Our Cardiothoracic surgeons and interventionalists are amongst the best in the world; this is especially true at RPAH, where, through the Baird Institute and the new Institute of Academic Surgery, they have led a dramatic research-centric culture shift over the past decade. More than half of the research published in the field of Cardiothoracic Surgery in Australia and New Zealand in the last five years has emanated from this precinct. Amongst many other positions held, its surgeons head the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the National Cardiothoracic Surgical Research Network.vInternationally the Cardiothoracic surgeons of RPAH and the Baird are well recognised with existing collaborations with Oxford and Stanford Universities as well as many other major clinical institutions.
The RPAH Cardiothoracic Surgery Department in conjunction with The Baird Institute is conducting and assisting research that directly benefits cardiothoracic surgical patients in the areas of new materials for heart valves, best practice management of asbestos-related surgical disease, improved surgical techniques, the use of stents, balloons and patches, drug therapies and the use of a patient support group to improve peri-operative and post-surgery quality of life.
These multimodal areas of research are described under the following:
- Aortic Disease Research.
Thoracic aortic aneurysm disease is rapidly becoming one of the most common but silent killers in western society. Many conditions are inherited including Marfan's disease, and those conditions associated with abnormal heart valves. Our research is aimed at determining the precise genetic basis of the condition, the mechanisms leading to the changes in the aorta, and developing peripheral tests to detect enlargement of the aorta and imminent rupture. The Aortic Valve Disease Group has strengthened ties with The Centenary Institute and continues to investigate issues of abnormal heart valves or enlargement of the Aorta. Database information has been developed to monitor genetic and familial representations of these diseases, which in clinical practice is used to help determine how these killer conditions are inherited. The goal is to determine when surgical intervention is optimal or at the lowest risk time for the patient. We are affiliated with the Collaborative Research (CORE) Group, responsible for establishing and organizing the world's largest multi-institutional Aortic ARCH Registry, consisting of 14,000 patients from 37 leading aortic centers from 11 countries.
Many different devices are now implanted surgically to repair or improve the function of the heart. These devices, including artificial blood vessels and heart valves, are inserted with minimal risk. However, many are not biocompatible. They may be seen as foreign objects by the body, and may require life-long blood thinning medication, which carries its own burden of disease. Thus, our research is aimed at producing biocompatible devices by electromagnetically coating foreign surfaces with recombinant synthetic human elastin and fibronectin. This technique is currently being developed to build new blood vessels in the laboratory. As biocompatibility is demonstrated, the technology and knowledge gained may be used to produce other biocompatible devices. Past fellow and current surgeon, Dr. Michael Byrom is commencing further laboratory-based research in conjunction with Associate Professor Martin Ng (Heart Research Institute) and is working with current students, to continue work on new materials and coatings in novel vascular bypass conduits. Laboratory studies will take place at The Charles Perkins Centre, RPAH, which provides a first-class facility for in-vivo training, testing and assessment of new vascular biomaterial implants including valves, stents, and conduits. Outcomes from this work include the development of a biocompatible 'off-the-shelf' blood vessel for use in patients when the patient's own blood vessels are not suitable or appropriate to the surgery.
- Innovative Heart Surgery
Heart surgery in our aging population presents us with unique difficulties, challenges and opportunities. Our research aims to improve the survival and quality of life of the higher risk cardiac patient through the development of novel surgical techniques and strategies, investigating the specific interactions between the heart-lung machine and the body in the laboratory, and determine the optimum approach for each individual patient through meta-analysis. A major impact from this research is to decrease the incidence of stroke during cardiac surgery; as well as to reduce the impact of an artificial heart and blood oxygen machine upon the patient's intra-operative and post-operative recovery. In addition to these anticipated outcomes, further research is being conducted to confirm or alter the advantages between the uses of coronary surgery versus coronary stenting.
- Thoracic Oncology Group
Research understanding has been progressed within the areas of lung cancer, mesothelioma, surgical correction and life extension at The Baird for over 10 years. Our researchers have coordinated a planned approach to the surgical management of patients with these devastating cancers and have built an international reputation for excellence in surgical results and within total patient care. Research into early detection and surgical management are making some inroads into improving patient outcomes. We are affiliated with the VATS Lobectomy Consensus Group, involving 50 world experts in Minimally Invasive Thoracic Surgery
Commencement at RPAH of the Vision cardiac surgery study
The VISION Cardiac Surgery Study will establish the role of perioperative hsTnI measurements in identifying prognostically important myocardial injury after cardiac surgery and the proportion that would go undetected without routine troponin monitoring. This, in turn, will facilitate further studies of timely interventions. This cohort study will also determine the current incidence of major perioperative vascular events in a representative sample of contemporary adult patients undergoing cardiac surgery. 246 patients have been recruited at RPAH with a world-wide goal of 15,000 patients. The study aims to determine the relationship between postoperative high-sensitivity Troponin I measurements and the 30-day risk of mortality, the proportion of perioperative myocardial injuries that may go undetected without perioperative troponin monitoring, and the incidence of major vascular complications after surgery.
- Setting up the foundation of, in conjunction with the RPAH anaesthetic department, a research program to study the Effect of ECMO on end-organ perfusion
Extra-corporeal membrane oxygenation (ECMO) is used to provide cardiovascular and respiratory support of patients with severe respiratory disorders. It is an external circuit that drains the patient's blood, oxygenates it through an artificial lung before returning the blood to the patient. This allows the patient's lungs and heart to rest. Veno-arterial (VA) ECMO involves draining deoxygenated blood from the right atrium (via femoral vein cannulation) into a centrifugal pump and oxygenator, before returning oxygenated blood to the patient's circulation via the femoral artery, at a rate of approximately 4 L/min. Whilst this can help greatly with supporting critically ill patients, the effects of the ECMO circuit on end-organ perfusion is relatively unknown.
VA ECMO pushes flow up the descending aorta, in the reverse direction to normal flow. If the patient has some residual heart function, this retrograde flow mixes with native heart flow, with the effect on end organ perfusion unknown. The research question is to identify the differences in end organ perfusion (particularly kidneys and stomach/intestines) between a healthy person, an ECMO patient with no heart function and a recovering ECMO patient with some heart function. This information will then be used to determine optimal ECMO flow conditions for a range of residual heart functions. This project will be conducted in collaboration with researchers from Royal Prince Alfred Hospital, Sydney Translational Imaging Laboratory at the University of Sydney and the Graduate School of Biomedical Engineering at University of New South Wales.
To meet the project aim, 3D models of the descending aorta (including femoral arteries) will be created and validated using 4D-Flow MRI data. An ECMO patient will then be simulated, and ECMO flow rates set between 0 and 4L/min, in order to determine the optimal level of support for suitable end organ perfusion. The study will be repeated for a recovering ECMO patient.
Models will be validated using a silicone re-creation of the descending aorta. Patient flows will be recreated using a MRI-compatible mock circulation loop. 4D flow images will be recorded for all three different flow conditions (healthy, full ECMO support, partial ECMO support) and compared to the results produced by the model.
- The initiation of, in collaboration with the Charles Perkins Centre at the University of Sydney, a Translational research Facility.
The model for this facility includes a hybrid imaging system a coupled MRI suite, as well as the only Robotic training facility in the southern hemisphere. A hybrid surgical approach involves the integrated use of imaging, percutaneous and invasive surgical techniques to perform minimally invasive surgical techniques with greater precision, maximising outcomes and minimising damage to patients. A hybrid procedural approach emphasises multidisciplinary care, and typical hybrid procedures involve proceduralists from a number of different specialties. The cross-disciplinary nature of the hybrid approach highlights a unifying role for the Facility as a place where engineers, computer scientists, physiologists, molecular scientists and clinicians will collaborate. Invasive measurements of physiology, cell and molecular biology, and immunology are vitally important in conditions as varied as heart failure, atherosclerosis, valve stenosis, cardiomyopathy, peripheral vascular disease and metabolic diseases. We envisage a broad scientific role for the facility that will extend well beyond the interventions that are practiced clinically - including refinement of biosynthetic vessels, development of new percutaneous devices, validation of non-invasive imaging tests, in vivo measurements of clotting and endothelial dysfunction and basic science experiments involving delivery of percutaneous stem cells or pharmacological agents.
Complementary to the hybrid approach is the use of both robotic surgical techniques and the integrated use of high-end imaging such as MRI to guide procedures. RPAH has been at the forefront of the adoption of robotic surgery, and in 2015 plans were well in place for the SLHD to provide RPAH with of the latest generation Da Vinci Robotic system The Cardiothoracic surgery department was also making plans in 2015 to submit an ethics proposal in early 2016 to use the Davinci robot in Coronary artery bypass graft surgery
- Professor Paul Bannon
Head of Research, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW. Chairman, The Baird Institute for Applied Heart and Lung Surgery,Newtown, NSW.Advanced Scholar, Macquarie University, NSW.Professor, Chair of Cardiothoracic Surgery,University of Sydney, NSW.
- Professor Michael Vallely, Cardiothoracic surgeon, Chair of Structural Heart
- Dr Michael Byrom, Cardiothoracic Surgeon
- Professor Michael Wilson, Cardiothoracic Surgeon.
- Professor Tristan Yan, Cardiothoracic Surgeon
- Dr Matthew Bayfield, Cardiothoracic Surgeon
- Ms Lisa Turner, Cardiovascular Surgery Research CNC
- Ms Lorna Beattie, Cardiovascular Clinical Trial Coordinator
Publications and Presentations
Professor Paul Bannon
- Dhurandhar V, Parikh R, Saxena A, Vallely MP, Wilson MK, Black DA, Tran L,Reid CM, Bannon PG. The Aortic Root Replacement Procedure: 12-year Experience from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database. Heart Lung Circ. 2016 Dec;25(12):1245-1251. doi: 10.1016/j.hlc.2016.04.014. Epub 2016 May 16. PubMed PMID: 27269475.
- Lal S, Turner L, Powell C, Wilson M, Bannon P. Improvements in left
ventricular ejection fraction and quality of life in patients with heart failure who undergo coronary artery bypass surgery. Int J Cardiol. 2016 Nov 1;222:671-3. doi: 10.1016/j.ijcard.2016.08.061. Epub 2016 Aug 4. PubMed PMID: 27522375.
- Robertson EN, van der Linde D, Sherrah AG, Vallely MP, Wilson M, Bannon PG,Jeremy RW. Familial non-syndromal thoracic aortic aneurysms and dissections - Incidence and family screening outcomes. Int J Cardiol. 2016 Oct 1;220:43-51. doi: 10.1016/j.ijcard.2016.06.086. Epub 2016 Jun 23. PubMed PMID: 27372041.
- Sherrah AG, Andvik S, van der Linde D, Davies L, Bannon PG, Padang R, Vallely MP, Wilson MK, Keech AC, Jeremy RW. Nonsyndromic Thoracic Aortic Aneurysm and Dissection: Outcomes With Marfan Syndrome Versus Bicuspid Aortic Valve Aneurysm. J Am Coll Cardiol. 2016 Feb 16;67(6):618-26. doi: 10.1016/j.jacc.2015.11.039. PubMed PMID: 26868685.
- Saxena A, Dhurandhar V, Bannon PG, Newcomb AE. The Benefits and Pitfalls of the Use of Risk Stratification Tools in Cardiac Surgery. Heart Lung Circ. 2016 Apr;25(4):314-8. doi: 10.1016/j.hlc.2015.12.094. Epub 2016 Jan 28. PubMed PMID: 26857968.
- Sheriff MJ, Mouline O, Hsu C, Grieve SM, Wilson MK, Bannon PG, Vallely MP,Puranik R. Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery. Heart Lung Circ. 2016 Jun;25(6):613-9. doi: 10.1016/j.hlc.2015.11.011. Epub 2016 Jan 18. PubMed PMID: 26839164.
- Zhao DF, Seco M, Wu JJ, Edelman JB, Wilson MK, Vallely MP, Byrom MJ, Bannon PG. Mechanical Versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2016 Jul;102(1):315-27. doi: 10.1016/j.athoracsur.2015.10.092. Epub 2016 Jan 12. Review. PubMed PMID: 26794881.
- McLaughlin A, McGiffin D, Winearls J, Tesar P, Cole C, Vallely M, Clarke A,Fraser J. Veno-Arterial ECMO in the Setting of Post-Infarct Ventricular Septal Defect: A Bridge to Surgical Repair. Heart Lung Circ. 2016 Nov;25(11):1063-1066. doi: 10.1016/j.hlc.2016.02.024. Epub 2016 May 10. Review. PubMed PMID: 27374861.
Professor Michael Vallely
- Kao, S., Kirschner, M., Cooper, W., Tran, T., Burgers, S., Wright, C., Korse, T., van den Broek, D., Edelman, J., Vallely, M., McCaughan, B., Pavlakis, N., Clarke, S., van Zandwijk, N., Reid, G., et al (2016). A proteomics-based approach identifies secreted protein acidic and rich in cysteine as a prognostic biomarker in malignant pleural mesothelioma. British Journal of Cancer, 114(5), 524-531. Haymet, A., Edelman, J., Seco, M., Duflou, J., Vallely, M., Ng, H., Ng, M., Wilson, M. (2016). Aortic perforation following transcatheter aortic valve deployment. International Journal of Cardiology, 207, 384-386.
- Sheriff, M., Mouline, O., Hsu, C., Grieve, S., Wilson, M., Bannon, P., Vallely, M., Puranik, R. (2016). Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery. Heart, Lung and Circulation, 25(6), 613-619.
- Dhurandhar, V., Parikh, R., Saxena, A., Vallely, M., Wilson, M., Black, D., Tran, L., Reid, C., Bannon, P. (2016). Early and Late Outcomes Following Valve Sparing Aortic Root Reconstruction: The ANZSCTS Database. Heart, Lung and Circulation, 25(5), 505-511.
- Robertson, E., van der Linde, D., Sherrah, A., Vallely, M., Wilson, M., Bannon, P., Jeremy, R. (2016). Familial non-syndromal thoracic aortic aneurysms and dissections - Incidence and family screening outcomes. International Journal of Cardiology, 220, 43-51.
- Cheng, Y., Wright, C., Kirschner, M., Williams, M., Sarun, K., Sytnyk, V., Leshchynska, I., Edelman, J., Vallely, M., McCaughan, B., van Zandwijk, N., Reid, G., et al (2016). KCa1.1, a calcium-activated potassium channel subunit alpha 1, is targeted by miR-17-5p and modulates cell migration in malignant pleural mesothelioma. Molecular Cancer, 15(1), 1-12.
- Sherrah, A., Jeremy, R., Puranik, R., Bannon, P., Hendel, P., Bayfield, M., Wilson, M., Brady, P., Marshman, D., Mathur, M., Vallely, M., et al (2016). Long Term Outcomes Following Freestyle Stentless Aortic Bioprosthesis Implantation: An Australian Experience. Heart, Lung and Circulation, 25(1), 82-88.
- Zhao, D., Seco, M., Wu, J., Edelman, J., Wilson, M., Vallely, M., Byrom, M., Bannon, P. (2016). Mechanical Versus Bioprosthetic Aortic Valve Replacement in Patients Aged 40 to 70 Years: A Systematic Review and Meta-Analysis. The Annals of Thoracic Surgery, 102(1), 315-327.
- Sherrah, A., Andvik, S., van der Linde, D., Davies, L., Bannon, P., Padang, R., Vallely, M., Wilson, M., Keech, A., Jeremy, R. (2016). Nonsyndromic Thoracic Aortic Aneurysm and Dissection: Outcomes With Marfan Syndrome Versus Bicuspid Aortic Valve Aneurysm. Journal of the American College of Cardiology, 67(6), 618-626.
- Dhurandhar, V., Parikh, R., Saxena, A., Vallely, M., Wilson, M., Black, D., Tran, L., Reid, C., Bannon, P. (2016). The Aortic Root Replacement Procedure: 12-year Experience from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database. Heart, Lung and Circulation, 25(12), 1245-1251.
- Callaghan, F., Kozor, R., Sherrah, A., Vallely, M., Celermajer, D., Figtree, G., Grieve, S. (2016). Use of multi-velocity encoding 4D flow MRI to improve quantification of flow patterns in the aorta. Journal of Magnetic Resonance Imaging, 43(2), 352-363.
- McLaughlin, A., McGiffin, D., Winearls, J., Tesar, P., Cole, C., Vallely, M., Clarke, A., Fraser, J. (2016). Veno-arterial ECMO in the setting of post-infarct ventricular septal defect: a bridge to surgical repair. Heart, Lung and Circulation, 25(11), 1063-1066.
Professor Tristan Yan
- Phan, K., Zhao, D., Zhou, J., Karagaratnam, A., Phan, S., Yan, T. (2016). Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients: Systematic review and metaanalysis. Journal of Thoracic Disease, 8(5), 769-777.
- Cao, C., D'Amico, T., Demmy, T., Dunning, J., Gossot, D., Hansen, H., He, J., Jheon, S., Petersen, R., Sihoe, A., Yan, T., et al (2016). Less is more: a shift in the surgical approach to non-small-cell lung cancer. The Lancet Respiratory Medicine, 4(3), e11-e12.
- Yan, T. (2016). Mini-Bentall Procedure: The "French Cuff" Technique. Annals of Thoracic Surgery, 101(2), 780-782.
- Phan, K., Khuong, J., Xu, J., Kanagaratnam, A., Yan, T. (2016). Obesity and postoperative atrial fibrillation in patients undergoing cardiac surgery: Systematic review and meta-analysis. International Journal of Cardiology, 217, 49-57.
- Munkholm-Larsen, S., Yan, T. (2016). Percutaneous coronary intervention versus bypass grafting in left main coronary artery disease. Journal of Thoracic Disease, 8(10), 2677-2679.
- Wang, N., Qian, P., Yan, T., Phan, K. (2016). Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: A systematic review and trial sequential analysis. International Journal of Cardiology, 206, 143-152.
- Xie, A., Yan, T., Forrest, P. (2016). Recirculation in venovenous extracorporeal membrane oxygenation. Journal of Critical Care, 36, 107-110.
- Xiao, Z., Cao, C., Mei, J., Liao, H., Yan, T., Liu, L. (2016). Should tumor with direct adjacent lobe invasion (Tdali) be assigned to T2 or T3 in non-small cell lung cancer: A meta-analysis. Journal of Thoracic Disease, 8(8), 1956-1965.
- Harris, C., James, R., Tian, D., Yan, T., Doyle, M., Gonzalez-Rivas, D., Cao, C. (2016). Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer. Annals of Cardiothoracic Surgery, 5(2), 76-84.
- Phan, K., Phan, S., Thiagalingam, A., Medi, C., Yan, T. (2016). Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation. European Journal Of Cardio-Thoracic Surgery, 49(4), 1044-1051.
- Wang, N., Tsai, Y., Niles, N., Tchantchaleishvili, V., Di Eusanio, M., Yan, T., Phan, K. (2016). Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: A systematic review and meta-analysis of matched studies. Journal of Thoracic Disease, 8(11), 3283-3293.
- Phan, K., Huo, Y., Zhao, D., Yan, T., Tchantchaleishvili, V. (2016). Ventricular recovery and pump explantation in patients supported by left ventricular assist devices: A systematic review. ASAIO Journal, 62(3), 219-231.
Contact details for department
Head of Department: Professor Paul Bannon
Department/Unit: Cardiothoracic Surgery
Level 6 West, RPA Hospital
Telephone: (02) 9515 6377
Facsimile: (02) 9515 8629