Current Research at the Division of Cardiothoracic Surgery,SUNY Downstate Medical Center

Surgical Research

The academic research activities in the Division of Cardiothoracic Surgery had been largely dormant over the past decade.
However, we have revitalized both clinical and basic science research with the recruitment of Dr. Daniel Lee as a surgeon-scientist. We aim to utilize these initial studies toward additional NIH funding. We aim to utilize these initial studies toward additional NIH funding. Dr. Lee is also committed to a faculty appointment in the School of Biomedical Engineering under the administration of the Dean of Graduate Studies.

In addition, we also have the pleasure of Dr. Daniel Beckles joining us this year (2008). Dr. Beckles will re-establish his work with the basic scientists and the Chairman of Anatomy and Cell Biology to expand on the work they have accomplished during his residency training at SUNY Downstate Medical Center.

Myocardial Ischemia-Reperfusion Study

We are investigating the effects of myocardial ischemia-reperfusion injury on autoimmune response, lipid metabolism, transforming growth factor regulation, cardiac lineage protein expression, and clinical outcome.
Three models are utilized in this study:
1. Non-human primate model (2 monkeys done)
2. Patients undergoing cardiac surgery with aortic cross-clamping (50 pts done)
3. Patients undergoing coronary artery bypass grafting with a novel on-pump beating heart technique without myocardial arrest or aortic cross-clamping.

Investigators:
Daniel Lee, M.D., Wilson Ko, M.D.,Ketan Shevde, M.D.,Ming Zhang, M.D.,Eduardo Mascareno, M.D.,Xiang-Chen Jiang, M.D., Olcay Batuman, M.D.

Clinical Trial with Custodiol Cardioplegia

A great majority of the cardiac surgeons utilize blood-based cardioplegia solution to arrest the heart during open heart surgery. However, a head to head comparison of blood-based cardioplegia versus crystalloid cardioplegia has yet to be done. Downstate Medical Center is participating in a multi-institutional prospective randomized trial comparing clinical outcomes associated with blood-based cardioplegia and Custodial crystalloid cardioplegia to be funded by ICON.

Investigators:
Daniel Lee, M.D.,Wilson Ko, M.D., and ICON investigators

Cerebral Perfusion on Cardiopulmonary Bypass

Cerebral perfusion during cardiopulmonary bypass has long been a controversial subject in cardiac surgery. Optimal strategy of cerebral protection varied widely with no consensus on standard of care. The Division of Cardiothoracic Surgery is collaborating with the Downstate Optical Tomography Group to develop a technology to monitor cerebral perfusion and autoregulation during cardiopulmonary bypass non-invasively. The results of this study will lead to ground-breaking discoveries in neurophysiology as well as novel methods of cerebral protection in cardiac surgery.

Investigators:
Daniel Lee, M.D.,Randall Barbour, M.D.,Wilson Ko, M.D.,Susan Schwartz-Giblin, M.D., and Ketan Shevde, M.D.

Peripheral Vascular Reactivity/Perfusion and Cardiac Function

This is a NIH funded study investigating the relationship between peripheral vascular reactivity and perfusion as measured by Dynamic Near-infrared Optical Tomography with cardiac function measured by Swan-Ganz catheter. The objective of this study is to develop a non-invasive method of assessing cardiac function and monitoring degree of resuscitation in the Intensive Care Unit.

Investigators:
Daniel Lee, M.D.,Randall Barbour, M.D.,Harry Graber, M.D.,and Wilson Ko, M.D.

Octogenarian Off-pump versus On-pump CABG: Long Term Survival Study

We are conducting a retrospective review of 100 consecutive octogenarian patients who underwent coronary artery bypass grafting by one surgeon over two years ((1999-2000) using traditional on-pump technique versus off-pump technology. In addition to perioperative complications, long term survival was also analyzed in this study. Data collection and analysis are nearly complete. Manuscript is being drafted.

Investigators:
Daniel Lee, M.D., Wilson Ko, M.D. and Anita Chiu, M.D.

Glycemic Control in Cardiac Surgical Patients

This study attempts to elucidate the incidence, natural history, and clinical implications of non-diabetic cardiac surgical patients with persistent perioperative hyperglycemia. Furthermore, we are assessing the feasibility of a cutting-edge, nurse-driven, glycemic control protocol currently utilized at the Cardiothoracic Intensive Care Unit.

Investigators:
Peter Terry, M.D., Daniel Lee, M.D., and Wilson Ko, M.D.

Continuous Ultra Filtration in Cardiac Surgery Patients with Renal Insufficiency

The optimal perioperative fluid and electrolyte management of cardiac surgical patients with renal insufficiency has yet to be determined. There is a large population of patients with kidney disease being treated at Downstate Medical Center. These patients with baseline renal insufficiency requiring cardiac surgery will be randomized into 3 treatment groups: dialysis vs. ultra filtration vs. medical diuresis. The results of this study will help establishing the standard of care in this patient population undergoing cardiac surgical procedures.

Investigators:
Peter Terry, M.D., Daniel Lee, M.D., Moro Salifu, M.D., and Wilson Ko, M.D.

Differential Expression of Cholesterol Regulatory Genes in a Non-human Primate Model

The clinical implications of adipose cell distribution and its relative cardiac risk is a topic of intense speculation. We are laying the ground work for this investigation by elucidating the differential expression of genes regulating lipid metabolism with respect to the anatomic location of adipose tissues in a non-human primate model. Experimental work was completed in 10 monkeys. Molecular analysis is currently underway.

Investigators:
Daniel Lee, M.D., Xiang-Chen Jiang, M.D., and John Kral, M.D.

Topical Sternal Antibiotic Application and Systemic Toxicity

Deep sternal wound infection is a feared complication of cardiac surgery. A potential strategy to decrease the incidence of this complication is by application of topical antibiotic to the sternal edge. This study establishes the pharmacokinetics and feasibility of topical antibiotic on the sternum. The data collection and analysis have been completed. Manuscript is being drafted.

Investigators:
Daniel Lee, M.D., Anita Chiu, M.D. and Wilson Ko, M.D.

Use of Recombinant Factor VIIa as Rescue for Severe Coagulopathy after Cardiopulmonary Bypass

Recombinant activated factor VII is a hemostatic agent initially developed for the treatment of bleeding in patients with hemophilia. Its off-label use has been reported in life-threatening bleeding after trauma as well as abdominal surgery. We are reviewing our experience in the application of recombinant factor VIIa in patients with severe coagulopathy after cardiac surgery to report its use and safety in this patient population.

Investigators:
Wilson Ko, M.D., Daniel Lee, M.D., Aaron Winnick, M.D., and Ramesh Godara, M.D.

In addition to the clinical and basic science projects described above, the Division of Cardiothoracic Surgery has encountered many reportable cases. These case reports are currently being drafted by the residents involved in the care of the patient.
These cases include the following:

Mediastinal tumor mimicking pulmonary artery aneurysm. ( Resident Investigators: Christopher Turner, M.D. and Christopher Lau, M.D.)

Atrial thrombosis after surgical ablation for atrial fibrillation. ( Resident Investigator: Rabih Nemr, M.D.)

Persistent central aortic insufficiency associated with Edwards Magna bioprosthetic valve. ( Resident Investigator: Rabih Nemr, M.D.)

Thoracoabdominal exposure in trauma surgery. ( Resident Investigator: Giancarlo Cires, M.D.)

Lower extremity compartment syndrome following coronary artery bypass grafting and endoscopic vein harvest. ( Resident Investigators: Aparna Kolli, M.D. and Joyce Au, M.D.)

To Contact Us:

Division of Cardiothoracic Surgery
450 Clarkson Avenue, Box 40
Brooklyn, New York 11203
Tel: 718-270-1981 | Fax: 718-270-3843