Division of Cardiac Surgery / Research
Medical Research (Education); Generalizability Theory; Evaluation; Transference
Besides coronary and valvular surgery, his fields of interest include adult congenital surgery and complex valvular and aortic disease. He is currently involved with the clinical evaluation of a new aortic prosthesis.
1) Clinical outcomes related to warm heart surgery; 2) Increased risk of coronary bypass surgery in females; 3) Left ventricular mass regression and gradient reduction in patients undergoing aortic valve surgery with various alternative prostheses.
Is currently involved in a Xenotransplantation Research Program which is the elucidation of the mechanism of hyperacute rejection using the clinically relevant human porcine xenogeneic system. Our work has identified an important regulatory role of programmed cell death in the mediation of endothelial cell injury on exposure to xenogenic stimuli. The objective of this program is to develop anti-apoptotic strategies capable of mitigating the hyperacute rejection response. The Xenotransplantation Research Program offers office research training programs at both the Master's and Ph.D. level of postgraduate training.
Development of minimally invasive techniques of cardiac surgery. Also interested in heart failure and methods to increase collateral blood vessel formation in ischemic myocardium.
Research activities are centered around heart valve disease, aortic root aneurysms and mechanical complications of myocardial infarction.
Cardiac preservation for transplantation and management of pulmonary hypertension in the heart transplant patient and stentless aortic valve.
Aortic valve replacement with the stentless porcine valve, mitral valve repair and valve surgery in the elderly; coronary artery bypass grafting with emphasis on myocardial protection, coronary endarterectomy, and arterial revascularization. Cardiac pacing with specific interest in surgical aspects of implantation, management of complications and extraction.
Management of the patient in the Intensive Care Unit after cardiac surgery, Cerebral Protection and Surgical Education. I have made several presentations regarding Early Extubation after Cardiac Surgery including one recently at the American Association for Thoracic Surgery. In addition I am the Director of the Clinical Clerkship for the Department of Surgery at the hospital. I am the principal investigator for the Mosaic Heart Valve, a new bioprosthesis which has been implanted here since January of this year.
Organizing clinical trials focused on clinical outcomes, patient satisfaction and cost benefit analysis.
Current and Future Health Care Policy in Canada.
The effects of ischemic preconditioning on cardiac viability, metabolism, signal transduction and second messenger activation in a cell culture model employing human cardiomyocytes endothelial cells and fibroblasts (Cardiovascular Research, 1994;28:1285-1291). We recently evaluated oxyradical - induced antioxidant lipid changes in human cardiomyocytes (American Journal of Physiology, 1994;26, Heart Circulation Physiology 35;H2204-H2211). We identified the oxygen responsive element of the human glutathione peroxidase gene (Journal of Biologic Chemistry, 1993;36:26904-26910).
We investigated the effects of ischemic preconditioning on cardiac viability, metabolism, signal transduction and second messenger activation in a cell culture model employing human cardiomyocytes endothelial cells and fibroblasts (Cardiovascular Research, 1994;28:1285-1291). We recently evaluated oxyradical - induced antioxidant lipid changes in human cardiomyocytes (American Journal of Physiology, 1994;26, Heart Circulation Physiology 35;H2204-H2211). We identified the oxygen responsive element of the human glutathione peroxidase gene (Journal of Biologic Chemistry, 1993;36:26904-26910).
We evaluated the protective effects of vitamin E for coronary bypass surgery in a prospective, double-blind randomized trial (Journal of Thoracic and Cardiovascular Surgery, 1994;108:302-310). We carefully evaluated ventricular function employing a nuclear ventriculography and intraventricular pressure measurements in patients who received either warm or cold heart surgery (Journal of Thoracic and Cardiovascular Surgery, 1993; 105:833-844). We compared alternate techniques of myocardial protection on the recovery of heart function and metabolism ( Annals of Thoracic Surgery, 1993;56:1020-1028, Journal of Thoracic and Cardovascular Surgery, 1994; 107:510-519, Annals of Thoracic Surgery, 1994;58:961-971).
The ischemic and reperfusion group of the Centre for Cardiovascular Research has an interest in molecular biology, cell signalling and large animal studies to determine the best methods of protecting the heart from ischemic and reperfusion injury during cardiac surgery. We have performed a series of clinical trails of evaluating techniques and additives for cardioplegic protection. We evaluate outcomes at The Toronto Hospital and with the Institute for Evaluative Sciences at Sunnybrook. We span the spectrum of research from the bench to the bedside.
Understanding and preventing damage to the hearts of infants undergoing heart surgery as well as those hearts with advanced pathology such as hypertrophy and failure. Functional and metabolic approaches are used to study these conditions and identify specific limitations amenable to intervention which would favourably ameliorate the surgical outcome and minimize risk. Present professional activities include running the Cardiovascular Sciences Collaborative Program (graduate program) at the university; Staff, Division of Cardiovascular Surgery, The Hospital for Sick Children and consultant to their Research Institute; member, Centre for Cardiovascular Research. Future interests are in the molecular and cellular biology of the developing myocardium and the long term effects of cyanosis.
The Cardiovascular Sciences Collaborative Program
Is an exciting program created to develop co-operative and joint graduate teaching and research across departmental boundaries under the Faculty of Medicine. The Program builds on the strengths of the collaborating clinical and graduate departments, institutes and centres - enhancing the visibility of cardiovascular studies and facilitating interdisciplinary training and research. The Program offers diverse areas of training including 2 major streams of studies: Cardiac and Vascular.