Personalized INNovative peri/operAtive Care and Long-Term outcomes rEsearch (PINNACLE)

CIHI data covering 2012 to 2014 reveals that the University of Ottawa Heart Institute (UOHI) presents the lowest cardiac surgical mortality in Canada, and is the only Canadian centre with statistically significant, comparatively superior outcomes in all three monitored spheres of care, i.e. CABG surgery, valve surgery, and combined CABG+valve surgery. These results stem from tremendous, sustained team efforts involving cardiology at the referral and preparation stages; anesthesia with patient optimization and perioperative/critical care; surgical excellence, research and innovation; and attentive postoperative ward and follow-up care, all within the supportive operational structure of the Heart Institute. In addition to these results, the Heart Institute has the highest patient satisfaction of Ontario hospitals at 99.5%.

In Canada, only the Heart Institute offers a full scope of cardiac surgical care, from mitraclip to TEVARs, to minimally invasive coronary surgery, to left-heart valve repair, on to VADs and transplants. Our institution also hosts the most academically productive adult cardiac surgical division in the country. Its publication output represents 60 to 80 papers per year. The Heart Institute also is world renowned in minimally invasive cardiac surgery and valve repair surgery. This Innovation Cluster is dedicated to supporting personalized innovative perioperative and surgical care, in order for the Heart Institute to maintain its cardiac surgical and anesthesia innovation leadership, build upon its research tradition, and address important knowledge gaps. The areas proposed in this cluster are a mix of new and already developed Heart Institute innovation/research programs where gaps in tailored care and therapeutic dilemmas exist, building on strong programmatic foundations with involvement of both young and established Heart Institute investigators.

Goals of the Cluster

The PINNACLE cluster is composed of three sub-clusters, each with its distinct focus and goals:

  1. Personalized & Innovative Perioperative Care
  2. Personalized & Innovative Surgical Solutions
    1. Personalized Aortic Valve Therapies
    2. Personalized Mitral Valve Therapies
    3. Personalized Coronary Revascularization Therapies
  3. Long-Term Outcomes Research

Innovation Cluster Scientists

Innovation Cluster Principal Investigators:

Lead: Marc Ruel MD, University of Ottawa Heart Institute (UOHI)
Co-leads: Munir Boodhwani, MD, UOHI; Vincent Chan, MD, UOHI; David Glineur, MD, PhD, UOHI; Bernard McDonald, MD, PhD, UOHI;  Louise Sun, MD, UOHI; Diem Tran, MD, UOHI

Team members at the University of Ottawa Heart Institute:
Kwan Chan, MD, Robert Chen, MD, Thais Coutinho, MD, Marino Labinaz, MD, Lisa Mielniczuk, MD, Benjamin Sohmer, MD, George Wells, PhD

Other Team members:
Michel Labrosse, D.Eng, University of Ottawa
Jeffrey Perry, MD, CCFP-EM, Ottawa Hospital Research Institute (OHRI), University of Ottawa


Industry partners

Institute for Evaluative Sciences (Louise Sun; Stephen Hawken)
St. Jude Medical (Karen Percy)
AMGEN (Jefferson Tea)
Medtronic, Inc.
CARDIOLINK Research Network (Subodh Verma)
MCRI Technologies (Stephen Ottmers)
Edwards Lifesciences

Selected Innovation Cluster Publications
  1. Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, Lopez-Jimenez F, McNallan SM, Patel M, Roger VL, Sellke FW, Sica DA, Zimmerman L. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart AssociationCirculation. 2015 Mar 10;131(10):927-64.
  2. Une D, Al-Atassi T, Kulik A, Voisine P, Le May M, Ruel M. Impact of clopidogrel plus aspirin versus aspirin alone on the progression of native coronary artery disease after bypass surgery: analysis from the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) randomized trialCirculation. 2014 Sep 9;130(11 Suppl 1):S12-8.
  3. Chan V, Ahrari A, Ruel M, Elmistekawy E, Hynes M, Mesana TG. Perioperative deaths after mitral valve operations may be overestimated by contemporary risk modelsAnn Thorac Surg. 2014 Aug;98(2):605-10;
  4. Toeg H, Chan V, Rao RV, Chan KL, Ruel M, Mesana T, Boodhwani M. Contemporary midterm echocardiographic outcomes of Bentall procedure and aortic valve sparing root replacementAnn Thorac Surg. 2014 Aug;98(2):590-6.
  5. Price J, Toeg H, Lam BK, Lapierre H, Mesana TG, Ruel M. The impact of prosthesis-patient mismatch after aortic valve replacement varies according to age at operationHeart. 2014 Jul;100(14):1099-106.
  6. Verma S, Farkouh ME, Yanagawa B, Fitchett DH, Ahsan MR, Ruel M, Sud S, Gupta M, Singh S, Gupta N, Cheema AN, Leiter LA, Fedak PW, Teoh H, Latter DA, Fuster V, Friedrich JO. Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised controlled trialsLancet Diabetes Endocrinol. 2013 Dec;1(4):317-28.
  7. Ruel M, Shariff MA, Lapierre H, Goyal N, Dennie C, Sadel SM, Sohmer B, McGinn JT Jr. Results of the Minimally Invasive Coronary Artery Bypass Grafting Angiographic Patency Study. J Thorac Cardiovasc Surg. 2014 Jan;147(1):203-8.
  8. Mesana TG, Lam BK, Chan V, Chen K, Ruel M, Chan K. Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: potential affect on surgical strategy. J Thorac Cardiovasc Surg. 2013 Dec;146(6):1418-23.
  9. Une D, Kulik A, Voisine P, Le May M, Ruel M. Correlates of saphenous vein graft hyperplasia and occlusion 1 year after coronary artery bypass grafting: analysis from the CASCADE randomized trialCirculation. 2013 Sep 10;128.
  10. Al-Atassi T, Lam K, Forgie M, Boodhwani M, Rubens F, Hendry P, Masters R, Goldstein W, Bedard P, Mesana T, Ruel M. Cerebral microembolization after bioprosthetic aortic valve replacement: comparison of warfarin plus aspirin versus aspirin onlyCirculation. 2012 Sep 11;126.

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