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Zientara A, Salmasi MY, Milan-Chhatrisha B, Kapadia S, Bashir R, Cummings I, Quarto C, Asimakopoulos G. Thrombocytopenia after sutureless and standard stented aortic valve replacement: a retrospective analysis of risk factors, clinical course, and early outcome. J Cardiothorac Surg 2024; 19:219. [PMID: 38627820 PMCID: PMC11020882 DOI: 10.1186/s13019-024-02755-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES Thrombocytopenia following Perceval aortic valve replacement has been described previously with variable outcome. Studies have lacked a robust analysis of platelet fluctuation and factors affecting it. We aimed to statistically describe the trend in thrombocyte variability as compared with conventional aortic valve replacement, and to assess predictors as well as impact on associated outcomes. METHODS One hundred consecutive patients with first-time Perceval were retrospectively compared to 219 patients after Perimount Magna Ease valve replacement. The primary outcome was the serial thrombocyte count on day 0-6. Generalized estimating equations were used to analyse the data using fixed-effect models: for the effect of the post-operative day on platelet count, and random-effect models estimating both time-variant (platelets) and time in-variant variables (valve type, age, LV function, pre-op platelet level). RESULTS Perceval patients were older (72 ± 1 vs 68 ± 1 years, p < 0.01) with higher NYHA status (3(2-3) vs 2(1-2), p < 0.001). Mean platelet count in the sutureless group was lowest on day 2 (91.9 ± 31.6 vs 121.7 ± 53.8 × 103 µl-1), and lower on day 4 (97.9 ± 44) and 6 (110.6 ± 61) compared to the conventional group (157.2 ± 60 and 181.7 ± 79) but did not result in a higher number of transfusions, bleeding or longer hospital stay (p > 0.05). Reduced platelet count was a strong predictor of red cell transfusion in the conventional (p = 0.016), but not in the sutureless group (p = 0.457). Age (Coef -1.025, 95%CI-1.649--0.401, p < 0.001) and CPB-time (Coef 0.186, 95%CI-0.371--0.001, p = 0.048) were predictors for lower platelet levels. CONCLUSION Considering the older patient profile treated with Perceval, postoperative thrombocytopenia does not impact on outcome in terms of transfusions, complications or hospital stay.
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Affiliation(s)
- Alicja Zientara
- University Hospital Freiburg, Heart Centre, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Mohammad Yousuf Salmasi
- Department of Surgery, Imperial College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Hill End Road, Uxbridge, UB9 6JH, UK
| | | | - Sharan Kapadia
- Department of Surgery, Imperial College London, London, UK
| | - Ryan Bashir
- Guy's and St Thomas' NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Ian Cummings
- Guy's and St Thomas' NHS Foundation Trust, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Cesare Quarto
- Guy's and St Thomas' NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - George Asimakopoulos
- Guy's and St Thomas' NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
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Kapadia SJ, Salmasi MY, Zientara A, Roussin I, Quarto C, Asimakopoulos G. Perceval sutureless bioprosthesis versus Perimount sutured bioprosthesis for aortic valve replacement in patients with aortic stenosis: a retrospective, propensity-matched study. J Cardiothorac Surg 2024; 19:95. [PMID: 38355617 PMCID: PMC10865583 DOI: 10.1186/s13019-024-02575-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Rapid-deployment aortic valve replacement (RDAVR) is an alternative to conventional AVR (cAVR) for aortic stenosis. Benefits include a reduction in operative times, facilitation of minimal access surgery and superior haemodynamics compared to conventional valves. However, further evidence is required to inform guidelines, preferably in the form of propensity-matched studies that include mid-term follow-up data. METHODS This was a single-centre, retrospective, propensity-matched cohort study comparing the Perceval and conventional Perimount Magna Ease valve for short- and mid-term clinical parameters and size-matched mid-term echocardiographic parameters (n = 102 in both groups) from 2014 to 2020. Data were extracted from a nationally managed dataset. RESULTS There were no demographic differences between the matched groups. The Perceval group had shorter cross-clamp time (Perceval 62 [49-81] minutes; Perimount 79 [63-102] minutes, P < 0.001), shorter bypass time (Perceval 89 [74-114] minutes; Perimount 104 [84-137] minutes, P < 0.001), and more frequent minimally-invasive approaches (Perceval 28%; Perimount 5%, P < 0.001). Size-matched haemodynamics showed initially higher gradients in the Perceval group, but haemodynamics equalised at 12 + months. The Perceval group had a more favourable % change in the left ventricular posterior wall dimension at 2 + years (Perceval - 4.8 ± 18; Perimount 17 ± 2). CONCLUSIONS The Perceval facilitated shorter operations, which may benefit intermediate-high-risk, elderly patients with comorbidities requiring concomitant procedures. It also facilitated minimally invasive surgery. Size-matched haemodynamic performance was similar at mid-term follow-up, with the Perceval possibly better facilitating regression of left ventricular hypertrophy.
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Affiliation(s)
- Sharan J Kapadia
- Imperial College School of Medicine, Exhibition Rd, South Kensington, London, SW7 2BX, UK.
| | - Mohammed Yousuf Salmasi
- Imperial College School of Medicine, Exhibition Rd, South Kensington, London, SW7 2BX, UK
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - Alicja Zientara
- Department for Cardiac and Vascular Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Isabelle Roussin
- Department of Cardiology, Lister Hospital East and North Hertfordshire NHS Trust, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - George Asimakopoulos
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
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Cummings I, Salmasi MY, Bulut HI, Zientara A, AlShiekh M, Asimakopoulos G. Sutureless Biological Aortic Valve Replacement (Su-AVR) in Redo operations: a retrospective real-world experience report of clinical and echocardiographic outcomes. BMC Cardiovasc Disord 2024; 24:28. [PMID: 38172707 PMCID: PMC10765636 DOI: 10.1186/s12872-023-03652-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to compare the outcomes of sutureless aortic valve replacement (su-AVR) and conventional bioprosthetic sutured AVR (cAVR) in high-risk patients undergoing redo surgery. METHODS A total of 79 patients who underwent redo AVR between 2014 and 2021 were included in the study. Of these, 27 patients underwent su-AVR and 52 underwent cAVR. Patient characteristics and clinical outcomes were analysed using multivariate regression and Kaplan Meier survival test. RESULTS The groups were similar in terms of age, gender, left ventricular function, and number of previous sternotomies. In cases of isolated AVR, su-AVR had significantly lower cross clamp times than cAVR (71 vs. 86 min, p = 0.03). Postoperatively, 4 cAVR patients required pacemaker compared to zero patients in the su-AVR group. There were no significant differences between the two groups in terms of postoperative complications, intrahospital stay (median 9 days, IQR 7-20), or in-hospital mortality (1 su-AVR; 2 cAVR). The long-term survival rate was similar between the su-AVR (90%) and cAVR (92%) groups (log rank p = 0.8). The transvalvular gradients at follow-up were not affected by the type of valve used, regardless of the valve size (coef 2.68, 95%CI -3.14-8.50, p = 0.36). CONCLUSION The study suggests that su-AVR is a feasible and safe alternative to cAVR in high-risk patients undergoing redo surgery. The use of su-AVR offers comparable outcomes to cAVR, with reduced cross clamp times and a lower incidence of postoperative pacemaker requirement in isolated AVR cases. The results of this study contribute to the growing body of evidence supporting the use of su-AVR in high-risk patients, highlighting its feasibility and safety in redo surgeries.
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Affiliation(s)
- Ian Cummings
- Department of Cardiac Surgery, St Thomas Hospital, London, UK
| | - M Yousuf Salmasi
- Department of Surgery, Imperial College London, QEQM Building, South Wharf Road, London, UK.
| | - Halil Ibrahim Bulut
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alicja Zientara
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mahmoud AlShiekh
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - George Asimakopoulos
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Thakur S, Asimakopoulos G, Dimarakis I. The elephant trunk procedure continues to evolve 40 years since its initial description. J Thorac Dis 2023; 15:6405-6407. [PMID: 38249917 PMCID: PMC10797337 DOI: 10.21037/jtd-2023-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Sameer Thakur
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
| | | | - Ioannis Dimarakis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
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Ton Loy AF, Lee JE, Asimakopoulos G, Sakamoto MS, Merritt VC. Symptom attribution is a stronger predictor of PVT-failure than symptom endorsement in treatment-seeking Veterans with remote mTBI history: A pilot study. Appl Neuropsychol Adult 2023:1-6. [PMID: 38113857 DOI: 10.1080/23279095.2023.2293979] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To examine relationships between performance validity testing (PVT), neurobehavioral symptom endorsement, and symptom attribution in Veterans with a history of mild traumatic brain injury (mTBI). METHOD Participants included treatment-seeking Veterans (n = 37) with remote mTBI histories who underwent a neuropsychological assessment and completed a modified version of the Neurobehavioral Symptom Inventory (NSI) to assess symptom endorsement and symptom attribution (the latter evaluated by having Veterans indicate whether they believed each NSI symptom was caused by their mTBI). Veterans were divided into two subgroups, PVT-Valid (n = 25) and PVT-Invalid (n = 12). RESULTS Independent samples t-tests showed that two of five symptom endorsement variables and all five symptom attribution variables were significantly different between PVT groups (PVT-Invalid > PVT-Valid; Cohen's d = 0.67-1.02). Logistic regression analyses adjusting for PTSD symptoms showed that symptom endorsement (Nagelkerke's R2 = .233) and symptom attribution (Nagelkerke's R2 = .279) significantly distinguished between PVT groups. According to the Wald criterion, greater symptom endorsement (OR = 1.09) and higher attribution of symptoms to mTBI (OR = 1.21) each reliably predicted PVT-failure. CONCLUSIONS While both symptom endorsement and symptom attribution were significantly associated with PVT-failure, our preliminary results suggest that symptom attribution is a stronger predictor of PVT-failure. Results highlight the importance of assessing symptom attribution to mTBI in this population.
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Affiliation(s)
- Adan F Ton Loy
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Jeong-Eun Lee
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | | | - McKenna S Sakamoto
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Victoria C Merritt
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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Shehata M, Bashir R, Al-Alao B, Salmasi MY, Asimakopoulos G, Hoschtitzky A. Type A aortic dissection following a tetralogy of Fallot repair. JTCVS Tech 2023; 22:145-146. [PMID: 38152233 PMCID: PMC10750883 DOI: 10.1016/j.xjtc.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Monicka Shehata
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Ryan Bashir
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Bassel Al-Alao
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - M. Yousuf Salmasi
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | | | - Andreas Hoschtitzky
- Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
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Salmasi MY, Pirola S, Asimakopoulos G, Nienaber C, Athanasiou T. Risk prediction for thoracic aortic dissection: Is it time to go with the flow? J Thorac Cardiovasc Surg 2023; 166:1034-1042. [PMID: 35672182 DOI: 10.1016/j.jtcvs.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery, Imperial College London, London, United Kingdom.
| | - Selene Pirola
- BHF Centre of Research Excellence, Institute of Clinical Sciences, Imperial College London, London, United Kingdom
| | - George Asimakopoulos
- Department of Cardiology, Royal Brompton and Harefield Trust, London, United Kingdom
| | - Christoph Nienaber
- Department of Cardiology, Royal Brompton and Harefield Trust, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery, Imperial College London, London, United Kingdom
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Hewitson LJ, Cadiz S, Al-Sayed S, Fellows S, Amin A, Asimakopoulos G, Barnes E, Beale A, Browne S, Chandrasekaran B, Dalby M, Foley P, Hawkins M, Haynes D, Heng EL, Hyde T, Kabir T, Khavandi A, Mirsadraee S, McCrea W, Petrou M, Senior R, Smith D, Smith R, Spartera M, Wamil M, Panoulas V, Rahbi H. Time to TAVI: streamlining the pathway to treatment. Open Heart 2023; 10:e002170. [PMID: 37666643 PMCID: PMC10481834 DOI: 10.1136/openhrt-2022-002170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/27/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Severe aortic stenosis is a major cause of morbidity and mortality. The existing treatment pathway for transcatheter aortic valve implantation (TAVI) traditionally relies on tertiary Heart Valve Centre workup. However, this has been associated with delays to treatment, in breach of British Cardiovascular Intervention Society targets. A novel pathway with emphasis on comprehensive patient workup at a local centre, alongside close collaboration with a Heart Valve Centre, may help reduce the time to TAVI. METHODS The centre performing local workup implemented a novel TAVI referral pathway. Data were collected retrospectively for all outpatients referred for consideration of TAVI to a Heart Valve Centre from November 2020 to November 2021. The main outcome of time to TAVI was calculated as the time from Heart Valve Centre referral to TAVI, or alternative intervention, expressed in days. For the centre performing local workup, referral was defined as the date of multidisciplinary team discussion. For this centre, a total pathway time from echocardiographic diagnosis to TAVI was also evaluated. A secondary outcome of the proportion of referrals proceeding to TAVI at the Heart Valve Centre was analysed. RESULTS Mean±SD time from referral to TAVI was significantly lower at the centre performing local workup, when compared with centres with traditional referral pathways (32.4±64 to 126±257 days, p<0.00001). The total pathway time from echocardiographic diagnosis to TAVI for the centre performing local workup was 89.9±67.6 days, which was also significantly shorter than referral to TAVI time from all other centres (p<0.003). Centres without local workup had a significantly lower percentage of patients accepted for TAVI (49.5% vs 97.8%, p<0.00001). DISCUSSION A novel TAVI pathway with emphasis on local workup within a non-surgical centre significantly reduced both the time to TAVI and rejection rates from a Heart Valve Centre. If adopted across the other centres, this approach may help improve access to TAVI.
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Affiliation(s)
| | - Suzane Cadiz
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Sarah Fellows
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alaaeldin Amin
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | | | - Edward Barnes
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Andrew Beale
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Suzy Browne
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Miles Dalby
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Paul Foley
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Mark Hawkins
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Douglas Haynes
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Ee Ling Heng
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Tom Hyde
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Tito Kabir
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Ali Khavandi
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - William McCrea
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Mario Petrou
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Roxy Senior
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - David Smith
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Robert Smith
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Marco Spartera
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vasileios Panoulas
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Cardiovascular Sciences, Imperial College London National Heart and Lung Institute, London, UK
| | - Hazim Rahbi
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Jenner WJ, Rajakaruna G, Asimakopoulos G, Lynch M. Petechial Rash and Glomerulonephritis: First Presentation of Endocarditis on a Patent Foramen Ovale Closure Device. JACC Case Rep 2023; 17:101899. [PMID: 37670736 PMCID: PMC10475670 DOI: 10.1016/j.jaccas.2023.101899] [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] [Received: 02/01/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 09/07/2023]
Abstract
Patent foramen ovale device closure is rarely associated with complications. This case report is believed to be the first description of a patient with infective endocarditis of a patent foramen ovale closure device presenting as glomerulonephritis. This article serves to educate as to this rare device complication and its unusual presentation. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | | | - George Asimakopoulos
- East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
- Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Mary Lynch
- East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
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Hartley P, Salmasi MY, Morosin M, Mensah K, Asimakopoulos G. Comparison of outcomes between aortic root replacement and supra-coronary interposition graft for type A aortic dissection: A retrospective case series. J Card Surg 2022; 37:4398-4405. [PMID: 36183392 DOI: 10.1111/jocs.16985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The decision to conserve or replace the native aortic valve following acute type-A aortic dissection (ATAAD) is an area of cardiac surgery without standardized practice. This single-center retrospective study analysed the long-term performance of the native aortic valve and root following surgery for ATAAD. METHODS Between 2009 and 2018 all cases ATAAD treated at Royal Brompton and Harefield NHS Foundation Trust were analysed. Patients were divided into two groups: (a) ascending aorta (interposition) graft (AAG) without valve replacement and (b) nonvalve-sparing aortic root replacement (ARR). Preoperative covariates were compared, as well as operative characteristics and postoperative complications. Long-term survival and echocardiographic outcomes were analysed using regression analysis. RESULTS In total, 116 patients were included: 63 patients in the AAG group and 53 patients in the ARR group. In patients where the native aortic valve was conserved, nine developed severe aortic regurgitation and two patients developed dilation of the aortic root requiring subsequent replacement during the follow-up period. Aortic regurgitation at presentation was not found to be associated with subsequent risk of developing severe aortic regurgitation or reintervention on the aortic valve. Overall mortality was observed to be significantly lower in patients undergoing AAG (17.5% vs. 41.5%, p = .004). CONCLUSIONS With careful patient selection, the native aortic root shows good long-term durability both in terms of valve competence and stable root dimensions after surgery for ATAAD. This study supports the consideration of conservation of the aortic valve during emergency surgery for type-A dissection, in the absence of a definitive indication for root replacement, including in cases where aortic regurgitation complicates the presentation.
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Affiliation(s)
- Philip Hartley
- Royal Brompton and Harefield NHS Foundation Trust, Department of Cardiothoracic Surgery, London, UK
| | - M Yousuf Salmasi
- Royal Brompton and Harefield NHS Foundation Trust, Department of Cardiothoracic Surgery, London, UK
| | - Marco Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Department of Cardiothoracic Surgery, London, UK
| | - Kwabena Mensah
- Royal Brompton and Harefield NHS Foundation Trust, Department of Cardiothoracic Surgery, London, UK
| | - George Asimakopoulos
- Royal Brompton and Harefield NHS Foundation Trust, Department of Cardiothoracic Surgery, London, UK
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Salmasi MY, Morris-Rosendahl D, Jarral OA, Rosendahl U, Asimakopoulos G, Raja S, Aragon-Martin JA, Child A, Pepper J, Oo A, Athanasiou T. Determining the genetic contribution in patients with non-syndromic ascending thoracic aortic aneurysms: Correlation with findings from computational pathology. Int J Cardiol 2022; 366:1-9. [PMID: 35830949 DOI: 10.1016/j.ijcard.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study aims to identify the clinical utility of targeted-genetic sequencing in a cohort of patients with TAA and establish a new method for regional histological characterisation of TAA disease. METHODS Fifty-four patients undergoing surgery for proximal TAA were recruited. EXCLUSIONS connective tissue disease, bicuspid aortic valves, redo surgery. All patients underwent next generation sequencing (NGS) using a custom gene panel containing 63 genes previously associated with TAA on Illumina MiSeqor NextSeq550 platforms. Explanted TAA tissue was obtained en-bloc from 34/54 patients, and complete circumferential strips of TAA tissue processed into whole slides which were subsequently digitalised. Computational pathology methods were employed to quantify elastin, cellularity and collagen in six equally divided regions across the whole aneurysm circumference. RESULTS Of 54 patients, clearly pathogenic or potentially pathogenic variants were found in 7.4%: namely LOX, PRKG1, TGFBR1 and SMAD3 genes. 55% had at least one variant of unknown significance (VUS) and seven of the VUSs were in genes with a strong disease association (category A) genes, whilst 15 were from moderate risk (category B) genes. Elastin and collagen abundance displayed high regional variation throughout the aneurysm circumference. In patients with <60% total elastin, the loss of elastin was more significant on the outer curve (38.0% vs 47.4%, p = 0.0094). The presence of VUS, higher pulse wave velocity and advancing age were predictors of elastin loss (regression analysis: p < 0.05). CONCLUSIONS These findings demonstrate the heterogeneity of TAA disease microstructure and the potential link between histological appearance and clinical factors, including genetic variation.
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Affiliation(s)
| | | | - Omar A Jarral
- Department of Surgery and Cancer, Imperial College London, UK
| | | | | | - Shahzad Raja
- Royal Brompton and Harefield Foundation Trust, UK
| | | | - Anne Child
- Guy Scadding Building, Marfan Trust, London, UK; Sonalee Laboratory, Imperial College, London, UK
| | - John Pepper
- Royal Brompton and Harefield Foundation Trust, UK
| | - Aung Oo
- Aortovascular Unit, Barts Heart Centre, UK
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Tsampasian V, Grafton-Clarke C, Gracia Ramos AE, Asimakopoulos G, Garg P, Prasad S, Ring L, McCann GP, Rudd J, Dweck MR, Vassiliou VS. Management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis. Open Heart 2022; 9:e001982. [PMID: 35581008 PMCID: PMC9109115 DOI: 10.1136/openhrt-2022-001982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/05/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing the two management strategies. METHODS PubMed, Cochrane and Web of Science databases were systematically searched from inception until 10 January 2022. The search key terms were 'asymptomatic', 'severe aortic stenosis' and 'intervention'. RESULTS Meta-analysis of two published randomised trials, AVATAR and RECOVERY, included 302 patients and showed that early intervention resulted in 55% reduction in all-cause mortality (HR=0.45, 95% CI 0.24 to 0.86; I2 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I2 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I2 78%). Additionally, meta-analysis of eight observational studies showed improved mortality in patients treated with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I2 77%). CONCLUSION This meta-analysis provides evidence that, in patients with severe asymptomatic aortic stenosis, early intervention reduces all-cause mortality and improves outcomes compared with conservative management. While this is very encouraging, further randomised controlled studies are needed to draw firm conclusions and identify the optimal timing of intervention. PROSPERO REGISTRATION NUMBER CRD42022301037.
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Affiliation(s)
- Vasiliki Tsampasian
- Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ciaran Grafton-Clarke
- Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Abraham Edgar Gracia Ramos
- Departamento de Medicina Interna, Centro Medico Nacional "La Raza", IMSS, Ciudad de Mexico, Mexico
- Seccion de Estudios de Posgrado e Investigacion, Escuela Superior de Medicina, Instituto Politecnico Nacional, Mexico City, Mexico
| | - George Asimakopoulos
- Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
- School of Medicine, Imperial College London, London, UK
| | - Pankaj Garg
- Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sanjay Prasad
- Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
- School of Medicine, Imperial College London, London, UK
| | - Liam Ring
- Cardiology, West Suffolk Hospital NHS Trust, Bury Saint Edmunds, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - James Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Vassilios S Vassiliou
- Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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13
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Psarris A, Sindos M, Antsaklis P, Theodora M, Tasias K, Asimakopoulos G, Rodolakis A, Daskalakis G. 154 Prenatal diagnosis of atretic parietal cephalocele: A case report. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.053] [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: 11/24/2022]
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14
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Psarris, Antsaklis P, Theodora M, Sindos M, Asimakopoulos G, Tasias K, Rodolakis A, Daskalakis G. 223 Prenatal diagnosis of trisomy 21-the role of aberrant right subclavian artery (ARSA) As an ultrasound marker. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.257] [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: 11/26/2022]
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15
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Tasias K, Psarris A, Antsaklis P, Sindos M, Theodora M, Asimakopoulos G, Rodolakis A, Daskalakis G. 153 The experience of the largest greek maternity hospital during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol 2022. [PMCID: PMC8941269 DOI: 10.1016/j.ejogrb.2021.11.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Salmasi MY, Ramaraju S, Haq I, B Mohamed RA, Khan T, Oezalp F, Asimakopoulos G, Raja SG. Rapid deployment technology versus conventional sutured bioprostheses in aortic valve replacement. J Card Surg 2022; 37:640-655. [PMID: 35028981 PMCID: PMC9305745 DOI: 10.1111/jocs.16223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
Objectives Despite the benefits of rapid deployment aortic valve prostheses (RDAVR), conventional sutured valves (cAVR) are more commonly used in the treatment for aortic stenosis. Given the paucity of randomized studies, this study aimed to synthesize available data to compare both treatment options. Methods A systematic search of Pubmed, OVID, and MEDLINE was conducted to retrieve comparative studies for RDAVR versus cAVR in the treatment of aortic stenosis. Out of 1773 returned titles, 35 papers were used in the final analysis, including 1 randomized study, 1 registry study, 6 propensity‐matched studies, and 28 observational studies, incorporating a total of 10,381 participants (RDAVR n = 3686; cAVR n = 6310). Results Random‐effects meta‐analysis found no difference between the two treatment groups in terms of operative mortality, stroke, or bleeding (p > .05). The RDAVR group had reduced cardiopulmonary bypass (standardized mean difference [SMD]: −1.28, 95% confidence interval [CI]: [−1.35, −1.20], p < .001) and cross‐clamp times (SMD: −1.05, 95% CI: [−1.12, −0.98], p < .001). Length of stay in the intensive care unit was also shorter in the RDAVR group (SMD: −0.385, 95% CI: [−0.679, −0.092], p = .010). The risk of pacemaker insertion was higher for RDAVR (odds ratio [OR]: 2.41, 95% CI: [1.92, 3.01], p < .001) as was the risk of paravalvular leak (PVL) at midterm follow‐up (OR: 2.52, 95% CI: [1.32, 4.79], p = .005). Effective orifice area and transvalvular gradient were more favorable in RDAVR patients (p > .05). Conclusions Despite the benefits of RDAVR in terms of reduced operative time and enhanced recovery, the risk of pacemaker insertion and midterm PVL remains a significant cause for concern.
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Affiliation(s)
- Mohammad Yousuf Salmasi
- Department of Surgery, Imperial College London, UK.,Department of Cardiac Surgery, Royal Brompton and Harefield Trust, London, UK
| | | | - Iqraa Haq
- Department of Surgery, Imperial College London, UK
| | - Ryan A B Mohamed
- Department of Cardiac Surgery, Royal Brompton and Harefield Trust, London, UK
| | - Taimoor Khan
- Department of Cardiac Surgery, Royal Brompton and Harefield Trust, London, UK
| | - Faruk Oezalp
- Department of Cardiac Surgery, Royal Brompton and Harefield Trust, London, UK
| | | | - Shahzad G Raja
- Department of Cardiac Surgery, Royal Brompton and Harefield Trust, London, UK
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17
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Salmasi MY, Papa K, Mozalbat D, Ashraf M, Zientara A, Chauhan I, Karadatkou N, Athanasiou T, Roussin I, Quarto C, Asimakopoulos G. Converging rapid deployment prostheses with minimal access surgery: analysis of early outcomes. J Cardiothorac Surg 2021; 16:355. [PMID: 34961528 PMCID: PMC8714419 DOI: 10.1186/s13019-021-01739-w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS). Methods A retrospective analysis of prospectively collected data was conducted for all isolated aortic valve replacement (AVR), using the Perceval valve, for severe aortic stenosis cases in the period 2014 to 2019. Patients undergoing concomitant valve or revascularisation surgery were excluded. Results A total of 78 patients were included: MS group 41; MIS group 37. Operatively, bypass times were comparable between MS and MIS groups (mean 89.3 vs 83.4, p = 0.307), as were aortic cross clamp times (58.4 vs 55.9, p = 0.434). There were no operative deaths or new onset post-operative neurology. MIS was a predictor of reduced stay in the intensive care unit (coef − 3.25, 95% CI [− 4.93, − 0.59], p = 0.036) and hospital stay overall (p = 0.004). Blood transfusion units were comparable as were the incidence of heart block (n = 5 vs n = 3, p = 0.429) and new onset atrial fibrillation (n = 15 vs n = 9, p = 0.250). Follow-up echocardiography found a significant improvement in effective orifice area, left ventricular dimension and volume indices, and LVEF (p > 0.05) for all patients. Multivariate analysis found mini-sternotomy to be a predictor for reduced LV diastolic volume (coef − 0.35, 95% CI [− 1.02, − 0.05], p = 0.05). Conclusions The combination of minimal access surgery and sutureless AVR may enhance patient recovery and provide early LV remodelling.
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Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery, Imperial College London, 10th Floor QEQM, Praed Street, London, W2 1NY, UK. .,Royal Brompton and Harefield Foundation Trust, London, UK.
| | - Kristo Papa
- Royal Brompton and Harefield Foundation Trust, London, UK
| | - David Mozalbat
- Royal Brompton and Harefield Foundation Trust, London, UK
| | | | | | - Ishaan Chauhan
- Royal Brompton and Harefield Foundation Trust, London, UK
| | | | - Thanos Athanasiou
- Department of Surgery, Imperial College London, 10th Floor QEQM, Praed Street, London, W2 1NY, UK
| | | | - Cesare Quarto
- Royal Brompton and Harefield Foundation Trust, London, UK
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18
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Maltezou HC, Stavros S, Asimakopoulos G, Pergialiotis V, Raftopoulos V, Talias MA, Pavli A, Daskalakis G, Sindos M, Koutroumanis P, Theodora M, Antsaklis P, Kostis E, Stratiki E, Kossyvakis A, Theodoridou M, Mentis A, Drakakis P, Loutradis D, Rodolakis A. Effectiveness of maternal vaccination with quadrivalent inactivated influenza vaccine in pregnant women and their infants in 2019-2020. Expert Rev Vaccines 2021; 21:983-992. [PMID: 34878959 DOI: 10.1080/14760584.2022.2013820] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Influenza is associated with an increased risk for serious illness, hospitalization and death in pregnant women and young infants. Our aim was to estimate the effectiveness of a quadrivalent inactivated influenza vaccine (QIV) in pregnant women and their infants during 2019-2020 influenza season. METHODS A QIV vaccine was offered to pregnant women followed in a maternity hospital. Women were contacted weekly during the influenza season and asked about symptoms. Polymerase chain reaction testing in pharyngeal samples was offered to pregnant women and infants with influenza-like illness. A Bayesian beta-binomial model was used. RESULTS We studied 636 pregnant women (406 vaccinated and 230 unvaccinated) and 474 infants (281 of mothers vaccinated in pregnancy and 193 of unvaccinated mothers). Using a Bayesian beta-binomial model, it was estimated that influenza vaccination of pregnant women reduced their logit to develop laboratory-confirmed influenza by -4.2 (95% CI -3,7 -4,7) and the logit of their infants to develop laboratory-confirmed influenza by -4.2 (95% CI -3.6, -4.9). The QIV effectiveness against laboratory-confirmed influenza was 43.5% in pregnant women and 31.4% in infants. CONCLUSION Maternal influenza vaccination with QIV in pregnancy reduced the odds of pregnant women and their infants to develop influenza. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier is NCT04723771.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Sofoklis Stavros
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - George Asimakopoulos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Michael A Talias
- Healthcare Management Postgraduate Program, Open University of Cyprus, Nicosia, Cyprus
| | | | - George Daskalakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Michael Sindos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Pelopidas Koutroumanis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Panagiotis Antsaklis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Evangelia Stratiki
- Neonatal Intensive Care Unit, Alexandra General Hospital, Athens, Greece
| | - Athanasios Kossyvakis
- National Influenza Reference Laboratory of Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Mentis
- National Influenza Reference Laboratory of Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Petros Drakakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
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19
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Yuan X, Rosendahl U, Asimakopoulos G, Quarto C, Rosser B, Gaer J, Petrou M, Bhudia S, Bahrami T, Nienaber C. Impact of COVID-19 pandemic on surgical care of patients with acute aortic conditions. Eur Heart J 2021. [PMCID: PMC8767605 DOI: 10.1093/eurheartj/ehab724.1996] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The outbreak of COVID-19 pandemic catastrophically interrupted medical care systems causing substantial decrease in the admission of patients and consecutively a sharp decline in the number of surgeries and interventions. In several European countries, the nationwide lockdown severely restricted movement which may have contributed to this phenomenon on top of anxiety of patients to contract COVID-19 when admitted to hospital. Purpose The aim of this analysis was to evaluate the impact of the COVID-19 pandemic onto acute and elective thoracic aortic surgeries and interventions and to compare the data with the same period in 2019 in a single aortic centre. Methods Information on admission and surgery/intervention was extracted from hospital electronic record system. Patients who were admitted for treatment of aortic conditions between January 1st to June 30th both in 2019 and 2020 were identified and selected for this analysis. The time from referral to admission and surgery/intervention was noted for service delay analysis. Aortopathies were classified as type A aortic dissection, type B aortic dissection, aortic aneurysm and others. In a daily central hub meeting, urgency was defined as emergent (operation required before the next working day), urgent (operation needed within 48 hours), and elective. Patients' condition and comorbidities were represented by ACEF II score. Results Total case volume of 81 in 2019 reference period was reduced to 70 in 2020 (−14%). Elective cases significantly declined from 59 (72.8%) in 2019 to 30 (42.8%) in 2020 (−49%). Urgent and emergent cases were performed more frequently in 2020 with 40 cases versus 22 in 2019 (+45%). The ACEF II score showed no difference for patients in both periods (2.1±1.9 vs. 2.5±2.1, p=0.221), however, a trend to higher ACEF II score in 2020 consistent with a higher proportion of urgent and emergent cases. The overall in-hospital delay (from admission to surgery) was not significant affected with 1 (IQR 1–2) versus 1 (IQR 0–2); p=0.991. However, with the official declaration of a pandemic and introduction of restrictions, no in-hospital delay was documented. In-hospital mortality was observed lower in 2019 as compared in 2020 (6.1% vs 11.4%, P=0.251). Conclusion The first wave of COVID-19 pandemic disrupted the aortic service, however, acute care for urgent thoracic aortic conditions and subsequent procedures even increased compared to 2019 as a result of both centralised allocation system and decline of elective cases. Acute aortic syndromes were managed despite COVID-19 according to current guidelines. Funding Acknowledgement Type of funding sources: None.
Impact of COVID on aortic case load ![]()
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Affiliation(s)
- X Yuan
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - U Rosendahl
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - G Asimakopoulos
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - C Quarto
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - B Rosser
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - J Gaer
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - M Petrou
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - S Bhudia
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - T Bahrami
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - C Nienaber
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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20
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Whittaker G, Salmasi Y, Asimakopoulos G, Athanasiou T. 1306 Recommendations for the Use of Simulators in Cardiothoracic Surgical Training. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.836] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To systematically review the simulators that are currently available for cardiothoracic surgical procedures and the validation evidence supporting them. Additionally, to recommend several simulators for training based on analysis of results.
Method
A systematic literature search of the MEDLINE® (1946 to December 2019) and EMBASE® (1947 to December 2019) databases was performed to identify simulators for basic skills and procedures in cardiothoracic surgery. A selection of keywords and MeSH terms were used to execute the literature search. After identification of relevant articles, data were extracted and analysed.
Results
Ninety simulators were found in eighty-one articles. Simulators for basic skills (n=24) and coronary artery bypass graft (n=22) were the most commonly described, followed by miscellaneous (n=14), valve surgery (n=13), thoracic lobectomy (n=10), and mechanical circulatory support (n=7). The majority of models were either benchtop (n=42) or hybrid (n=33) modalities. Evidence of validity was demonstrated in 38 (42.2%) simulators. Five (5.6%) simulators had three or more elements of validity established and only one (1.1%) accomplished full validation.
Conclusions
Five simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills development and high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilised in early training, at which point the learning curve of trainees is steepest.
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Affiliation(s)
- G Whittaker
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Y Salmasi
- Imperial College London, London, United Kingdom
| | - G Asimakopoulos
- Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
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21
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Vlastos D, Chauhan I, Mensah K, Cannoletta M, Asonitis A, Elfadil A, Petrou M, De Souza A, Quarto C, Bhudia SK, Rosendahl U, Pepper J, Asimakopoulos G. The impact of COVID-19 pandemic on aortic valve surgical service: a single centre experience. BMC Cardiovasc Disord 2021; 21:434. [PMID: 34521355 PMCID: PMC8438903 DOI: 10.1186/s12872-021-02253-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. Methods Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 with only one of the two sites resuming operative activity and compared with the respective 2019 period. A similar comparison was conducted with the period between June 2020 and August 2020, when operative activity was restored at both institutional sites. The experience of centres world-wide was invoked to assess the efficiency of our services. Results There was an initial 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9–5.2] in 2020 versus 2.1 [0.9–3.7] in 2019 (p = 0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p > 0.05 for all comparisons). Recommencement of activity at both institutional sites conferred a surgical volume within 17% of the pre-COVID-19 era. Conclusions Our institution managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.
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Affiliation(s)
| | | | - Kwabena Mensah
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | - Ahmed Elfadil
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mario Petrou
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Cesare Quarto
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sunil K Bhudia
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - John Pepper
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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22
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Whittaker G, Salmasi MY, Aydin A, Magouliotis D, Raja SG, Asimakopoulos G, Moorjani N, Athanasiou T. Recommendations for the use of coronary and valve simulators in cardiac surgical training: a systematic review. Eur J Cardiothorac Surg 2021; 61:1-10. [PMID: 34337649 DOI: 10.1093/ejcts/ezab350] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to systematically review the simulators that are currently available for coronary artery bypass graft and valve surgery and, in addition, to review the validation evidence supporting them and to recommend several simulators for training based on the analysis of results. METHODS A systematic literature search of the MEDLINE® (1946 to May 2021) and EMBASE® (1947 to May 2021) databases was performed to identify simulators for coronary artery and valvular procedures in cardiothoracic surgery. A selection of keywords and MeSH terms was used to execute the literature search. After identification of relevant articles, data were extracted and analysed. RESULTS Thirty-seven simulators were found in 31 articles. Simulators were found for coronary artery bypass graft (n = 24) and valve surgery (n = 13). The majority of models were either benchtop (n = 28) or hybrid (n = 8) modalities. Evidence of validity was demonstrated in 15 (40.5%) simulators. Twenty-two (59.5%) simulators had no validation evidence, and 1 (2.7%) simulator had 3 or more elements of validity established. CONCLUSIONS Two simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills' development whereas high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilized in early training, at which point the learning curve of trainees is steepest.
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Affiliation(s)
- George Whittaker
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | | | - Shahzad G Raja
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - George Asimakopoulos
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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23
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Zhu Y, Mirsadraee S, Asimakopoulos G, Gambaro A, Rosendahl U, Pepper J, Xu XY. Association of hemodynamic factors and progressive aortic dilatation following type A aortic dissection surgical repair. Sci Rep 2021; 11:11521. [PMID: 34075164 PMCID: PMC8169847 DOI: 10.1038/s41598-021-91079-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022] Open
Abstract
Type A aortic dissection (TAAD) involves the ascending aorta or the arch. Acute TAAD usually requires urgent replacement of the ascending aorta. However, a subset of these patients develops aortic rupture due to further dilatation of the residual dissected aorta. There is currently no reliable means to predict the risk of dilatation following TAAD repair. In this study, we performed a comprehensive morphological and hemodynamic analysis for patients with and without progressive aortic dilatation following surgical replacement of the ascending aorta. Patient-specific models of repaired TAAD were reconstructed from post-surgery computed tomography images for detailed computational fluid dynamic analysis. Geometric and hemodynamic parameters were evaluated and compared between patients with stable aortic diameters (N = 9) and those with aortic dilatation (N = 8). Our results showed that the number of re-entry tears and true/false lumen pressure difference were significantly different between the two groups. Patients with progressive aortic dilatation had higher luminal pressure difference (6.7 [4.6, 10.9] vs. 0.9 [0.5, 2.3] mmHg; P = 0.001) and fewer re-entry tears (1.5 [1, 2.8] vs. 5 [3.3, 7.5]; P = 0.02) compared to patients with stable aortic diameters, suggesting that these factors may serve as potential predictors of aneurysmal dilatation following surgical repair of TAAD.
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Affiliation(s)
- Yu Zhu
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Saeed Mirsadraee
- Department of Radiology, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - George Asimakopoulos
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - Alessia Gambaro
- Department of Cardiology, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - Ulrich Rosendahl
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - John Pepper
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK.
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Baghai M, Glauber M, Fontaine R, Castillo JC, Walker AH, Livi U, Montiel J, Royse A, Bisleri G, Pacini D, Argano V, Roumy A, Asimakopoulos G, Solinas M. Clinical outcomes after implantation of a sutureless aortic bioprosthesis with concomitant mitral valve surgery: the SURE-AVR registry. J Cardiothorac Surg 2021; 16:154. [PMID: 34053453 PMCID: PMC8165775 DOI: 10.1186/s13019-021-01523-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background Early treatment of aortic valve stenosis is recommended in eligible symptomatic patients with severe aortic valve stenosis who would otherwise have a poor prognosis. The sutureless aortic valve bioprosthesis offers an alternative to standard aortic valve replacement with a sutured valve, but limited data are available in patients who have undergone multiple valve procedures involving the new, sutureless technology. We sought to investigate outcomes in high operative risk patients with previous or concomitant valve surgery who were implanted with a sutureless valve. Methods SURE-AVR is an ongoing, prospective, multinational registry of patients undergoing aortic valve replacement. In-hospital and post-discharge outcomes up to 5 years were collected. Results The study population comprised 78 patients (mean ± SD: age 73.6 ± 7.6 years, logistic EuroSCORE 18.0 ± 17.5) enrolled at 13 sites who presented for concomitant or previous mitral valve repair (n = 45) or replacement (n = 33), with or without additional concomitant procedures, and were implanted with a sutureless valve. Mean ± SD overall aortic cross-clamp time was 109 ± 41 min and cardiopulmonary bypass time was 152 ± 49 min. Mean ± SD aortic pressure gradients decreased from 37.6 ± 17.7 mmHg preoperatively to 13.0 ± 5.7 mmHg at hospital discharge, and peak aortic pressure gradient from 61.5 ± 28.7 to 23.4 ± 10.6 mmHg. Early events included 1 death, 1 transient ischaemic attack, and 1 bleed (all 1.3%); a permanent pacemaker implantation was required in 6 patients (7.7%), and 2 reoperations (not valve related) (2.6%) took place. Over a median follow-up of 55.5 months (Q1 13.4, Q3 68.6), 12 patients died (6 cardiovascular and 6 non-cardiovascular, both 2.1% per patient-year). Five-year survival was 81.3%. Late paravalvular leak occurred in 2 patients (0.7% per patient-year) and permanent pacemaker implantation was required in 3 patients (0.1% per patient-year). There was no apparent rise in mean or peak aortic pressure gradient over the study. Conclusions These results suggest that the sutureless implant is a technically feasible procedure during mitral surgery and is associated with good clinical outcomes.
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Affiliation(s)
- Max Baghai
- Department of Cardiovascular Medicine, King's College Hospital, Brixton, London, SE5 9RS, UK.
| | - Mattia Glauber
- U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | | | - Antony H Walker
- Cardiothoracic Surgery, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ugolino Livi
- Cardiochirurgia, Az. Osp. Univ. S. Maria della Misericordia, Udine, Italy
| | - José Montiel
- Cirurgia Cardiaca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alistair Royse
- Cardiovascular department, The University of Melbourne, Melbourne, Australia
| | | | - Davide Pacini
- Cardiochiurgia, Policlinico Sant'Orsola, Bologna, Italy
| | - Vincenzo Argano
- U.O.C. Cardiochirurgia, AOU Policlinico "Paolo Giaccone", Palermo, Italy
| | - Aurelien Roumy
- Service de chirurgie cardio-vasculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Marco Solinas
- U.O.C Cardiochirurgia Adulti, Ospedale del Cuore G. Pasquinucci, Fondazione Toscana Fabriele Monasterio, Massa, Italy
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Glauber M, Kent WDT, Asimakopoulos G, Troise G, Padrò JM, Royse A, Marnette JM, Noirhomme P, Baghai M, Lewis M, Di Bacco L, Solinas M, Miceli A. Sutureless Valve in Repeated Aortic Valve Replacement: Results from an International Prospective Registry. Innovations (Phila) 2021; 16:273-279. [PMID: 33866845 DOI: 10.1177/1556984521999323] [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: 11/16/2022]
Abstract
OBJECTIVE To report early and midterm results registry of patients undergoing repeated aortic valve replacement (RAVR) with sutureless prostheses from an international prospective registry (SURE-AVR). METHODS Between March 2011 and June 2019, 69 patients underwent RAVR with self-expandable sutureless aortic bioprostheses at 22 international cardiac centers. RESULTS Overall mortality was 2.9% with a predicted logistic EuroSCORE II of 10.7%. Indications for RAVR were structural valve dysfunction (84.1%) and infective prosthetic endocarditis (15.9%) and were performed in patients with previously implanted bioprostheses (79.7%), mechanical valves (15.9%), and transcatheter valves (4.3%). Minimally invasive approach was performed in 15.9% of patients. Rate of stroke was 1.4% and rate of early valve-related reintervention was 1.4%. Overall survival rate at 1 and 5 years was 97% and 91%, respectively. No major paravalvular leak occurred. Rate of pacemaker implantation was 5.8% and 0.9% per patient-year early and at follow-up, respectively. The mean transvalvular gradient at 1-year and 5-year follow-up was 10.5 mm Hg and 11.5 mm Hg with a median effective orifice area of 1.8 cm2and 1.8 cm2, respectively. CONCLUSIONS RAVR with sutureless valves is a safe and effective approach and provides excellent clinical and hemodynamic results up to 5 years.
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Affiliation(s)
| | - William D T Kent
- 70401 Libin Cardiovascular Institute and University, Calgary, AB, Canada
| | | | | | | | | | | | | | - Max Baghai
- 111990 King's College Hospital, London, UK
| | - Michael Lewis
- 1949 Brighton and Sussex University Hospitals, Sussex, UK
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26
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Mohamed W, Asimakopoulos G. Preoperative C-reactive protein as a predictor of postoperative acute kidney injury in patients undergoing coronary artery bypass grafting. Perfusion 2020; 36:330-337. [PMID: 32781890 DOI: 10.1177/0267659120947684] [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: 11/15/2022]
Abstract
C-reactive protein is a well-known marker of inflammation and may be preoperatively elevated in the absence of infection in adult cardiac surgery patients, indicating a baseline inflammatory process. We conducted a literature search to assess the available evidence on whether there is an association between preoperative C-reactive protein and acute kidney injury after coronary artery bypass grafting. Included only were observational studies which investigated this association. We excluded abstracts, case reports, animal studies and articles in languages other than English. Altogether, 199 papers were retrieved from the search strategy reported, of which 6 studies were included in the final review. The study types, publication details, patient groups and key results are tabulated. A qualitative assessment of these papers was conducted. We conclude that there is some evidence to support the association between high preoperative C-reactive protein level and postoperative acute kidney injury and complications after coronary artery bypass grafting. Owing to variability in acute kidney injury definitions and C-reactive protein levels for different cohorts in the observational studies reviewed, it is unclear from current evidence what serum C-reactive protein cut-off level is significantly associated with postoperative acute kidney injury. Further evidence is needed to investigate whether raised preoperative C-reactive protein in the absence of an infective cause could have a role in risk prediction models for cardiac surgery-associated acute kidney injury.
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Affiliation(s)
- Walid Mohamed
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
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27
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Salmasi MY, Panda A, Hartley P, Abdulkhader A, Osman A, Nienaber C, Athanasiou T, Asimakopoulos G. Aortic root replacement to treat type A aortic dissection: A comparison of midterm outcomes between composite valve grafts and porcine aortic roots. J Card Surg 2020; 35:1840-1847. [PMID: 32643831 DOI: 10.1111/jocs.14712] [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: 10/23/2022]
Abstract
BACKGROUND Porcine aortic roots (PAR) have been reported in the literature with acceptable short- and long-term outcomes for the treatment of aortic root aneurysms. However, their efficacy in type A aortic dissection (TAAD) is yet to be defined. METHODS Using data from a locally collated aortic dissection registry, we compared the outcomes in patients undergoing aortic root replacement for TAAD using either of two surgical options: (a) PAR or (b) composite valve grafts (CVG). A retrospective analysis was conducted for all procedures in the period from 2005 to 2018. RESULTS A total of 252 patients underwent procedures for TAAD in the time period. Sixty-five patients had aortic root replacements (PAR n = 30, CVG n = 35). Between-group comparisons identified a younger CVG group (50.5 vs 64.5, P < .05) although all other covariates were comparable. Operative parameters were comparable between the two groups. The use of PAR did not significantly impact operative mortality (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.22-3.61; P = .992), stroke (OR, 2.91, 0.25-34.09, P = .395), reoperation (OR, 0.91; 95% CI, 0.22-3.62; P = .882) or length of stay (coeff 2.33, -8.23 to 12.90; P = .659) compared to CVG. Five-year survival was similar between both groups (PAR 59% vs CVG 69%; P = .153) and reoperation was negligible. Echocardiography revealed significantly lower aortic valve gradients in the PAR group (8.69 vs 15.45mm Hg; P < .0001), and smaller left ventricular dimensions both at 6-week and 1-year follow-up (P < .05). CONCLUSIONS This study highlights the comparable short- and midterm outcomes of PAR in cases of TAAD, in comparison to established therapy.
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Affiliation(s)
| | - Abinash Panda
- Royal Brompton and Harefield Foundation Trust, London, UK
| | - Philip Hartley
- Royal Brompton and Harefield Foundation Trust, London, UK
| | | | - Ahmed Osman
- Royal Brompton and Harefield Foundation Trust, London, UK
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28
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Asimakopoulos G, Pergialiotis V, Anastasiou E, Antsaklis P, Theodora M, Vogiatzi E, Kallergi A, Sindos M, Loutradis D, Daskalakis G. Effect of dietary myo-inositol supplementation on the insulin resistance and the prevention of gestational diabetes mellitus: study protocol for a randomized controlled trial. Trials 2020; 21:633. [PMID: 32646482 PMCID: PMC7346495 DOI: 10.1186/s13063-020-04561-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset or first recognition during pregnancy, which is characterized by an increased insulin resistance. Gestational diabetes mellitus is associated with pregnancy-related maternal and fetal morbidity (both antenatal and perinatal). Myo-inositol has been suggested to improve insulin resistance in women with polycystic ovary syndrome. The aim of this study is to examine the impact of myo-inositol supplementation during pregnancy on the incidence of gestational diabetes mellitus. Methods We will conduct a single-center, open-label, randomized controlled trial. A total of 160 healthy pregnant women with singleton pregnancy at 11–13+6 weeks of gestation will be randomly allocated in two groups: intervention group (N = 80) and control group (N = 80). The intervention group will receive myo-inositol and folic acid (4000 mg myo-inositol and 400 mcg folic acid daily) from 11 to 13+6 weeks of gestation until 26–28 weeks of gestation, while the control group will receive folic acid alone (400 mcg folic acid daily) for the same period of time as intervention group. The primary outcome will be gestational diabetes incidence rate at 26–28 weeks of gestation, according to the results of a 75 g oral glucose tolerance test held at 26–28 weeks of gestation. The secondary outcomes will include fasting blood glucose levels, glycated hemoglobin levels, insulin resistance level (evaluated by homeostasis model assessment of insulin resistance and Matsuda Index), and incidence rate of diet-treated gestational diabetes and diabetes requiring insulin therapy at 26–28 weeks of gestation. Discussion This trial will provide evidence for the effectiveness of myo-inositol supplementation during pregnancy in reducing the incidence of gestational diabetes mellitus. Trial registration ISRCTN registry: ISRCTN16142533. Registered on 9 March 2017.
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Affiliation(s)
- George Asimakopoulos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece.
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Eleni Anastasiou
- Endocrine Section - Diabetes Centre, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Panagiotis Antsaklis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Mariana Theodora
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Evangelia Vogiatzi
- Endocrine Section - Diabetes Centre, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Aggela Kallergi
- Endocrine Section - Diabetes Centre, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Michael Sindos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
| | - George Daskalakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vasilissis Sofias Avenue, Athens, Greece
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29
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Mohamed W, Asimakopoulos G. Is it safe and effective to reduce the target anticoagulation range for patients with mechanical prosthetic aortic valves? Interact Cardiovasc Thorac Surg 2020; 30:904-909. [PMID: 32236555 DOI: 10.1093/icvts/ivaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/11/2019] [Accepted: 01/31/2020] [Indexed: 11/12/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is it safe and effective to reduce the target anticoagulation range for patients with mechanical aortic valves?' Altogether 922 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. Only studies that compared high (target international normalized ratio 2-3) versus low (target international normalized ratio <2-3) intensity anticoagulation were included. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that there is growing evidence for the reduction of the target anticoagulation range for patients with mechanical prosthetic aortic valves, especially bileaflet valves with presumed better haemodynamic properties. Several large randomized controlled trials and a meta-analysis have concluded that reducing the target international normalized ratio range (below the conventional range of 2-3) for mechanical aortic valves in patients with no thrombogenic risk factors produces less bleeding and does not increase thromboembolic events.
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Affiliation(s)
- Walid Mohamed
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
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30
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Maltezou HC, Asimakopoulos G, Stavrou S, Daskalakis G, Koutroumanis P, Sindos M, Theodora M, Katerelos P, Kostis E, Gavrili S, Kossyvakis A, Theodoridou M, Mentis A, Drakakis P, Loutradis D, Rodolakis A. Effectiveness of quadrivalent influenza vaccine in pregnant women and infants, 2018-2019. Vaccine 2020; 38:4625-4631. [PMID: 32402751 DOI: 10.1016/j.vaccine.2020.04.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 01/01/2023]
Abstract
Influenza is associated with an increased risk for serious illness, hospitalization and/or death in pregnant women and young infants. We prospectively studied the effectiveness of a quadrivalent inactivated influenza vaccine (QIV) in pregnant women and their infants during the 2018-2019 influenza season. A QIV was offered to pregnant women cared in a maternity hospital in Athens. Women were contacted weekly by telephone during the influenza season and PCR test was offered to women or infants who developed influenza-like illness (ILI). We studied 423 pregnant women and 446 infants. Unvaccinated pregnant women had a 7.5% probability to develop laboratory-confirmed influenza compared to 2.1% among vaccinated women (Odds ratio: 3.6; confidence intervals: 1.14-11.34, p-value = 0.029). Infants whose mothers were not vaccinated had a 7.9% probability to develop laboratory-confirmed influenza compared to 2.8% among infants of vaccinated mothers (Odds ratio = 2.849, confidence intervals: 0.892-9.102, p-value = 0.053). Cox regression analyses showed that QIV vaccination was significantly associated with a decreased probability for laboratory-confirmed influenza, ILI, healthcare seeking and hospitalization among pregnant women and a decreased probability for laboratory-confirmed influenza, healthcare seeking and prescription of antibiotics among infants. The effectiveness of QIV against laboratory-confirmed influenza was 72% among pregnant women and 64.5% among infants during the 2018-2019 influenza season. Vaccination of pregnant women with the QIV was associated with a lower risk for laboratory-confirmed influenza for them and their infants during the influenza season. Our findings strongly support the World Health Organization recommendations for vaccinating pregnant women against influenza.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece.
| | - George Asimakopoulos
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Sofoklis Stavrou
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - George Daskalakis
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Pelopidas Koutroumanis
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Michael Sindos
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Marianna Theodora
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Panos Katerelos
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | - Stavroula Gavrili
- Neonatal Intensive Care Unit, Alexandra General Hospital, Athens, Greece
| | - Athanassios Kossyvakis
- National Influenza Reference Laboratory of Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, National Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Andreas Mentis
- National Influenza Reference Laboratory of Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Petros Drakakis
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Gynecology and Obstetrics, National Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
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Pal S, Hartley P, Salmasi Y, Asimakopoulos G. Establishing the Safety of Training in Off-Pump Coronary Artery Bypass Surgery: A Retrospective Comparison of Outcomes between Trainees and a Consultant Surgeon. Thorac Cardiovasc Surg 2020; 68:674-678. [PMID: 32199404 DOI: 10.1055/s-0040-1701668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The safety of training in off-pump coronary artery bypass (OPCAB) surgery and the stage at which trainees should be exposed to this technique remain controversial. This single-center retrospective study aimed to compare outcomes of OPCAB surgery in consultant and trainee cases. METHODS Between 2014 and 2018, all isolated OPCAB operations performed under the care of a consultant surgeon (G.A.) were analyzed. Cases where a surgeon below consultant grade performed at least 70% of the distal anastomoses were designated as "trainee cases" with the remaining cases designated as "consultant cases." The baseline characteristics of patients, perioperative data, and short-term outcomes were prospectively collated and analyzed. RESULTS During the study period, 245 OPCAB cases were identified: 142 (58%) consultant and 103 (42%) trainee cases. The trainee cases were performed exclusively by trainees in the final 2 years of the UK National Cardiothoracic Training Program. Both trainee and consultant groups had low mortality with two perioperative deaths occurring in either group. The rates of serious postoperative complications including stroke (n = 1 vs. 2, p = 0.759), resternotomy for bleeding (n = 3 vs. 7, p = 0.431), and mediastinal infection (n = 2 vs. 3, p = 0.926) were low and not significantly different between the two groups. Patients operated on by trainees had a slightly longer hospital stay than those operated on by the consultant surgeon, although this did not reach statistical significance (9.9 vs. 7.9 days). CONCLUSIONS These results demonstrate comparable outcomes in OPCAB surgery between a consultant surgeon and trainees. This study supports the conclusion that training surgeons in OPCAB is appropriate for trainees in the final years of cardiac surgery training.
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Affiliation(s)
- Soumik Pal
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Philip Hartley
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.,Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Yousuf Salmasi
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - George Asimakopoulos
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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32
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Muretti M, Elmahdy W, Ttofi I, Mozalbat D, Murphy M, Asimakopoulos G, Rosendahl U. Surgical Repair of Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm in a High-Risk Patient 13 Years after Aortic Root Replacement. Tex Heart Inst J 2019; 46:147-150. [PMID: 31236084 DOI: 10.14503/thij-17-6493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pseudoaneurysms of the mitral-aortic intervalvular fibrosa are rare complications that can develop after mitral or aortic valve surgery, endocarditis, or Takayasu arteritis. The optimal timing of surgery to avoid potentially life-threatening complications of pseudoaneurysms has not been established, and watchful waiting has been adopted in specific situations. We describe the case of a 50-year-old man in whom a pseudoaneurysm of the mitral-aortic intervalvular fibrosa developed after aortic root replacement with a homograft. After 13 years of watchful waiting, reoperation was deemed necessary because the pseudoaneurysm had grown to 48 mm and the aortic regurgitation caused by the degenerated homograft had become severe. This case highlights the need for increased awareness of mitral-aortic intervalvular fibrosa pseudoaneurysms and their management.
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33
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Vaja R, Talukder S, Norkunas M, Hoffman R, Nienaber C, Pepper J, Rosendahl U, Asimakopoulos G, Quarto C. Impact of a streamlined rotational system for the management of acute aortic syndrome: sharing is caring†. Eur J Cardiothorac Surg 2018; 55:984-989. [DOI: 10.1093/ejcts/ezy386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ricky Vaja
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Shagorika Talukder
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Mindaugas Norkunas
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Ross Hoffman
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Christoph Nienaber
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - John Pepper
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Ulrich Rosendahl
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - George Asimakopoulos
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
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Mitsis A, Yuan X, Christodoulou E, Semple T, Murphy M, Asimakopoulos G, Nienaber CA. Right ventricular dysfunction 10 years following a Bentall procedure. J Card Surg 2018; 33:563-564. [PMID: 30136319 DOI: 10.1111/jocs.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andreas Mitsis
- Cardiology and Aortic Centre, Royal Brompton Hospital and National Heart and Lung Institute of Imperial College London, Sydney Street, London, UK
| | - Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton Hospital and National Heart and Lung Institute of Imperial College London, Sydney Street, London, UK
| | | | - Thomas Semple
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Michael Murphy
- Cardiothoracic Department, Royal Brompton Hospital, London, UK
| | | | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton Hospital and National Heart and Lung Institute of Imperial College London, Sydney Street, London, UK
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Gambaro A, Murphy MO, Duncan A, Pepper J, Quarto C, Rosendahl U, Moat N, Asimakopoulos G. P5471Stroke volume index of sutureless, trans-catheter and stented pericardial valves in the early postoperative period - A propensity matched analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Gambaro
- Royal Brompton Hospital, London, United Kingdom
| | - M O Murphy
- Royal Brompton Hospital, London, United Kingdom
| | - A Duncan
- Royal Brompton Hospital, London, United Kingdom
| | - J Pepper
- Royal Brompton Hospital, London, United Kingdom
| | - C Quarto
- Royal Brompton Hospital, London, United Kingdom
| | - U Rosendahl
- Royal Brompton Hospital, London, United Kingdom
| | - N Moat
- Royal Brompton Hospital, London, United Kingdom
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Pirola S, Jarral OA, O'Regan DP, Asimakopoulos G, Anderson JR, Pepper JR, Athanasiou T, Xu XY. Computational study of aortic hemodynamics for patients with an abnormal aortic valve: The importance of secondary flow at the ascending aorta inlet. APL Bioeng 2018; 2:026101. [PMID: 31069298 PMCID: PMC6481743 DOI: 10.1063/1.5011960] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/06/2018] [Indexed: 12/05/2022] Open
Abstract
Blood flow in the aorta is helical, but most computational studies ignore the presence of secondary flow components at the ascending aorta (AAo) inlet. The aim of this study is to ascertain the importance of inlet boundary conditions (BCs) in computational analysis of flow patterns in the thoracic aorta based on patient-specific images, with a particular focus on patients with an abnormal aortic valve. Two cases were studied: one presenting a severe aortic valve stenosis and the other with a mechanical valve. For both aorta models, three inlet BCs were compared; these included the flat profile and 1D through-plane velocity and 3D phase-contrast magnetic resonance imaging derived velocity profiles, with the latter being used for benchmarking. Our results showed that peak and mean velocities at the proximal end of the ascending aorta were underestimated by up to 41% when the secondary flow components were neglected. The results for helical flow descriptors highlighted the strong influence of secondary velocities on the helical flow structure in the AAo. Differences in all wall shear stress (WSS)-derived indices were much more pronounced in the AAo and aortic arch (AA) than in the descending aorta (DAo). Overall, this study demonstrates that using 3D velocity profiles as inlet BC is essential for patient-specific analysis of hemodynamics and WSS in the AAo and AA in the presence of an abnormal aortic valve. However, predicted flow in the DAo is less sensitive to the secondary velocities imposed at the inlet; hence, the 1D through-plane profile could be a sufficient inlet BC for studies focusing on distal regions of the thoracic aorta.
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Affiliation(s)
- S Pirola
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - O A Jarral
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London W2 1NY, United Kingdom
| | - D P O'Regan
- Institute of Clinical Science, Imperial College London, Hammersmith Hospital, London W12 0HS, United Kingdom
| | - G Asimakopoulos
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, United Kingdom
| | - J R Anderson
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, United Kingdom
| | - J R Pepper
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, United Kingdom
| | - T Athanasiou
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London W2 1NY, United Kingdom
| | - X Y Xu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
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Vassiliou VS, Wassilew K, Cameron D, Heng EL, Nyktari E, Asimakopoulos G, de Souza A, Giri S, Pierce I, Jabbour A, Firmin D, Frenneaux M, Gatehouse P, Pennell DJ, Prasad SK. Identification of myocardial diffuse fibrosis by 11 heartbeat MOLLI T 1 mapping: averaging to improve precision and correlation with collagen volume fraction. MAGMA 2018; 31:101-113. [PMID: 28608326 PMCID: PMC5813064 DOI: 10.1007/s10334-017-0630-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/04/2017] [Accepted: 05/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Our objectives involved identifying whether repeated averaging in basal and mid left ventricular myocardial levels improves precision and correlation with collagen volume fraction for 11 heartbeat MOLLI T 1 mapping versus assessment at a single ventricular level. MATERIALS AND METHODS For assessment of T 1 mapping precision, a cohort of 15 healthy volunteers underwent two CMR scans on separate days using an 11 heartbeat MOLLI with a 5(3)3 beat scheme to measure native T 1 and a 4(1)3(1)2 beat post-contrast scheme to measure post-contrast T 1, allowing calculation of partition coefficient and ECV. To assess correlation of T 1 mapping with collagen volume fraction, a separate cohort of ten aortic stenosis patients scheduled to undergo surgery underwent one CMR scan with this 11 heartbeat MOLLI scheme, followed by intraoperative tru-cut myocardial biopsy. Six models of myocardial diffuse fibrosis assessment were established with incremental inclusion of imaging by averaging of the basal and mid-myocardial left ventricular levels, and each model was assessed for precision and correlation with collagen volume fraction. RESULTS A model using 11 heart beat MOLLI imaging of two basal and two mid ventricular level averaged T 1 maps provided improved precision (Intraclass correlation 0.93 vs 0.84) and correlation with histology (R 2 = 0.83 vs 0.36) for diffuse fibrosis compared to a single mid-ventricular level alone. ECV was more precise and correlated better than native T 1 mapping. CONCLUSION T 1 mapping sequences with repeated averaging could be considered for applications of 11 heartbeat MOLLI, especially when small changes in native T 1/ECV might affect clinical management.
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Affiliation(s)
- Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, Norwich Research Park, Norwich, NR4 7UQ, UK.
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- Imperial College, National Heart and Lung Institute, London, UK.
| | - Katharina Wassilew
- The Pathology Department, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Donnie Cameron
- Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Ee Ling Heng
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Evangelia Nyktari
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - George Asimakopoulos
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Anthony de Souza
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | | | - Iain Pierce
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Andrew Jabbour
- Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia
| | - David Firmin
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Michael Frenneaux
- Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Peter Gatehouse
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Dudley J Pennell
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Sanjay K Prasad
- CMR Unit and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, National Heart and Lung Institute, London, UK
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Vassiliou V, Wassilew K, Asimakopoulos G, Souza AD, Quarto C, Heng EL, Raphael CE, Spottiswoode BS, Greiser A, Nyktari E, Alpendurada F, Firmin D, Jabbour A, Pepper J, Pennell DJ, Gatehouse P, Prasad S. Histological validation of a new CMR T1-mapping-based protocol to improve accuracy for fibrosis assessment in patients with aortic stenosis. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032424 DOI: 10.1186/1532-429x-18-s1-q56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Konstantinidou MK, Nelson M, Rosendahl U, Asimakopoulos G. Giant cell aortitis in treatment-naive human immunodeficiency virus and hepatitis C coinfection. Ann R Coll Surg Engl 2016; 98:e192-e194. [PMID: 27502343 DOI: 10.1308/rcsann.2016.0247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/22/2022] Open
Abstract
Giant cell arteritis is a common form of vasculitis, although involvement of the aorta is unusual. There is no established association between giant cell aortitis and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. We present the case of a 46-year-old female coinfected with HIV and HCV who had never received antiretroviral therapy and developed symptoms of deteriorating shortness of breath on exertion. Investigations demonstrated aortic root and ascending aorta dilatation, along with severe aortic valve regurgitation, for which the patient underwent valve-sparing aortic root replacement (a David procedure). Histopathology confirmed giant cell aortitis.
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Affiliation(s)
| | - M Nelson
- Chelsea and Westminster Hospital , UK
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Nesbitt JJ, Mori G, Mason-Apps C, Asimakopoulos G. Comparison of early and late quality of life between left anterior thoracotomy and median sternotomy off-pump coronary artery bypass surgery. Perfusion 2016; 32:50-56. [PMID: 27440802 DOI: 10.1177/0267659116657166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Abstract
OBJECTIVE Minimally invasive coronary artery bypass surgery performed through a left thoracotomy has potential benefits over conventional sternotomy, including reduced surgical trauma, faster recovery and potential improvement in quality of life. This study is a prospective assessment of quality of life in patients undergoing off-pump coronary bypass by median sternotomy and left anterior thoracotomy. METHODS Quality of life was assessed by the EuroQoL questionnaire, with additional questions on dyspnoea, angina, wound pain and scar aesthetics. Outcomes were compared across the data sets at pre-operation, three weeks and three months post-operation. RESULTS Sixty-six (17 minimally invasive and 49 off-pump) patients (mean age 65±12, 7 females and 59 males) were included. Significant differences in mean EuroQol outcomes were observed for activities, F(1,64) = 5.86, (p<0.05), pain scores, F(1,64) = 4.658 (p=0.035) and scar aesthetics, F(1,64) = 16.83 (p<0.05). There was an additional significant interaction, F(1.898, 121.49) = 3.282, (p<0.05), between time and group for activity levels; exploring this further indicated no significant difference at baseline, but significantly greater improvement observed in the minimally invasive group over time. At 3 weeks, 50% of minimally invasive patients compared to 82% of sternotomy patients (p<0.001) required oral analgesia. At 3 months, 8% of minimally invasive patients and 21% of sternotomy patients (p<0.001) required oral analgesia. CONCLUSIONS Off-pump coronary artery bypass performed with a minimally invasive approach through a left thoracotomy appears to result in earlier improvement in quality of life outcomes compared to conventional sternotomy. These results are important when counselling patients regarding the benefits and difference between a left anterior thoractomy MIDCABG and conventional OPCAB and can be used as pilot data for a larger trial examining differences in the MIDCABG and conventional full sternotomy OPCAB procedures.
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Affiliation(s)
- Julian J Nesbitt
- 1 Great Western Hospital, Swindon, UK.,2 University of Bristol, UK
| | - George Mori
- 3 Yorkshire and Humber School of Surgery, Yorkshire, UK
| | | | - George Asimakopoulos
- 2 University of Bristol, UK.,4 Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK
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Abstract
Lung carcinoma is the most frequently diagnosed malignancy in the world, with the incidence increasing through the 20th century. Presentation may be as a tumor mass primarily obstructing the central bronchial lumen, or a mass infiltrating lung tissue. Cryosurgery can be used as a method of palliative treatment for both these endobronchial and extra-bronchial presentations. The aim of this study is two-fold: to present data relating to our extensive experience in treating obstructing endobronchial tumors and to present our initial results of direct cryosurgery to infiltrating lung tumor masses. During a nine-year period, 521 consecutive patients (male:female ratio 1.8:1) with a mean age of 67.9 years who had advanced obstructive tracheobronchial malignant tumors underwent cryosurgery with a mean of 2.4 treatments per patient. Hemoptysis, cough, dyspnoea and chest pain improved by at least one class in 76.4%, 69.0%, 59.25% and 42.6% (p<0.01) of symptomatic patients respectively. Quality of life studies showed that the mean Karnofsky score improved from 60 ± 7 to 75 ± 8 and the mean WHO score from 3.04 ± 0.7 to 2.20 ± 0.56. There were 7 (1.2%) in-hospital deaths, and 2-year survival was 15.9%. Direct cryosurgery to carcinoma of the lung was performed on 15 patients at exploratory thoracotomy. Results showed an increase in FEV1 from 1.80 ± 0.6 liters to 1.95 ± 0.8 (8.3%) liters and in FVC from 2.50 ± 0.8 to 2.68 ± 0.8 liters (7.2%). The Karnofsky score improved from 68 ± 9 to 78 ± 10 and the WHO score from 2.63 ± 0.81 to 2.38 ± 0.78 (9.6%). Major symptoms including cough, dyspnoea, and hemoptysis were assessed and showed improvement in 77.8%, 66.7%, and 100% (p<0.01) of symptomatic patients respectively. Patients were followed for a mean period of 18 months (range 4–84 months). Median survival from the date of surgery (Kaplan-Meier, 95%Cl) was 11.6 (6.8 to 18.2) months, range 1 to 84 months. Cryosurgery provides a safe and effective method for the palliation of advanced central bronchial obstructive tumors, and compares favorably with other methods in terms of safety, cost, and complications. Initial experience suggests that similar palliation may be achieved by cryosurgery applied to advanced parenchymal tumor masses.
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Affiliation(s)
- M O Maiwand
- Department of Thoracic Surgery, Harefield Hospital, Harefield, Middlesex, England.
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Bakos Z, Harnek J, Jenkins N, Johnson T, Strange J, Asimakopoulos G, Baumbach A, Kliger C, Ruiz CE. How should I treat an accidentally misplaced 8 Fr drainage catheter in the right ventricle? EUROINTERVENTION 2015; 10:768-70. [PMID: 24682506 DOI: 10.4244/eijv10i61a131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Zoltan Bakos
- Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden
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Smith TA, Asimakopoulos G. How safe is it to train residents to perform off-pump coronary artery bypass surgery? Interact Cardiovasc Thorac Surg 2015; 20:658-61. [PMID: 25662959 DOI: 10.1093/icvts/ivu447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 12/19/2014] [Indexed: 11/12/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in [patients undergoing off-pump CABG] are [postoperative mortality and morbidity outcomes] acceptable when performed by [trainees]? Altogether more than 597 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. Six retrospective cohort studies directly compared the performance of trainees and experienced surgeons in off-pump coronary artery bypass graft surgery. Of the remaining papers, one recorded the performance of trainees in on- and off-pump operations and finally one paper evaluated a single trainee's performance in off-pump coronary artery bypass graft surgery, both supervised and unsupervised, over a 1-year period. It is important to note that the two respective cohort studies included in our analysis compared similar cohorts of patients. However, both studies were included in our paper as they provide additional information regarding trainee performance. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Although a heterogeneous range of postoperative complications were recorded in the identified studies, we were able to determine that, overall, there was no significant difference in the 30-day mortality seen in operations performed by trainees or experienced surgeons. The incidence of myocardial infarction and stroke were also similar among cases performed by both groups. However, senior surgeons were more likely to operate on patients with more complex or severe disease, or those requiring more urgent operations. Therefore, it was not possible to directly compare outcomes between trainees and experienced surgeons in operations of similar complexity. However, we conclude that despite the absence of randomized controlled trials comparing the performance of trainees and experienced surgeons in off-pump coronary artery bypass (OPCAB) surgery, the evidence provided in this paper supports the involvement of trainees in performing off-pump coronary artery bypass graft surgery as a reliable and safe alternative to on-pump coronary artery bypass graft surgery in selected cases.
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Dimarakis I, Grant S, Corless R, Velissaris T, Prince M, Bridgewater B, Asimakopoulos G. Impact of hepatic cirrhosis on outcome in adult cardiac surgery. Thorac Cardiovasc Surg 2014; 63:58-66. [PMID: 25291160 DOI: 10.1055/s-0034-1389084] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Increasing prevalence of hepatic disease is likely to translate in a growing number of patients with significant hepatic disease requiring cardiac surgery. Available cardiac risk stratification models do not address the risk associated with hepatic disease. However, weighted mean mortality rates based on previous studies of cardiac surgery in patients with hepatic disease demonstrate operative mortality rates that range from 9.88% (standard deviation [SD] 9.69) for patients in Child-Turcotte-Pugh (CTP) class A cirrhosis to 69.23% (SD 28.55) for patients with CTP class C cirrhosis. This review comprehensively appraises the pathophysiology of hepatic disease, reported clinical outcomes and considerations for risk stratification.
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Affiliation(s)
- Ioannis Dimarakis
- Department of Cardiothoracic Surgery, University Hospital South Manchester, Manchester, United Kingdom
| | - Stuart Grant
- Department of Cardiothoracic Surgery, University Hospital South Manchester, Manchester, United Kingdom
| | - Rebecca Corless
- Department of Clinical Oncology Research, University Hospital South Manchester, Manchester, United Kingdom
| | - Theodore Velissaris
- Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Martin Prince
- Department of Gastroenterology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ben Bridgewater
- Department of Cardiothoracic Surgery, University Hospital South Manchester, Manchester, United Kingdom
| | - George Asimakopoulos
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol, Bristol, United Kingdom
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Gibbison B, Walker J, Russell G, Stevenson K, Kershaw Y, Asimakopoulos G, Angelini GD, Lightman SL. Cardiac surgery alters the sensitivity of the dynamic interaction between the pituitary and adrenal glands. Crit Care 2014. [PMCID: PMC4069468 DOI: 10.1186/cc13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Birla R, Patel P, Aresu G, Asimakopoulos G. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Ann R Coll Surg Engl 2013; 95:481-5. [PMID: 24112493 PMCID: PMC5827271 DOI: 10.1308/003588413x13629960047119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. METHODS Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. RESULTS Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). CONCLUSIONS MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.
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Dooley A, Asimakopoulos G. Does a minimally invasive approach result in better pulmonary function postoperatively when compared with median sternotomy for coronary artery bypass graft? Interact Cardiovasc Thorac Surg 2013; 16:880-5. [PMID: 23442936 DOI: 10.1093/icvts/ivt035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 11/14/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does a minimally invasive approach result in better pulmonary function postoperatively when compared with median sternotomy for coronary artery bypass graft?'. Procedures such as limited sternotomy and minimally invasive direct coronary artery bypass (MIDCAB) though a minithoracotomy were regarded as minimally invasive. Overall, 681 papers were found, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, evidence level, relevant outcomes and results of these papers were tabulated. Three randomized, controlled trials (RCT) were included: One study suggested that ministernotomy dividing the corpus sterni (n = 50) offers no advantage over standard sternotomy (n = 50) during the first 10 postoperative days. Two further studies reported on minithoracotomy: one trial presented data suggesting that minithoracotomy (n = 21) is as safe as standard sternotomy with (n = 18) or without (n = 19) cardiopulmonary bypass, but without the benefit ascribed to the minimally invasive incision. A two-centre report investigated pulmonary function as a secondary outcome and claimed that minithoracotomy worsens FEV1 and FVC. The study was not powered to detect these differences as pulmonary function data were available only for one of the centres. Five non-randomized reports were also included in this analysis: These investigated outcomes after minithoracotomy or limited sternotomy compared with standard sternotomy. Patient groups were small, involving <20 subjects per group. Non-randomized studies suggested a benefit to postoperative lung function in using thoracotomy. One of these reports included only patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 <70% of predicted) and detected benefits in selected patients undergoing MIDCAB. A further study was in agreement with the above statement in patients without COPD. MIDCAB may be more painful initially, but results in quicker recovery of lung function. Demonstrating the benefits of ministernotomy compared with the standard sternal incision was less clear. One paper demonstrates better outcomes when compared with standard sternotomy, while another reports no difference. We conclude that non-randomized studies support the hypothesis that minimally invasive coronary artery bypass benefits postoperative lung function in patients with known respiratory problems.
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Abstract
Objectives: We describe our ten-year experience with surgery for isolated tricuspid valve (TV) infective endocarditis. Methods: Data were collected through a retrospective patient record review. Between 1999 and 2009, 13 (4.6%) patients had isolated TV surgery. The mean age was 40+/-15 years and there were nine male patients and 4 female patients. Eight (61%) patients were previous intravenous drug users. Indications for surgery included severe TV regurgitation (n=5), uncontrolled infection (n=4), septic pulmonary emboli (n=3) and TV stenosis (n=1). Staphylococcus aureus (n=3) and gram negative organisms (n=2) were isolated pre-operatively. Eleven patients had replacement surgery while two valves were repaired. Results: There were no hospital deaths. Post-operative complications included new atrial fibrillation (n=5), re-operation (n=2), permanent pacemaker (n=2), and renal dialysis (n=1). Five (38%) patients died during the follow-up period. Cause of death was cardiac related in four patients. Actuarial survival was 63.1% at 3 years and 50.4% at 5 years. One patient developed recurrent TV endocarditis. There were no further cases of prosthetic valve failure. TV regurgitation remained trivial in both repaired valves. Conclusions: Surgery for isolated TV endocarditis is often associated with previous intravenous drug use. The procedure can be performed with acceptable hospital morbidity and no mortality. Late mortality is high, despite the young age of the patients.
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Affiliation(s)
- R. Capoun
- Bristol Heart Institute University Hospitals Bristol NHS Foundation Trust Bristol, UK
| | - M. Thomas
- Bristol Heart Institute University Hospitals Bristol NHS Foundation Trust Bristol, UK
| | - M. Caputo
- Bristol Heart Institute University Hospitals Bristol NHS Foundation Trust Bristol, UK
| | - G. Asimakopoulos
- Bristol Heart Institute University Hospitals Bristol NHS Foundation Trust Bristol, UK,
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Akowuah E, Asimakopoulos G. Does Statin Treatment Really Remove the Need for Bilateral Internal Thoracic Artery Grafts? Ann Thorac Surg 2010; 89:1703; author reply 1704. [DOI: 10.1016/j.athoracsur.2009.11.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 11/05/2009] [Accepted: 11/30/2009] [Indexed: 11/25/2022]
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50
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Shaikhrezai K, Tasca G, Amrani M, Dreyfus G, Asimakopoulos G. Third-Time Aortic Valve Replacement: Patient Characteristics and Operative Outcome. Ann Thorac Surg 2010; 89:479-83. [DOI: 10.1016/j.athoracsur.2009.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 04/12/2009] [Accepted: 04/14/2009] [Indexed: 11/29/2022]
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