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Perioperative Inflammation

Contact

Anna Aston and Steffi Klier
+44 (0)20 3315 8816

What we do

As clinical academics at one of the world’s unique and specialist cardiothoracic centre and motivated by offering better solutions for frequent and severe postoperative complications in high-risk patients, we are concerned with the postoperative pulmonary and systemic organ and multiorgan failure. Our research is dedicated to better understanding the fundamental mechanisms involved in these complications and translating mechanistic insights into sophisticated diagnostics in real time at the bedside. We are also committed to improving outcomes by assessing our patient care locally and on a global international scale and by evaluating novel therapeutic options and by building international consensus towards the highest quality of care.

We are focusing on two principle mechanistic areas namely the surgical inflammatory response and the consequent metabolic disequilibrium. As the cytokine and inflammatory mediator concept is generally too simplistic, we are evaluating pro-and anti-inflammatory response and balance in a broader context. This strategy allows integrating these with multiple cellular and global phenotyping approaches both as systemic and organ specific compartments (plasma, urine, breath). Translating these alterations, we are conducting biomarker research with major interest in methods that are suitable for deployment into the operating room and intensive care unit with real time data acquisition (Nephrocheck, exhaled breath analysis). In the therapeutic domains we are improving ventilation practices, modulating surgical inflammation by novel cytokine absorption therapy, optimising metabolism by inhaled nitric oxide and improving transplantation by revolutionary ex vivo platforms.

Why it is important

Modern cardiothoracic surgery provides some of the most innovative treatment options for patients suffering from severe and end stage cardiovascular and respiratory disease, including mechanical assist and heart-lung transplantation. Despite major progress, these complex surgeries represent some of the most invasive insults to humans and are associated with high perioperative complication rates, disability, severe morbidity and mortality.

How it can benefit patients

The promise of perioperative medicine is that we accurately identify and minimise patients’ risks for the surgery, conduct every aspect of the operation to the highest standards, manage postoperative pain effectively, prevent postoperative complications or detect them at early stage and treat them efficiently so the patient can leave intensive care unit, the hospital and return to their loved ones in an improved and fully functional state. However, clinical risk scoring is largely inadequate, and requires better understanding of the biological condition of the patient. Our efforts towards bioprediction of systemic and organ dysfunction will better stratify patients before the operation. Our research with inhaled nitric oxide already changed clinical practice and part of international guidelines to protect the heart during artificial heart insertion. Now we need to better define the role of pulmonary vasodilator treatment in more routine cardiac surgery. Our extensive utilisation of ex vivo heart and lung perfusion already increased and possibly improved transplantation and made heart transplantation possible using donation after cardiac death. But monitoring and decision making of acceptance or rejection for human transplantation is limited and new inventions are needed to maximise the potential of these sophisticated technologies. Our activities with haemoadsorption already made emergency cardiac operations safer by effectively removing blood thinning medications and reducing surgical bleeding or the need for transfusions. But now we need to fully define the role of this technology and cytokine removal strategies in the urgent patient populations.

Overall, our research has the potential that we better understand the individual patient, personalise treatment and offer higher standard of care.