Major trial questions the need for invasive monitoring in heart surgery

Australians undergoing open-heart surgery could soon benefit from safer, simpler care and get home earlier thanks to the results of a world-first clinical trial led by Monash University's Victorian Heart Institute.

The PUMA trial has been co-designed with patients and their families to determine if invasive devices used to monitor cardiac function during and after surgery help or harm the more than 20,000 Australians who go under the knife for open heart surgery each year.

The recipient of a $3.7 million Medical Research Future Fund grant announced today, the trial will compare the commonly used pulmonary artery catheter (PAC) and the less invasive central venous catheter (CVC), a simpler alternative that researchers hope will reduce unnecessary treatments, shorten ICU stays, reduce healthcare costs, and significantly cut the environmental footprint of intensive care by 2030.

Lead investigator Dr Luke Perry, Head of Anesthetic Research at the Victorian Heart Institute, said PUMA will modernize the field of cardiac surgery, which is decades behind on evidence for PACs.

These invasive devices have been broadly de-adopted in other high-risk patient groups after large clinical trials due to sepsis, acute respiratory distress syndrome, and use in non-cardiac surgery failing to show a benefit to patients.

PUMA will resolve decades of international controversy around the role of pulmonary artery catheters in contemporary practice, paving the way for high-value care that could reduce major complications and get patients home to their families sooner."

Dr. Luke Perry, Head of Anesthetic Research, Victorian Heart Institute

At the heart of the study is strong patient leadership, including lived-experience investigator Paige Druce, a two-time cardiac surgery survivor whose insights have shaped the study's priorities and approach from the earliest pilot phase.

"It is important to feel confident that every procedure is truly necessary," she said.

"Co-designing clinical trials with people who have lived experience is important because it helps to make sure the research focuses on things that matter to the people it's meant to help.

"It also ensures that the research is done in a way that feels fair and respectful to those taking part."

PUMA co-investigator Associate Professor Lachlan Miles, Head of Research in the Department of Anaesthesia at Austin Health, said the study will gather important information to ensure the best patient outcomes.

"Pulmonary artery catheters provide important information about heart function," Associate Professor Miles said.

"Unfortunately, they are not without risk, and could even trigger unnecessary treatments, increase complications, and prolong hospital admissions." 

The 2,000 patient trial, endorsed by the Australia and New Zealand College of Anaesthetists Clinical Trials Network, will begin recruitment in Australia and internationally in 2026.