Awards: 
Sir Alexander McCormick Fellowship

Committees: 
Cardiac Society of Australia and New Zealand - Board member - Victorian State Committee
National Heart Foundation - Board member
Executive Cardiovascular Therapeutics Laboratory, The University of Melbourne

Organisations: 
Melbourne University
Royal Australasian College of Surgeons
Australasian Society of Cardiothoracic Surgeons (ASCTS)
Society of Thoracic Surgeons (STS)
European Association of Cardio-Thoracic Surgeons (EACTS)
Cardiac Society of Australia and New Zealand (CSANZ)
Australian Army

Current Positions: 
Cardiothoracic surgeon Royal Melbourne Hospital, Western Hospital, Warringal, Epworth, Melbourne Private, and John Fawkner private hospitals
Co-Director, Certificate, Diploma and Masters courses, The University of Melbourne

Research Interests: (Summary)
MD thesis: Exclusively pedicled arterial coronary reascularisation 1999. Download the MD Thesis (4.7MB)  This thesis was undertaken over 4 years full time.
Intraoperative echocardiography, ultrasound use, Diploma of Ultrasound teaching
Arterial and composite coronary revascularisation, radial artery in particular, late assessment of the ulnar artery
Off pump coronary surgery, high thoracic epidural use
Levosimendan, ischaemia / reperfusion injury, Desflurane
Bleeding with surgery, NovoSeven (rFVIIa)

Research Interests: (Detailed) 
Total arterial coronary artery bypass surgery. This arose from increased use of a new arterial conduit, the radial artery. Also it related to more efficient use of conduit by the reintroduction of sequential grafting (more than one anastomosis per conduit) as well as joining conduits together to save on wasted conduit length (composite or Y grafting). The research resulted in a number of publications and is summarised in the MD thesis relating to this work. Patient information coronary artery bypass surgery. See a presentation. 

Radial artery angiography - postoperative angiography in the period approximating 5 years in both aorto-coronary and Y graft configurations is nearing completion. Interestingly there are angiograms approximating 10 years and there is very little evidence of progressive conduit atheroma developing. This supports the notion that arterial conduits may behave similarly as a group; and different from venous grafts. Radial artery leaflet. Radial artery harvest technique. Radial artery harvest and use paper.  Flow is preserved to the hand years later.   

An ongoing study examining the residual ulnar artery following radial artery harvest 7-10 years prior. The arteries are compared to the contralateral forearm where the radial artery was not harvested using ultrasound assessment. This forms the basis for the medical student thesis of Greg Chang. We found that where we had harvested the radial artery, there was no new atheroma in the remaining ulnar artery on that side. Additional publications include one which found that the maximal flow to the forearm where the radial artery had been previously harvested was preserved.

Off pump vs On pump coronary surgery. There are two studies nearing completion relating to a comparison of 1999 patients (2% off pump) vs 2001 patients (98% off pump) and their clinical outcome. A second study has now closed, involving MRI brain scans prior to and post CABG. Both groups had total arterial revascularisation using the Y graft method (to minimise brain atheroembolism), and were prospectively randomised to on pump vs off pump. The manuscript is being constructed. An additional paper related to alterations inflow of the native coronary artery and conduit during off pump coronary grafting during application and then release of the Medtronic Octopus 4 stabiliser.

Postoperative orders sheet 

High thoracic epidural. A randomised study found markedly improve pain relief with this technique and a reduced incidence of postoperative depression and post traumatic stress disorder when compared to patient controlled intravenous narcotic infusions for postoperative pain relief. HTEA Review HTEA dressing

Epiaortic echocardiography (Intraoperatve Epivascular aortic ultrasound). Much of postoperative brain dysfunction following cardiac surgery may relate to subtle brain atheroembolism. Ultrasound assesment is therefore performed immediately prior to any aortic manipulation such as cannulation, clamping or anastomosis construction. We have shown a reduction in postoperative neurocognitive (neuropsychological) dysfunction when aortic atheroma was detected by these methods and surgery was altered to avoid any detected atheroma. Recently we have published the standardised technique on how to perform this examination including line drawings of the expected ultrasound images, in the European journal of cardio-thoracic surgery.

Echocardiography as a tool for assessing systolic and diastolic cardiac function.There have been quite a few papers examining this subject and formed the main body of research for the MD Thesis of Colin Royse. These studies include comparison with haemodynamic data from the Swan-Ganz catheter during surgery as well as pressure-volume loops in the animal model. Recently, a paper has been accepted examining echocardiography indices of function in patients where intraoperative pressure-volume loop data has been acquired. This material has formed part of the PhD thesis of Kim Connelly. Pulsed wave tissue Doppler (Peak Sm) and after load corrected fractional area change (FACac) were the two most promising indices. Additional papers relate to assessment of aortic atheroma assessment as well as flow in the descending aorta using pulsed wave Doppler to assess the impact of heart retraction as a beat to beat assessment of flow or cardiac output.

Bleeding. Cardiac surgery uses blood and blood products frequently, and perhaps second only to Haematology / Oncology. Long cardiopulmonary bypass runs and complex surgery frequently result in a coagulation deficit. However, the heart wil not tolerate much pressure from blood or clot (tamponade) and so mostly bleeding must cease based on the ability of the blood to clot. We have conducted a large audit of more than 200 patients examining the clinical and economic data relating to long and complex cardiac surgery cases. In particular use of blood transfusions and the use of alternative agents such as activated recombinant Factor VII (NovoSeven) is currently being analysed. The preliminary data confirms adverse outcome when blood products were required.

Levosimendan. This novel inotrope is being tested in a variety of ways as part of the PhD thesis of Paul Soeding. This included in vitro analysis using right atrial tissue organ baths as well as in vivo analysis using pressure-volume loops. Perhaps the most interesting preliminary finding is that this agent may have some protective properties for ischaemia / reperfusion.

Ischaemia / reperfusion. This research forms the basis of the PhD of David Andrews  and involves both an animal model as well as a proposed clinical study. The data is examining whether some newer anaesthetic agents may be relatively protective in ischaemia / reperfusion caused by various surgical procedures. In particular, the studies will be comparing the differences in brain and heart outcome for Propofol vs Desflurane in cardiac surgery patients.

Milrinone. This agent was investigated using pressure-volume loops in the animal model and appears to be a weak inotrope and a relatively potent vasodilator. The manuscript has recently been accepted for publication.