Gianni Angelini, BHF Professor of Cardiac Surgery at the Bristol Medical School: Translational Health Sciences (THS), and his team at the Bristol Heart Institute pioneered a new technique to perform coronary artery bypass surgery on the beating heart, off-pump in the late 1990s, significantly reducing postoperative complications. Conventional coronary artery bypass surgery is usually performed after attaching the patient to a machine that takes over the work of the heart and lungs and after stopping the heart.
Professor Angelini said: “We know that using the heart-lung machine and stopping the heart is unnatural and produces damage to the body. We can minimise this damage with the new technique, but it took time to develop it. The main breakthrough was when we devised an instrument Stabiliser which constrained the small part of the heart and coronary on which we performed the suturing. Otherwise, it would be nearly impossible to stitch a moving target."
The idea for the stabiliser came to Professor Angelini while visiting his family in Italy.
He said: “My aunt is a seamstress, and she was altering a pair of trousers for me. As she lowered the foot of the sewing machine onto the material to keep it still while she sewed, I thought, that’s what I need.”
Professor Angelini designed the stabiliser device and devoted two years to its development. It was made of stainless steel and cost about £800, but it could be reused hundreds of times. Although disposable stabilisers are now commercially available and sold by many medical manufacturers, prototypes like Professor Angelini’s stabiliser helped pave the way for today's sophisticated designs.
Professor Angelini said “When I started my training in the early 80s, the mortality for coronary artery bypass surgery was around 15-20%; now it is down to 1-2%.”
With funding from the British Heart Foundation from 1997 to 2005, Professor Angelini’s team conducted a comparison of the beating heart off-pump against the standard technique. Patients who had off-pump surgery appeared to suffer less damage to their heart muscle, experienced less bleeding and need for transfusion, and had fewer episodes of heart rhythm disturbance immediately after surgery. The research suggested they may also be less likely to develop certain serious complications, such as a stroke. Their stay in the hospital while recovering was also usually shorter.
Beating heart surgery is more difficult to perform than conventional technique, and surgeons need specialist training. However, the success of the trials in Bristol and larger studies that have been carried out since has meant that more surgeons are learning how to perform beating heart surgery.
Professor Angelini said: “I must always stress everybody's contribution. I joined the Trust at a very challenging time, and many people have put a lot of effort into changing how we manage patients. For this kind of surgery, you must rely on and have the support of the team, particularly the anaesthetists and theatre nurses. I also fondly remember the help and encouragement from my colleague, now retired Alan Bryan [former Associate Medical Director of University Hospitals Bristol].
In recognition of Professor Angelini’s innovative work, which also acknowledged his contribution to teaching and training cardiac surgeons worldwide, the International Society for Coronary Artery Surgery bestowed upon him their Lifetime Achievement Award for 2024, describing him as “a leader who has contributed enormously to the advancement of the science and technique of the surgical treatment of coronary artery disease.”
Professor Evelyn Welch, Vice-Chancellor and President of the University of Bristol, said: “On behalf of the University, I extend my warmest congratulations to Professor Gianni Angelini on receiving the Lifetime Achievement Award from the International Society for Coronary Artery Surgery.
“This honour is testament to Professor Angelini’s groundbreaking contributions to cardiac surgery. His dedication to innovation, patient care, and the training of future generations of surgeons has transformed patient care and improved countless lives worldwide. We proudly celebrate this well-deserved recognition of his extraordinary career and lasting impact on cardiovascular medicine."
Dr Rebecca Maxwell, Chief Medical Officer for University Hospitals Bristol and Weston NHS Foundation Trust, added: “Congratulations to Gianni on this wonderful accolade and recognition of his significant contribution to cardiac surgery. These awards, and achievements, are something to be immensely proud of and I want to thank Gianni for everything he has contributed, not only locally but nationally and internationally, over his incredible career.”
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said: “Professor Angelini is a true pioneer in cardiac surgery, and we are proud to have supported his work for many years. In helping advance heart surgery, Professor Angelini has advanced our understanding of what is possible in cardiac medicine.
“BHF-funded research has shown that beating heart surgery can have real benefits for patients both in the short and long term. Now, with technological advances and more surgeons specifically trained to perform the technique, there is potential for it to reduce complications for more people than ever before. This is all thanks to the strong foundations laid by innovative surgeons like Professor Angelini. The British Heart Foundation would like to congratulate him on his lifetime achievement award.”
The Lifetime Achievement Award is a further honour for Professor Angelini, as earlier last year he was also named as one of the Seven Wise Cardiac Surgeons of the Golden Age of the 90s, a reference to the Ancient Greek tradition of naming the seven wisest men.
Professor Angelini was honoured alongside some of his heroes at a ceremony in the old Greek Parliament.
The seven surgeons, who are credited with some of the most pioneering work in their field, are considered to have helped shape modern cardiac surgery.
Professor Angelini said: “It was such an honour, because I was standing with surgeons I had admired early on in my career. To be considered a peer of theirs was a wonderful feeling.”
Since beginning his training in heart surgery in the UK in the late 1970s, Professor Angelini has seen many changes to the service and countless patients.
One of his most well-known patients, explorer Sir Ranulph Fiennes, has stayed in touch since his life-saving surgery in 2003 following a heart attack.
Sir Ranulph was brought to the hospital from Bristol Airport after having a heart attack on board a plane bound for Edinburgh. Professor Angelini was the surgeon called upon to perform the emergency double bypass.
Just three months later, Sir Ranulph returned to see Professor Angelini to ask if he was well enough to complete a record-breaking challenge: seven marathons in seven days across seven continents.
Professor Angelini said, “I knew something about running. I was a champion runner in Italy in my late teens, so I understood the feat he was undertaking. But I had never been asked questions like this before by a patient, so I could only wish him good luck.
“A few years later, he sought my advice, wanting to climb Mount Everest. Finally, on his third attempt in 2009, he reached the top of Everest, becoming the oldest British person to achieve this. His achievements since his double bypass are a testament to the success of his operation; it has allowed him to return to health and reach these incredible goals.”
Having achieved several “incredible goals”, Professor Angelini is continuing his clinical and research work with UHBW and the University of Bristol.
Professor Angelini added: “These two awards are a recognition of the work done over the last 30 years by the team at the Bristol Heart Institute.”