The Division of Cardiothoracic Surgery is composed of 11 physicians and scientists, who are involved in a broad scope of research to include basic science, translational components and clinical studies.
Dr. James Kirklin was instrumental in the formation of the Cardiac Transplant Research Database and the Pediatric Heart Transplant Study, and in establishing UAB as headquarters for both programs. This project is funded by participating hospitals and with money from the UAB Division of Cardiothoracic Surgery. Clinical information from more than 40 major heart transplant centers in the United States is entered into these databases for use in analyses that help guide doctors in the management of heart transplant cases.
Dr. Kirklin also is the principal investigator of INTERMACS, or Interagency Registry for Mechanically Assisted Circulatory Support, a federally funded, national registry that tracks patients who are receiving mechanical circulatory support device therapy to treat advanced heart failure. All hospitals that implant FDA-approved mechanically assisted circulatory support devices are mandated to contribute to this registry. The registry is a joint effort of the National Heart Lung and Blood Institute, Centers for Medicare and Medicaid Services, the Food and Drug Administration, clinicians, scientists and industry representatives. Researchers at UAB coordinate data collection and analysis, and the United Network for Organ Sharing is responsible for maintaining the database. UAB established this registry in 2005 and recently received a renewal of its NIH funding for another five years.
These multi-institutional studies are a large part of the research activities of the Division, involving the cooperation of hundreds of physician-scientists and dozens of hospitals. Studies of patients at UAB are also used to improve care at UAB Hospital and address problems that are especially prevalent in the Southeast, such as ischemic heart disease, valvular diseases, and heart failure with no specific identifiable cause.
The Division's nearly five decades of experience in cardiothoracic surgery allows surgeons to observe long-term outcomes of various procedures, which helps set the bar for best practices in technique and technology. For example:
- Results of valve-replacement surgeries at UAB have been used to improve the reliability and ease of placement of mechanical heart valves and pig valves.
- The INTERMACS registry has been used to improve the outcomes and reliability of ventricular assist devices, which are used to preserve the lives of patients experiencing end-stage heart failure and who are not eligible for transplant.
- The technology for ventricular assist devices as well as artificial hearts is continuing to improve with the help of data analyzed and collected at UAB.
These research activities extend to other organs in the thorax, especially the lungs and esophagus. Dr. Cerfolio is a recognized leader in research on improvements in surgical and pharmacological treatments for lung cancer as well as the implementation of robotic techniques for thoracic surgery.
Dr. Holman is a national co-principal investigator of CSP #474: A Randomized Prospective Comparison of Radial Artery versus Saphenous Vein in Coronary Artery Bypass Grafting.clinicians in Cardiac Surgery at UAB participate in basic and/or clinical research. These studies include Industry-sponsored trials of new mechanical circulatory support devices pending FDA approval as well as other new devices and new drugs. Other prospective randomized multicenter clinical trials in the Division of Cardiothoracic Surgery include VA Cooperative Studies Projects.
Drs. James E. Davies is especially interested in outcomes and the development of new procedures in cardiacvascular surgery trauma and transplant patients. Dr. Spencer J. Melby is leading studies in the mechanisms and treatment of atrial fibrillation. Both Dr. Melby and Dr. Davies have been working together in these endeavors with the goal of improving outcomes in a wide range of cardiac surgery patients.
Three division faculty members, Drs. David C. Naftel, James F. George, and Ayesha Bryant conduct research full-time. Dr. Naftel is an internationally recognized outcomes researcher who has developed new techniques of statistical analysis of cardiac surgery outcomes. He is also a leader in multi-institutional studies of outcomes in cardiac transplantation and mechanical circulatory support. He was also instrumental in the establishment of the INTERMACS registry and is in charge of the day-to-day administration and management of scientific studies under INTERMACS auspices. Dr. George is an established investigator in outcomes and basic science of heart failure, transplantation, and vascular disease. He has special expertise in the development of animal models of disease that can be exploited to determine the detailed molecular mechanisms of cardiac disease and treatments. He is currently the principal investigator of an NIH funded study to study the mechanisms of vascular disease after transplantation. Drs. Naftel, Kirklin, and George have collaborated for many years and have developed an extensive research enterprise in cardiac surgery. Dr. Bryant and Dr. Cerfolio are studying new drugs for treatment of lung cancer in conjunction with surgical methods in which the cancerous cells are removed. These techniques are also being combined with newly developed methods of genetic analysis in which treatment or the probable outcomes of a specific treatment can be predicted for individual patients. They are also developing new surgical techniques using robotics, in order to improve patient outcomes and to significantly reduce recovery times of patients undergoing major surgery.
UAB's cardiovascular research laboratories are a primary site for the development of rodent surgical models of ischemic injury and transplantation. The microsurgeons at UAB are among the most skilled in the country, capable of performing heart, kidney, and aortic transplants in mice, allowing Division investigators to study disease processes using mice that have been genetically engineered to express or not express specific molecules under study. Division scientists and their collaborators have discovered new molecular targets for drug therapy of acute cardiac injury due to a loss of blood supply and for the treatment of cardiac transplant rejection. These molecular targets, called stress proteins, enable cells in the body to adapt to stressful events that can result in organ damage. Division scientists have shown that one such protein, called heme oxygenase-1, can protect organs from acute injury and vascular damage resulting from immunologic or physical injury.
Medical, Resident and Graduate Student Research Opportunities
CaRES program - This is a summer internship research program sponsored by the National Cancer Institute for medical and graduate students interested in cancer research. Interns are paid a competitive hourly wage, and may receive limited funds for research supplies. Preceptors will be drawn from a pool of more than 250 CCC faculty who currently direct approximately 400 research grants. Drs Bryant and Cerfolio have precepted 10 interns over the past 4 years. Interns will be encouraged to present their findings at UAB Graduate Student Research Day, UAB Medical Student Research Day, the Annual CCC Research Retreat, or at a regional or national professional meeting. More information about the CaRES program can be found on the CaRES UAB website.
AATS Summer Internship Program - This program was established in 2007 to introduce the field of cardiothoracic surgery to first and second year medical students in US Medical schools to broaden their educational experience by providing an opportunity to spend eight weeks during the summer (June thru September) working in an AATS' members cardiothoracic surgery department, performing both research and clinical activities. Funded and administered by the Association, a grant of $2,500 will be provided to successful applicants to underwrite their living expenses during the eight weeks of training at the selected host institution. Additionally all awardees will receive complimentary registration to the association's 2011 Annual Meeting taking place May 7-11 in Philadelphia, PA. More information and application instructions can be found at the medical student AATS website. Previous recipients include Lee Maniscalco, who precepted with Dr. Robert Cerfolio during 2008-2009.