Research Overview: Cardiovascular

Our investigators, funded by the National Institutes of Health (NIH), American Heart Association (AHA), Department of Defense (DoD), VA Office of Research and Development, the Patient-Centered Outcomes Research Institute (PCORI), Cardiothoracic Surgical Trials Network (CSTN), foundations and industry, pursue a wide array of cardiovascular issues, including coronary artery disease, atherosclerosis and ischemia, limb salvage, heart failure and cardiomyopathy, arrhythmias, congenital heart disease, aortopathies, valvular heart disease, cardiovascular regenerative medicine, heart assist devices, stem cell research and genetics.

Our cardiac surgery research team maintains the Thoracic Aortic Disease Tissue Bank, one of the world’s most extensive and well-catalogued tissue banks, which has served as a core resource for NHLBI-supported Specialized Center of Clinically Oriented Research (SCCOR) in Thoracic Aortic Aneurysms and Dissections. This core resource facilitates investigations into the causes and progression of aortic disease pursued by our researchers, as well as researcher from other academic institutions.

Research by Area

Cellular and Molecular Biology

Myocardial Regeneration via In Situ Cellular Reprogramming (320x240)
credit: Scott Holmes © Baylor College of MedicineCardiac cellular reprogramming represents an exciting new potential treatment for individuals with end-stage heart disease and heart failure

NIH NHLBI R01 Grant for Myocardial Cellular Reprogramming

Our NIH-funded department chair Todd K. Rosengart, M.D., is one of the pioneers in the field of gene therapy, with his work beginning in the early 90’s. He now leads the Laboratory for Cardiac Regeneration, a team of surgical researchers and basic scientists, whose research is developing a means to use cellular reprogramming to convert cardiac scar tissue into new heart muscle. Dr. Rosengart’s lab is supported by an NIH NHLBI R01 grant for his project, “In Situ Cardiac Infarct Cellular Reprogramming.” This research offers the possibility of “bio-interventions” for the treatment of hundreds of thousands of patients with advanced heart disease not treatable by conventional therapies.

NIH-NHLBI R01 Grants to Study Molecular Pathobiology of Aortic Aneurysms and Dissections

Our NIH-funded department vice chair for research, Scott A. LeMaire, M.D., and his team in focus their basic science research on the role of various aspects of extracellular matrix degeneration in the development of aortic aneurysms and dissections. Led by Dr. LeMaire and Ying Shen, M.D., Ph.D., associate professor in the Division of Surgical Research, the Aortic Disease Research Laboratory has several ongoing projects investigating the mechanisms of aortic disease and developing pharmacological treatments to prevent aortic degeneration, maladaptive remodeling and disease progression funded by the NIH and AHA. These studies include:  NIH NHLBI R01 (HL127111) funded study entitled “Targeting the Inflammasome to Prevent Thoracic Aortic Aneurysms and Dissections” and the NIH NHLBI R01 (HL131980) funded project, “Targeting ER Stress to Treat Thoracic Aortic Aneurysms and Dissections.”

AATS Graham Foundation Award to Study the Role of Mechanical Microenvironment in Stem Cell Survival in Ischemic Myocardium

Ravi K. Ghanta, M.D., associate professor of surgery in the Division of Cardiothoracic Surgery, received the Ethicon Surgical Investigator Award from the AATS Graham Foundation for his research proposal entitled, “Understanding the Role of Mechanical Microenvironment in Stem Cell Survival in Ischemic Myocardium.” This award provides funding for Dr. Ghanta’s second year of research as a Graham Surgical Investigator. 

A Novel Strategy to Improve Pulmonary Hypertension in Congenital Diaphragmatic Hernia

Sundeep Keswani, M.D., associate professor in the Division of Pediatric Surgery at Baylor and surgical director of Basic Science Research at Texas Children’s Hospital, was awarded a $300,000 grant from the March of Dimes Foundation for a three-year study entitled, “Targeting the Extracellular Matrix: an Innovative Strategy to Improve Pulmonary Hypertension in Congenital Diaphragmatic Hernia.” 

Balaji receives Wound Healing Foundation Research Grant

Dr. Swathi Balaji received the 2017 Wound Healing Foundation-FLASH Clinical Wound Healing Grant Award for her proposal titled "Pathogenesis of Cutaneous Fibrosis and Scarring." 

It is unknown why some individuals heal with robust fibrosis and scarring while others heal from similar injuries with less scarring. Balaji and her colleagues want to understand how immunoregulatory factors, particularly lymphocytes, make decisive contributions to dermal fibrosis. They propose that there are fundamental biologic differences in how fibroblasts and lymphocytes crosstalk to influence scar formation in different people. At the completion of this study, their team hopes to better understand how inflammation shapes scar formation and start working towards the development of innovative tools to promote immune regulatory responses in wounds to prevent dermal scarring as well as help other disease processes characterized by excessive fibroplasia.

Basic science research conducted by Balaji received national awards

The Wound Healing Foundation (WHF), through the support of the Wound Reach Foundation presented this award to Balaji at the 2017 Wound Healing Society Annual Meeting in San Diego. Balaji was this year’s recipient of the Young Investigator Faculty Award presented to a junior faculty member for a research abstract at the Regenerative Medicine Workshop at Hilton Head. Balaji presented a keynote lecture on her work titled “Effect of Stretch on Extracellular Matrix and Morphology of Fibroblasts in Regenerative Wound Healing.”

Tissue repair after an injury can have a spectrum of fibrosis outcomes, and fibroblasts are the major cell type that regulates the extracellular matrix and fibrosis. Even within a single tissue, fibroblasts exhibit considerable functional diversity in response to different environmental factors such as biomechanical tension and inflammation.

Balaji and her colleagues want to explain the signaling mechanisms among fibroblasts that communicate and regulate their fibrogenic phenotype. Their group is studying the role of exosomes, which are microvesicles on the order of 30-150 nm and contain functional biomolecules such as proteins, lipids, RNA, miRNA, as biomarkers and/or targeted therapeutics to regulate the functional diversity of tissue fibroblasts and their cellular cross talk.

Dr. Monica Fahrenholtz, the postdoctoral fellow on this research project, received the Wound Healing Society trainee travel award at the conference. She gave a quick presentation at this year’s annual meeting.

Device Innovation

Micromed (320x240)
credit: Courtesy Texas Heart InstituteMicromed VAD

Engineering a Total Artificial Heart

Professors in the Division of Cardiothoracic Transplantation and Circulatory Support, O. H. Frazier, M.D., and William E. Cohn, M.D., are the leaders of a team of cardiac surgeons and engineers who received a $2.8 million federal grant from the NIH to develop a new smaller, less costly, pulseless artificial heart device that could perform the functions of both left and right ventricles. Drs. Frazier and Cohn collaborate with physician scientists, engineers and biologists from Texas Heart Institute, the University of Houston and Rice University to develop a control system that mimics the heart’s response to the body’s physiological conditions.

The team currently includes Dr. Daniel Timms, a biomedical engineer from Australia, who has designed a small, lightweight device called the BiVACOR. It uses a magnetic field, a spinning disc and centrifugal force to pump blood. Because there is only a single moving part and no friction, we expect it to be extremely durable.

Clinical Trials

Dr. Panos Kougias Leading National Transfusion Triggers Trial

Panagiotis Kougias, M.D., M.Sc., associate professor in the Division of Vascular Surgery and Endovascular Therapy, is the national principal investigator on a 17-million dollar trial titled “TOP Trial: Transfusion Triggers After Operations in High Cardiac Risk Patients” (NCT03229941), funded by the VA Office of Research and Development - Cooperative Studies Program (CSP). The goal of the TOP Trial is to determine whether a liberal transfusion strategy (transfusion trigger at hemoglobin < 10 gm/dl) in veterans at high cardiac risk who undergo major vascular and general surgery operations is associated with decreased risk of adverse postoperative outcomes compared to a restrictive transfusion strategy (transfusion trigger at hemoglobin < 7 gm/dl).

Dr. Todd Rosengart Heads Baylor College of Medicine Site of TRICS-III Trial

Our NIH-funded chair Todd K. Rosengart, M.D., is the principal investigator of the Baylor College of Medicine site of the Transfusion Requirements in Cardiac Surgery III (TRICS-III) (NCT02042898) trial, sponsored by St. Michael’s Hospital in Toronto, Canada, the Canadian Institute of Health Research, Health Canada and the Population Health Research Institute (PHRI). The TRICS-III trial aims to determine the optimal hemoglobin for transfusion in cardiac surgery.

Cardiovascular Outcomes for People Using Anticoagulation Strategies

Ramyar Gilani, M.D., assistant professor in the Division of Vascular Surgery and Endovascular Surgery, is the principal investigator of the Baylor College of Medicine site of the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) (NCT01776424) randomized control trial of rivaroxaban for the prevention of major cardiovascular events. The purpose of the study is to evaluate whether treatment with rivaroxaban and aspirin or rivaroxaban alone is better than aspirin alone in prevention of heart attacks, stroke or cardiovascular death in patients with coronary or peripheral artery disease.

PCORI Grant to Support a Project on Improving Delivery of Diabetic Foot Care to Prevent Amputation

Joseph L. Mills, M.D., professor and chief of Division of Vascular Surgery and Endovascular Therapy and medical director of Baylor St. Luke’s Diabetic Foot and Wound Care Center, was approved for an awarded by the Patient-Centered Outcomes Research Institute (PCORI) to support a project on “Improving Delivery of Diabetic Foot Care to Prevent Amputations: A Comparative Effectiveness Trial.” The funds provided through PCORI’s Pipeline to Proposal Awards program will support Dr. Mills and his multidisciplinary research team’s engagement with patients, their caregivers and stakeholders who desire to advance patient-centered research on diabetic foot care.

Dr. Mills has spent over a decade developing a multi-disciplinary care model of the diabetic foot that involves podiatrists, vascular surgeons, orthotists and bioengineers to address the ischemic and neuropathic problems of the diabetic foot in a comprehensive fashion.

Research by Disease

Aortic Disease

Pioneering the Future of Aortic Surgery

World-renowned cardiac surgeon, Joseph S. Coselli, M.D., professor of surgery and chief of the Division of Cardiothoracic Surgery and Vice Chair of the Department, leads clinical studies on methods to reduce postoperative mortality, paralysis and stroke during complex aortic repair. Dr. Coselli and his team’s efforts have borne fruit; their success in improving the process of aortic repair has resulted in better patient outcomes than those achieved in previous eras. Dr. Coselli is the principal investigator of numerous ongoing clinical studies evaluating new technologies for aortic repair.

NIH-Funded Studies to Get to the Root of Aortic Disease

Our NIH-funded Vice Chair for Research in the Department, Scott A. LeMaire, M.D., and his team in focus their basic science research on the role of various aspects of extracellular matrix degeneration in the development of aortic aneurysms and dissections. Led by Dr. LeMaire and Ying Shen, M.D., Ph.D., the Aortic Disease Research Laboratory has several ongoing projects investigating the mechanisms of aortic disease and developing pharmacological treatments to prevent aortic degeneration, maladaptive remodeling and disease progression funded by the NIH and AHA. These studies include:  NIH-NHLBI R01 (HL127111) funded study entitled “Targeting the Inflammasome to Prevent Thoracic Aortic Aneurysms and Dissections” and the NIH NHLBI R01 (HL131980) funded project, “Targeting ER Stress to Treat Thoracic Aortic Aneurysms and Dissections.”

National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC)

Dr. Scott LeMaire served as on the steering committee on the NIH-sponsored national GenTAC registry since its inception. He served as the principal investigator of the Baylor College of Medicine clinical center in the GenTAC Registry.

Ischemic Heart Disease

AATS Graham Foundation Award to Study the Role of Mechanical Microenvironment in Stem Cell Survival in Ischemic Myocardium

Ravi K. Ghanta, M.D., associate professor of surgery in the Division of Cardiothoracic Surgery, received the Ethicon Surgical Investigator Award from the AATS Graham Foundation for his research proposal entitled, “Understanding the Role of Mechanical Microenvironment in Stem Cell Survival in Ischemic Myocardium.” This award provides funding for Dr. Ghanta’s second year of research as a Graham Surgical Investigator. 

Advanced Heart Failure

NIH-NHLBI R01 Grant for Cardiac Cellular Reprogramming

Our NIH-funded department chair Todd K. Rosengart, M.D., is one of the pioneers in the field of gene therapy, with his work beginning in the early 90’s. He now leads the Laboratory for Cardiac Regeneration, a team of surgical researchers and basic scientists, whose research is developing a means to use cellular reprogramming to convert cardiac scar tissue into new heart muscle. Dr. Rosengart’s lab is supported by an NIH NHLBI R01 grant for his project, “In Situ Cardiac Infarct Cellular Reprogramming.” This research offers the possibility of “bio-interventions” for the treatment of hundreds of thousands of patients with advanced heart disease not treatable by conventional therapies.

A New Artificial Heart on the Horizon

Professors in the Division of Cardiothoracic Transplantation & Circulatory Support, O. H. Frazier, M.D., and William E. Cohn, M.D., are the leaders of a team of cardiac surgeons and engineers who received a $2.8 million federal grant from the NIH to develop a new smaller, less costly, pulseless artificial heart device that could perform the functions of both left and right ventricles. Drs. Frazier and Cohn collaborate with physician scientists, engineers and biologists from Texas Heart Institute, the University of Houston and Rice University to develop a control system that mimics the heart’s response to the body’s physiological conditions.

Peripheral Vascular Disease

PCORI Grant to Support a Project on Improving Delivery of Diabetic Foot Care to Prevent Amputation

Joseph L. Mills, M.D., professor and chief of Division of Vascular Surgery and Endovascular Therapy and medical director of Baylor St. Luke’s Diabetic Foot and Wound Care Center, was approved for an award by the Patient-Centered Outcomes Research Institute (PCORI) to support a project on “Improving Delivery of Diabetic Foot Care to Prevent Amputations: A Comparative Effectiveness Trial.” The funds provided through PCORI’s Pipeline to Proposal Awards program will support Dr. Mills and his multidisciplinary research team’s engagement with patients, their caregivers and stakeholders who desire to advance patient-centered research on diabetic foot care.

Dr. Mills has spent over a decade developing a multi-disciplinary care model of the diabetic foot that involves podiatrists, vascular surgeons, orthotists and bioengineers to address the ischemic and neuropathic problems of the diabetic foot in a comprehensive fashion.

Voyager PAD—An International, Multicenter, randomized, double-blind, placebo controlled phase 3 trial investigating the efficacy and safety of Rivaroxaban to reduce the risk of major thrombotic vascular events in patients with symptomatic peripheral artery disease undergoing lower extremity revascularization procedures (NCT02504216)

Novel Offloading for Diabetic Foot Ulcers with PulseFlow

Bijan Najafi, Ph.D., MSc., professor and director of clinical research in the Division of Vascular Surgery and Endovascular Therapy and director the Interdisciplinary Consortium for Advance Motion Performance (iCAMP), is principal investigator of an interventional study to determine whether a novel low voltage, battery powered medical device, PulseFlow DF ® (The Diabetic Boot Company, Ltd. UK)can help improve lower extremity perfusion, whilst improving balance and spatio-temporal parameters of gait.

Cardiac Valve Disease

CTSN Heart Valve Repair/Replacement Trials

Baylor College of Medicine was selected as a Core Clinical Center (CCC) for the NIH-funded Cardiothoracic Surgical Trials Network (CTSN).  Led by our NIH-funded chair Todd K. Rosengart, M.D., and the Michael E. DeBakey Department of Surgery at Baylor College of Medicine is one of 30 highly experienced cardiothoracic surgical centers participating in the CTSN Tricuspid Repair Trial entitled “Evaluating the Benefit of Concurrent Tricuspid Valve Repair during Mitral Surgery,” as well as the design, conduct and analysis of other CTSN trials.

Transfusion and Anticoagulation

Transfusion Requirements in Cardiac Surgery (TRICS-111)

Dr. Todd Rosengart is principal investigator of an ongoing international, multi-center randomized controlled trial to assess transfusion thresholds in patients undergoing cardiac surgery, funded by the Population Health Research Institute (PHRI).

Cardiovascular Outcomes for People using Anticoagulation Strategies (COMPASS) (NCT01776424)

Ramyar Gilani, M.D., assistant professor in the Division of Vascular Surgery & Endovascular Surgery, is the principal investigator of the Baylor College of Medicine site of the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) randomized control trial of Rivaroxaban for the prevention of major cardiovascular events. The purpose of the study is to evaluate whether treatment with rivaroxaban and aspirin or rivaroxaban alone is better than aspirin alone in prevention of heart attacks, stroke or cardiovascular death in patients with coronary or peripheral artery disease.

Cardiac Arrhythmia

Left Atrial Appendage Occlusion Study III (LAAOS) (NCT01561651)

Study funded by Hamilton Health Sciences Corporation.