Research

The Senior Clinicians from Alder Hey Heart Centre are involved in developing a variety of research projects in different areas, in order to help improve treatment and care for future cardiac patients. Below, you can find information on research conducted in conjuction with our consultants.

Mr Lotto promotes education, training and teaching amongst Cardiothoracic surgeons in training. Trainees are given lectures about all aspects of Congenital Cardiac Surgery. They are able to perform operations, guided by supervisors, of non- living models.

The following pictures are trainees, progressing from simple closures of holes, to more advanced operations such as Aortic Root enlargement and Ross Operation.

Research with Local Academic Institutions

Several projects in collaboration with local academic institutions.

Risk associated with Child Heart Surgery is now complete. The results have been presented and accepted for publication.
Two studies are at present underway and recruiting in line with plans;

Looking at Doppler waveform of brain vascular flow patterns during circulatory arrest.
Exploring blood flow to the brain in patients undergoing ECMO for respiratory failure, with the appointment of a full time PhD student.

Life course of systemic hypertension in patients who underwent aortic coarcation repair- In conjunction between AHCH and LHCH, we have received a grant from a local funding body, matched by UoL to appoint a PhD student for 3 years.

Our research partners

Liverpool Centre for Cardiovascuar Science (LCCS) - https://www.liverpool.ac.uk/health-and-life-sciences/liverpool-centre-for-cardiovascular-science/staff-list/

Liverpool Health Partners - http://www.liverpoolhealthpartners.org.uk/index.php

Institute of Health Research - https://www.ljmu.ac.uk/research/centres-and-institutes/institute-of-health-research

Research with National & International Institutions

1) Risk Perception of parents of children undergoing congenital heart surgery

Researchers: Mr. A. Lotto (Co-Applicant), Dr. R. Lotto (Lead applicant)
Funding Body: Florence Nightingale Foundation (2016-2018)
Host organisation: Alder Hey
Status: recruited 93 parents. Presented nationally and internationally
Output: 2 papers accepted for publication, abstracts at international level

2) Brain Vascular Reactivity during aortic arch augmentation with circulatory arrest

Researchers: Mr. A. Lotto (Principal Investigator), Prof H. Jones (Co-investigator)
Funding Body: LJMU (2017-2019)
Host Organisation: Alder Hey
Status: started in September 2018; recruited 9 patients fr target of 20 patients

3) Brain Vascular Reactivity in children during treatment for acute respiratory failure

Researchers: Mr. A. Lotto (Principal Investigator), Prof H. Jones (Co-investigator)
Full time PhD student appointed July 2018, started August 2018
Funding Body: LJMU (2017-2020)
Hosting Organisation: Alder Hey
Status: October 2018; recruited 7 patients over target of 15 patients

4) Exploring the life course of hypertension in corrected coarctation of the aorta: Pathophysiological insights into the mechanisms leading to persistent hypertension

Researcher: Mr. A. Lotto (PI - AHCH & LJMU), Mr. G. Lip (PI – LHCH & UoL)

Full time PhD student appointed in February 2019

Part time PhD student appointed in February 2019 (LCHC funded)

Funding Body: H. Greenwood Legacy – University of Liverpool – LHCH (2018-2021)

Host Organisation: Alder Hey, Liverpool Heart and Chest Hospital

Status: PhD students appointed, due to star in June 2019

Research with National and International Institutions

We have fostered academic collaborations with several national and international institutions. Mr. Lotto, as UK representative on the international steering panel of a multicentre RCT led by Royal Victoria Children’s Melbourne Australia, have sent a BHF application for the UK arm on an international study looking at the effects of Nitric Oxide during CPB operations in neonates undergoing Arterial Switch Operation.

Moreover, continuing some previous work with the University of Nottingham (Institute of Child Health), we have co-applied for a BHF grant to fund a larger a project looking at epicardial brown fat mitochondria function and CHD.

Mr. Lotto is a Co-applicant of an NIHR portfolio study, led by UCL, looking at developing a risk stratification tool for ACHD patients undergoing surgery.

In collaboration with University of Birmingham, Mr R. Guerrero is a co-applicant for a national multicentre RCT on different cardioplegic solutions in paediatric cardiac surgery.

Ongoing studies

1) A national multicentre randomised controlled trial of nitric oxide administration during cardiopulmonary bypass in infants undergoing Arterial Switch Operation for repair of transposition of the great arteries.

Researcher: Prof Attilio Lotto (Principal Investigator)

Host Organisation: Alder Hey and LJMU

Funding Body: British Heart Foundation

2) Mitochondrial development and function in epicardial adipose tissue

Researcher: Mr. Attilio Lotto (co-applicant), Mr. S. Ojha (Principal Investigator)

Host Organisation: University of Nottingham

Funding Body: British Heart Foundation

3) Congenital Heart Audit: Measuring Progress In Outcomes Nationally (CHAMPION)

Researchers: Mr. A. Lotto (co-applicant), S. Crowe (Lead Applicant)

Host Organisation: University College London

Funding body: NIHR

4) Del Nido versus St. Thomas’ blood cardioplegia: a pragmatic, multi-centre randomised controlled trial in children undergoing cardiac surgery in the UK & Ireland

Researcher: Mr. R. Guerrero (co-applicant), Mr. N. Drury (Lead Applicant)

Host Organisation: University of Birmingham

Funding Body: British Heart Foundation

Other ongoing research activities

Micro CT for detection of the conduction system and CHD microanatomy (Lead Dr C Jones / Mr Guerrero). Collaborative work with Dr Stephenson and Prof J Jarvis at Liverpool John Moores University in examining the microanatomy of specimens in the Alder Hey cardiac archive. Application for BHF funding in progress in conjunction with Birmingham Children’s to create a micro CT virtual archive of congenital heart malformations.
Cross CRG-NIHR approved project looking at National variations of PDA closures in preterm babies. A collaborative work between the Congenital Cardiac Service CRG and the Neonatology CRG. (Lead: Mr. A. Lotto, Dr. N. Subhedar, Dr A. Paweletz; Status: application and funds)
Participation in two Multicentre International retrospective studies led by European Congenital Heart Surgery Association (ECHSA) on: Long term follow up of patient with myocardial Ischaemia following Arterial Switch Operation (Lead: Dr. J. Lim; status: ongoing)
3D Printing of heart models in complex CHD (Lead: Mr. R. Guerrero; status: ongoing)

Retrospective studies at Alder Hey

Total anomalous pulmonary venous drainage: single centre experience on the evolution of surgical repair using normothermia (Lead: Mr. Guerrero; Status: terminated 2018)
Surgical excision of cardiac tumors: 20-year experience at a single institution (Lead: Mr. Lotto; Status: terminated 2018)

Undergraduate research projects in collaboration with the University of Liverpool

Three RS3 medical students in 2018-2019 cycle.

Recent Abstracts at National and International Meetings

- European Congenital Heart Surgery Association and World Society for Pediatric and Congenital Heart Surgery June 2019 – Sofia, Bulgaria

A Lotto, N Pupala, R Dhannapuneni, R Guerrero, M Horan: Successful management of Extra-Corporeal Life Support (ECLS) in a child with thrombotic prosthetic mitral valve

R. Lotto, I Jones, H Peens-Hugh, R Guerrero, R Dhannapuneni, A Lotto: A qualitative study exploring risk perception in congenital cardiac surgery: the perspective of UK surgeons

S Loggos, H Peens-Hough, S Xu, A Abousteit, A Lotto, R Dhanapunneni, l Guerrero: Large sinus of Valsava aneurysm from the left coronary sinus in a 2 year old. Case report

- Society of Cardiothoracic Surgery in Gb and Ir, March 2019 – London, UK

S Loggos, E Kapravelou*, H Peens-Hough, G Pellela, A Lotto, R Dhanapunneni, M Bowes, R Guerrero: Outcomes of Anomalous Left Coronary Artery From Pulmonary artery repair: a ten year review of our centre.

S. Logos, H Peens-Hough, K Chetcuti , G Pelella, A Lotto, R Guerrero,R Dhannapuneni: Left internal Jugular aneurysm in a 15 month old Boy. A case report

- British Congenital Cardiac Association, November 2018 - Liverpool – UK

P Fernandes, R Ramaraj , U Agarwal, Lim J.S.L: 3-years outcome of antenatal diagnosis of isolated right aortic arch at a single unit.

Chivers S, Patil M, Gardner D, Dhannapuneni R, Guerrero R, Lotto A, Lim JSL: Transposition of the Great Arteries – 17 years experience in a single institution

- European Association of CardioThoracic Surgery, October 2018 - Milan, Italy

G. Pelella, S. Loggos, , H. Peens-Hough, , J. Faulkner, Liverpool, P. Arnold, Liverpool, A. Lotto, R. Dhannapuneni, R. Guerrero: Total anomalous pulmonary venous drainage: single centre experience on the evolution of surgical repair using normothermia

- European Congenital Heart Surgery Association, June 2018 – Cascais, Portugal

Charlene Tennyson, Ram Dhannapuneni, Rafael Guerrero, Attilio Lotto. Current trends and usage of homograft’s in congenital paediatric cardiac surgery in the UK.

Spiros Loggos, Giuseppe Pelella, Hyla Peens-Hough, Charlene Tennyson, Attilio Lotto, Ram Dhannapuneni,Rafael Guerrero: 10 years of experience from a single center, of TAPVDs repair. The comparison of Normothermia to DHCA.

Attilio Lotto, Hyla Peens-Hough, Rafael Guerrero, Ram Dhannapuneni, Robyn Lotto: Risk perception of mothers and fathers of children undergoing heart surgery: A quantitative longitudinal analysis. 44

Hyla Peens-Hough, Charlene Tennyson, Spiros Loggos, Giuseppe Pellela, Ram Dhannapuneni, Attilio Lotto, Rafael Guerrero: Current Application of Patient Specific 3D Printing in Complex Congenital Heart Disease

Spiros Loggos, Giuseppe Pelella, Charlene Tennyson, Hyla Peens-Hough, Robert Johnson, Attilio Lotto, Ram Dhannapuneni, Rafael Guerrero: Tamponade on a premature newborn due to a large intrapericardial immature teratoma.

Spiros Loggos, Sian Chivers, Guiseppe Pellela, James Hayden, Shauq Arjamand, Attilio Lotto, Ram Dhannapuneni, Rafael Guerrero: Large inflammatory myofibroblastoma , causing SVC compression in a neonate. A case report

Spiros Loggos, Sian Chivers, Guiseppe Pellela, James Hayden, Shauq Arjamand, Attilio Lotto, Ram Dhannapuneni, Rafael Guerrero: Aortic intraluminal mass with dystrophic calcification and coagulative necrosis, resembling CoA. A case report

- Society of Cardiothoracic Surgery in Gb and Ir., March 2018 – Glasgow, UK

H Peens-Hough; R Lotto; S Seaton; I Jones; R Guerrero; R Dhannapuneni; A Lotto: Risk perception of mothers and fathers of children undergoing heart surgery: a quantitative longitudinal analysis

S Loggos; G Pelella; H Peens-Hough; C Tennyson; A Lotto; R Dhannapuneni; R Guerrero: Total anomalous pulmonary venous connection: 10 years results of the evolution of surgical repair without the use Deep Hypothermia Circulatory Arrest

H Peens-Hough; M Richards; S Loggos; G Pelella; A Lotto; R Dhannapuneni; R Guerrero: Current application of patient specific 3D printing in complex congenital heart disease

- European Congenital Heart Surgery Association, June 2017 - Leicester, UK

Giuseppe Pelella, Rafael Guerrero, Ramana Dhannapuneni, Attilio Lotto: SURGICAL EXCISION OF CARDIAC TUMORS: 20-YEAR EXPERIENCE AT A SINGLE INSTITUTION

- Society of Cardiothoracic Surgery in Gb and Ir., March 2017 – Belfast, UK

Rafael Guerrero: Advance surgical imaging: 3D printing and virtual reality in congenital cardiac surgery

- Society of Cardiothoracic Surgery in Gb and Ir., March 2016 - Birmingham - UK

N Sullo, S Mariani, M T JnTala, W Dott, M J Wozniak, D Chan,T Kumar, A A Lotto, G J Murphy: Analysis of platelets and platelets derived microvesicles as marker of acute kidney injury in a paediatric population following cardiac surgery

G Pelella; G Hardman; M DeSoysa; N Tiwari; N Raj; P Venugopal; R Guerrero; R Dhannapuneni: Early extubation following repair of Tetralogy of Fallot: Alder Hey experience

- The Society of Thoracic Surgeons, January 2016 – Arizona, US

G. Pelella, P. Venugopal, N. Raj, R. R. Guerrero: Early Extubation Within 6 Hours Should Be Standard Practice Following Primary Repair For Tetralogy of Fallot

Recent Papers Published in Peer Reviewed Journals

R. Lotto, I. Jones, R. Dhannapuneni, R. Guerrero and A Lotto: Congenital cardiac surgery and parental perception of risk; a quantitative analysis.

Journal of Congenital Cardiology, 2019 in press.

R. Lotto, H. Peens-Hough, I. Jones, R. Guerrero, R Dhannapuneni and A. Lotto: A qualitative study exploring risk perception in congenital cardiac surgery: the perspective of UK surgeons.

Cardiology in the Young, 2019 in press

Lim J, Higgins C, Ramaraj R, Agarwal U Early fetal cardiac screening: Detection of congenital heart disease and outcomes at a single tertiary fetal cardiac unit.

Ultrasound, 2019 in press

Bauer A, Khalil M, Schmidt D, Recla S, Bauer J, Esmaeili A, Penford G, Akintuerk H, Schranz D. Transcatheter left atrial decompression in patients with dilated cardiomyopathy: bridging to cardiac transplantation or recovery.

Cardiology in the Young, 2019 Mar;29(3):355-362

Gabrielle Norrish, Ella Field, Karen Mcleod, Maria Ilina, Graham Stuart, Vinay Bhole, Orhan Uzun, Elspeth Brown, Piers E. F. Daubeney, Amrit Lota, Katie Linter, Sujeev Mathur, Tara Bharucha, Khoon Li Kok, Satish Adwani, Caroline B. Jones, Zdenka Reinhardt, and Juan Pablo Kaski: Clinical presentation and survival of childhood hypertrophic cardiomyopathy: a retrospective study in United Kingdom

European Heart Journal (2019) 40, 986–993

Stephenson RS, Rowley-Nobel J, Jones CB, Guerrero R, Lowe T, Zhao J, Zhang H, Jarvis JC: Morphological Substrates for Atrial Arrhythmogenesis in a Heart With Atrioventricular Septal Defect.

Front Physiol. 2018 Aug 23;9:1071

Precylia Fernandes, Lito Mantagou, Ram Ramaraj, Umber Agarwal and Joyce Su Ling Lim: Antenatal diagnosis of total anomalous pulmonary venous connection in functional single ventricle hearts: Outcomes over 13-year period

Ultrasound 2018, Vol. 26(1) 42–48

Stephenson RS, Jones CB, Guerrero R, Zhao J, Anderson RH, Jarvis JC: High-Resolution Contrast-Enhanced Micro-Computed Tomography to Identify the Cardiac Conduction System in Congenitally Malformed Hearts: Valuable Insight From a Hospital Archive.

JACC Cardiovasc Imaging. 2018 Nov;11(11):1706-1712

Pelella G, Ramaraj R ,Dhannapuneni R, Guerrero R: The Use of Video-Assisted Cardioscopy for Neonatal Left Ventricular Tumor Resection.

World J Pediatr Congenit Heart Surg. 2018 Jul;9(4):463-466.

Boulemden A, Speggiorin S, Pelella G, Lotto AA: Use of an Extracellular Matrix Patch for Sternal Wound Dehiscence after Cardiac Surgery in a Neonate.

Tex Heart Inst J. 2018 Jun 1;45(3):176-178

Sullo N, Mariani S, JnTala M, Kumar T, Woźniak MJ, Smallwood D, Pais P, Westrope C, Lotto A, Murphy GJ: An Observational Cohort Feasibility Study to Identify Microvesicle and Micro-RNA Biomarkers of Acute Kidney Injury Following Pediatric Cardiac Surgery.

Pediatr Crit Care Med. 2018 Sep;19(9):816-830

Tume LN, Baines P, Guerrero R, Johnson R, Ritson P, Scott E, Arnold P, Walsh L. Patterns of Instability Associated With Endotracheal Suctioning in Infants With Single-Ventricle Physiology.

Am J Crit Care. 2017 Sep;26(5):388-394

H. Pinckerbeck, M Richards, R. Guerrero: Utilizing 3D printing models to assists in complex pediatric cardiac surgery: an interview.

Journal of 3D printing in Medicine (2017) 1(4):215-218

L. Tume, P. Baines, R.Guerrero, M. Hurley, R. Johnson, A. Kalantre, R. Ramaraj, P. Ritson, L. Walsh, P. Arnold. Pilot Study Comparing Closed Versus Open Tracheal Suctioning in Postoperative Neonates and Infants With Complex Congenital Heart Disease.

Pediatr Crit Care Med. 2017 Jul;18(7):647-654.

Hoskote A, Tume LN, Trieschmann U, Menzel C, Cogo P, Brown KL, Broadhead MW: A Cross-Sectional Survey of Near-Infrared Spectroscopy Use in Pediatric Cardiac ICUs in the United Kingdom, Ireland, Italy, and Germany

Pediatr Crit Care Med. 2016 Jan;17(1):36-44

Ojha S, Fainberg HP, Wilson V, Pelella G, Castellanos M, May ST, Lotto AA, Sacks H, Symonds ME, Budge H: Gene pathway development in human epicardial adipose tissue during early life.

JCI Insight. 2016 Aug 18;1(13):e87460

Tume LN, Arnold P: Near-infrared spectroscopy after high-risk congenital heart surgery in the paediatric intensive care unit

Cardiol Young. 2015 Mar;25(3):459-67

Hawcutt DB, Ghani AA, Sutton L, Jorgensen A, Zhang E, Murray M, Michael H, Peart I, Smyth RL, Pirmohamed M. Pharmacogenetics of warfarin in a paediatric population: time in therapeutic range, initial and stable dosing and adverse effects.

Pharmacogenomics J. 2014 Dec;14(6):542-8

Book Chapters

- S. Logos, A. A. Lotto. Extracorporeal life support. In “Key Topics in Congenital Cardiac Surgery”. Editors: N. Viola, N. Morjani, C. Calderone. TFM Publishing Limited. 2019

- S. Chivers, A. A. Lotto. Isolated VSD. In “Cardiac Surgery: a complete guide”.

Editor: R. Balachandran, Springer Nature. 2019

- Simpson J.M., Jones C.B. (2014) Structural Heart Disease in the Fetus. In: Da Cruz E., Ivy D., Jaggers J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London – update in press

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