Academic cardiac surgery


What

We are widely recognised as the top academic cardiac surgery centre in the UK, using a fully translational approach that enables us to pioneer and validate new surgical techniques via rigorous trials. 

A key example is ‘off-pump coronary artery bypass’.  We developed the technique, demonstrated its advantages compared to conventional surgery, its impact on health outcome, organ function (including retinal and cerebral microvascular injury), late follow up, and investigated the science behind its benefits. 

We then translated these findings back to the clinic, further refining the technique, improving clinical outcomes, and training junior doctors at national and international level.  This research has had a major impact on coronary surgical practice. 

Being able to use this two-way translational approach in Bristol CardioVascular means we are able to advance many other areas of cardiac surgery. 

These include identifying novel stem cell therapy for myocardial repair, reducing the side effects of blood transfusion, and diabetes mellitus, creating biocompatible valves for use in paediatric cardiac surgery; investigating ways to reduce vein graft failure; testing cardio-pulmonary protective therapies to lessen reperfusion injury – and many more.

Evaluation through clinical trials is a crucial stage in the research pathway and Bristol has been accredited as a UKCRN-registered trials unit, with around 40 full time staff.   We also benefit from the historical network created with outstanding basic science groups in the South-West and nationally and from access to the latest imaging technologies, research facilities, and a dedicated surgical suite.

Where

Research is conducted in the School of Clinical Sciences, NIHR Biomedical Research Unit, School of Biochemistry, and in different divisions of the University Hospitals Bristol NHS Foundation Trust including the new Bristol Heart Institute Hospital in which we have embedded over the years a tangible research structure for the benefit of our patients.

How

Characteristic methods and techniques routinely used in this area of research include randomised control trials (RCTs), and techniques involved in the basic science research that partners our surgical research, e.g. cell culture and stem cell biology. The Academic Cardiac Surgery Unit conduct outstanding preclinical experimental work using relevant large models of cardiopulmonary bypass, cardiac and pulmonary reperfusion injury, and cardiovascular regeneration models that are unique in the UK.

Highlights

There are currently 11 ongoing surgical trials at our academic unit and more than 90% of our patients are offered the opportunity to take part in a research project (overall recruitment rate per year ranges from 50-60% depending on the complexity of the project). These projects largely investigate novel interventions aimed at reducing postoperative complications associated with complex cardiac surgery.

Current ongoing research trials in patients include:

  • COPTIC: Coagulation and platelet laboratory testing in cardiac surgery
  • HArVeST: An RCT to assess the extent of intimal hyperplasia and atherogenesis in bypass vein grafts following different surgical preparation techniques
  • OXIC-2: An RCT of normoxic vs. standard cardiopulmonary bypass in cyanotic children undergoing cardiac surgery
  • Pasport: An RCT to assess patient-specific cerebral oxygenation monitoring as part of an algorithm to reduce transfusion during heart valve surgery
  • ProMPT: An RCT to assess propofol based cardioplegia on blood and myocardial biomarkers of stress and injury in patients having bypass graft or heart valve surgery
  • Protection : An RCT to assess pulmonary protection with low frequency ventilation during cardiac surgery with cardiopulmonary bypass
  • SCAT: An RCT to assess shortening cardioplegic arrest time during combined coronary and valvular surgery
  • TransACT 1: A double-blind RCT to assess transplantation of enriched autologous bone-marrow derived CD133+ cells in patients having coronary surgery after acute large myocardial infarction
  • TransACT 2: A double-blind pilot RCT to assess the feasibility of transplantation of bone-marrow derived CD133+ cells in patients undergoing left ventricular restoration surgery for dilated chronic ischemic heart failure
  • Thermic-2: An RCT to compare normothermic versus hypothermic cardiopulmonary bypass in children undergoing open heart surgery
  • VeRDiCT: Preoperative volume replacement vs. usual care in diabetic patients having CABG

Current ongoing pre-clinical research trials in our large experimental models include:

  • Protection 2: An RCT to assess pulmonary protection with intermittent retrograde pulmonary perfusion with intermittent or continuous low frequency ventilation during cardiopulmonary bypass.

More information

Further details on research in this area can be found at:

Professor Gianni Angelini’s research web page

Professor Raimondo Ascione's research webpage

Professor Massimo Caputo’s research webpage

You can read more about our academic cardiac surgery research by seeing the list of current clinical trials; and details of research in the Biomedical Research Unit.