently been conducted to compare these two surgical techniques for patients with resectable MPM. The present study indicated that selected patients who underwent extended P/D had lower perioperative morbidity and mortality with similar, if not superior, long-term survival compared to EPP, in the context of multi-modality therapy. This may represent an important paradigm shift in the surgical management of MPM.

Systematic review of robotic minimally invasive mitral valve surgery

Seco M, Cao C, Modi P, Bannon PG, Wilson MK, Vallely MP, Phan K, Misfeld M, Mohr F, Yan TD

Ann Cardiothorac Surg 2013 Nov;2(6):704-16

PMID: 24349971


BACKGROUND: Robotic telemanipulators have evolved to assist the challenges of minimally invasive mitral valve surgery (MVS). A systematic review was performed to provide a synopsis of the literature, focusing on clinical outcomes and cost-effectiveness.

METHOD: Structured searches of MEDLINE, Embase, and Cochrane databases were performed in August 2013. All original studies except case-reports were included in qualitative review. Studies with ≥50 patients were presented quantitatively.

RESULTS: After applying inclusion and exclusion criteria to the search results, 27 studies were included in qualitative review, 16 of which had ≥50 patients. All studies were observational in nature, and thus the quality of evidence was rated low to medium. Patients generally had good left ventricular performance, were relatively asymptomatic, and mean patient age ranged from 52.6-58.4 years. Rates of intraoperative outcomes ranged from: 0.0-9.1% for conversion to non-robotic surgery, 106±22 to 188.5±53.8 min for cardiopulmonary bypass (CPB) time and 79±16 to 140±40 min for cross-clamp (XC) time. Rates of short-term postoperative outcomes ranged from: 0.0-3.0% for mortality, 0.0-3.2% for myocardial infarction (MI), 0.0-3.0% for permanent stroke, 1.6-15% for pleural effusion, 0.0-5.0% for reoperations for bleeding, 0.0-0.3% for infection, and 1.1-6% for prolonged ventilation (>48 hours), 1.5-5.4% for early repair failure, 12.3±6.7 to 36.6±24.7 hours for intensive care length of stay, 3.1±0.3 to 6.3±3.9 days for hospital length of stay (HLOS) and 81.7-97.6% had no or trivial mitral regurgitation (MR) before discharge.

CONCLUSIONS: All subtypes of mitral valve prolapse are repairable with robotic techniques. CPB and XC times are long, and novel techniques such as the Cor-Knot, Nitinol clips or running sutures may reduce the time required. The overall rates of early postoperative mortality and morbidity are low. Improvements in postoperative quality of life (QoL) and expeditious return to work offset the increase in equipment and intraoperative cost. Evidence for long-term outcomes is as yet limited.

Custodiol for myocardial protection and preservation: a systematic review

Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J

Ann Cardiothorac Surg 2013 Nov;2(6):717-28

PMID: 24349972


INTRODUCTION: Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant.

METHODS: Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant.

RESULTS: Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant.

CONCLUSIONS: Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.

Stay in the loop

Subscribe to our Heart to Heart newsletter to keep up with the latest developments in heart and lung research from The Baird Institute.

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

This content is currently being updated.

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.