University for Cardiac Surgery

302018, 302026, 302048, 302083, 304007

aortic surgery, basic science on myocardial fibrosis, basic science on myocardial regeneration, biomarker in cardiac surgery, ex-vivo donor heart perfusion, genetics in aortic disease, minimally invasive cardiac surgery, translational research on myocardial regeneration with epicardial shockwave therapy, and valve surgery

Our research includes clinical projects (minimally invasive valve and aortic surgery, biomarkers) as well as basic science projects in our surgical research lab. The latter focuses on translational research on myocardial regeneration, myocardial fibrosis and aortic valve calcification.

The University Clinic of Cardiac Surgery is the second largest tertiary centre for open heart surgery in Austria. As well as standard open heart surgery, we offer heart and lung transplantation and ventricular assist device therapy. Our unit comprises 20 surgeons, approximately 50% of whom are affiliated with the Medical University).

Clinical and research activities are closely interdependent. Staff members are directly involved in clinical services and research programmes, focusing on translational research. Clinical research is dependent on case load. Our department is facing the same global shortage of nursing staff that is affecting operative slots and numbers. The clinical and research outcomes have remained stable over the years. The department is undoubtedly one of the most cited university centres in Europe.

Ass. Prof. PD Dr. Julia Dumfarth, PhD – International clinical collaboration is implemented as an affiliated member of the European Reference Network for hereditary thoracic aortic disease (VASCERN). Scientific collaborations within the D-A-CH region (Charité Berlin, University Freiburg, University Bern) result in relevant scientific output. The Medical University Innsbruck is represented scientifically and internationally through two key channels: in the guidelines committee (EACTS/STS Guidelines for aortic disease) and the European Association of Cardiac and Thoracic Surgery (EACTS).

Clinical research

The Department has produced a range of clinical publications throughout the last years. These focus on enhancing surgical techniques, improving patient outcomes and integrating innovative technologies. Clinical research topics include outcome research and technology development on cutting-edge endoscopic valve surgery. In addition, a significant breakthrough has been achieved in the treatment on left ventricular function using shock wave therapy as an add-on to classic surgical revascularisation techniques in patients with ischemic cardiomyopathy. Clinical research has demonstrated that current troponin thresholds may underestimate postoperative myocardial injury. This indicates a need for revised, patient-specific cut-off values. Studies also revealed that biomarker release correlates with coronary artery disease complexity but is not significantly influenced by myocardial mass. Combining cardiac biomarkers like hs-cTnT and NT-proBNP improves prognostic accuracy in valve disease, while multi-marker strategies enhance early detection of complications after surgery.

Subsection thoracic aortic disease (Ass. Prof PD Dr. Julia Dumfarth, PhD) -The clinical programme provides surgical repair, an outpatient clinic for pre- and postoperative management and a facility to offer genetic testing and counselling. Our special aim is the characterisation of thoracic aortic disease and to plan interdisciplinary treatment.

Basic research 

Myocardial regeneration – Shock wave therapy (SWT) is a proven treatment for ischemic heart failure. It promotes angiogenesis, reduces myocardial scarring and improves left ventricular function. Mechanistically, SWT reliably induces the release of angiogenic extracellular vesicles and modulates inflammatory pathways through Toll-like receptor 3 (TLR3) activation. We developed a miniaturised shock wave applicator to facilitate translation into large animal models and clinical application.

Spinal cord regeneration – Application of SWT to spinal cord ischemia demonstrated clear benefits: enhanced neuronal sprouting, reduced neuronal degeneration, and improved motor function in preclinical models. A first-in-human feasibility study treating patients with spinal cord ischemia after aortic dissection confirmed safety and provided a foundation for further clinical trials.

We have identified a novel pathway involving the extracellular matrix proteoglycan biglycan, TLR3 activation and interferon signalling was identified as a driver of aortic valve stenosis. Genetic and pharmacologic inhibition of this axis in preclinical models prevented calcific remodelling. Therapeutic candidates, including oligonucleotides, antibodies, and mRNA-based vaccines, are under development. A corresponding patent has been filed, and translational efforts are ongoing in collaboration with industry partners.

Anti-fibrotic strategies for myocardial fibrosis – We identified a previously uncharacterised gene, KIAA0408 as a potent regulator of myocardial fibrosis, particularly in the right ventricle. Functional studies revealed its anti-fibrotic mechanism via the JNK/ELK-1/SRF axis. Gene therapy approaches, including AAV- and mRNA-based strategies, are currently being evaluated for the treatment of heart failure with preserved ejection fraction (HFpEF).

In our study, we have thoroughly investigated the clinical significance of cardiac biomarkers in relation to outcomes following cardiac surgery. We analysed both pre- and postoperative biomarker levels, focusing particularly on NT-proBNP in patients with heart failure. Our findings confirm that elevated preoperative NT-proBNP levels are strongly associated with increased perioperative risk and adverse outcomes. We also observed dynamic postoperative changes in biomarkers such as troponins, which provided valuable insights into myocardial stress and injury. Our analysis revealed significant gender differences in biomarker profiles and their prognostic implications. This highlights the vital importance of sex-specific considerations in perioperative risk assessment and management.

Cardiac shockwave therapy in addition to coronary bypass surgery improves myocardial function in ischaemic heart failure: the CAST-HF trial
Johannes Holfeld, Felix Nägele, Leo Pölzl, Clemens Engler, Michael Graber, Jakob Hirsch, Sophia Schmidt, Agnes Mayr, Felix Troger, Mathias Pamminger, Markus Theurl, Michael Schreinlechner, Nikolay Sappler, Elfriede Ruttmann-Ulmer, Wolfgang Schaden, John P Cooke, Hanno Ulmer, Axel Bauer, Can Gollmann-Tepeköylü, Michael Grimm
European Heart Journal, Volume 45, Issue 29, 1 August 2024, Pages 2634-2643, https://doi.org/10.1093/eurheartj/ehae341

Association of High-Sensitivity Cardiac Troponin T With 30-Day and 5-Year Mortality After Cardiac Surgery.
Pölzl L, Engler C, Sterzinger P, Lohmann R, Nägele F, Hirsch J, Graber M, Eder J, Reinstadler S, Sappler N, Kilo J, Tancevski I, Bachmann S, Abfalterer H, Ruttmann-Ulmer E, Ulmer E, Griesmacher A, Heuts S, Thielmann M, Bauer A, Grimm M, Bonaros N, Holfeld J, Gollmann-Tepeköylü C.
J Am Coll Cardiol. 2023 Sep 26;82(13):1301-1312.

Modulation of cell fate by shock wave therapy in ischaemic heart disease.
Graber M, Gollmann-Tepeköylü C, Schweiger V, Hirsch J, Pölzl L, Nägele F, Lener D, Hackl H, Sopper S, Kirchmair E, Mair S, Voelkl J, Plattner C, Eichin F, Trajanoski Z, Krogsdam A, Eder J, Fiegl M, Hau D, Tancevski I, Grimm M, Cooke JP, Holfeld J.
Eur Heart J Open. 2025 Apr 8;5(2):oeaf011.

Toll-Like Receptor 3 Mediates Aortic Stenosis Through a Conserved Mechanism of Calcification.
Gollmann-Tepeköylü C, Graber M, Hirsch J, Mair S, Naschberger A, Pölzl L, Nägele F, Kirchmair E, Degenhart G, Demetz E, Hilbe R, Chen HY, Engert JC, Böhm A, Franz N, Lobenwein D, Lener D, Fuchs C, Weihs A, Töchterle S, Vogel GF, Schweiger V, Eder J, Pietschmann P, Seifert M, Kronenberg F, Coassin S, Blumer M, Hackl H, Meyer D, Feuchtner G, Kirchmair R, Troppmair J, Krane M, Weiss G, Tsimikas S, Thanassoulis G, Grimm M, Rupp B, Huber LA, Zhang SY, Casanova JL, Tancevski I, Holfeld J.
Circulation. 2023 May 16; 147(20):1518-1533. doi: 10.1161/CIRCULATIONAHA.122.063481. Epub 2023 Apr 4.

Thoracic aortic aneurysm – Nature Disease Primer
Berger T, Dumfarth J, Kreibich M
Nature Review Disease Primers – accepted

2024 Tiroler Wissenschaftsfonds

2024 MUI START

2023 Dutch Heart Foundation € 263.000,-
PRIMARY – postoperative biomarker measurements after coronary bypass surgery

2023 Max Kade Scholarship Transdifferentiation in non-ischemic heart failure €50.000.-

2023 DOC Scholarship € 93.518,-
Regulation of innate immune system orchestrates inflammation in
calcific aortic valve disease

2023 Austrian Heart Fund € 10.850,-
Developing a treatment to tackle Calcific Aortic Valve Disease (202302)

2023 Tiroler Nachwuchsforscher*innenförderung: A differential immune response in the right ventricle upon ischemia enables regeneration. €39.453,-

ESC / EACTS Guidelines Committees

Prof. John P. Cooke
Houston Methodist Hospital, Dept. of Cardiovascular Sciences
Weill Cornell Medical School, TX, US
Joint research on myocardial regeneration

Prof. George Thanassoulis
McGill University, Montreal, Canada, Dept. of Preventive and Genomic Cardiology
Collaboration on Genome-wide association studies (GWAS) on calcific aortic valve disease (incl. UK biobank)

Prof. Jean-Laurent Casanova
The Rockefeller University, Howard Hughes Medical Institute, St. Giles Laboratory of Human Genetics of Infectious Diseases, NY, US
Joint research on innate immunity in cardiovascular disease

Prof. Josef Penninger
Austrian Academy of Sciences, Institute of Molecular Biotechnology
(IMBA), Vienna, Austria
Joint research on proteoglycan glycosylation patterns in aortic valve disease

Prof. Olaf Bergmann
Karolinska Institute, Stockholm; Sweden

Tom Lumbers
UCL London, Genetics of Heart Failure, UK

John Elefteriades
Yale New Haven Aortic Institute, Yale School of Medicine, New Haven CT USA¸University of Pennsylvania, Philadelphia, PA USA

Aortic disease cooperation
Deutsches Herzzentrum der Charité, Berlin, Deutschland
Inselspital Bern, Bern, Schweiz,
Universitäts-Herzzentrum Freiburg Bad Krozingen, Freiburg, Deutschland
European Reference Network for hereditary thoracic aortic disease (VASCERN)