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Holland LC, Harky A, Haqzad Y, Roman M, Hope E, Jahangeer S, Oo A, Lopez-Marco A. Effect of COVID-19 on outpatient services in patients with aortovascular disease: a UK multicentre study. Ann R Coll Surg Engl 2023; 105:S42-S45. [PMID: 35638905 PMCID: PMC10390245 DOI: 10.1308/rcsann.2022.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION The SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services worldwide. Outpatient services have necessarily been restructured to accommodate COVID-19 patients and to maintain social distancing measures. The aim of our study was to investigate how the COVID-19 pandemic has affected outpatient healthcare provision for patients with aortovascular disease. METHODS In this prospective study, a standardised proforma was circulated to seven aortic centres in the UK. Data on outpatient encounters were collected from March to July 2020. Captured data included demographic details, disease pattern, type of encounter (face-to-face, video or telephone), clinic outcome and availability of imaging. RESULTS A total of 632 patients were included in the study, including 164 (25.9%) new referrals. In this cohort, clinic settings have shifted towards remote consultations, with 424 (67.1%) patients undergoing telephone appointments. Over a third of new patients (34.8%) had a delay in diagnostic tests, which might be attributable to the indirect effects of COVID-19. A total of 102 (16.1%) patients were added to a surgical waiting list following clinic. CONCLUSIONS To the best of our knowledge, this is the largest study of outpatient activity during the COVID-19 pandemic in patients with aortovascular disease. We demonstrate how the speciality has adapted to accommodate government-endorsed changes in healthcare provision, and question how COVID-19 may have affected access to diagnostics. Finally, we discuss how COVID-19 will affect patients added to surgical waiting lists.
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Affiliation(s)
| | - A Harky
- Liverpool Heart and Chest Hospital, UK
| | | | | | - E Hope
- Southampton General Hospital, UK
| | | | - A Oo
- St Bartholomew's Hospital, UK
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Bueser T, Clayton T, Dodd M, Beaumont E, Owens G, Murray S, Sepehripour A, Oo A, Sanders J. The impact of COVID-19 on recovery after heart surgery: preliminary findings from the CardiacCovid Study. Eur J Cardiovasc Nurs 2021. [PMCID: PMC8344890 DOI: 10.1093/eurjcn/zvab060.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background/Introduction The COVID-19 pandemic has had far-reaching effects on everyday life leading to stress and anxiety, which may be heightened in those undergoing cardiac surgery. Health impacts following a traumatic event may be apparent at one month but can also present after many months. Purpose The aim of the CardiacCovid study was to explore the effect of the pandemic on recovery from cardiac surgery. We report the preliminary results from a single centre study in the UK during the early phase of the COVID-19 pandemic. Methods Patients >18 years old undergoing any form of cardiac surgery between 23rd March 2020 (UK lockdown) to 4th July 2020 (lifting of most restrictions) were recruited to this prospective observational study. Those too unwell or unable to give consent/complete study questionnaires were excluded. Participants completed a Quality of Life (QoL) (EQ-5D), impact of event (IES-R), depression (CES-D) and health service use questionnaire at baseline, 1 week after hospital discharge, and 6 weeks after surgery. Questionnaires were completed electronically on the Amplitude platform or via post. Ethics approval (20/YH/0132) was obtained and the study was registered (Clinicaltrials.gov:NCT04366167). Results A total of 395 patients had surgery of which 298 (91.7%) were screened and 203 (68.1%) were enrolled to the study. Participants were mostly male (74.6%), with a mean age of 63 years, undergoing urgent/emergency (57.9%) CABG +/-valve (70.1%). Mean inpatient stay was 8.6 days and in-hospital mortality was 0.5%. No patients had Covid-19. The initial findings suggest a deterioration of QoL at 1 week post discharge with near restoration to baseline level at 6 weeks post-surgery. Mean scores for CES-D and IES-R remained within subclinical levels at all available time points. However, at 6 weeks, a proportion of patients reached levels for depression on the CES-D and had high IES-R scores indicating possible post-traumatic stress. Conclusion We believe that this is the largest/only study exploring the impact of the pandemic on cardiac surgery recovery, including QoL, spanning the immediate recovery phase but will continue until 1 year. The findings so far show that recovery from cardiac surgery during the Covid-19 pandemic is similar to that reported prior to the pandemic (Cromhout et al 2018) and reinforces the need for psychosocial assessments to identify patients who may require additional support during the immediate recovery phase.
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Affiliation(s)
- T Bueser
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - T Clayton
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom of Great Britain & Northern Ireland
| | - M Dodd
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom of Great Britain & Northern Ireland
| | - E Beaumont
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom of Great Britain & Northern Ireland
| | - G Owens
- Chair, Aortic Dissection Awareness UK & Ireland, London, United Kingdom of Great Britain & Northern Ireland
| | - S Murray
- National Institute for Cardiovascular Outcomes Research, Patient Engagement Lead; Society for Cardiothoracic Surgery, Lay Representative, London, United Kingdom of Great Britain & Northern Ireland
| | - A Sepehripour
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A Oo
- St Bartholomew"s Hospital, Barts Heart Centre; Queen Mary University, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sanders
- St Bartholomew"s Hospital, Barts Heart Centre; Queen Mary University, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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Salmasi M, Jarral O, Pirola S, Sasidharan S, Pepper J, Oo A, Moore Jr J, Xu X, Athanasiou T. In-vivo blood flow parameters can predict at-risk aortic aneurysms and dissection: a comprehensive biomechanics model. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Abnormal blood flow patterns can alter the material properties of the thoracic aorta via altered vascular biology and tissue biomechanics. In-vivo haemodynamic assessment of the aorta is yet to penetrate clinical practice due to our limited understanding of its effect on aortic wall properties. The decision for surgical treatment is based on size thresholds, limited to a single measurement of aortic diameter from routine imaging, although many aortic dissections (40–60%) occur below these size thresholds. This multi-centre study aims to assess the clinical utility of biomechanics principles in thoracic aortic aneurysm (TAA) risk rupture prediction using a substantial sample size.
Methods
Fifty-five patients undergoing surgery for root or ascending TAA were recruited from five cardiac centres. Bicuspid aortic valves and connective tissue disease were excluded from this study.Haemodynamic assessment Pre-operative 4-dimensional flow magnetic resonance imaging (4D-MRI) were conducted. Direct 4D-flow analysis and computational fluid dynamics (CFD) were performed creating detailed wall shear stress (WSS) maps across the whole aneurysms. Aortic wall assessment The aneurysmal aortic sample was obtained from surgery and subjected to region specific uniaxial failure tests in the circumferential and longitudinal directions, as well as delamination testing within the aortic media. Whole aneurysm histological characterisation was also conducted using computational pathology techniques. Blood flow, tissue mechanics and microstructural properties were used to develop a risk prediction model with assessment of elastin, collagen and smooth muscle cell composition, as well as failure strain assessment and dissection energy function.
Results
Outcomes of mechanical properties were: Young's Elastic Modulus as a measure of aortic stiffness (0.85 MPa ±0.69), as well as maximal tensile strength (0.49 MPa ± 0.36), which demonstrated reduced aortic wall strength in the outer curvature. This correlated with increased wall shear stress (WSS) (up to 10 Pa) and flow velocity (up to 43 l/min). Regions of abnormal flow and tissue mechanics correlated significantly with degraded medial microstructure (elastin abundance: 34 vs 66%; collagen abundance 26 vs 57%, p<0.05).
Conclusions
CFD modelling has the potential to provide a risk prediction of acute events in TAA beyond the current size classification, as validated by altered aortic tissue properties. Future longitudinal studies are warranted to validate this methods in moderately enlarging thoracic aortas.
Flow, mechanical, histology properties
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): NIHR Imperial College BRC
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Affiliation(s)
- M Salmasi
- Imperial College London, London, United Kingdom
| | - O.A Jarral
- Imperial College London, London, United Kingdom
| | - S Pirola
- Imperial College London, London, United Kingdom
| | | | - J Pepper
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - A Oo
- Barts Heart Centre, London, United Kingdom
| | - J Moore Jr
- Imperial College London, London, United Kingdom
| | - X.Y Xu
- Imperial College London, London, United Kingdom
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Jafarzadeh F, Oo A, Kuduvalli M, Harrington D, Bashir M, Field M, Desmond M. 253 * INTRAOPERATIVE MOTOR EVOKED POTENTIAL CHANGES, PROCEDURE ALTERATIONS AND NEUROLOGICAL OUTCOME IN THORACIC AND THORACO-ABDOMINAL AORTIC ANEURYSM REPAIR. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fok M, Bashir M, Hammoud I, Harrington D, Kuduvalli M, Field M, Oo A. An apical left ventricular aneurysm rupture presenting as left breast mass 11 years after surgical repair. Ann R Coll Surg Engl 2014; 96:e6-7. [PMID: 25245713 DOI: 10.1308/003588414x13946184900561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition's natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis. We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died. With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications.
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Affiliation(s)
- M Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
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Yan TD, Tian DH, LeMaire SA, Misfeld M, Elefteriades JA, Chen EP, Chad Hughes G, Kazui T, Griepp RB, Kouchoukos NT, Bannon PG, Underwood MJ, Mohr FW, Oo A, Sundt TM, Bavaria JE, Di Bartolomeo R, Di Eusanio M, Roselli EE, Beyersdorf F, Carrel TP, Corvera JS, Della Corte A, Ehrlich M, Hoffman A, Jakob H, Matalanis G, Numata S, Patel HJ, Pochettino A, Safi HJ, Estrera A, Perreas KG, Sinatra R, Trimarchi S, Sun LZ, Tabata M, Wang C, Haverich A, Shrestha M, Okita Y, Coselli J. The ARCH Projects: design and rationale (IAASSG 001). Eur J Cardiothorac Surg 2013; 45:10-6. [DOI: 10.1093/ejcts/ezt520] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Theologou T, Ellison G, Vicinanza C, Torella M, Galuppo V, Leone A, Mendicino I, Sacco W, Bochicchio A, Field M, Oo A, Kuduvalli M, Indolfi C, Nadal-Ginard B, Torella D. European Society for Surgical Research: Biological Properties & Regenerative Potential, in Vitro & in Vivo, of Human Cardiac Stem Cells Isolated from the Adult Human Heart. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Field M, Doolan J, Safar M, Kuduvalli M, Oo A, Mills K, Kendall J, Desmond M. The safe use of spinal drains in thoracic aortic surgery. Interact Cardiovasc Thorac Surg 2011; 13:557-65. [DOI: 10.1510/icvts.2011.272211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Patwala A, Woods P, Clements R, Albouaini K, Rao A, Goldspink D, Tan LB, Oo A, Wright D. A prospective longitudinal evaluation of the benefits of epicardial lead placement for cardiac resynchronization therapy. Europace 2009; 11:1323-9. [DOI: 10.1093/europace/eup251] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Privat SJ, Oo A, Waterbury LD. Production of interleukin-6, but not interleukin-8, induced by TNF-alpha or IL-1 beta in human fibroblast-like synoviocyte increases over cell passage. Proc West Pharmacol Soc 2002; 44:9-13. [PMID: 11794009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- S J Privat
- Centaur Pharmaceuticals, Inc., Santa Clara, California 95050, USA
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Hallas CN, Patel N, Oo A, Jackson M, Murphy P, Drakeley MJ, Soorae A, Page RD. Five-year survival following oesophageal cancer resection: psychosocial functioning and quality of life. PSYCHOL HEALTH MED 2001. [DOI: 10.1080/13548500020021955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Hallas CN, Patel N, Oo A, Jackson M, Murphy P, Drakeley MJ, Soorae A, Page RD. Five-year survival following oesophageal cancer resection: Psychosocial functioning and quality of life. PSYCHOL HEALTH MED 2001. [DOI: 10.1080/13548500124671] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wang JY, Russell GN, Page RD, Oo A, Pennefather SH. A comparison of the effects of desflurane and isoflurane on arterial oxygenation during one-lung ventilation. Anaesthesia 2000; 55:167-73. [PMID: 10651681 DOI: 10.1046/j.1365-2044.2000.055002167.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a randomised prospective cross-over study, we compared the effects of desflurane and isoflurane on arterial oxygenation, heart rate and mean arterial pressure during one-lung anaesthesia. Thirty patients scheduled for oesophagogastrectomy were randomly assigned to one of two groups. One group of 15 patients received desflurane to an end-tidal concentration of 6% in oxygen from induction until the end of 30 min of open chest one-lung ventilation in the lateral position. This was followed by isoflurane to an end-tidal concentration of 1.1% in oxygen for the next 30 min of one-lung ventilation. The other group of 15 patients received the two anaesthetic agents in the reverse order. We found no significant difference in arterial oxygenation, heart rate or mean arterial pressure between the two inhalational agents. In the subgroup of 10 patients with pulmonary artery catheters, we found no significant differences in mixed venous saturation, derived shunt or cardiac output. We conclude that during one-lung ventilation, the choice between desflurane and isoflurane does not significantly influence arterial oxygenation.
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Affiliation(s)
- J Y Wang
- Cardiothoracic Centre, Liverpool, UK
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Abstract
We describe an 82-year-old woman who presented with acute tracheal obstruction secondary to advanced, asymptomatic achalasia. Conventional treatment of her achalasia failed to relieve recurrent episodes of airway obstruction requiring endotracheal intubation. Because she was not fit for an operation, a Gianturco endotracheal stent was placed bronchoscopically. She remains without respiratory or upper gastrointestinal symptoms 2 years later. Recent information regarding the pathophysiology and surgical treatment of this complication is reviewed.
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Abstract
A new triple surgery procedure was applied to 20 primary open-angle glaucomatous (POAG) eyes. This technique comprises trabeculotomy with narrow (2-3 mm) fornix-based scleral flap, combined with extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation. As to surgical results, at two years postsurgery 53% (9/17) of the eyes were controlled under 21 mm Hg without medication, 35% (6/17) with topical medication alone. Eighteen (90%) eyes showed improved visual acuity of two or more Snellen lines. No serious postoperative complications occurred. There was no significant difference in postoperative astigmatism as compared with ordinary ECCE and PC-IOL surgery. Trabeculotomy with fornix-based scleral flap offers the advantage of simple and safe surgery when combined with ECCE and PC-IOL implantation.
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Affiliation(s)
- Y Saito
- Department of Ophthalmology, Osaka University Medical School
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