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Solving the mysteries of heart surgery

Toronto, July 24, 2015

By Geoff Koehler

Dr. Subodh Verma looks at a heart model through a magnifying glass
Dr. Subodh Verma is linking experts around the globe to CARDIOLINK – a collection of researchers working to advance cardiovascular surgery research. (Photo by Katie Cooper)

Cardiovascular surgeon Dr. Subodh Verma was troubled by the lack of data to guide decision making and treatment choices for patients undergoing heart or vascular surgery.

“There are still too many unknowns when it comes to cardiovascular surgery outcomes,” said Dr. Verma. “I think the best way to find those missing links is by connecting smart people and asking smart questions.”

Dr. Verma formed a research hub, called CARDIOLINK, to answer questions that will improve care and prevent hospitalization for patients with heart and vascular disease or diabetes.

CARDIOLINK brings together top experts from across St. Michael’s, Canada and the world to address five major themes of cardiovascular surgery: atrial fibrillation, aortic aneurysms, peripheral arterial disease, valvular heart disease and community-based interventions to reduce re-hospitalization.

“For each of our five themes, there is a randomized clinical trial being developed – each designed to address an important gap in cardiovascular research and deliver definitive and potentially practice-changing results,” said Dr. Verma.

  
  • In creating CARDIOLINK, Dr. Verma teamed up with cardiovascular anesthesiologist, Dr. David Mazer, and Dr. Muhammad Mamdani, director of the Applied Health Research Centre.

  • Several other members of St. Michael’s are leading or involved in individual CARDIOLINK themes. Dr. Mark Peterson is working on the ACE trial; Dr. Mohammed Al-Omran on EXTINGUISH, Dr. Howard Leong-Poi on CAMARA-1 and Dr. Akshay Bagai on ENABLE-NP. CARDIOLINK includes representation from Calgary, Hamilton, Ottawa and London, Ont., as well as Saudi Arabia and Australia.

The SEARCH-AF trial will investigate whether using a new heart rhythm monitoring device after heart surgery will uncover new rhythm irregularities and help identify individuals at risk of having a stroke following heart surgery. This trial is funded and underway.

The ACE trial is aimed at comparing strategies to protect the brain when surgeons need to cool the body and stop blood circulation during complex aortic surgery. Dr. Verma said brain protection is the Achilles’ heel of aortic surgery and ACE will help answer whether a new technique—developed at St. Michael’s—is safe for patients undergoing these operations.

Critical limb ischemia is a serious problem that affects patients with peripheral arterial disease. It carries a high risk of limb amputation and a 50 per cent chance of dying within five years. CARDIOLINK has developed the EXTINGUISH trial to test whether an anti-inflammatory medication can reduce rates of death in patients with critical limb ischemia.

The CAMARA-1 trial will compare two different ways to repair the mitral valve to see whether one is better at improving the functional capacity of patients and restoring them to more meaningful lives.

The ENABLE-NP study will try to find better ways to meet the complex needs of vulnerable patients by engaging their communities. It will evaluate whether interventions delivered by nurse practitioners in the community can reduce rates of re-hospitalizations after peripheral artery surgery.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.