Royal Brompton Hospital, London.

Royal Brompton Hospital locally known as The Brompton, can trace its origins back to the 1840s. As a tuberculosis and respiratory hospital, it pioneered treatment in the field but it was only in the late 1940s that cardiac care was explored. Today, from its West London site in Chelsea, it is still renowned for its respiratory work but throughout the second part of the 20th century, and into the 21st, evolved into a leading cardiac centre. Partnered with Harefield Hospital near Uxbridge, sharing the same management, and working alongside the National Heart and Lung Institute (NHLI) at Imperial College London as the university arm of the National Health Service (NHS) trust, it is a centre which prides itself on leading innovative research whilst providing first class care to patients. Particular areas of specialty in cardiology and research expertise include heart failure, cardiovascular genetics and inherited cardiac conditions, congenital heart disease, arrhythmias, device implantation, and remote monitoring, as well as percutaneous valve replacements, and imaging advances (particularly magnetic resonance imaging), with the umbilical link to Harefield as one of Europe’s main transplant centres. Martin Cowie, Professor of Cardiology at the NHLI and Consultant Cardiologist at Royal Brompton & Harefield NHS Foundation Trust, explained: ‘We view ourselves as the first place to come to in the UK, and probably in Europe, for many innovations across the board of cardiac disease. If somebody is developing a new drug, diagnostic technique or procedure, we want to be the first into that space when it moves from animal work into first-in-man trials and early randomized trials’. Consequently, for example, the hospital was the first to work in Europe with the CardioMems system with a microchip placed in the pulmonary artery for patients with heart failure to facilitate remote monitoring. Royal Brompton took on the first 12 cases and then led a pan-UK study in 15 hospitals. Another example, in an overlap with respiratory specialists at Royal Brompton, was in developing new ventilation and mask technologies within SERVE-HF, the world’s largest randomized trial of treatment of sleep apnoea and heart failure. Gene therapy work led by Dr Alexander Lyon, saw the Brompton deliver the UK element of the global CUPID 2 trial focussing on a virus to transfect the myocardium with genes that in heart failure are switched off. ‘We used the virus to put the genes back into the heart’, added Professor Cowie, who stressed that trials are not always about delivering positive results but also about changing guidelines and clinical practice. ‘Electrophysiology has also rapidly expanded and we are very interested in exploring new techniques, equipment, and procedures, not just with cardiologists but with cardiac surgeons with hybrid procedures for some patients with complex issues. This organisation is not siloed, there is a lot of cross talk within the organisation.’ Royal Brompton has a cardiac sarcoid clinic as a sub-speciality with a large cohort of patients jointly working between respiratory consultants and cardiologists. In addition to heart failure (led by Professor Cowie), congenital heart disease is a stand-out area of research and care and the world’s first adult congenital heart disease unit in the world, set up by Professor Jane Somerville, now sees 10 000 patients a year. Other areas of strength are in cardiac magnetic resonance imaging—developing, imaging, training, and working with inherited cardiomyopathies— and with a new sleep centre focussing on sleep apnoea and cardiac problems as well as cutting edge aortic and mitral valvular procedures. The hospital also hosts world-class research facilities including an advanced cath lab—with a showpiece magnetically guided catheter— and consulting room facilities that underpin much of the research in areas ranging from drug studies to complex interventions. The Genetics and Genomics Group is integral to cardiovascular research at the trust, with research focused on identifying new genes and mechanisms for inherited cardiac conditions. Leading experts at Royal Brompton include Dr Ali Vazir for acute heart failure; Drs Sabine Ernst and Tom Wong for electrophysiology; Professor Stuart Cook in cardiovascular genetics, notably in inherited dilated cardiomyopathies; and Professor Dudley Pennell in cardiovascular imaging. Innovation in imaging includes using three-dimensional imaging and printing to create replicas of patients’ hearts—research led by Dr Sonya Babu-Narayan—to help plan and carry out surgery with CMR. They follow a long line of renowned cardiologists and cardiac surgeons associated with Royal Brompton and Harefield including Professor Sir Magdi Yacoub for transplantation; coronary stent pioneer Dr Ulrich Sigwart, Professor Carlo Di Mario for various complex procedures; Neil Moat in the aortic arena; Professor Jane Somerville for adult congenital heart disease; and Professor Philip Poole-Wilson for heart failure. CardioPulse 2527