I am a dedicated clinician with 15 years experience in clinical medicine including specialist training in Anaesthesia, Intensive care and Neurology. Passionate about advancing clinical research and advocating for clinician-researchers, I balance research leadership, teaching and mentoring alongside my own research and active medical practice.
My research portfolio is diverse. I am most passionate about harm minimisation (especially neurological injury) in operative and critical care settings.
To achieve this, bringing together expertise from different disciplines is key to innovativce discovery and advancing perioperative medicine and research. To this end, I invest considerable effort in building research capacity through collaboration with national and international research institutions, recruit and supervise senior scientisists, clinician-researchers and top PhD and MPhil students.
As lead investigator for both perioperative and neurological research within the Critical Care Research Group my contribution has been intellectual, technical and logistical. I have assembled a multidisciplinary team of local and international healthcare, basic science and statistical experts and sourced (as Chief Investigator A or equivalent) over $1M in competitive funding towards this area of research.
Research to date has resulted: 1) improved surgical / anaesthetic risk prediction; 2) improved techniques (procedural and prosthesis related) during cardiac surgery / intervention); 3) novel strategies for analysing brain perfusion and blood flow; and 4) first descriptions of brain signatures using advanced imaging strategies. Direct clinical translation is evidenced by authorship of and citations in major national and international guidelines and expert consensus statements.
Journal Article: The epidemiology of silent brain infarction: a systematic review of population-based cohorts
Fanning, Jonathon P., Wong, Andrew A. and Fraser, John F. (2014). The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Medicine, 12 (1) 119, 119.1-119.11. doi: 10.1186/s12916-014-0119-0
Journal Article: The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY): concept, design and rationale
Fanning, Jonathon P., Wesley, Allan J., Platts, David G., Walters, Darren L., Eeles, Eamonn M., Seco, Michael, Tronstad, Oystein, Strugnell, Wendy, Barnett, Adrian G., Clarke, Andrew J., Bellapart, Judith, Vallely, Michael P., Tesar, Peter J. and Fraser, John F. (2014). The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY): concept, design and rationale. BMC Cardiovascular Disorders, 14 (1) 45, 45. doi: 10.1186/1471-2261-14-45
Journal Article: Characterization of neurological injury in transcatheter aortic valve implantation: how clear is the picture?
Fanning, Jonathon P., Walters, Darren L., Platts, David G., Eeles, Eamonn, Bellapart, Judith and Fraser, John F. (2014). Characterization of neurological injury in transcatheter aortic valve implantation: how clear is the picture?. Circulation, 129 (4), 504-515. doi: 10.1161/CIRCULATIONAHA.113.004103
Journal Article: Emerging Spectra of Silent Brain Infarction
Fanning, Jonathon P., Wesley, Allan J., Wong, Andrew A. and Fraser, John F. (2014). Emerging Spectra of Silent Brain Infarction. Stroke, 45 (11), 3461-3471. doi: 10.1161/STROKEAHA.114.005919
Journal Article: Transcatheter aortic valve implantation (TAVI): Valve design and evolution
Fanning J.P., Platts D.G., Walters D.L. and Fraser J.F. (2013). Transcatheter aortic valve implantation (TAVI): Valve design and evolution. International Journal of Cardiology, 168 (3), 1822-1831. doi: 10.1016/j.ijcard.2013.07.117
(2016–2018) National Heart Foundation of Australia
Novel neuroimaging biomarkers for defending cerebral perfusion during noncardiac surgery
Master Philosophy
Optimising intraoperative coagulation management for precision vascular surgery
Overview:
Vascular clamping, interruption of in-line laminar flow and exposure of blood to artificial surfaces, air and prothrombotic layers of the vascular wall all make vascular surgery one of the most prothrombotic settings in medicine, necessitating anticoagulation to avoid thrombotic burden, morbidity and mortality. Except among patients with known drug allergies, bolus dosing of intravenous unfractionated heparin (UFH) is universally selected as the anticoagulation of choice and is initiated immediately prior to arterial clamping. Precision care is essential to optimise the risk/benefit of its use. However, in practice, heparin use and reversal is a concerningly inexact science. This prospective, observational study has been designed explicitly to provide robust, impartial and industry-free data: (1) to accurately model the the pharmacokinetics (PK) and pharmacodynamics (PD) of UFH boluses and maintenance dosing, and protamine reversal; and, (2) to assess how the anticoagulant effect is monitored with latest iteration viscoelastic haemostatic assay/s (VHA/s), so as to improve the precision of intraoperative care and optimise the risk/benefit balance associated with their use.
Objectives:
Aim 1: Accurately model the PK/PD of IV UFH and protamine in vascular surgery to improve the precision of care and optimise the risk/benefit balance associated with anticoagulant use.
Aim 2: To evaluate the validity of the two-clinically relevant, latest iteration VHA's during heparin use to provide vital information for coagulopathy monitoring and management.
Study methodology:
This is a prospective, observational study of 100 patients undergoing elective vascular surgery requiring intraoperative anticoagulation at tertiary hospitals in Brisbane. Serial blood samples will be concurrently measured for drug level, laboratory coagulation panels, TEG6s and ROTEMSigma parameters to allow accurate pharmacokinetic/pharmacodynamic modelling of intravenous antithrombotics
Outcomes and significance:
1. Addresses an area of need: This detailed ‘real-world’ assessment and analysis of heparin dosing and effects will standardise perioperative heparin use to improve the precision of patient management.
2. Directly influence a sizeable patient population: In 2017, over 2,000 surgeries requiring intravenous heparinisation were performed at TPCH, including 1,000 major vascular/hybrid procedures. As a major surgical hospital, TPCH has an obligation to advance the perioperative care of patients and ensure that best practice are employed to negotiate a safe perioperative period.
3. Be immediately translatable into improved clinical practice. We will ise these data to formulate precise antithrombotic recommendationsand best practice clinical guidelines.
4. Reduce the economic and social burdens of preventable surgical complications: the occurrence of potentially-preventable surgical complications is an important health economics burden for health systems and diminishes community confidence in the service provided.
Funding:
Funding obtained.
Individualised haemodynamic optimisation informed by the lower limit of cerebral autoregulation
Background:
Intraoperative hypotension (IOH) reportedly complicates between 35 - 85% of surgeries. Large observational studies demonstrate that even brief mild IOH below a mean arterial blood pressure (MAP) of 65mmHg are associated with perioperative organ ischaemia and injury (e.g., stroke, acute kidney injury, myocardial infarction). Due to its exquisite sensitivity to hypoperfusion and ischaemia the brain is considered the index organ of acceptable MAP threshold. Cerebral autoregulatory mechanisms maintain stable blood flow in the face of perfusion pressure changes reduction and determine the critical threshold below which vessel dilation cannot compensate for reduced MAP. Pre-clinical data show that this lower limit of cerebral autoregulation (LLA) can be measured using novel mathematical analysis and advanced non-invasive optical measurement of cerebral haemodynamics and metabolism with near infrared spectroscopy (NIRS). Translation and optimization of this to the clinical setting to provide real-time feedback to the anaesthetist and individual optimization of patient blood pressure will be a practice changing development.
Aims:
The aim of this study is to translate and optimize a novel measure of the LLA using NIRS in a non-cardiac surgical population to test its feasibility for individualizing MAP targets to prevent IOH and associated morbidity and mortality.
Study methodology:
This is a prospective observational study of 100 adult patients undergoing non-cardiothoracic elective surgery under general anaesthesia with invasive arterial monitoring at major tertiary hospitals in Brisbane. In addition to the routine standard of care and monitoring, bilateral NIRS optodes (INVOS, Medtronic) will be attached prior to induction and continuously recorded in a time-stamped manner in conjunction with other routinely monitored physiological parameters.
Outcomes and Significance of the project:
This study has the potential to substantially alter how we think about and individualise intraoperative blood pressure management to minimise IOH and associated morbidity and mortality.
The rich dataset obtained will: i) validate and optimise novel analysis techniques for the determination of LLA; ii) provide one of the largest repositories of data on cerebral autoregulatory limits in the general population undergoing surgery; and iii) determine associations with clinical/biochemical correlates of organ ischaemia. These data will form a platform for clinical guideline development and then be used to train and evaluate a convolutional neural network (CNN) for near real-time automated LLA analysis and ultimately inform the development of a prototype point-of-care cerebral autoregulation monitor.
Funding:
Funding obtained.
The epidemiology of silent brain infarction: a systematic review of population-based cohorts
Fanning, Jonathon P., Wong, Andrew A. and Fraser, John F. (2014). The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Medicine, 12 (1) 119, 119.1-119.11. doi: 10.1186/s12916-014-0119-0
Fanning, Jonathon P., Wesley, Allan J., Platts, David G., Walters, Darren L., Eeles, Eamonn M., Seco, Michael, Tronstad, Oystein, Strugnell, Wendy, Barnett, Adrian G., Clarke, Andrew J., Bellapart, Judith, Vallely, Michael P., Tesar, Peter J. and Fraser, John F. (2014). The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY): concept, design and rationale. BMC Cardiovascular Disorders, 14 (1) 45, 45. doi: 10.1186/1471-2261-14-45
Fanning, Jonathon P., Walters, Darren L., Platts, David G., Eeles, Eamonn, Bellapart, Judith and Fraser, John F. (2014). Characterization of neurological injury in transcatheter aortic valve implantation: how clear is the picture?. Circulation, 129 (4), 504-515. doi: 10.1161/CIRCULATIONAHA.113.004103
Emerging Spectra of Silent Brain Infarction
Fanning, Jonathon P., Wesley, Allan J., Wong, Andrew A. and Fraser, John F. (2014). Emerging Spectra of Silent Brain Infarction. Stroke, 45 (11), 3461-3471. doi: 10.1161/STROKEAHA.114.005919
Transcatheter aortic valve implantation (TAVI): Valve design and evolution
Fanning J.P., Platts D.G., Walters D.L. and Fraser J.F. (2013). Transcatheter aortic valve implantation (TAVI): Valve design and evolution. International Journal of Cardiology, 168 (3), 1822-1831. doi: 10.1016/j.ijcard.2013.07.117
Sato, Kei, White, Nicole, Fanning, Jonathon P., Obonyo, Nchafatso, Yamashita, Michael H., Appadurai, Vinesh, Ciullo, Anna, May, Meryta, Worku, Elliott T., Helms, Leticia, Ohshimo, Shinichiro, Juzar, Dafsah A., Suen, Jacky Y., Bassi, Gianluigi Li, Fraser, John F., Arora, Rakesh C. and on behalf of COVID-19 Critical Care Consortium Investigators (2022). Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study. BMC Cardiovascular Disorders, 22 (1) 123, 123. doi: 10.1186/s12872-022-02565-1
Li Bassi, Gianluigi, Suen, Jacky Y., White, Nicole, Dalton, Heidi J., Fanning, Jonathon, Corley, Amanda, Shrapnel, Sally, Hinton, Samuel, Forsyth, Simon, Parsons, Rex, Laffey, John G., Fan, Eddy, Bartlett, Robert, Brodie, Daniel, Burrell, Aidan, Chiumello, Davide, Elhazmi, Alyaa, Grasselli, Giacomo, Hodgson, Carol, Ichiba, Shingo, Luna, Carlos, Marwali, Eva, Merson, Laura, Murthy, Srinivas, Nichol, Alistair, Panigada, Mauro, Pelosi, Paolo, Torres, Antoni, Ng, Pauline Yeung ... on behalf of the COVID-19 Critical Care Consortium (2021). Assessment of 28-Day In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019: An International Cohort Study. Critical Care Explorations, 3 (11) e0567, 1. doi: 10.1097/cce.0000000000000567
Fulton, Rachel, Millar, Jonathan E., Merza, Megan, Johnston, Helen, Corley, Amanda, Faulke, Daniel, Rapchuk, Ivan L., Tarpey, Joe, Fanning, Jonathon P., Lockie, Philip, Lockie, Shirley and Fraser, John F. (2021). Prophylactic postoperative high flow nasal oxygen versus conventional oxygen therapy in obese patients undergoing bariatric surgery (OXYBAR Study): a pilot randomised controlled trial. Obesity Surgery, 31 (11), 4799-4807. doi: 10.1007/s11695-021-05644-y
Huth, Samuel F., Cho, Sung-Min, Robba, Chiara, Highton, David, Battaglini, Denise, Bellapart, Judith, Suen, Jacky Y., Li Bassi, Gianluigi, Taccone, Fabio Silvio, Arora, Rakesh C., Whitman, Glenn, Fraser, John F. and Fanning, Jonathon P. (2021). Neurological manifestations of coronavirus disease 2019: a comprehensive review and meta-analysis of the first 6 months of pandemic reporting. Frontiers in Neurology, 12 664599, 664599. doi: 10.3389/fneur.2021.664599
Fanning, Jonathon P., Murthy, Srinivas, Obonyo, Nchafatso G., Baillie, J. Kenneth, Webb, Steve, Dalton, Heidi J. and Fraser, John F. (2021). Global infectious disease research collaborations in crises: building capacity and inclusivity through cooperation. Globalization and Health, 17 (1) 84, 1-6. doi: 10.1186/s12992-021-00731-2
Cho, Sung-Min, Premraj, Lavienraj, Fanning, Jonathon, Huth, Samuel, Barnett, Adrian, Whitman, Glenn, Arora, Rakesh C., Battaglini, Denise, Porto, Diego Bastos, Choi, HuiMahn, Suen, Jacky, Bassi, Gianluigi Li, Fraser, John F., Robba, Chiara and Griffee, Matthew (2021). Ischemic and hemorrhagic stroke among critically ill patients with coronavirus disease 2019: an International Multicenter Coronavirus Disease 2019 Critical Care Consortium study. Critical Care Medicine, 49 (12), E1223-E1233. doi: 10.1097/CCM.0000000000005209
An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients
Li Bassi, Gianluigi, Suen, Jacky Y, Dalton, Heidi J, White, Nicole, Shrapnel, Sally, Fanning, Jonathon P, Liquet, Benoit, Hinton, Samuel, Vuorinen, Aapeli, Booth, Gareth, Millar, Jonathan E, Forsyth, Simon, Panigada, Mauro, Laffey, John, Brodie, Daniel, Fan, Eddy, Torres, Antoni, Chiumello, Davide, Corley, Amanda, Elhazmi, Alyaa, Hodgson, Carol, Ichiba, Shingo, Luna, Carlos, Murthy, Srinivas, Nichol, Alistair, Ng, Pauline Yeung, Ogino, Mark, Pesenti, Antonio, Trieu, Huynh Trung ... Obonyo, Gikenyi N. (2021). An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients. Critical Care, 25 (1) 199, 1-22. doi: 10.1186/s13054-021-03518-4
Fanning, Jonathon, Roberts, Shaun, Merza, Megan, Anstey, Chris, Poon, Karl, Incani, Alexander, Natani, Sarvesh and Fraser, John (2021). Evaluation of latest viscoelastic coagulation assays in the transcatheter aortic valve implantation setting. Open Heart, 8 (1) e001565, e001565. doi: 10.1136/openhrt-2020-001565
Woldendorp, Kei, Indja, Ben, Bannon, Paul G., Fanning, Jonathon P., Plunkett, Brian T. and Grieve, Stuart M. (2021). Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis. European Heart Journal, 42 (10), 1004-1015. doi: 10.1093/eurheartj/ehab002
Bassi, Gianluigi Li, Suen, Jacky, Barnett, Adrian Gerard, Corley, Amanda, Millar, Jonathan, Fanning, Jonathon, Lye, India, Colombo, Sebastiano, Wildi, Karin, Livingstone, Samantha, Abbate, Gabriella, Hinton, Samuel, Liquet, Benoit, Shrapnel, Sally, Dalton, Heidi and Fraser, John F. (2020). Design and rationale of the COVID-19 Critical Care Consortium international, multicentre, observational study. BMJ Open, 10 (12) e041417, e041417. doi: 10.1136/bmjopen-2020-041417
Ingelfinger imperative: when speed of release risks quality of research
Fanning, Jonathon P., Cohen, Jeremy and Venkatesh, Balasubramanian (2020). Ingelfinger imperative: when speed of release risks quality of research. Internal Medicine Journal, 50 (12), 1595-1596. doi: 10.1111/imj.15047
Welton, Thomas, Indja, Ben E., Maller, Jerome J., Fanning, Jonathon P., Vallely, Michael P. and Grieve, Stuart M. (2019). Replicable brain signatures of emotional bias and memory based on diffusion kurtosis imaging of white matter tracts. Human Brain Mapping, 41 (5) hbm.24874, 1274-1285. doi: 10.1002/hbm.24874
Ki, Katrina K., Passmore, Margaret R., Chan, Chris H. H., Malfertheiner, Maximilian V., Fanning, Jonathon P., Bouquet, Mahé, Millar, Jonathan E., Fraser, John F. and Suen, Jacky Y. (2019). Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit. Intensive Care Medicine Experimental, 7 (1) 51, 51. doi: 10.1186/s40635-019-0264-z
Fanning, Jonathon P., Hoe, Louise E. See, Passmore, Margaret R., Barnett, Adrian G., Obonyo, Nchafatso G., Millar, Jonathan E., Wesley, Allan J., Suen, Jacky Y. and Fraser, John F. (2019). Neuron specific enolase and matrix metalloproteinase 9 signal perioperative silent brain infarction during or after transcatheter aortic valve implantation. The American Journal of Cardiology, 123 (3), 434-439. doi: 10.1016/j.amjcard.2018.10.022
Pre-clinical study protocol: Blood transfusion in endotoxaemic shock
Obonyo, Nchafatso G., Byrne, Liam, Tung, John-Paul, Simonova, Gabriela, Diab, Sara D., Dunster, Kimble R., Passmore, Margaret R., Boon, Ai-Ching, See Hoe, Louise, Engkilde-Pedersen, Sanne, Esguerra-Lallen, Arlanna, Fauzi, Mohd H., Pimenta, Leticia P., Millar, Jonathan E., Fanning, Jonathon P., Van Haren, Frank, Anstey, Chris M., Cullen, Louise, Suen, Jacky, Shekar, Kiran, Maitland, Kathryn and Fraser, John F. (2019). Pre-clinical study protocol: Blood transfusion in endotoxaemic shock. MethodsX, 6, 1124-1132. doi: 10.1016/j.mex.2019.05.005
Fanning, Jonathon P., See Hoe, Louise E., Passmore, Margaret R., Barnett, Adrian G., Rolfe, Barbara E., Millar, Jonathan E., Wesley, Allan J., Suen, Jacky and Fraser, John F. (2018). Differential immunological profiles herald magnetic resonance imaging-defined perioperative cerebral infarction. Therapeutic Advances in Neurological Disorders, 11, 1756286418759493. doi: 10.1177/1756286418759493
Fanning, Jonathon P., Wesley, Allan J., Walters, Darren L., Wong, Andrew A., Barnett, Adrian G., Strugnell, Wendy E., Platts, David G. and Fraser, John F. (2017). Topographical distribution of perioperative cerebral infarction associated with transcatheter aortic valve implantation. American Heart Journal, 197, 113-123. doi: 10.1016/j.ahj.2017.12.008
Indja, B., Fanning, J. P., Maller, J. J., Fraser, J. F., Bannon, P. G., Vallely, M. and Grieve, S. M. (2017). Neural network imaging to characterize brain injury in cardiac procedures: the emerging utility of connectomics. British Journal of Anaesthesia, 118 (5), 680-688. doi: 10.1093/bja/aex088
Murdoch, Dale and Fanning, Jonathon P. (2017). Early cerebrovascular events after transcatheter aortic valve replacement: patient- and procedure-specific predictors. Journal of Thoracic Disease, 9 (3), 434-437. doi: 10.21037/jtd.2017.02.52
Millar, Jonathan E., Fanning, Jonathon P., McDonald, Charles I., McAuley, Daniel F. and Fraser, John F. (2016). The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Critical Care, 20 (1) 387, 387. doi: 10.1186/s13054-016-1570-4
Neurological injury in intermediate-risk transcatheter aortic valve implantation
Fanning, Jonathon P., Wesley, Allan J., Walters, Darren L., Eeles, Eamonn M., Barnett, Adrian G., Platts, David G., Clarke, Andrew J., Wong, Andrew A., Strugnell, Wendy E., O'Sullivan, Cliona, Tronstad, Oystein and Fraser, John F. (2016). Neurological injury in intermediate-risk transcatheter aortic valve implantation. Journal of the American Heart Association, 5 (11) 004203. doi: 10.1161/JAHA.116.004203
Fanning, Jonathan P., Nyong, Jonathan, Scott, Ian A., Aroney, Constantine N. and Walters, Darren L. (2016). Routine invasive strategies versus selective invasive strategies for unstable angina and non-ST elevation myocardial infarction in the stent era (Review). Cochrane Database of Systematic Reviews, 2016 (5) CD004815, CD004815. doi: 10.1002/14651858.CD004815.pub4
Transcatheter Aortic-Valve Replacement in Clinical Practice
Fanning, Jonathon P. and Fraser, John F. (2016). Transcatheter Aortic-Valve Replacement in Clinical Practice. New England Journal of Medicine, 374 (17), 1691-1691. doi: 10.1056/NEJMc1601697
Obonyo, Nchafatso G., Fanning, Jonathon P., Ng, Angela S. Y., Pimenta, Leticia P., Shekar, Kiran, Platts, David G., Maitland, Kathryn and Fraser, John F. (2016). Effects of volume resuscitation on the microcirculation in animal models of lipopolysaccharide sepsis: a systematic review. Intensive Care Medicine Experimental, 4 (1) 38, 1-16. doi: 10.1186/s40635-016-0112-3
Fanning, J., Walters, D., Wesley, A., Clarke, A., O'Sullivan, C., Strugnell, W. and Fraser, J. (2015). Characterisation of neurological injury in the modern era of transcatheter aortic valve implantation (TAVI). Heart, Lung and Circulation, 24 (Supplement 3), S266-S266. doi: 10.1016/j.hlc.2015.06.366
Comparison of new brain infarction associated with isolated aortic valve surgeries
Fanning, Jonathon P., Clarke, Andrew J., Platts, David G., O'Sullivan, Cliona, Walters, Darren L. and Fraser, John F. (2015). Comparison of new brain infarction associated with isolated aortic valve surgeries. Heart, Lung and Circulation, 24, e17-e18. doi: 10.1016/j.hlc.2014.12.041
The epidemiology of silent brain infarction: a systematic review of population-based cohorts
Fanning, Jonathon P., Wong, Andrew A. and Fraser, John F. (2014). The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Medicine, 12 (1) 119, 119.1-119.11. doi: 10.1186/s12916-014-0119-0
Fanning, Jonathon P., Wesley, Allan J., Platts, David G., Walters, Darren L., Eeles, Eamonn M., Seco, Michael, Tronstad, Oystein, Strugnell, Wendy, Barnett, Adrian G., Clarke, Andrew J., Bellapart, Judith, Vallely, Michael P., Tesar, Peter J. and Fraser, John F. (2014). The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY): concept, design and rationale. BMC Cardiovascular Disorders, 14 (1) 45, 45. doi: 10.1186/1471-2261-14-45
Fanning, Jonathon P., Walters, Darren L., Platts, David G., Eeles, Eamonn, Bellapart, Judith and Fraser, John F. (2014). Characterization of neurological injury in transcatheter aortic valve implantation: how clear is the picture?. Circulation, 129 (4), 504-515. doi: 10.1161/CIRCULATIONAHA.113.004103
Emerging Spectra of Silent Brain Infarction
Fanning, Jonathon P., Wesley, Allan J., Wong, Andrew A. and Fraser, John F. (2014). Emerging Spectra of Silent Brain Infarction. Stroke, 45 (11), 3461-3471. doi: 10.1161/STROKEAHA.114.005919
Fanning, Jonathon P., Walters, Darren L. and Fraser, John F. (2013). Letter by Fanning et al regarding article, "histopathology of embolic debris captured during transcatheter aortic valve replacement". Circulation, 128 (25), E477-E477. doi: 10.1161/CIRCULATIONAHA.113.004551
Transcatheter aortic valve implantation (TAVI): Valve design and evolution
Fanning J.P., Platts D.G., Walters D.L. and Fraser J.F. (2013). Transcatheter aortic valve implantation (TAVI): Valve design and evolution. International Journal of Cardiology, 168 (3), 1822-1831. doi: 10.1016/j.ijcard.2013.07.117
Percutaneous closure of an aortic prosthetic paravalvar leak: an Australian first
Fanning, Jonathon P., Cox, Stephen V. and Scalia, Gregory M. (2012). Percutaneous closure of an aortic prosthetic paravalvar leak: an Australian first. Heart Lung and Circulation, 21 (3), 174-177. doi: 10.1016/j.hlc.2011.09.008
Fanning, Jonathon P., Hoe, See Louise E., Passmore, Margaret R., Barnett, Adrian G., Obonyo, Nchafatso G., Millar, Jonathan E., Suen, Jacky Y. and Fraser, John F. (2018). Neuron specific enolase and matrix metaloproteinase 9 signal silent brain infarction associated with TAVI. Philadelphia, PA, United States: Lippincott Williams & Wilkins.
Fanning, Jonathon P., Obonyo, Nchafatso G., Tung, John-Paul, Byrne, Liam, Simonova, Gabriela, Diab, Sara, Dunster, Kimble, Passmore, Margaret, Boon, Ai-Ching, Hoe, See Louise, Engkilde-Pedersen, Sanne, Esguerra-Lallen, Arlanna, Fauzi, Hashairi Mohd, Pretti, Pimenta Leticia, Millar, Jonathan, Anstey, Christopher, van Haren, Frank, Cullen, Louise, Suen, Jacky, Shekar, Kiran, Maitland, Kathryn and Fraser, John (2018). Packed red cell age associated with adverse cardiovascular changes in an ovine model of septic shock resuscitation. -, -, 2018. Philadelphia, PA United States: Lippincott Williams & Wilkins.
Fanning, J., Wesley, A., Walters, D., Wong, A. and Fraser, J. (2016). Topographical distribution of cerebral infarction associated with Transcatheter Aortic Valve Implantation (TAVI). Annual Conference of the Asia Pacific Stroke Organization (APSO) Combined with Stroke Society of Australasia, Brisbane, Qld, Australia, 14-17 July 2016. Basel, Switzerland: S. Karger. doi: 10.1159/000447732
Fanning, Jonathon P. (2017). Perioperative stroke and cognitive impairment: Incidence, predictors and outcomes in the transcatheter aortic valve implantation setting. PhD Thesis, Faculty of Medicine, The University of Queensland. doi: 10.14264/uql.2018.166
(2016–2018) National Heart Foundation of Australia
Novel neuroimaging biomarkers for defending cerebral perfusion during noncardiac surgery
Master Philosophy — Principal Advisor
Other advisors:
Note for students: The possible research projects listed on this page may not be comprehensive or up to date. Always feel free to contact the staff for more information, and also with your own research ideas.
Optimising intraoperative coagulation management for precision vascular surgery
Overview:
Vascular clamping, interruption of in-line laminar flow and exposure of blood to artificial surfaces, air and prothrombotic layers of the vascular wall all make vascular surgery one of the most prothrombotic settings in medicine, necessitating anticoagulation to avoid thrombotic burden, morbidity and mortality. Except among patients with known drug allergies, bolus dosing of intravenous unfractionated heparin (UFH) is universally selected as the anticoagulation of choice and is initiated immediately prior to arterial clamping. Precision care is essential to optimise the risk/benefit of its use. However, in practice, heparin use and reversal is a concerningly inexact science. This prospective, observational study has been designed explicitly to provide robust, impartial and industry-free data: (1) to accurately model the the pharmacokinetics (PK) and pharmacodynamics (PD) of UFH boluses and maintenance dosing, and protamine reversal; and, (2) to assess how the anticoagulant effect is monitored with latest iteration viscoelastic haemostatic assay/s (VHA/s), so as to improve the precision of intraoperative care and optimise the risk/benefit balance associated with their use.
Objectives:
Aim 1: Accurately model the PK/PD of IV UFH and protamine in vascular surgery to improve the precision of care and optimise the risk/benefit balance associated with anticoagulant use.
Aim 2: To evaluate the validity of the two-clinically relevant, latest iteration VHA's during heparin use to provide vital information for coagulopathy monitoring and management.
Study methodology:
This is a prospective, observational study of 100 patients undergoing elective vascular surgery requiring intraoperative anticoagulation at tertiary hospitals in Brisbane. Serial blood samples will be concurrently measured for drug level, laboratory coagulation panels, TEG6s and ROTEMSigma parameters to allow accurate pharmacokinetic/pharmacodynamic modelling of intravenous antithrombotics
Outcomes and significance:
1. Addresses an area of need: This detailed ‘real-world’ assessment and analysis of heparin dosing and effects will standardise perioperative heparin use to improve the precision of patient management.
2. Directly influence a sizeable patient population: In 2017, over 2,000 surgeries requiring intravenous heparinisation were performed at TPCH, including 1,000 major vascular/hybrid procedures. As a major surgical hospital, TPCH has an obligation to advance the perioperative care of patients and ensure that best practice are employed to negotiate a safe perioperative period.
3. Be immediately translatable into improved clinical practice. We will ise these data to formulate precise antithrombotic recommendationsand best practice clinical guidelines.
4. Reduce the economic and social burdens of preventable surgical complications: the occurrence of potentially-preventable surgical complications is an important health economics burden for health systems and diminishes community confidence in the service provided.
Funding:
Funding obtained.
Individualised haemodynamic optimisation informed by the lower limit of cerebral autoregulation
Background:
Intraoperative hypotension (IOH) reportedly complicates between 35 - 85% of surgeries. Large observational studies demonstrate that even brief mild IOH below a mean arterial blood pressure (MAP) of 65mmHg are associated with perioperative organ ischaemia and injury (e.g., stroke, acute kidney injury, myocardial infarction). Due to its exquisite sensitivity to hypoperfusion and ischaemia the brain is considered the index organ of acceptable MAP threshold. Cerebral autoregulatory mechanisms maintain stable blood flow in the face of perfusion pressure changes reduction and determine the critical threshold below which vessel dilation cannot compensate for reduced MAP. Pre-clinical data show that this lower limit of cerebral autoregulation (LLA) can be measured using novel mathematical analysis and advanced non-invasive optical measurement of cerebral haemodynamics and metabolism with near infrared spectroscopy (NIRS). Translation and optimization of this to the clinical setting to provide real-time feedback to the anaesthetist and individual optimization of patient blood pressure will be a practice changing development.
Aims:
The aim of this study is to translate and optimize a novel measure of the LLA using NIRS in a non-cardiac surgical population to test its feasibility for individualizing MAP targets to prevent IOH and associated morbidity and mortality.
Study methodology:
This is a prospective observational study of 100 adult patients undergoing non-cardiothoracic elective surgery under general anaesthesia with invasive arterial monitoring at major tertiary hospitals in Brisbane. In addition to the routine standard of care and monitoring, bilateral NIRS optodes (INVOS, Medtronic) will be attached prior to induction and continuously recorded in a time-stamped manner in conjunction with other routinely monitored physiological parameters.
Outcomes and Significance of the project:
This study has the potential to substantially alter how we think about and individualise intraoperative blood pressure management to minimise IOH and associated morbidity and mortality.
The rich dataset obtained will: i) validate and optimise novel analysis techniques for the determination of LLA; ii) provide one of the largest repositories of data on cerebral autoregulatory limits in the general population undergoing surgery; and iii) determine associations with clinical/biochemical correlates of organ ischaemia. These data will form a platform for clinical guideline development and then be used to train and evaluate a convolutional neural network (CNN) for near real-time automated LLA analysis and ultimately inform the development of a prototype point-of-care cerebral autoregulation monitor.
Funding:
Funding obtained.