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Heart surgeon leading clinical research to prevent catastrophic aortic dissections

Cardiothoracic surgeon and researcher Mr Nishith Patel has been awarded the 2023 Foundation100 Fellowship from the Heart Foundation. During the tenure of the fellowship, Nishith plans to better understand a life-threatening condition known as aortic dissection, which is believed to be more common in New Zealand compared to other countries.

Aortic dissection is a medical emergency caused by a tear in the lining of the aorta that carries blood from the heart to the rest of the body.

The statistics are sobering. In international studies, 50% of patients who experience aortic dissection die before reaching hospital, and of those who make it to hospital 50% die within 30 days.

The two-year Foundation100 Fellowship awarded to Nishith, a Waikato Hospital surgeon, could lead to new techniques to manage risk and predict dissection in people with thoracic aortic disease, the precursor to aortic dissection.

Aortic dissection is a rare and under-researched condition globally, and data is particularly limited in New Zealand where the incidence is thought to be higher than other countries – an evidence gap that Nishith hopes to fill.

"Aortic dissection can be such a devastating event with a huge impact on people, their families and careers, and requires intensive healthcare resources," says Nishith.

Researching a three-part puzzle

During his fellowship Nishith plans to undertake three separate projects.

Identifying the incidence of thoracic aortic disease and variations in treatment across New Zealand will be studied and the results will help inform strategies to standardise care and monitoring.

Another study will use novel imaging techniques and artificial intelligence (AI) to help predict future aortic dissections, thereby permitting early intervention and preventing premature death or disability.

Applying AI to CT scans will train software to detect features that suggest which people are most at risk of aortic dissection and may need preventative surgery. Those features won't be visible to the human eye. But if the AI software looks at a CT scan 10,000 times and correlates it with patients who had an aortic dissection, it may detect very fine features which indicate the people at highest risk.

The association between high blood pressure and aortic dissection is well recognised. However, many of these patients are young – not a common demographic for high blood pressure.

Nishith's final study will research potential causes for this unusual ‘neurogenic' hypertension in younger people who have experienced aortic dissection. This tests the hypothesis that neurogenic high blood pressure in this group is caused by an overdrive of the sympathetic nervous system which is responsible for our fight or flight response.

"I'm immensely grateful to the Heart Foundation and the Foundation100 alumni for funding this fellowship," says Nishith. "I hope we can use the insights and advanced technology to benefit patients and prevent catastrophic events in the future."

Collaborations achieve more

These research projects involve a collaboration of leading experts in bioengineering, physiology, population health and cardiovascular clinicians. They'll be working together to reduce premature deaths and disability in New Zealanders.

"The strength of collaboration is you can achieve more," says Nishith. That's why he's bringing together experts in their fields to perform high-quality research and produce valuable data and conclusions.

With UK experience in large international multi-centre trials, he knows the value of building connections. He's able to bring these skills to this research to benefit New Zealanders with the support of the Foundation100 Fellowship.

Why does a cardiac surgeon want to do research?

Improving outcomes for people has always been of interest to Nishith. Being a cardiothoracic surgeon and performing cardiac operations provides immediate benefits to patients and gives him satisfaction.

"But being involved in clinical research allows me to hopefully help a much wider group of people at once," explains Nishith.

According to Heart Foundation Medical Director, Dr Gerry Devlin, "Nishith is an impressive recipient of the Foundation100 Fellowship and an academic leader of the future in heart health. His proposed studies will lead to a better understanding of the burden of aortic dissection in New Zealand and potentially lead to earlier diagnosis and management of at-risk individuals."