Our complex aortic program has allowed our team to take on patients that may not have been offered therapy in the past, due to innovations and improvements in cardiovascular anesthesia, surgical techniques and post-operative intensive care. Surgery to correct pathology of the ascending aorta and aortic arch often requires deep hypothermic circulatory arrest to allow reconstruction of the aorta at the level of the distal ascending aorta or proximal aortic arch. Since cold temperature alone is insufficient to provide adequate protection to the brain, previous investigators have demonstrated that perfusing cold blood to the brain may improve neurological protection and improve outcomes following aortic surgery.
These techniques, known collectively as cerebral protection, refer to blood delivery to the brain during the period of circulatory arrest, in either an antegrade or retrograde manner. Our publication, demonstrates the effective use of a small cannula that is inserted over a wire directly into the innominate artery, to allow delivery of antegrade cerebral protection.
Dr Mark Peterson is the Principal Investigator for the International Registry of Acute Aortic Dissection (IRAD) since 2008. The IRAD group is a research consortium comprised primarily of cardiologists and cardiovascular surgeons from over 30 international academic centers in 11 countries. As one of the primary investigators for IRAD, which is based out of the University of Michigan, Dr. Peterson has the opportunity to participate and contribute to original research on all aspects of patients with Type A and B acute aortic dissections. The clinical and imaging database on patients who present with acute dissections allows for study on all aspect of the disease process: natural history, presentation, outcomes with medical, surgical and endovascular therapy, response to medical therapy. Late outcomes can also be study as a result of active longitudinal follow-up.
The Toronto Aortic Collaborative (TAC) was conceived and founded by Dr. Peterson in conjunction with colleagues in the University of Toronto (U of T), Drs. Bradley, Dueck and Caldarone. The TAC is comprised of Cardiac and Vascular Surgeons, Cardiologists, Radiologists, Basic and Clinical Scientists and Geneticists interested in improving the care and science related to patients with aortic pathology. The TAC bring together specialists from across the Academic Hospitals who meet regularly to discuss complex clinical aortic cases, as well as to advance multiple research initiatives in Aortic Diseases. The TAC has received funding to study the management of patients with acute aortic syndromes, and to design a U of T wide management system for effective triage and improve care for these patients.
Principal Investigator: Dr David A Latter
The CTSN is the co-creation of the Canadian Institutes for Health Research (CIHR), National Heart, Lung, and Blood Institute (NHLBI), and National Institute of Neurologic Disorders and Stroke (NINDS). The mission of the Network is to design, conduct, and analyze multiple, collaborative clinical trials that evaluate surgical interventions, and related management approaches, for the treatment of cardiovascular disease in adult patients. The latest publication from the CTSN focussed on surgical ablation of atrial fibrillation during mitral-valve surgery (N Engl J Med. 2015 Apr 9;372(15):1399-409)
Steering Committee Member and site lead: Dr Subodh Verma
The CIRT will determine if low-doses of the anti-folate methotrexate reduce heart attacks, strokes, or death in people with type 2 diabetes or metabolic syndrome who have had a heart attack or multiple coronary blockages.
Site lead: Dr Subodh Verma
This study is designed to compare traditional and emerging interventions for harvesting saphenous vein grafts with the goal of reducing the incidence of blockages in the veins used for heart bypass surgery