Perioperative Imaging
Myocardial injury is increasingly recognized as a frequent perioperative complication even in non-cardiac surgery. It is clearly associated with increased postoperative mortality, even though most patients do not experience ischaemic symptoms. Anaesthesia in combination with surgical trauma establishes a complex perioperative setting, which increases cardiovascular risk especially in multimorbid patients. Our group investigates the prevalence of peri-operative myocardial injury and its possible triggers. We have a large research focus on the role of hyperoxia and fluctuations of arterial carbon dioxide as potential negative triggers. We investigate the association of these triggers not only with long-term post-operative outcomes, but we also research how these potential triggers directly impact cardiac function during general anaesthesia. By applying transoesophageal echocardiography, including 3D acquisitions and strain analysis, cardiac dysfunction can be monitored and be used to guide anaesthesia management in the hope of avoiding significant adverse outcomes in future patients. For these studies, we collaborate with clinicians and scientists from the departments of cardiology, cardiac surgery and vascular surgery.
Cardiovascular Magnetic Resonance Imaging (CMR)
MRI is a useful imaging modality for performing an in-depth analysis of the cardiovascular system, and can measure a range of factors including, function, scar, fibrosis, oedema, ischaemia, and intraventricular haemodynamics using exciting 4D blood flow techniques. We utilize CMR as a diagnostic tool to detect cardiovascular features that may increase a patient’s risk to anaesthesia and to measure cardiovascular responses to anaesthetic stimuli in order to detect if and when the heart is compromised. Specifically, our group optimises and validates CMR techniques to assess the myocardial oxygenation reserve and translates these techniques to a peri-operative environment to answer anaesthesia related research conundrums. In our research group, we not only pioneered the technique of oxygenation-sensitive (OS)-CMR to measure changes in myocardial oxygenation and function simultaneously in response to blood gas changes, but we were also the first research group to induce general anaesthesia in an MRI scanner to interrogate the impact of general anaesthesia on the myocardium in patients. This was a ground-breaking step in anaesthesia research. Our previous and current studies have ranged from in-vitro studies, fundamental assessments, development to translation and application into human studies. Our future projects are directed to find CMR features that can be used for stratification of perioperative risk and to learn how we can make general anaesthesia safer and patients with compromised cardiovascular health using novel imaging markers. In these studies we collaborate with multiple national and international research centres including the fields of anaesthesiology, cardiology and radiology.
Blood Glucose Homeostasis during Cardiopulmonary Bypass
Hyperglycemia is a risk factor during surgery that leads to increased patient morbidity. The complex physiology during cardiopulmonary bypass for open-heart surgery poses a risk for hyperglycemia not only for patients with diabetes but also for non-diabetic patients. Our group tries to better understand the pathophysiology of glucose homeostasis during cardiopulmonary bypass and to improve glycemic control during cardiac surgery. Our collaborators include clinicians, scientists and perfusionists of departments of endocrinology and cardiac surgery.
