Research and Innovation
Core to any comprehensive service is a programme of research underpinning clinical innovation. We have a strong programme of collaboration with academic and commercial institutions nationally and internationally, including external funding from British Heart Foundation.
Central to the programme has been collaboration between The Brompton Hospital, Imperial College, University of Liverpool and Liverpool Heart and Chest Hospital registered as The Institute for Cardiovascular Medicine and Science (ICMS (aorta and valve) http://www.theicms.co.uk/).
Diagnosis, investigation and treatment of thoracic and thoraco-abdominal aortic disease is complex and multi-disciplinary however as a “boutique” sub-speciality there are a small number of patients and little evidence base. Management algorithms are often based on a few patients and largely clinical experience. Treating patients and achieving quality outcomes requires collaboration and institutional learning from patients and their treatment outcomes. Research is key to understanding disease aetiology, natural history, clinical innovation and the efficacy of treatments. As such collaborative networks are a pre-requisite for a successful aortic programme. Within the United Kingdom treatment of patients with thoracic and thoraco-abdominal disease is multi-disciplinary involving cardiac surgeons, vascular surgeons, interventional radiologists with the mandatory involvement of cardiology, radiology, clinical genetics and intensivists. Aortic programmes are mostly embryonic and evolving in a geographically and clinically sporadic manner driven by pockets of interested clinicians. Liverpool Heart and Chest Hospital and The Royal Brompton and Harefield Hospital are two centres with historically rich aortic programmes matured over several decades. Both hospitals have established yet continuously evolving elective aortic programmes taking referrals nationally, and both are involved in provision of specialist emergency aortic services. Through ICMS the two hospitals have established a collaborative aortic network with a large clinical and research base with the sum being larger than the two parts. Over the last five years many of the structures, governance and facilitators necessary for a network of aortic centres have been developed and this work stream of ICMS is now entering an exciting era advocating national systems, standards and governance which will improve care for these patients through the United Kingdom which will be unique and eventually serve as an international template.
At the birth of ICMS in 2011 we stated our general aims were to “improve our understanding of disease processes of the root, ascending, arch and descending aorta and translate this knowledge into improved clinical outcomes for our patients”. With this approach in mind we set out two main work streams with Research and Clinical objectives.
Applied basic sciences research
The overarching approach in this work stream will be unification of Genome projects and Physiome projects to generate a patient specific risk prediction model for thoracic aortic aneurysms.
This work stream will focus on non-randomised, prospective and retrospective clinical studies aimed at improving diagnosis, investigation and management of thoracic aortic aneurysms.
Clinical and cost effectiveness
This work stream will focus on service line reporting, clinical outcome reporting and meta-analysis to define clinical and cost effectiveness of treatment modalities for ascending, arch and descending/thoracoabdominal aorta.
The clinical trials arm will set up a “National Thoracic Aorta Trials Network” to define relevant clinical questions and run multi-centre clinical trials with CTEU.
Clinical processes and service delivery
This work stream aims to openly engage in a process of sharing of clinical processes and service delivery for the entire patient pathway from Clinic to Theatre to ITU to Outpatients follow-up. This will include paramedical professions such as nursing, perfusion and physiotherapy.
Setting the quality agenda
The primary aim here is to set the agenda for sub-specialisation of emergency and elective thoracic aortic aneurysm intervention with MDT led processes within the United Kingdom.
Sub-specialty training in all forms of thoracic aortic intervention is key for the future of this specialty. Our intention is to set the agenda for a formal post FRCS, multicentre, subspecialised training programme. In addition to this we hope to encourage exchange of non-training middle grade medical staff to share expertise – an International Fellowship Programme in thoracic aortic intervention.
Education of the wider medical community in acute and elective services, early diagnosis and referral and treatment options is key to expansion and quality.
Current LHCH based Aortic centred Grants:
- BHF Project Grant no PG/16/107/32681 “Exploring the interplay between biochemical and biomechanical heterogeneity as a risk factor for acute Type A aortic dissection”. Funded £155, 355 over two years with Dr Riaz Akhter (https://www.liverpool.ac.uk/engineering/staff/riaz-akhtar/), Jill Madine (https://www.liverpool.ac.uk/integrative-biology/staff/jillian-madine/) and Mr Mark Field.
Portfolio of Aortic Team research papers
Individual Research Profiles:
- Mark Field (https://www.researchgate.net/profile/Mark_Field3)
- Manoj Kuduvalli (https://www.researchgate.net/profile/Manoj_Kuduvalli/publications)
- Deborah Harrington (https://www.researchgate.net/profile/Deborah_Harrington2/publications)
- Ivan Gambardella (https://www.researchgate.net/profile/Ivancarmine_Gambardella)
- Omar Nawaytou (https://www.researchgate.net/profile/Omar_Nawaytou)