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Abdelbar A, Knowles A, Zacharias J. Fourth Cardiac Procedure: Redo Endoscopic Mitral Surgery for a Stuck Leaflet. Innovations (Phila) 2024; 19:124. [PMID: 38576088 DOI: 10.1177/15569845241239015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Elhassan H, Abdelbar A, Taylor R, Laskawski G, Saravanan P, Knowles A, Zacharias J. A Propensity Score Analysis of Early and Long-Term Outcomes of Retrograde Arterial Perfusion for Endoscopic and Minimally Invasive Heart Valve Surgery in Both Young and Elderly Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9020044. [PMID: 35200698 PMCID: PMC8879712 DOI: 10.3390/jcdd9020044] [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] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Minimal invasive cardiac surgery via right anterolateral thoracotomy for heart valve surgery and other intracardiac procedures proven to have lower postoperative complications. We aim to compare the neurological complications and post-operative outcomes in two cohort groups as well as survival rates up to 5 years postoperatively; (2) Methodology: Retrospective observational study for patients who had minimally invasive cardiac valve surgery with retrograde femoral arterial perfusion between 2007 and 2021 (n = 596) and the categorized patients into two groups based on their age (≥70 years old and below 70). Propensity match analysis was conducted. The primary endpoint consisted of major postoperative complications and the secondary endpoint was the long-term survival rate. (3) Results: There was no difference between the two groups in terms of postoperative outcomes. Patients ≥ 70 years old had no increased risk for neurological complications (p = 0.75) compared with those below 70 years old. The mortality rate was also not significant between the two groups (p = 0.37) as well as the crude survival rates. (4) Conclusions: The use of retrograde femoral arterial perfusion in elderly patients is not associated with increased risk compared to the younger patients’ group for a spectrum of primary cardiac valve procedures. Hence, minimally invasive approaches could be offered to elderly patients who might benefit from it.
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Abstract
Primary cardiac tumours for which surgical resection is the main stay of treatment are rare and present both diagnostic and management challenges. The majority of patients are asymptomatic and one third of those who have symptoms present with vague constitutional symptoms which further complicates the process of early diagnosis. The current state-of-the art multi-modality imaging, routine use of intra-operative transoesophageal echocardiogram (TOE) in most cardiac centres and the tremendous advances of endoscopic adjuncts greatly enhances both the diagnosis and management of those group of patients. The surgical burden of median sternotomy and the contemporary trend towards less invasive surgery urged the necessity for adopting minimally invasive surgery in general and cardiac tumours are no exception. Despite the rarity of theses tumours, minimally invasive resection is successful in the hands of experienced minimally invasive surgeons who employ the same minimal access valve surgery platform to access the tumours in various cardiac chambers and valves with no compromise to the oncological clearance and hence achieve the benefits of minimally invasive surgery without compromising long term outcomes.
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Affiliation(s)
- Ayman Kenawy
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Abdelrahman Abdelbar
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
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Abstract
Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.
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Affiliation(s)
- Abdelrahman Abdelbar
- Department of Cardiothoracic surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Ayman Kenawy
- Department of Cardiothoracic surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
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Laskawski G, Abdelbar A, Zacharias J. An endoscopic repair of residual post-myocardial infarction ventricular septal defect. Interact Cardiovasc Thorac Surg 2020; 31:580-582. [PMID: 33091930 DOI: 10.1093/icvts/ivaa127] [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] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
Post-myocardial infarction (MI) ventricular septal defect (VSD) is a serious condition that is, fortunately, less diagnosed nowadays due to the advances in early diagnosis and treatment of ischaemic heart disease (incidence 1-2%). Despite the lower mortality of both surgical and interventional closure of the defect (25%) as compared to medical therapy (40-50%), there are still risks of residual leak in both approaches. Herein, we describe a case of a successful endoscopic-assisted repair of a delayed residual leak post-MI VSD after surgical repair. An attempt for interventional closure of the leaking point had failed; an endoscopic-assisted minimal access closure was successfully performed.
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Affiliation(s)
- Grzegorz Laskawski
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, UK.,Department of Cardiothoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Abdelrahman Abdelbar
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, UK
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Kenawy A, Abdelbar A, Tennyson C, Taylor R, Zacharias J. Is it safe to move away from a full sternotomy for aortic valve replacement? Asian Cardiovasc Thorac Ann 2020; 28:553-559. [PMID: 32727206 DOI: 10.1177/0218492320948321] [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: 11/17/2022]
Abstract
BACKGROUND Minimally invasive surgical approaches have gained popularity among patients and surgeons. The aim of this project was to assess the safety of initiating aortic valve replacement via an anterior right thoracotomy program. METHODS Between May 2015 and May 2019, data of all isolated primary aortic valve replacements were extracted retrospectively from our prospectively collected database and categorized into conventional median sternotomy, hemisternotomy, and anterior right thoracotomy cases. In total, 661 patients underwent isolated primary aortic valve replacement, of whom 429 (65%) had a median sternotomy, 126 (19%) had a hemisternotomy, and 106 (16%) had an anterior right thoracotomy. Preoperative characteristics were similar in each of the three groups. Statistical testing of the surgical groups was undertaken using the chi-square test for categorical variables and one-way analysis of variance with Tukey post-hoc pairwise tests (where appropriate) for continuous variables, to identify differences between pairs of data. RESULTS Cardiopulmonary bypass and crossclamp times were significantly longer in the anterior right thoracotomy group compared to the hemisternotomy and median sternotomy groups (p < 0.001). Blood loss was significantly less and hospital stay significantly shorter in the hemisternotomy group compared to median sternotomy group but not the anterior right thoracotomy group. Mortality, stroke, renal, gastrointestinal and respiratory complications showed no statistical differences. CONCLUSION Surgical aortic valve replacement had a very low mortality and morbidity in our experience, and it is safe to start a minimal access program for aortic valve replacement.
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Affiliation(s)
- Ayman Kenawy
- Department of Cardiothoracic surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - Abdelrahman Abdelbar
- Department of Cardiothoracic surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - Charlene Tennyson
- Department of Cardiothoracic surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - Rebecca Taylor
- Clinical Research Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic surgery, Blackpool Victoria Hospital, Blackpool, UK
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Abdelbar A, Niranjan G, Tynnson C, Saravanan P, Knowles A, Laskawski G, Zacharias J. Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option. Innovations (Phila) 2020; 15:66-73. [PMID: 31903869 DOI: 10.1177/1556984519887946] [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] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Isolated tricuspid surgery through median sternotomy can be associated with a high morbidity and mortality. Reports of minimally invasive isolated tricuspid valve operations are rare, but the outcomes are encouraging. We present our experience of endoscopic isolated tricuspid valve surgery. METHODS In our institution, 452 patients underwent endoscopic minimal access cardiac surgery between August 2008 and December 2018. A total of 90 patients underwent tricuspid valve surgery whether isolated or with other cardiac procedure. We further selected patients who had isolated tricuspid valve surgery (n = 24). Of these patients, 13 (54%) had more than one previous sternotomy. RESULTS Tricuspid repair was performed in 18 patients (75%) with the remaining 6 (25%) having bioprosthetic tricuspid replacement. Three (12.5%) were performed with a beating heart, the remaining with endoaortic clamping and cardioplegia. There were no conversions to sternotomy. None of the patients had reoperation for bleeding, tamponade, or valve issues. Three patients (12.5%) required blood transfusion, 3 patients (12.5%) required renal dialysis, and 7 patients (29%) had respiratory complications such as chest infection, requiring continuous positive airway pressure (CPAP) with 2 being re-intubated. One patient (4.1%) died within 30 days from chest sepsis leading to multi-organ failure. Mean hospital stay was 11.1 ± 8.9 days (median of 8). All patients had mild or less regurgitation on follow-up echo at 6 months. CONCLUSIONS Isolated tricuspid valve surgery can be performed through an endoscopic minimally access approach, with good results. It appears to provide better results than a sternotomy approach. A high repair rate can be achieved, and the procedure is particularly valuable in redo-surgery with low mortality and morbidity compared to historical sternotomy case series.
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Affiliation(s)
- Abdelrahman Abdelbar
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Gunaratnam Niranjan
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Charlene Tynnson
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Palanikumar Saravanan
- 171993 Department of Cardiothoracic Anaesthesia, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Andrew Knowles
- 171993 Department of Cardiothoracic Anaesthesia, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Grzegorz Laskawski
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK.,171993 Department of Cardiovascular Surgery, Medical University of Gdansk, Poland
| | - Joseph Zacharias
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
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Abdelbar A, Knowles A, Sanjeev Kumar BT, Zacharias J. An Endoscopic Solution to Mitral Regurgitation in a Complex Patient With Marfan Syndrome. Innovations (Phila) 2019; 14:569-572. [PMID: 31530070 DOI: 10.1177/1556984519874799] [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
Cardiac presentations of Marfan syndrome are not uncommon. Patients with Marfan syndrome can present with aortic pathology, valvular pathology, or both. Hence, Marfan syndrome patients can undergo more than one cardiac surgery in their lifetime. Endoscopic mitral valve surgery can be a good alternative to redo sternotomy. We present a case of a 77-year-old woman who had an aortic root replacement and replacement of the ascending aorta. She presented to our center 13 years later with severe mitral regurgitation. Femoral cannulation for cardiopulmonary bypass was not possible due to the presence of a type B aortic dissection that occurred sometime after the initial procedure. Mitral valve replacement was performed with an empty beating heart using axillary artery inflow with an excellent result.
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Affiliation(s)
| | - Andrew Knowles
- Department of Cardiothoracic Anaesthesia, Blackpool Victoria Teaching Hospital, UK
| | | | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Blackpool Victoria Teaching Hospital, UK
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Azzam R, Abdelbar A, Brazier A, Kirmani BH, Hasan R. Acute gastric obstruction following cardiopulmonary bypass in a patient with an adjustable gastric band. J Cardiothorac Surg 2015; 10 Suppl 1:A170. [PMID: 26739499 PMCID: PMC4693822 DOI: 10.1186/1749-8090-10-s1-a170] [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: 11/24/2022] Open
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Abdelbar A, Schmitt M, Jenkins P, Hoschtitzky JA. Intracardiac extension of uterine leiomyomatosis. BMJ Case Rep 2015; 2015:bcr-2014-209278. [PMID: 26055596 DOI: 10.1136/bcr-2014-209278] [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: 11/04/2022] Open
Affiliation(s)
| | - Matthias Schmitt
- Department of Cardiac Imaging, South Manchester University Hospital, Manchester, UK
| | - Petra Jenkins
- Department of Cardiac Surgery, Northwest Adult Congenital Heart Disease, Manchester, UK
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Azzam R, Abdelbar A, Yap KH, Abousteit A. Carney complex: fourth time excision of recurrent atrial myxoma via left thoracotomy. BMJ Case Rep 2014; 2014:bcr-2013-201827. [PMID: 24789151 DOI: 10.1136/bcr-2013-201827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 51-year-old male patient with a known history of Carney complex, who was operated on for the fourth time due to recurrent left atrial myxomas. Despite surgical challenge, the operation was uneventful. The patient had a difficult postoperative period and needed further treatment for complications. After a prolonged recovery, he is currently well and remains myxoma-free up until now (36 months postsurgery) with regular follow-up using cardiac CT and transthoracic echocardiogram.
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Affiliation(s)
- Raed Azzam
- Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester, UK
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Abdelbar A, Mahadevan VS, Austin C, Hoschtitzky JA. Late bidirectional glenn anastomosis in a 54-year-old patient with unoperated functionally univentricular heart. World J Pediatr Congenit Heart Surg 2013; 4:444-6. [PMID: 24327645 DOI: 10.1177/2150135113485759] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the case of a 54-year-old patient with complex univentricular physiology who presented with worsening exercise intolerance, chronic cyanosis, and uncontrolled heart failure. Investigations included echocardiography, cardiac magnetic resonance imaging, and cardiac catheterization. After discussion in a multidisciplinary meeting, the patient underwent successful surgery that included a bidirectional Glenn anastomosis and repair of the atrioventricular (AV) junction. She recovered well and on follow-up had substantially less cyanosis and heart failure. We demonstrated that common AV valve repair and Glenn shunt can be used together successfully in appropriately selected older patients as palliation for complex congenital heart disease with functionally univentricular physiology.
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Affiliation(s)
- Abdelrahman Abdelbar
- Northwest Adult Congenital Heart Disease Unit, Manchester Heart Centre, Central Manchester Foundation Trust, Oxford Road, Manchester, United Kingdom
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Elmahy H, Abdelbar A, Schmitt M. Striking temporally dynamic ECG changes associated with recurrent chest pain in a case of myopericarditis. BMJ Case Rep 2013; 2013:bcr-2013-010012. [PMID: 23709561 DOI: 10.1136/bcr-2013-010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 33-year-old man without medical history or cardiovascular disease risk factors presented with recurrent progressively worsening chest pain that had been preceded by few days of flu like illness. His initial ECG and troponin rise supported the diagnosis of myopericarditis for which he was treated with aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) with good response initially. He later on developed severe recurrent chest pain and became tachycardic and hypotensive. Serial ECGs revealed a pattern of significant dynamic ST elevation in several leads, a pattern that is not usually seen in pericarditis. Subsequently, features of bedside echo did not support the diagnosis of acute ST-elevation myocardial infarction. The patient did well on conservative management with NSAIDs. He did not undergo urgent coronary angiography which would not have offered the patient any clinical benefit at the time and would have put him at procedural risk unnecessarily. The diagnosis of myopericarditis was confirmed retrospectively with typical features on cardiovascular magnetic resonance.
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Affiliation(s)
- Hossam Elmahy
- Department of Cardiology, Blackpool Victoria Hospital, Blackpool, UK
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Khoshbin E, Abdelbar A, Allen S, Hasan R. The mechanism of endocardial lead-induced tricuspid regurgitation. BMJ Case Rep 2013; 2013:bcr-2012-008191. [PMID: 23576646 DOI: 10.1136/bcr-2012-008191] [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: 11/03/2022] Open
Abstract
Using this case report we attempt to define the mechanism of endocardial lead-induced tricuspid regurgitation (TR) in particular the direct effect of endocardial pacing leads on the competence of the tricuspid valve. We recommend a high index of suspicion and an early diagnostic strategy in order to reduce long-term morbidity which is associated with this condition and the need for a potentially avoidable surgery.
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Affiliation(s)
- Espeed Khoshbin
- Department of Cardiac Surgery, Manchester Royal Infirmary, Manchester, UK
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Abdelbar A, Azzam R. eComment. Learning curves in coronary revascularization. Interact Cardiovasc Thorac Surg 2013; 16:208. [PMID: 23334745 DOI: 10.1093/icvts/ivs567] [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: 11/14/2022] Open
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