PROFESSOR JULIAN SMITH PROFESSOR Matters of the heart Expert cardiac and thoracic surgeon Professor Julian Smith describes the challenges facing his field of medicine today, and elucidates his role as researcher and educator and academic interest in cardiopulmonary patient’s underlying cardiac condition and transplantation and the mechanical support function, and the urgency of their procedure. of circulation. Upon returning to Australia, I We are operating on progressively older worked at the Alfred Hospital in Melbourne patients, with more medical comorbidities prior to taking up my current position in 2001. and poorer cardiac function. At present, 5-10 I am Professor and Head of the Department of per cent of our patients would be considered Surgery (Monash Medical Centre) at Monash high-risk and would be at increased risk of University and Head of the Department of morbidity and mortality. Cardiothoracic Surgery at Monash Health. Can you shed light on the importance of What is your current research focus? continually developing techniques in your medical field? My current research interests include less invasive and robotic methods of cardiac Cardiac surgeons have been constantly surgery, cognitive function after coronary striving for safer, simpler, less invasive, heart surgery, the inflammatory response to cheaper and more effective methods in the cardiopulmonary bypass, acute kidney injury surgical management of our patients. As a post cardiac surgery, and the use of databases result patient morbidity and mortality will be to monitor cardiac surgical outcomes. reduced and a greater overall benefit will be To begin, can you provide an overview of delivered to patients in terms of quality of life your background and the professional Which factors exert the greatest influence and long-term outcomes. positions you hold? on cardiac surgery outcomes? You have often been at the forefront of I am a graduate of the University of The strongest impacts on cardiac surgery Australia’s pioneering medical procedures; Melbourne. I trained in general and then outcomes are patient age, associated medical when you developed the less invasive cardiothoracic surgery in Melbourne, Stanford comorbidities (diabetes, obesity, respiratory Heartport system for coronary heart and Cambridge with a particular clinical dysfunction, renal dysfunction, etc.), the surgery, for example. Can you discuss 68 INTERNATIONAL INNOVATION PROFESSOR JULIAN SMITH the advances you have made in surgical techniques and their benefits to both patient and practitioner? I was fortunate to be involved in the early development of less intrusive cardiac surgery The through the Heartport system. Although not currently used in its entirety, many technological spinoffs from the Heartport system are employed routinely in practice today. Minimally invasive cardiac surgery surgical has a place in selected patients allowing them to recover more quickly and resume an active lifestyle and employment. I have also participated in clinical trials of several ventricular assist devices either as a bridge strategist to cardiac transplantation or as destination therapy. The sophistication of these devices has increased markedly in recent times; they have become much simpler for the Researchers at Monash cardiac surgeon to insert, and much more University and Monash Medical comfortable for the patient. Centre in Melbourne are making What importance do you place on remarkable contributions to the education of upcoming medical research relying on surgical data professionals for the future of cardiac surgery? PERSONALISED MEDICINE HAS been a SERVING SUBGROUPS We are all in cardiac surgical practice owing popular term in medical research for some to the teachers and mentors with whom we time, usually in reference to the development Professor Julian Smith, a cardiac and thoracic have been privileged to train and work. One of patient-specific treatment approaches surgeon and Head of the Department of Surgery of my teachers often said that we are ‘only based on genomic information. Recently, the (Monash Medical Centre) at Monash University as good as the people we train’. The future term has become more controversial, with is leading a group of researchers playing a of coronary heart surgery relies heavily on many scientists preferring to refer to this kind prominent role in this field of study. Smith and outstanding education and training and also of treatment as ‘precision medicine’. In fact, his collaborators focus specifically on patients on the continuing professional development many clinicians argue that they have been from small subgroups, who may present of practising cardiac surgeons. Cardiothoracic practising ‘personalised medicine’ for years, unique challenges to surgeons as they undergo surgery remains a popular surgical specialty by responding with care and attention to the treatment. In his role as Head of Department among those doctors applying to enter needs of individual patients. Though emerging he also oversees many other research projects, surgical training in Australia. solutions for patient care are new and exciting, concerning orthopaedic surgery, vascular and many practices in the clinic have already proven transplantation surgery, neurosurgery, urology, How can improvements be made? their worth by standing the test of time. upper gastrointestinal surgery, colorectal surgery, plastic and reconstructive surgery, There is still room for improvement in cardiac The clinic, including the operating theatre, otorhinolaryngology and head and neck surgical education and training. Low and is the first line of defence when it comes to surgery, to name a few. As Smith explains: “It high fidelity simulations have potential as maintaining human health on an individual is important that institutions such as ours with formative and possibly summative assessment basis – but surgery and patient care are more expert multidisciplinary teams who have treated tools, and as methods for teaching basic and than simply static facilities that can be improved a series of patients with these conditions report advanced techniques and for the provision of and changed by research. In addition to their our experiences widely”. feedback on trainee performance. Australia practical value, clinical facilities serve as centres and New Zealand’s leading global position in for data gathering, both on the individual level A PREGNANT PAUSE cardiothoracic surgical education and training of a surgeon’s acquired experience, and in terms has been achieved through collaborations of clinical research. This kind of study can be Pregnant women and those suffering from between the Royal Australasian College of seen as combining the practical experience of the rare genetic disorder alkoptonuria are two Surgeons and the Australian and New Zealand surgery with the informative power of research, subgroups of patients within those undergoing Society of Cardiac and Thoracic Surgeons. I and is an important resource for practitioners. cardiac and thoracic surgery that present a have been fortunate to have held leadership In the context of cardiac and thoracic surgery, special risk, and on which Smith and his team positions in both organisations and have been where procedures can have myriad impacts on have specifically focused. Aortic dissection, involved in the education and training of almost every other area of the body, information a condition where a tear in the aorta allows cardiothoracic surgeons for many years. gathered in this way is particularly vital. blood between the tissue layers, forcing them WWW.RESEARCHMEDIA.EU 69 INTELLIGENCE CARDIOTHORACIC SURGERY OBJECTIVES In addition to continuing to maintain their extensive patient database, To explore less invasive and robotic methods of over the next five to 10 years the Monash researchers aim to develop cardiac surgery. models to help predict and prevent kidney injury after surgery KEY COLLABORATORS Professor Ian Meredith, Monash Heart, Monash Health and Department of Medicine apart, most regularly affects young pregnant KIDNEY COMPLICATIONS (Monash Medical Centre), Monash University women. Its occurrence is fairly rare, but using • Professor Bijan Shirinzadeh, Department the surgical database at Monash Health Centre, As well as patient subgroups predisposed of Mechanical and Aerospace Engineering, the researchers were able to determine that a to risk before a procedure is undertaken, Monash University • Professor Christopher high index of suspicion and timely investigations cardiothoracic surgeons also have to be Reid, School of Public Health, Monash were crucial in ensuring definitive management prepared for possible complications caused University • Associate Professor Roger of the condition. As well as reflecting on optimal by their work and informed as to how these Evans, Department of Physiology, Monash University • Dr Abe deAnda Jr, Department of surgical strategies, the study emphasised the problems can be mitigated. Specifically, Cardiothoracic Surgery, New York University need for teamwork in response to this problem, injuries to the kidneys and gastrointestinal (Bellevue Hospital Center) • Professor Debra and essentially recommended that pregnant tract following surgery have concerned Smith’s Nestel, Department of Surgery (Austin patients with chest pain should be considered group. In 2011, they were able to analyse Health), University of Melbourne and School of in danger of dissection, embolism or myocardial the problem of surgery’s gastrointestinal Rural