"... science is an peculiar phenomenon in human experience: not an ideology, yet defending its interests; not politics, yet making fateful decisions; not jurisprudence, yet following strict standards; not ethics, yet requiring morality; not a religion, yet believing in its methods; not an art, yet revealing the harmony of the world; not technics, yet its truths being converted to technology; not magic, yet doing miracles; discovering but not regulating laws; perceiving parts of the reality, yet comprehending the particular not being its objective; studying but not understanding man ..."

THE IDEA

The idea of a research laboratory at Department of Cardiac Surgery, Dubrava University Hospital, was launched at the beginning of 2003, in line with the worldwide trend of establishing so-called "cardiothoracic research laboratory" at many renowned cardiac surgery departments (Cleveland Clinic Foundation, Boston University Medical Campus, Medizinische Hochschule Hannover).

The question most commonly posed on mentioning the idea of a research laboratory at cardiac surgery is: What do cardiac surgeons have to do with biochemical research laboratory? The question has been most thoroughly answered by Professor Jarle Vaage, cardiac surgeon from the Ulleval University Hospital, University of Oslo, Norway.

"The question is why cardiac surgeons cannot leave basic science, physiology, cellular and molecular biology, and technical-computer science to those professionally engaged in the fields? As in the time to come, ever more steps in the management of cardiac surgery patients will take place beyond operating theater, such an attitude may hamper the dynamics and development of cardiac surgery.
Our strength as clinicians lies in our ability to identify the fields that require improvement, to direct the knowledge to solving the issues relevant for our clinical practice, thus promoting the evolution of our specialty into a modern, scientifically based clinical practice.
The cardiac surgeon's comprehending and understanding the methods of molecular and cellular biology is advantageous for qualifying him for full collaboration with scientists. This means that we as surgeons neither can nor need to be in the forefront to perform all the work necessary in molecular and cellular biology but can lead in initiating collaboration with different laboratory professions".

J Vaage. The cardiothoracic surgeon and the basic scientist.
European Journal of Cardio-thoracic Surgery 26 (2004) 237-238

Professor Vaage organized a postgraduate course on the topic, as part of the 3rd EACTS/ESTS (European Association of Cardio-Thoracic Surgery/European Society of Thoracic Surgeons) Joint Annual Meeting held in Leipzig, Germany, in September 2004, offering the participants an overview of molecular biology methods in vivo (animal models) and in vitro (cell cultures), and of methods of computer simulations useful in a cardiovascular research laboratory. Although the Course was considered as experimental, the high interest in and need of this type of training stimulated Professor Vaage to organize another course on the topic of The Vascular Graft and Basic Science (Postgraduate Course) to be held at the 4th EACTS/ESTS Joint Annual Meeting in Barcelona, Spain, to deal with the use of cellular and molecular biology techniques in vascular graft quality assessment.

STRUCTURE

The reconstruction of the experimental medicine premises, located in the Hospital basement, began in April 2003. The area layout is shown in Fig. 1.

Figure 1. Layout of the Surgical Laboratory of Biomedical Research (the area belonging to the Surgical Laboratory of Biomedical Research is marked with green lines).

In June 2003, we were entered a competition for scientific equipment of our Ministry of science and technology. HERAsafe Microbiological Safety cabinet, two personal computers and laboratory furniture were bought from this funding.

Department of Cardiac Surgery implemented ISO 9001:2000 quality system in march 2005. This laboratory is part of Department's organization chart and is called Surgical Laboratory for Biomedical Research (SLBR).

There are two types of research that will be performed in SLBR:

1. scientific research (defined as investigating the use of new molecular marker(s) or therapeutic approach to cardiac patients and performing additional diagnostic tests)
2. clinical research (defined as collecting and following different clinical data regarding to patient condition, beside routine data collection)
   

The Surgical Laboratory of Biomedical Research (SLBR) consists of the following structural units:

• Cell Culture Laboratory
• Preparatory Laboratory
• Library
• Store Room
• Researchers Rooms
  

At present, SLBR has the following equipment:

• microbiology unit
• microtiter plate reader with plate washer
• centrifuge
• fluorescent microscope with digital camera
• sterilizer
• refrigerator
• freezer -20 °C
• light microscope
  
  

Necessary equipment for cell culture manipulation:

• CO2 incubator
• freezer -70 °C
• autoclave
• ice machine
  

The first (in)formal SLBR presentation was held on May 27, 2005, when the first WET LAB in Croatia as a part of concept launch for novel mitral valve repair device took place. The WET LAB was attended by 25 cardiac surgeons from United States, Germany, Belgium, France, Slovenia, Poland, Czech Republic and The Netherlands. All participants performed implantation of a MF device into the pig heart themselves. Photos taken on that occasion are shown in figures.

RESEARCH

Research in the frame of the project entitled Inflammatory Markers After Cardiac Surgery, launched by the Ministry of Science, Education and Sports of the Republic of Croatia (project code 0198005) has just been under way. The study includes determination of biochemical inflammation markers (interleukins 8 and 10, E-selectin and neopterin) in patients undergoing cardiac surgery.

Another scientific project to be conducted at the institution is entitled "Effect of Lacidipine on Vasospasm Following Aortocoronary Bypass", with Professor Ž. Sutlić as Principal Investigator. The project has been designed in collaboration with GlaxoSmithKline Croatia (the manufacturer of the drug lacidipine) and has currently been in the phase of registration.

Brief description: Perioperative myocardial ischemia due to vasospasm is one of the potential complications of arterial revascularization and use of extracorporeal circulation, with excessive accumulation of intracellular calcium as the main mediator of myocardial ischemia/reperfusion. Therefore, prevention of intracellular calcium accumulation is a possible therapeutic approach in the treatment and/or prevention of myocardial ischemia/reperfusion. Lacidipin is a third-generation calcium antagonist, primarily used in the management of hypertension. Lacidipin is specific for its highly selective entry in the arterial endothelial cells. This property of lacidipin is of interest for the present project. The project hypothesis is that the administration of lacidipin immediately before cardiac surgery and during the early postoperative period will reduce the incidence of vasospasm.

FUTURE PROSPECTS

The main objective of SLBR is to grow into the leading biomedical research laboratory for applied molecular biology in surgery in the Republic of Croatia and neighboring region.

The mission of SLBR includes the following:

1. teaching the surgeons-to-be in applied molecular biology and research methodology to make them fully competent and independent physicians-scientists; and
2. solving clinical problems encountered in cardiac surgery while comprehending basic physiology and pathology of the issues.

As one of the goals of the Department of Cardiac Surgery in 2005 refers to implementation of the ISO9001:2000 quality system also in the SLBR, the procedure of the certificate acquisition has just been under way. The SLBR will also apply for the ISO17025:2001 (System of Laboratory Management) and ISO13485:1996 (Quality Management System - Medical Equipment) standard certificates.