Head of Division: Professor Peter Zilla
Divisional Profile (Clinical)
The Chris Barnard Division of Cardiothoracic Surgery continues to offer most of the full spectrum of Cardiothoracic Surgery under difficult circumstances of a severe cutback in financing of tertiary services over the last ten to fifteen years. Our theatre lists and ward and ICU beds have been cut by 50% which has lead to an reduction in the annual number of adult cardiac cases from more than 650 cases a year in the early to mid 1990s to less than 300 currently. The number of heart transplants performed has dropped even more dramatically from between 30 and 35 transplants annually to between 3 and 5 annually over the last 5 years this is in part indirectly due to the reduction in funding and more importantly due to a reduction in the numbers of available donors which also need to be shared nationwide with 5 private transplant units, whereas 15 years ago our unit was the only heart transplant unit serving the whole country.
We offer the full range of adult cardiac surgery services, including all forms of myocardial revascularisation (both on and off-pump), cardiac valvular surgery including an active program to repair of preserve the patients own valves rather than replace the patients valves with prostheses, each type of which has problems and complications particularly inn our patient population which is of a younger age due to rheumatic fever, an uncommon condition in the developed world. We also offer thoracic aortic surgery. The only technology we do not have access to is are long-term left ventricular assist devices and the artificial heart both of which are prohibitively expensive in a developing world situation. We are also having difficultly gaining access to the most recent development in heart valve replacement, that of transcatheter delivered valve prostheses which in many ways would be the ideal manner of replacement of valves in a third world setting. Presently this technology is prohibitively expensive and as such within both our research laboratories and within our clinical arena, we are looking at developing alternative transcatheter devices; this will including collaborative studies with the medical device industry and other international academic units to allow newer and more cost-effective devices to become available to us.
Divisional Profile (Cardiovascular Research Unit)
2009 saw a migration towards a more balanced distribution of research funding between local parastatal and overseas institutional grant and industry partners. Our long-term collaboration with a global medical device company has continued to evolve in line with changes in the global economy and 2010 will see our involvement in two main projects.
The Western Cape Heart Research Grouping of the Medical Research Council, of which the Cardiovascular Research Unit is a member, was formally reviewed and extended for another five year term. New collaborative projects between the Groups members were identified and initiated.
Our unit is also a participant in Welcome grant in collaboration with the Department of Medical Biochemistry, and a NRF grant supporting our research on the biomechanics of cardiovascular devices.
Research into the application of external shape-memory support for saphenous vein bypass grafts has progressed to a worldwide multicentre clinical trial.
Research focusing on the cell biology of the process of neovascularisation has spear-headed our regenerative medicine approach to facilitating the bodys own ability to remodel semi-synthetic prostheses. In this regard, a small animal circulatory vascular model for screening of graft healing has been fully established and is providing very promising initial results.
Additionally, a model for assessment of the regenerative capacity of synthetic hydrogels in the treatment of heart failure induced by myocardial infarction has been established and has led to published results and interest from overseas collaborators.
Postgraduate training remained a priority in 2009. Interdigitation between our clinical staff and researchers also remains a key goal for which the Division continues to strive and served to greatly facilitate both clinical and applied research during 2009.