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Magni F, Al-Omari A, Vardanyan R, Rad AA, Honeyman S, Boukas A. An update on a persisting challenge: A systematic review and meta-analysis of the risk factors for surgical site infection post craniotomy. Am J Infect Control 2024; 52:650-658. [PMID: 37989412 DOI: 10.1016/j.ajic.2023.11.005] [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: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) postcraniotomy continue to impose a significant burden on health care systems and patient outcomes. It is, therefore, important to understand their risk factors in order to promote effective preventative measures. This meta-analysis aims to provide a comprehensive, up-to-date analysis of the risk factors associated with SSIs in neurosurgical procedures. METHODS A systematic review was conducted as per preferred reporting items for systematic reviews and meta-analysis guidelines to explore existing primary evidence on the risk factors for SSIs postcraniotomy. A comprehensive search of MEDLINE, EMBASE, and Pubmed was performed from database inception up to June 2023. 43 studies were included in the meta-analysis, encompassing a total of 68,881 patients. RESULTS The strongest predictor for SSIs was found to be cerebrospinal fluid (CSF) leak (OR: 8.91, CI: 4.30-18.44). Other significant factors included infratentorial surgery (OR: 0.43, CI: 0.31-0.61), emergency surgery (OR: 1.41, CI: 1.05-1.91), reintervention (OR: 3.19, CI: 1.77-5.75), prolonged operative time (mean difference: 33.25; CI: 18.83-47.67), hospital length of stay (mean difference: 0.60; CI: 0.23-0.98) and intracranial pressure monitor (ICPM) insertion (OR: 1.81; CI: 1.06-3.11). Contrarily, sex, body mass index (BMI), diabetes, antibiotic prophylaxis, immunosuppressive agents, trauma, use of artificial implants did not demonstrate statistical significance. CONCLUSIONS This meta-analysis provides an up-to-date and comprehensive evaluation of risk factors for SSIs postcraniotomy. It emphasizes the need for preventive strategies, particularly against CSF leaks, and calls for further research to elucidate the intricate relationships between these factors.
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Affiliation(s)
- Francesco Magni
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
| | - Aws Al-Omari
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Robert Vardanyan
- Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arian A Rad
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Susan Honeyman
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Alexandros Boukas
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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Ullah N, Kiu Chou W, Vardanyan R, Arjomandi Rad A, Shah V, Torabi S, Avavde D, Airapetyan AA, Zubarevich A, Weymann A, Ruhparwar A, Miller G, Malawana J. Machine learning algorithms for the prognostication of abdominal aortic aneurysm progression: a systematic review. Minerva Surg 2024; 79:219-227. [PMID: 37987755 DOI: 10.23736/s2724-5691.23.10130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA), often characterized by an abdominal aortic diameter over 3.0 cm, is managed through screening, surveillance, and surgical intervention. AAA growth can be heterogeneous and rupture carries a high mortality rate, with size and certain risk factors influencing rupture risk. Research is ongoing to accurately predict individual AAA growth rates for personalized management. Machine learning, a subset of artificial intelligence, has shown promise in various medical fields, including endoleak detection post-EVAR. However, its application for predicting AAA growth remains insufficiently explored, thus necessitating further investigation. Subsequently, this paper aims to summarize the current status of machine learning in predicting AAA growth. EVIDENCE ACQUISITION A systematic database search of Embase, MEDLINE, Cochrane, PubMed and Google Scholar from inception till December 2022 was conducted of original articles that discussed the use of machine learning in predicting AAA growth using the aforementioned databases. EVIDENCE SYNTHESIS Overall, 2742 articles were extracted, of which seven retrospective studies involving 410 patients were included using a predetermined criteria. Six out of seven studies applied a supervised learning approach for their machine learning (ML) models, with considerable diversity observed within specific ML models. The majority of the studies concluded that machine learning models perform better in predicting AAA growth in comparison to reference models. All studies focused on predicting AAA growth over specified durations. Maximal luminal diameter was the most frequently used indicator, with alternative predictors being AAA volume, ILT (intraluminal thrombus) and flow-medicated diameter (FMD). CONCLUSIONS The nascent field of applying machine learning (ML) for Abdominal Aortic Aneurysm (AAA) expansion prediction exhibits potential to enhance predictive accuracy across diverse parameters. Future studies must emphasize evidencing clinical utility in a healthcare system context, thereby ensuring patient outcome improvement. This will necessitate addressing key ethical implications in establishing prospective studies related to this topic and collaboration among pivotal stakeholders within the AI field.
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Affiliation(s)
- Nazifa Ullah
- Faculty of Medicine, University College London, London, UK
| | - Wing Kiu Chou
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK -
- Research Unit, The Healthcare Leadership Academy, London, UK
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
- Research Unit, The Healthcare Leadership Academy, London, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Saeed Torabi
- Department of Anesthesiology, University Hospital Cologne, Cologne, Germany
| | - Dani Avavde
- Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arkady A Airapetyan
- Department of Research and Academia, National Institute of Health, Yerevan, Armenia
| | - Alina Zubarevich
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
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Arjomandi Rad A, Zubarevich A, Osswald A, Vardanyan R, Magouliotis DE, Ansaripour A, Kourliouros A, Sá MP, Rassaf T, Ruhparwar A, Sardari Nia P, Athanasiou T, Weymann A. The Surgical Treatment of Infective Endocarditis: A Comprehensive Review. Diagnostics (Basel) 2024; 14:464. [PMID: 38472937 DOI: 10.3390/diagnostics14050464] [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: 12/19/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Infective endocarditis (IE) is a severe cardiac complication with high mortality rates, especially when surgical intervention is delayed or absent. This review addresses the expanding role of surgery in managing IE, focusing on the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite varying global data, a notable increase in surgical interventions for IE is evident, with over 50% of patients undergoing surgery in tertiary centres. This review synthesizes information from focused literature searches up to July 2023, covering preoperative to postoperative considerations and surgical strategies for IE. Key preoperative concerns include accurate diagnosis, appropriate antimicrobial treatment, and the timing of surgery, which is particularly crucial for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favouring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also delves into high-risk groups like intravenous drug users and the elderly, emphasizing the need for tailored surgical strategies. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, this review provides a comprehensive overview of current evidence in the surgical management of IE, highlighting the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes.
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Affiliation(s)
- Arian Arjomandi Rad
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Anja Osswald
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Robert Vardanyan
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | | | - Ali Ansaripour
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Tienush Rassaf
- Department of Cardiology, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, 45138 Essen, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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Shah V, Soh CL, Chhatwal K, Kucharczak J, Airapetyan AA, Avavde D, Torabi S, Mackenzie A, Miller G, Vardanyan R, Arjomandi Rad A, Malawana J. Autologous breast reconstruction in low- and middle-income countries (LMICs): a systematic review of current practices and challenges. Minerva Surg 2024; 79:73-81. [PMID: 38381032 DOI: 10.23736/s2724-5691.23.10111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Efforts to improve global healthcare persist, yet LMICs face challenges accessing surgical care, especially breast reconstruction amidst rising breast cancer cases. This review evaluates the present state and challenges of autologous breast reconstruction in low- and middle-income countries (LMICs). EVIDENCE ACQUISITION Utilizing the PRISMA guidelines and the Cochrane Collaboration's standards, databases such as EMBASE, MEDLINE, Cochrane, PubMed, and Google Scholar were examined for studies on breast reconstruction in LMICs (based on the World Bank's 2022-2023 definitions) up to August 2022. Articles and case reports focusing on autologous reconstruction following breast cancer surgery in these regions were incorporated. EVIDENCE SYNTHESIS From an initial 288 articles, 19 met the criteria after thorough assessment. These articles documented 4899 patient cases from LMICs, with the breakdown being: 11 on LD flaps, nine on TRAM flaps, eight on DIEP flaps, two on TDAP flaps, and one on TMG flap. Flap necrosis emerged as the prevalent complication in four studies. CONCLUSIONS While autologous breast reconstruction presents superior aesthetic benefits without notable long-term economic setbacks, its adoption in LMICs is limited. This is partly due to the domination of implant-based methods among patients and surgeons, selected due to convenience. The scarcity of concrete evidence and standardized metrics in LMICs clouds the understanding of this procedure. Despite its advantages, awareness is low, necessitating more training and awareness campaigns. Uniform reporting, quality data, and financial analysis can provide a comprehensive LMIC understanding, aiding future research.
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Affiliation(s)
- Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Chien L Soh
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Karanjot Chhatwal
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Arkady A Airapetyan
- Department of Research and Academia, National Institute of Health, Yerevan, Armenia
| | - Dani Avavde
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Saeed Torabi
- Department of Anesthesia, University Hospital Cologne, Cologne, Germany
| | - Alexandra Mackenzie
- Department of Emergency Surgery, Chelsea and Westminster Hospital NHS Trust, London, UK
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK -
| | - Arian Arjomandi Rad
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
- Clinical Academic Graduate School, The University of Oxford, Oxford, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
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Arjomandi Rad A, Fleet B, Zubarevich A, Nanchahal S, Naruka V, Subbiah Ponniah H, Vardanyan R, Sardari Nia P, Loubani M, Moorjani N, Schmack B, Punjabi PP, Schmitto J, Ruhparwar A, Weymann A. Left ventricular assist device implantation and concomitant mitral valve surgery: A systematic review and meta-analysis. Artif Organs 2024; 48:16-27. [PMID: 37822301 DOI: 10.1111/aor.14659] [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: 06/16/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The management of concomitant valvular lesions in patients undergoing left ventricular assist device (LVAD) implantation remains a topic of debate. This systematic review and meta-analysis aimed to evaluate the existing evidence on postoperative outcomes following LVAD implantation, with and without concomitant MV surgery. METHODS A systematic database search was conducted as per PRISMA guidelines, of original articles comparing LVAD alone to LVAD plus concomitant MV surgery up to February 2023. The primary outcomes assessed were overall mortality and early mortality, while secondary outcomes included stroke, need for right ventricular assist device (RVAD) implantation, postoperative mitral valve regurgitation, major bleeding, and renal dysfunction. RESULTS The meta-analysis included 10 studies comprising 32 184 patients. It revealed that concomitant MV surgery during LVAD implantation did not significantly affect overall mortality (OR:0.83; 95% CI: 0.53 to 1.29; p = 0.40), early mortality (OR:1.17; 95% CI: 0.63 to 2.17; p = 0.63), stroke, need for RVAD implantation, postoperative mitral valve regurgitation, major bleeding, or renal dysfunction. These findings suggest that concomitant MV surgery appears not to confer additional benefits in terms of these clinical outcomes. CONCLUSION Based on the available evidence, concomitant MV surgery during LVAD implantation does not appear to have a significant impact on postoperative outcomes. However, decision-making regarding MV surgery should be individualized, considering patient-specific factors and characteristics. Further research with prospective studies focusing on specific patient populations and newer LVAD devices is warranted to provide more robust evidence and guide clinical practice in the management of valvular lesions in LVAD recipients.
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Affiliation(s)
- Arian Arjomandi Rad
- Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ben Fleet
- School of Medicine, Lancaster University, Lancaster, UK
| | - Alina Zubarevich
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sukanya Nanchahal
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Robert Vardanyan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth NHS Trust, Cambridge, UK
| | - Bastian Schmack
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jan Schmitto
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Arjomandi Rad A, Vardanyan R, Rabiee P, Arjomandi Rad R, Miller G, Malawana J, Zubarevich A, Schmack B, Ruhparwar A, Weymann A. Implantable cardiac soft robotic sleeve: A promising technology for the millions with end-stage heart failure in low and middle-income countries. Artif Organs 2023; 47:1801-1804. [PMID: 37676107 DOI: 10.1111/aor.14642] [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] [Received: 04/13/2023] [Revised: 05/21/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Affiliation(s)
| | | | - Pedra Rabiee
- Hull York Medical School, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - George Miller
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Johann Malawana
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bastian Schmack
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Thavarajasingam SG, Vemulapalli KV, Vishnu K S, Ponniah HS, Vogel ASM, Vardanyan R, Neuhoff J, Kramer A, Shiban E, Ringel F, Demetriades AK, Davies BM. Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: a systematic review and meta-analysis. Sci Rep 2023; 13:15647. [PMID: 37730826 PMCID: PMC10511402 DOI: 10.1038/s41598-023-41381-1] [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: 06/16/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
Spondylodiscitis is the commonest spine infection, and pyogenic spondylodiscitis is the most common subtype. Whilst antibiotic therapy is the mainstay of treatment, some advocate that early surgery can improve mortality, relapse rates, and length of stay. Given that the condition carries a high mortality rate of up to 20%, the most effective treatment must be identified. We aimed to compare the mortality, relapse rate, and length of hospital stay of conservative versus early surgical treatment of pyogenic spondylodiscitis. All major databases were searched for original studies, which were evaluated using a qualitative synthesis, meta-analyses, influence, and regression analyses. The meta-analysis, with an overall pooled sample size of 10,954 patients from 21 studies, found that the pooled mortality among the early surgery patient subgroup was 8% versus 13% for patients treated conservatively. The mean proportion of relapse/failure among the early surgery subgroup was 15% versus 21% for the conservative treatment subgroup. Further, it concluded that early surgical treatment, when compared to conservative management, is associated with a 40% and 39% risk reduction in relapse/failure rate and mortality rate, respectively, and a 7.75 days per patient reduction in length of hospital stay (p < 0.01). The meta-analysis demonstrated that early surgical intervention consistently significantly outperforms conservative management in relapse/failure and mortality rates, and length of stay, in patients with pyogenic spondylodiscitis.
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Affiliation(s)
- Santhosh G Thavarajasingam
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK.
- Imperial Brain and Spine Initiative, Imperial College London, London, UK.
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany.
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
| | - Kalyan V Vemulapalli
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Sajeenth Vishnu K
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Hariharan Subbiah Ponniah
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Alexander Sanchez-Maroto Vogel
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
- Faculty of Medicine, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Robert Vardanyan
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Jonathan Neuhoff
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas Kramer
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Florian Ringel
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas K Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Division of Clinical Neurosciences, NHS Lothian, Edinburgh University Hospitals, Edinburgh, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Benjamin M Davies
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
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8
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Arjomandi Rad A, Zubarevich A, Shah V, Yilmaz O, Vardanyan R, Naruka V, Moorjani N, Ruhparwar A, Punjabi PP, Weymann A. Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta-analysis. Artif Organs 2023; 47:1250-1261. [PMID: 37086154 DOI: 10.1111/aor.14549] [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: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection. RESULTS Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed. CONCLUSION LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.
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Affiliation(s)
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Ogulcan Yilmaz
- School of Postgraduate Studies, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, National Heart and Lung Institute, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Khan H, Buaki-Sogo MA, Barlow P, Vardanyan R, Zatorska A, Miller G, Arjomandi Rad A, Malawana J, Shah NM. Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials. Eur J Obstet Gynecol Reprod Biol 2023; 287:80-92. [PMID: 37300982 DOI: 10.1016/j.ejogrb.2023.05.037] [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: 03/14/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND A systematic review to determine the efficacy and safety of prostaglandins (PG) and Foley catheter (FC) for cervical priming in the outpatient setting. Various methods are available to achieve cervical ripening prior to induction of labour (IOL). In this systematic review, we will report the literature to date, and investigate the efficacy and safety of using the Foley catheter balloon or prostaglandins for cervical ripening, comparing both methods with each other, and discuss the implications of these findings for midwifery led units. METHODS English peer-reviewed journals were systematically searched in the databases PubMed, MEDLINE, EMCARE, EMBASE and CINAHL, for studies investigating cervical ripening using the FC or PGs. Additional randomised controlled trials (RCTs) and non-RCTs were identified by a manual search. Search terms included: cervix dilatation effacement, cervix ripening, outpatient, ambulatory care, obstetric patients, pharmacological preparations, and Foley catheter. Only RCTs of FC versus PG or either intervention versus placebo or intervention in the in-patient Vs. outpatient setting were included. 15 RCTs were included. RESULTS The results of this review show that both FC and PG analogues are equally effective cervical ripening agents. When compared to FC, PGs lead to a reduced requirement for oxytocin augmentation and a shorter intervention to delivery interval. However, PG use is also associated with an increased risk of hyperstimulation, cardiotocographic monitoring abnormalities and negative neonatal outcomes. CONCLUSIONS FC cervical ripening is an effective method of outpatient cervical priming, which is safe, acceptable, and cost-effective and thus has a potential role in both resource-rich and resource-poor countries. With appropriate dosing, some PG analogues also appear to offer similar outcomes.
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Affiliation(s)
- Hiba Khan
- School of Medicine, University of Central Lancashire, 135A Adelphi St, Preston PR1 7BH, UK.
| | | | - Philip Barlow
- Chelsea and Westminster campus library, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Robert Vardanyan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anna Zatorska
- Department of Internal Medicine, York NHS Trust, York, UK
| | - George Miller
- School of Medicine, University of Central Lancashire, 135A Adelphi St, Preston PR1 7BH, UK
| | | | - Johann Malawana
- School of Medicine, University of Central Lancashire, 135A Adelphi St, Preston PR1 7BH, UK
| | - Nishel M Shah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
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10
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Weymann A, Foroughi J, Vardanyan R, Punjabi PP, Schmack B, Aloko S, Spinks GM, Wang CH, Arjomandi Rad A, Ruhparwar A. Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure. Adv Mater 2023; 35:e2207390. [PMID: 36269015 DOI: 10.1002/adma.202207390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/19/2022] [Indexed: 05/12/2023]
Abstract
Medical soft robotics constitutes a rapidly developing field in the treatment of cardiovascular diseases, with a promising future for millions of patients suffering from heart failure worldwide. Herein, the present state and future direction of artificial muscle-based soft robotic biomedical devices in supporting the inotropic function of the heart are reviewed, focusing on the emerging electrothermally artificial heart muscles (AHMs). Artificial muscle powered soft robotic devices can mimic the action of complex biological systems such as heart compression and twisting. These artificial muscles possess the ability to undergo complex deformations, aiding cardiac function while maintaining a limited weight and use of space. Two very promising candidates for artificial muscles are electrothermally actuated AHMs and biohybrid actuators using living cells or tissue embedded with artificial structures. Electrothermally actuated AHMs have demonstrated superior force generation while creating the prospect for fully soft robotic actuated ventricular assist devices. This review will critically analyze the limitations of currently available devices and discuss opportunities and directions for future research. Last, the properties of the cardiac muscle are reviewed and compared with those of different materials suitable for mechanical cardiac compression.
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Affiliation(s)
- Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Javad Foroughi
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, 72 Du Cane Rd, London, W12 0HS, UK
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Sinmisola Aloko
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Geoffrey M Spinks
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Chun H Wang
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
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11
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Quake SYL, Khoda F, Arjomandi Rad A, Subbiah Ponniah H, Vardanyan R, Frisoni P, Arjomandi Rad H, Brasesco M, Mustoe S, Godfrey J, Miller G, Malawana J. The Current Status and Challenges of Prehospital Trauma Care in Low- and Middle-Income Countries: A Systematic Review. PREHOSP EMERG CARE 2023; 28:76-86. [PMID: 36629481 DOI: 10.1080/10903127.2023.2165744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND This review aims to understand the present circumstances on the provision of prehospital trauma care in low- and middle-income countries (LMICs), particularly scoping the challenges experienced by LMICs in this regard. The objective is to systematically evaluate the currently available evidence on this topic. Based on the themes and challenges identified in the provision of prehospital trauma care in LMICs, we provide a series of recommendations and a knowledge base for future research in the field. METHODS A systematic database search was conducted of original articles that explored and reported on prehospital trauma care in LMIC in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to March 2022. All original articles reporting on prehospital trauma care from 2010 to 2022 in LMICs were assessed, excluding case reports, small case series, editorials, abstracts, and pre-clinical studies; those with data inconsistencies that impede data extraction; and those with study populations fewer than ten. RESULTS The literature search identified 2,128 articles, of which 29 were included in this review, featuring 27,848 participants from LMICs countries. Four main areas of focus within the studies were identified: (1) exploring emergency service systems, frameworks, and interconnected networks within the context of prehospital trauma care; (2) transportation of patients from the response site to hospital care; (3) medical education and the effects of first responder training in LMICs; and (4) cultural and social factors influencing prehospital trauma care-seeking behaviors. Due to overarching gaps in social and health care systems, significant barriers exist at various stages of providing prehospital trauma care in LMICs, particularly in injury identification, seeking treatment, transportation to hospital, and receiving timely treatment and post-intervention support. CONCLUSION The provision of prehospital trauma care in LMICs faces significant barriers at multiple levels, largely dependent on wider social, geographic, economic, and political factors impeding the development of such higher functioning systems within health care. However, there have been numerous breakthroughs within certain LMICs in different aspects of prehospital trauma care, supported to varying degrees by international initiatives, that serve as case studies for widespread implementation and targets. Such experiential learning is essential due to the heterogenous landscapes that comprise LMICs.
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Affiliation(s)
- Sharmaine Yen Ling Quake
- Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Fatimah Khoda
- Department of Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
- Research Unit, The Healthcare Leadership Academy, London, UK
| | | | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
- Research Unit, The Healthcare Leadership Academy, London, UK
| | - Paolo Frisoni
- Territorial Medical Emergency Services, San Martino University Hospital, Genoa, Italy
| | - Hoshang Arjomandi Rad
- Territorial Medical Emergency Services, San Martino University Hospital, Genoa, Italy
| | - Martina Brasesco
- Territorial Medical Emergency Services, San Martino University Hospital, Genoa, Italy
| | - Sophie Mustoe
- Emergency Medicine Department, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Jenna Godfrey
- Department of Anaesthetics, Imperial College NHS Trust, London, UK
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
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12
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Arjomandi Rad A, Kapadia S, Zubarevich A, Nanchahal S, Van den Eynde J, Vardanyan R, Bareka M, Krasopoulos G, Quarto C, Ruhparwar A, Athanasiou T, Weymann A. Sex disparities in left ventricular assist device implantation outcomes: A systematic review and meta-analysis of over 50 000 patients. Artif Organs 2023; 47:273-289. [PMID: 36461903 DOI: 10.1111/aor.14469] [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: 09/28/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVAD) represent an important therapeutic option for patients progressing to end-stage heart failure. Women have been historically underrepresented in LVAD studies, and have been reported to have worse outcomes despite technological optimisation. We aimed to systematically explore the evidence on sex disparities in the use and outcomes of LVAD implantation. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of men versus women undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to July 2022. Primary outcomes were stroke (haemorrhagic and ischaemic) and early/overall mortality. Secondary outcomes were LVAD thrombosis, right VAD implantation, major bleeding, kidney dysfunction, and device/driveline infection. RESULTS Our search yielded 137 relevant studies, including 22 meeting the inclusion criteria with a total of 53 227 patients (24.2% women). Overall mortality was higher in women (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.05-1.62, p = 0.02), as was overall stroke (OR 1.32, 95%CI 1.06-1.66, p = 0.01), including ischemic (OR 1.80, 95%CI 1.22-2.64, p = 0.003) and haemorrhagic (OR 1.72, 95%CI 1.09-2.70, p = 0.02). Women had more frequent right VAD implantation (OR 2.11, 95%CI 1.24-3.57, p = 0.006) and major bleeding (OR 1.40, 95%CI 1.06-1.85, p = 0.02). Kidney dysfunction, LVAD thrombosis, and device/driveline infections were comparable between sexes. CONCLUSIONS Our analysis suggests that women face a greater risk of adverse events and mortality post-LVAD implantation. Although the mechanisms remain unclear, the difference in outcomes is thought to be multifactorial. Further research, that includes comprehensive pre-operative characteristics and post-operative outcomes, is encouraged.
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Affiliation(s)
- Arian Arjomandi Rad
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Sharan Kapadia
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Sukanya Nanchahal
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Metaxia Bareka
- Department of Anaesthesiology, University of Laryssa, Laryssa, Greece
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospital NHS Trust, Oxford, UK
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Trust, London, UK
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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13
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Arjomandi Rad A, Subbiah Ponniah H, Shah V, Nanchahal S, Vardanyan R, Miller G, Malawana J. Leading Transformation in Medical Education Through Extended Reality. Adv Exp Med Biol 2023; 1421:161-173. [PMID: 37524987 DOI: 10.1007/978-3-031-30379-1_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] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Extended reality (XR) has exponentially developed over the past decades to incorporate technology whereby users can visualise, explore, and interact with 3-dimensional-generated computer environments, and superimpose virtual reality (VR) onto real-world environments, thus displaying information and data on various levels of the reality-virtuality continuum. In the context of medicine, VR tools allow for anatomical assessment and diagnosis, surgical training through lifelike procedural simulations, planning of surgeries and biopsies, intraprocedural guidance, and medical education. The following chapter aims to provide an overview of the currently available evidence and perspectives on the application of XR within medical education. It will focus on undergraduate and postgraduate teaching, medical education within Low-Middle Income Countries, key practical steps in implementing a successful XR programme, and the limitations and future of extended reality within medical education.
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Affiliation(s)
- Arian Arjomandi Rad
- Medical Sciences Division, University of Oxford, Oxford, UK
- The Healthcare Leadership Academy, London, UK
| | | | - Viraj Shah
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Sukanya Nanchahal
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- The Healthcare Leadership Academy, London, UK
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - George Miller
- The Healthcare Leadership Academy, London, UK
- University of Central Lancashire Medical School, Preston, UK
| | - Johann Malawana
- The Healthcare Leadership Academy, London, UK.
- University of Central Lancashire Medical School, Preston, UK.
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14
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Arjomandi Rad A, Naruka V, Vardanyan R, Salmasi MY, Tasoudis PT, Kendall S, Casula R, Athanasiou T. Renal outcomes in valve-in-valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2022; 37:3743-3753. [PMID: 36040611 PMCID: PMC9804591 DOI: 10.1111/jocs.16890] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality. RESULTS Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). CONCLUSION Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.
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Affiliation(s)
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Robert Vardanyan
- Department of Medicine, Imperial College LondonFaculty of MedicineLondonUK
| | | | | | - Simon Kendall
- Department of Cardiothoracic SurgeryJames Cook University HospitalMiddlesboroughUK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK,Department of Surgery and CancerImperial College LondonLondonUK
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15
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Soh CL, Shah V, Arjomandi Rad A, Vardanyan R, Zubarevich A, Torabi S, Weymann A, Miller G, Malawana J. Present and future of machine learning in breast surgery: systematic review. Br J Surg 2022; 109:1053-1062. [PMID: 35945894 PMCID: PMC10364755 DOI: 10.1093/bjs/znac224] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/09/2022] [Accepted: 05/30/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Machine learning is a set of models and methods that can automatically detect patterns in vast amounts of data, extract information, and use it to perform decision-making under uncertain conditions. The potential of machine learning is significant, and breast surgeons must strive to be informed with up-to-date knowledge and its applications. METHODS A systematic database search of Embase, MEDLINE, the Cochrane database, and Google Scholar, from inception to December 2021, was conducted of original articles that explored the use of machine learning and/or artificial intelligence in breast surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar. RESULTS The search yielded 477 articles, of which 14 studies were included in this review, featuring 73 847 patients. Four main areas of machine learning application were identified: predictive modelling of surgical outcomes; breast imaging-based context; screening and triaging of patients with breast cancer; and as network utility for detection. There is evident value of machine learning in preoperative planning and in providing information for surgery both in a cancer and an aesthetic context. Machine learning outperformed traditional statistical modelling in all studies for predicting mortality, morbidity, and quality of life outcomes. Machine learning patterns and associations could support planning, anatomical visualization, and surgical navigation. CONCLUSION Machine learning demonstrated promising applications for improving breast surgery outcomes and patient-centred care. Neveretheless, there remain important limitations and ethical concerns relating to implementing artificial intelligence into everyday surgical practices.
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Affiliation(s)
- Chien Lin Soh
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Arian Arjomandi Rad
- Correspondence to: Arian Arjomandi Rad, Imperial College London, Department of Medicine, Faculty of Medicine, South Kensington Campus, Sir Alexander Fleming Building, London SW7 2AZ, UK (e-mail: )
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Saeed Torabi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
- Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
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16
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Chou WK, Ullah N, Arjomandi Rad A, Vardanyan R, Shah V, Zubarevich A, Weymann A, Shah N, Miller G, Malawana J. Simulation training for obstetric emergencies in low- and lower-middle income countries: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 276:74-81. [PMID: 35820293 DOI: 10.1016/j.ejogrb.2022.07.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This review aims to systematically evaluate the currently available evidence investigating the effectiveness of simulation-based training (SBT) in emergency obstetrics care (EmOC) in Low- and Lower-Middle Income Countries (LMIC). Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the field. METHODS A systematic database search was conducted of original articles that explored the use of simulation-based training for EmOC in LMIC in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to January 2022. RESULTS The literature search identified 1,957 articles of which a total of 15 studies were included in this review, featuring 8,900 healthcare professionals from 18 countries. The SBT programmes varied in the reviewed studies. The most common training programme consisted of the PRONTO programme implemented by four studies, comprising of 970 participants across four different countries. In general, programmes consisted of lectures, workshops and simulations of emergency obstetric scenarios followed by a debrief of participants. There were thirteen studies, comprising of 8,332 participants, which tested for improvements in clinical knowledge in post-partum haemorrhage, neonatal resuscitation, pre-eclampsia, shoulder dystocia and sepsis. All the included studies reported improvements in clinical knowledge following the simulation of scenarios. Changes in teamwork, improvement in leadership and in communication skills were also widely reported. CONCLUSION The use of SBT programmes is not only sustainable, feasible and acceptable in LMIC, but could also improve clinical knowledge, communication, and teamwork among healthcare providers, thus directly addressing the UN Sustainable Development Goals.
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Affiliation(s)
- Wing Kiu Chou
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nazifa Ullah
- Faculty of Medicine, University College London, London, United Kingdom
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; Research Unit, The Healthcare Leadership Academy, London, United Kingdom.
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; Research Unit, The Healthcare Leadership Academy, London, United Kingdom
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Nishel Shah
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, United Kingdom; Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, United Kingdom
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, United Kingdom; Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, United Kingdom
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17
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Naruka V, Arjomandi Rad A, Subbiah Ponniah H, Francis J, Vardanyan R, Tasoudis P, Magouliotis DE, Lazopoulos GL, Salmasi MY, Athanasiou T. Machine learning and artificial intelligence in cardiac transplantation: A systematic review. Artif Organs 2022; 46:1741-1753. [PMID: 35719121 PMCID: PMC9545856 DOI: 10.1111/aor.14334] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/12/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 01/09/2023]
Abstract
Background This review aims to systematically evaluate the currently available evidence investigating the use of artificial intelligence (AI) and machine learning (ML) in the field of cardiac transplantation. Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the field of ML and heart transplantation. Methods A systematic database search was conducted of original articles that explored the use of ML and/or AI in heart transplantation in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to November 2021. Results Our search yielded 237 articles, of which 13 studies were included in this review, featuring 463 850 patients. Three main areas of application were identified: (1) ML for predictive modeling of heart transplantation mortality outcomes; (2) ML in graft failure outcomes; (3) ML to aid imaging in heart transplantation. The results of the included studies suggest that AI and ML are more accurate in predicting graft failure and mortality than traditional scoring systems and conventional regression analysis. Major predictors of graft failure and mortality identified in ML models were: length of hospital stay, immunosuppressive regimen, recipient's age, congenital heart disease, and organ ischemia time. Other potential benefits include analyzing initial lab investigations and imaging, assisting a patient with medication adherence, and creating positive behavioral changes to minimize further cardiovascular risk. Conclusion ML demonstrated promising applications for improving heart transplantation outcomes and patient‐centered care, nevertheless, there remain important limitations relating to implementing AI into everyday surgical practices.
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Affiliation(s)
- Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Arian Arjomandi Rad
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | | | - Jeevan Francis
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | - Robert Vardanyan
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery, University Hospital Thessaly, Larissa, Greece
| | | | - George L Lazopoulos
- Department of Cardiothoracic Surgery, University Hospital Thessaly, Larissa, Greece.,Department of Cardiac Surgery, University Hospital of Heraklion, Crete, Greece
| | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Cardiothoracic Surgery, University Hospital Thessaly, Larissa, Greece
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18
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Miah T, Mahmud M, Vardanyan R, Arjomandi-Rad A, Dhanjal M, Dassan P. Pre-pregnancy and antenatal care of women with epilepsy. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEpileptic seizures in pregnancy pose a significant risk to both the mother and fetus. There is little evidence of the impact of pre-pregnancy counselling (PPC) and specialist multi-disciplinary antenatal care on a pregnancy.ObjectivesTo determine critical components of care in preventing seizures and adverse outcomes in pregnancies of women with epilepsy.MethodA retrospective cohort study of pregnant women with epilepsy. Participants were seen in the Neuro-Obstetrics multidisciplinary clinic based in West London from 2012 to 2020.ResultsA total of 150 patients; including 242 pregnancies, were analysed. Of these pregnancies, 69 were reported to have had at least 1 seizure. The anti-epileptic drug profiles and dosages were recorded in each group; 71.5% of pregnancies involved anti-epileptic drugs (AEDs), 68.8% of these patients were on mono-therapy and 22.5% were on dual-therapy. Patients without access to PPC or specialist antenatal care had less frequent monitoring of AED levels, fewer dosage adjustments and a higher seizure frequency during the pregnancy. In 9.1% of pregnancies a new AED was started.ConclusionThese data support the use of PPC in preventing seizures in early pregnancy. The data also shows a reduction in seizure frequency following specialist multidisciplinary antenatal care.mtm116@ic.ac.uk
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Thavarajasingam SG, Vardanyan R, Arjomandi Rad A, Thavarajasingam A, Khachikyan A, Mendoza N, Nair R, Vajkoczy P. The use of augmented reality in transsphenoidal surgery: A systematic review. Br J Neurosurg 2022; 36:457-471. [PMID: 35393900 DOI: 10.1080/02688697.2022.2057435] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/02/2022]
Abstract
BACKGROUND Augmented reality (AR) has become a promising tool in neurosurgery. It can minimise the anatomical challenges faced by conventional endoscopic or microscopic transsphenoidal reoperations and can assist in intraoperative guidance, preoperative planning, and surgical training. OBJECTIVES The aims of this systematic review are to describe, compare, and evaluate the use of AR in endoscopic and microscopic transsphenoidal surgery, incorporating the latest primary research. METHODS A systematic review was performed to explore and evaluate existing primary evidence for using AR in transsphenoidal surgery. A comprehensive search of MEDLINE and EMBASE was conducted from database inception to 11th August 2021 for primary data on the use of AR in microscopic and endoscopic endonasal skull base surgery. Additional articles were identified through searches on PubMed, Google Scholar, JSTOR, SCOPUS, Web of Science, Engineering Village, IEEE transactions, and HDAS. A synthesis without meta-analysis (SWiM) analysis was employed quantitatively and qualitatively on the impact of AR on landmark identification, intraoperative navigation, accuracy, time, surgeon experience, and patient outcomes. RESULTS In this systematic review, 17 studies were included in the final analysis. The main findings were that AR provides a convincing improvement to landmark identification, intraoperative navigation, and surgeon experience in transsphenoidal surgery, with a further positive effect on accuracy and time. It did not demonstrate a convincing positive effect on patient outcomes. No studies reported comparative mortalities, morbidities, or cost-benefit indications. CONCLUSION AR-guided transsphenoidal surgery, both endoscopic and microscopic, is associated with an overall improvement in the areas of intraoperative guidance and surgeon experience as compared with their conventional counterparts. However, literature on this area, particularly comparative data and evidence, is very limited. More studies with similar methodologies and quantitative outcomes are required to perform appropriate meta-analyses and to draw significant conclusions.
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Affiliation(s)
| | - Robert Vardanyan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | | | - Artur Khachikyan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia
| | - Nigel Mendoza
- Department of Neurosurgery, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Ramesh Nair
- Department of Neurosurgery, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Vardanyan R, Yeghunyan S, Yeghunyan M. Obituary for Artur Khachikyan. World Neurosurg 2022:S1878-8750(22)00092-4. [DOI: 10.1016/j.wneu.2022.01.078] [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] [Received: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
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21
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Zubarevich A, Szczechowicz M, Osswald A, Arjomandi Rad A, Vardanyan R, Pompeu BO Sá M, Van den Eynde J, Schmack B, Wendt D, Koch A, Pizanis N, Kamler M, Ruhparwar A, Weymann A, Zhigalov K. Impact of gender in patients with continuous-flow left ventricular assist device therapy in end-stage heart failure. Int J Artif Organs 2021; 44:990-997. [PMID: 33784845 PMCID: PMC8581712 DOI: 10.1177/03913988211006715] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an ongoing debate about the influence of the female gender on postoperative outcomes after durable left ventricular assist device (LVAD) implantation. Despite the differences in pathophysiology of heart failure in females, therapy concepts are the same as in the male population. The aim of this study was to investigate the role of the female gender in surgical heart failure therapy. MATERIALS AND METHODS Between August 2010 and January 2020, 207 patients were treated with durable LVAD at out institution. We matched 111 patients in two groups to compare the outcomes in male and female patients and to stratify the risk factors of mortality. RESULTS The groups were matched 2:1 and were comparable after matching. We found no difference in in-hospital and follow-up mortality between male and female patients. Postoperative adverse events and complications were found to be unvaried across male and female patients. Female patients had higher rates of postoperative LVAD-thrombosis compared to their male counterparts (13.5% vs 0, p = 0.001) and the rates of renal replacement therapy lasting over 90 days were also higher in the female group (33.8% vs 56.8%, p = 0.021). Furthermore, the female gender was not an independent predictor neither of in-hospital nor follow-up mortality. CONCLUSIONS Durable continuous flow left ventricular assist devices as a bridge to transplantation or recovery in female patients are associated with a higher risk of acute kidney injury requiring RRT and are at a higher risk of LVAD-thrombosis. Nevertheless, survival rates between genders are similar.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Marcin Szczechowicz
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Michel Pompeu BO Sá
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Achim Koch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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22
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Zhigalov K, Van den Eynde J, Zubarevich A, Chrosch T, Goerdt L, Arjomandi Rad A, Vardanyan R, Sá MPBO, Luedike P, Pizanis N, Koch A, Schmack B, Kamler M, Ruhparwar A, Weymann A. Initial experience with CytoSorb therapy in patients receiving left ventricular assist devices. Artif Organs 2021; 46:95-105. [PMID: 34694644 DOI: 10.1111/aor.14099] [Citation(s) in RCA: 2] [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] [Received: 07/10/2021] [Revised: 08/24/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of left ventricular assist devices (LVAD) in patients with advance heart failure is still associated with an important risk of immune dysregulation and infections. The aim of this study was to determine whether extracorporeal blood purification using the CytoSorb device benefits patients after LVAD implantation in terms of complications and overall survival. MATERIALS AND METHODS Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation, of whom 72 underwent CytoSorb therapy and 135 did not. Overall survival, major adverse events, and laboratory parameters were compared between 112 propensity score-matched patients (CytoSorb: 72 patients; non-CytoSorb: 40 patients). RESULTS WBC (p = .033), CRP (p = .001), and IL-6 (p < .001), significantly increased with LVAD implantation, while CytoSorb did not influence this response. In-hospital mortality and overall survival during follow-up were similar with CytoSorb. However, patients treated with CytoSorb were more likely to develop respiratory failure (54.2% vs. 30.0%, p = .024), need mechanical ventilation for longer than 6 days post-implant (50.0% vs. 27.5%, p = .035), and require tracheostomy during hospitalization (31.9% vs. 12.5%, p = .040). No other significant differences were observed with regard to major adverse events during follow-up. CONCLUSIONS Overall, our results showed that CytoSorb might not convey a significant morbidity or mortality benefit for patients undergoing LVAD implantation.
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Affiliation(s)
- Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
| | - Jef Van den Eynde
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Cardiovascular Sciences, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Chrosch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Lukas Goerdt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Michel Pompeu Barros Oliveira Sá
- International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany.,Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Achim Koch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
| | - Markus Kamler
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR), Oldenburg, Germany
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23
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Zubarevich A, Zhigalov K, Szczechowicz M, Arjomandi Rad A, Vardanyan R, Torabi S, Papathanasiou M, Luedike P, Koch A, Pizanis N, Kamler M, Schmack B, Ruhparwar A, Weymann A. Rescue extracorporeal life support as a bridge to durable left ventricular assist device. Int J Artif Organs 2021; 45:371-378. [PMID: 34674570 PMCID: PMC8921882 DOI: 10.1177/03913988211053874] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The ideal timing of a durable assist device implantation in patients with end-stage heart failure presenting with INTERMACS profile I is still controversial. The data on extracorporeal life support (ECLS) bridge to durable left ventricular assist device (LVAD) in these patients is limited. MATERIALS AND METHODS We retrospectively analyzed the outcomes of 35 patients in acute cardiogenic shock (CS) who, between December 2013 and September 2020, were bridged with ECLS to durable LVAD. The mean age was 52.3 ± 12.0 years. The primary endpoints of this study were in-hospital, 30-day, 6-month, and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events and other characteristics during the follow-up period. We also assessed the impact of the rescue ECLS on the recovery of the end-organ function. RESULTS In-hospital, 30-day, 6-month, and 1-year survival was 65.6%, 75.9%, 69.2%, and 62.7% respectively. The median time on ECLS was 7 days (IQR 5.0-13.0). We observed a high incidence of a severe right heart failure (22.9%), acute kidney injury on dialysis (68.6%), and respiratory failure (77.1%). Bridge with ECLS provided a significant recovery of liver and kidney function prior to durable LVAD implantation. CONCLUSION The concept of bridging patients presenting in end-stage heart failure and cardiogenic shock with ECLS prior to durable LVAD implantation is a feasible method to ensure acceptable survival rates and significant recovery of the end-organ function.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Saeed Torabi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria Papathanasiou
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Achim Koch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Arjomandi Rad A, Vardanyan R, Thavarajasingam SG, Zubarevich A, Van den Eynde J, Sá MPBO, Zhigalov K, Sardiari Nia P, Ruhparwar A, Weymann A. Extended, virtual and augmented reality in thoracic surgery: a systematic review. Interact Cardiovasc Thorac Surg 2021; 34:201-211. [PMID: 34542639 PMCID: PMC8766198 DOI: 10.1093/icvts/ivab241] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Extended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery. METHODS A systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020. RESULTS Our search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient's anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy. CONCLUSION XR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.
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Affiliation(s)
- Arian Arjomandi Rad
- Corresponding author. Department of Medicine, Faculty of Medicine, Imperial College London, London, UK. Tel:+447397572231; e-mail: (A. Arjomandi Rad)
| | | | | | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, University of Pernambuco, Recife, Brazil
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Peyman Sardiari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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Zubarevich A, Szczechowicz M, Arjomandi Rad A, Vardanyan R, Marx P, Lind A, Jánosi RA, Roosta-Azad M, Malik R, Kamler M, Thielmann M, El Gabry M, Schmack B, Ruhparwar A, Weymann A, Wendt D. Mitral surgical redo versus transapical transcatheter mitral valve implantation. PLoS One 2021; 16:e0256569. [PMID: 34432834 PMCID: PMC8386843 DOI: 10.1371/journal.pone.0256569] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background Transcatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly because redo patients often present with multiple comorbidities and high operative risk. We sought to evaluate and compare our experience with transapical transcatheter mitral valve replacement (TA-TMVR) to conventional redo mitral valve replacement in patients presenting with degenerated biological mitral valve prostheses or failed valve annuloplasty. Methods and material Between March 2012 and November 2020, 74 consecutive high-risk patients underwent surgical redo mitral valve replacement (n = 33) or TA-TMVR (n = 41) at our institution. All patients presented with a history of a surgical mitral valve procedure. All transcatheter procedures were performed using the SAPIEN XT/3™ prostheses. Data collection was prospectively according to MVARC criteria. Results The mean logistic EuroSCORE-II of the whole cohort was 19.9±16.7%, and the median STS-score was 11.1±12.5%. The mean age in the SMVR group was 63.7±12.8 years and in the TMVR group 73.6±9.7 years. Patients undergoing TA-TMVR presented with significantly higher risk scores. Echocardiography at follow up showed no obstruction of the left ventricular outflow tract, no paravalvular leakage and excellent transvalvular gradients in both groups (3.9±1.2 mmHg and 4.2±0.8 mmHg in the surgical and transcatheter arm respectively). There was no difference in postoperative major adverse events between the groups with no strokes in the whole cohort. Both methods showed similar survival rates at one year and a 30-day mortality of 15.2% and 9.8% in SAVR and TMVR group, respectively. Despite using contrast dye in the transcatheter group, the rate of postoperative acute kidney failure was similar between the groups. Conclusion Despite several contraindications for surgery, we showed the non-inferiority of TA-TMVR compared to conventional surgical redo procedures in high-risk patients. With its excellent hemodynamic and similar survival rate, TA-TMVR offers a feasible alternative to the conventional surgical redo procedure in selected patients.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Philipp Marx
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Lind
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Mehdy Roosta-Azad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Rizwan Malik
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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26
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Osswald A, Zubarevich A, Rad AA, Vardanyan R, Zhigalov K, Wendt D, Schmack B, Mashhour A, Ruhparwar A, Weymann A. Geometric changes in aortic root replacement using Freestyle prosthesis. J Cardiothorac Surg 2021; 16:204. [PMID: 34321027 PMCID: PMC8320201 DOI: 10.1186/s13019-021-01583-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.
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Affiliation(s)
- Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany.
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Ahmed Mashhour
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany.,Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum Rotenburg an der Fulda, Rotenburg an der Fulda, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
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Rad AA, Vardanyan R, Lopuszko A, Alt C, Stoffels I, Schmack B, Ruhparwar A, Zhigalov K, Zubarevich A, Weymann A. Virtual and Augmented Reality in Cardiac Surgery. Braz J Cardiovasc Surg 2021; 37:123-127. [PMID: 34236814 PMCID: PMC8973146 DOI: 10.21470/1678-9741-2020-0511] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Virtual and augmented reality can be defined as a three-dimensional real-world
simulation allowing the user to directly interact with it. Throughout the years,
virtual reality has gained great popularity in medicine and is currently being
adopted for a wide range of purposes. Due to its dynamic anatomical nature,
permanent drive towards decreasing invasiveness, and strive for innovation,
cardiac surgery depicts itself as a unique environment for virtual reality.
Despite substantial research limitations in cardiac surgery, the current
literature has shown great applicability of this technology, and promising
opportunities.
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Affiliation(s)
| | - Robert Vardanyan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Aleksandra Lopuszko
- Faculty of Medicine, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Christina Alt
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Zubarevich A, Szczechowicz M, Zhigalov K, Rad AA, Vardanyan R, Easo J, Roosta-Azad M, Kamler M, Schmack B, Ruhparwar A, Wendt D, Weymann A. Surgical redo mitral valve replacement in high-risk patients: The real-world experience. J Card Surg 2021; 36:3195-3204. [PMID: 34227147 DOI: 10.1111/jocs.15787] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Redo surgical mitral valve replacement (SMVR) remains the gold standard treatment in patients with a history of mitral valve surgery presenting with recurrent mitral valve pathologies. Whilst this procedure is demanding, it is an inevitable intervention for some indications, such as infective endocarditis, thrombosis, or multivalve procedures. In this study, we aim to evaluate our institutional experience with SMVR on a real-life cohort, identifying the factors that contribute to poor surgical outcomes whilst avoiding selection bias. METHODS Between March 2012 and November 2020, 58 consecutive high-risk patients underwent a redo SMVR at our institution. The primary endpoints of this study were 30-day and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events. We analyzed and compared the survival in patients undergoing an isolated SMVR and in those that required at least one concomitant procedure. RESULTS The overall operative, 30-day, and 1-year mortality were 3.4%, 22.4%, and 25.9%, respectively. The mortality in patients undergoing isolated SMVR was significantly lower than in patients requiring concomitant procedures. The multivariable regression model showed that NYHA Class IV, infective endocarditis, and postoperative dialysis were significantly associated with 30-day mortality. Society of Thoracic Surgeons Score, infective endocarditis, concomitant procedures, and mechanical valve implantation appeared to predict long-term mortality. CONCLUSION This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian A Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Jerry Easo
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Mehdy Roosta-Azad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Vardanyan R, Hagana A, Iqbal H, Arjomandi Rad A, Mahmud M, Ruparell K, Rabee N, Khan J, Poole W, Shakir RA. A Cost Utility Analysis of Minimally Invasive Surgery with Thrombolysis Compared to Standard Medical Treatment in Spontaneous Intracerebral Haemorrhagic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105934. [PMID: 34167871 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105934] [Citation(s) in RCA: 2] [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] [Received: 10/20/2020] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Standard medical management of spontaneous intracerebral haemorrhage (ICH) and surgical hematoma evacuation starkly differ, and whilst landmark randomised control trials report no clinical benefit of early surgical evacuation compared with medical treatment in supratentorial ICH, minimally invasive surgery (MIS) with thrombolysis has been neglected within these studies. However, recent technological advancements in MIS have renewed interest in the surgical treatment of ICH. Several economic evaluations have focused on the benefits of MIS in ischaemic stroke management, but no economic evaluations have yet been performed comparing MIS to standard medical treatment for ICH. MATERIALS AND METHOD All costs were sourced from the UK in GBP. Where possible, the 2019/2020 NHS reference costs were used. The MISTIE III study was used to analyse the outcomes of patients undergoing either MIS or standard medical treatment in this economic evaluation. RESULTS The incremental cost-effectiveness ratio (ICER) for MIS was £485,240.26 for every quality-adjusted life year (QALY) gained. Although MIS resulted in a higher QALY compared to medical treatment, the gain was insignificant at 0.011 QALY. Four sensitivity analyses based on combinations of alternative EQ-5D values and categorisation of MIS outcomes, alongside alterations to the cost of significant adverse events, were performed to check the robustness of the ICER calculation. The most realistic sensitivity analysis showed a potential increase in cost effectiveness when clot size is reduced to <15ml, with the ICER falling to £74,335.57. DISCUSSION From the perspective of the NHS, MIS with thrombolysis is not cost-effective compared to optimal medical treatment. ICER shows that intention-to-treat MIS would require a cost of £485,240.26 to gain one extra QALY, which is significantly above the NHS threshold of £30,000. Further UK studies with ICH survivor utilities, more replicable surgical technique, and the reporting of clot size reduction are indicated as the present sensitivity analysis suggests that MIS is promising. Greater detail about outcomes and complications would ensure improved cost-benefit analyses and support valid and efficient allocation of resources by the NHS.
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Affiliation(s)
- Robert Vardanyan
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
| | - Arwa Hagana
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Haseeb Iqbal
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Arian Arjomandi Rad
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Kajal Ruparell
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Nuha Rabee
- School of Medicine and Dentistry, Barts and The London, Queen Mary, University of London, London, United Kingdom
| | - Javad Khan
- Faculty of Medicine, King's College London, London, United Kingdom
| | - William Poole
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Raad A Shakir
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Zubarevich A, Szczechowicz M, Zhigalov K, Osswald A, Van den Eynde J, Arjomandi Rad A, Vardanyan R, Wendt D, Schmack B, Ruhparwar A, Weymann A. Sutureless aortic valve replacement in multivalve procedures. J Thorac Dis 2021; 13:3392-3398. [PMID: 34277035 PMCID: PMC8264712 DOI: 10.21037/jtd-21-300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/02/2021] [Accepted: 04/02/2021] [Indexed: 11/06/2022]
Abstract
Background Despite the rapid expansion of transcatheter approaches for aortic valve implantation, surgical aortic valve replacement remains the treatment of choice in patients presenting with multiple valvular heart disease. We sought to review our clinical experience with sutureless aortic valve replacement (SU-AVR) in the setting of multivalve procedures, addressing the postoperative outcomes and technical challenges. Methods Between December 2019 and December 2020, 20 consecutive high-risk patients at our institution underwent SU-AVR and concomitant mitral valve procedure for various indications. Results The mean age of the patients at operation was 72.6±9.3 years. Fifty five percent of the patients (n=11) presented with moderate to severe symptomatic aortic valve stenosis, while 35% (n=7) suffered from severe aortic regurgitation. All patients had concomitant moderate to severe mitral valve disease, including regurgitation in 95% (n=19) and stenosis in 25% (n=5). Mean logistic EuroSCORE was 34.3%±24.7%. Cardiopulmonary bypass and cross-clamp times were 101 (88.0-123) minutes and 67.5 (51.7-85.2) minutes, respectively. Optimal sutureless aortic valve prosthesis device success was achieved in 20 patients (100%). One patient (5%) required permanent pacemaker implantation. Thirty-day mortality was 10% and no strokes were detected. Conclusions SU-AVR is a safe and feasible surgical alternative to conventional procedures in patients presenting with multiple valvular heart disease. It provides excellent hemodynamic performance with low risk of paravalvular leakage and low transvalvular gradients, whilst simplifying the surgical procedure. Precise sizing and positioning of the valve prostheses is crucial to ensure optimal postoperative outcome.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Zubarevich A, Zhigalov K, Schmack B, Rad AA, Vardanyan R, Wendt D, Ruhparwar A, Weymann A. Step-by-Step Minimally Invasive Aortic Valve Replacement: the RAT Approach. Braz J Cardiovasc Surg 2021; 36:420-423. [PMID: 33577265 PMCID: PMC8357396 DOI: 10.21470/1678-9741-2020-0393] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In the growing era of transcatheter aortic valve implantation, it is crucial to develop minimally invasive surgical techniques. These methods enable easier recovery from surgical trauma, especially in elderly and frail patients. Minimally invasive aortic valve replacement (MIAVR) is frequently performed via upper hemisternotomy. We describe MIAVR via right anterior thoracotomy, which is associated with less trauma, rapid mobilization, lower blood transfusion rates, and lower risk of postoperative wound infections. As minimally invasive procedures tend to take longer operative times, we suggest using rapid-deployment valve prostheses to overcome this limitation. This description focuses on the technical aspects and preoperative assessment.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomani Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, Great Britain
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, Great Britain
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Arjomandi Rad A, Naruka V, Vardanyan R, Viviano A, Salmasi MY, Magouliotis D, Kendall S, Casula R, Athanasiou T. Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis. Eur J Cardiothorac Surg 2021; 60:801-810. [PMID: 33880496 PMCID: PMC8535527 DOI: 10.1093/ejcts/ezab178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.
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Affiliation(s)
- Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | | | - Dimitris Magouliotis
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesborough, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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Zubarevich A, Szczechowicz M, Osswald A, Easo J, Rad AA, Vardanyan R, Schmack B, Ruhparwar A, Zhigalov K, Weymann A. Surgical treatment of infective endocarditis in intravenous drug abusers. J Cardiothorac Surg 2021; 16:97. [PMID: 33879196 PMCID: PMC8056573 DOI: 10.1186/s13019-021-01491-1] [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: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Jerry Easo
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Rad AA, Jayaraajan K, Remtulla R, Majeed GM, Ammar O, Ahmad A, Vardanyan R, Viviano A. P4 A cost utility analysis of robotic versus open mitral valve repair in mitral valve regurgitation. BJS Open 2021. [PMCID: PMC8030133 DOI: 10.1093/bjsopen/zrab032.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives For the first time this study carried out a cost-utility analysis comparing open surgical repair versus robotic minimally invasive surgical repair for Mitral Regurgitation. The respective benefits and costs of each treatment option gained from data in published literature have been analysed and subsequent suggestions for the allocation of resources and treatment recommendation will be offered. Methods The analysis was performed by including intraoperative and post-operative costs of the interventions and costs of the most prevalent complications associated with each operation. Thus, the Quality Adjusted Life Years (QALYs) calculated will guide the decision of resource allocation by assessing whether the added cost of robotic surgery is justified given the NICE (National institute of Clinical Excellence) threshold of £30,000/QALY. The choice of perspective taken is through the lens of the British National Healthcare System. Results The Incremental cost-effectiveness ratio (ICER) calculated was £4781.44/QALY. This ICER shows that if robotic surgery was to become gold standard, the NHS would be paying £4781.44/QALY gained per patient. Considering robotic surgery is associated with fewer complications for patients but also has a cost per QALY below the NICE threshold of £30,000/QALY, it seems that this is a fitting alternative to open heart mitral valve repair. After a sensitivity analysis accounting for the initial robotic capital investment the ICER resulted to £22,379.94/QALY, still below NICE’s threshold. Conclusion Our results have shown that robotic assisted minimally invasive repair of the mitral valve is a cost-effective option and can be implemented in the British national healthcare setting.
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Affiliation(s)
| | | | | | | | - Omer Ammar
- Imperial College London, Faculty of Medicine
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Torabi S, Arjomandi Rad A, Vardanyan R, Lopuszko AT, Van den Eynde J, Zubarevich A, Sá MPBO, Szczechowicz M, Weymann A. Surgical and multimodality treatment of cardiac sarcomas: A systematic review and meta-analysis. J Card Surg 2021; 36:2476-2485. [PMID: 33797789 DOI: 10.1111/jocs.15538] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/06/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary cardiac sarcomas (PCSs) are an extremely rare and aggressive type of malignancies that have been described only by a limited number of observational studies. This study aimed to evaluate the currently existing evidence comparing surgical to multimodality treatment of PCS. METHODS We systematically reviewed Embase, MEDLINE, Cochrane Database, and Google Scholar, from inception to December 2020, for original articles about surgical and multimodality treatment of PCS. The outcomes included were mortality at various time points, resection margin status, and mean estimated survival. The pooled treatment effects were calculated using a random-effects model. RESULTS Ten studies including a total of 1570 patients met our inclusion criteria. Surgery was associated with significantly lower mortality when compared to conservative treatment at 1, 2, and 3 years, whereas no significant difference was found at 5 years. Furthermore, multimodality treatment showed significantly lower mortality at 1 year when compared to surgery alone, but not at 2 and 5 years. We found no difference in mortality between angiosarcomas and other PCS subtypes. CONCLUSION Overall, surgery was found to provide a significant mortality advantage to PCS patients up to 3 years following treatment. Multimodality treatment might be of additional benefit, although only within the first year. Prospective randomized studies are needed to further explore these differences in the treatment of PCS.
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Affiliation(s)
- Saeed Torabi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Aleksandra T Lopuszko
- Faculty of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Michel P B O Sá
- Division of Cardiovascular Surgery-PROCAPE, Universidade de Pernambuco (UPE), Recife, Brazil
| | - Marcin Szczechowicz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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Zubarevich A, Zhigalov K, Rad AA, Vardanyan R, Wendt D, Schmack B, Ruhparwar A, Weymann A. Open Transcatheter Multivalve Replacement in Degenerated Valve Prostheses in High-Risk Patients with Endocarditis. Braz J Cardiovasc Surg 2021; 36:703-706. [PMID: 33577266 PMCID: PMC8597607 DOI: 10.21470/1678-9741-2020-0394] [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] [Indexed: 11/04/2022] Open
Abstract
Multivalve redo procedures carry a high surgical risk. We describe an alternative surgical treatment for patients presenting with severely degenerated aortic and mitral valve prostheses who have to undergo open surgery due to endocarditis. Open transcatheter multivalve implantation is a feasible bailout strategy in high-risk patients to save cross-clamp and procedural times to reduce morbidity and mortality.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Zubarevich A, Zhigalov K, Osswald A, Arjomandi Rad A, Vardanyan R, Wendt D, Sá MPBO, Schmack B, Ruhparwar A, Weymann A. Essen-Commando: How we do it. J Card Surg 2020; 36:286-289. [PMID: 33085137 DOI: 10.1111/jocs.15140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/31/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/01/2022]
Abstract
In rare cases of extensive aortic root or mitral valve infective endocarditis (IE), severe calcification of the aortic and mitral valves, or double-valve procedures in patients with small aortic and mitral annuli, surgical reconstruction of the intervalvular fibrous body (IVFB) is required. A high mortality is generally associated with this procedure, and it is frequently avoided by surgeons due to a lack of experience. It is crucial to radically resect all tissues that are severely affected by IE to prevent recurrence in the patient. Our experience with the Commando procedure in patients with extensive double-valve IE involving the IVFB is presented in this article.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Affiliation(s)
- Arian Arjomandi Rad
- Faculty of Medicine, School of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Faculty of Medicine, School of Medicine, Imperial College London, London, UK
- Cardiothoracic Intensive Care Unit, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Natalie R Tas
- Faculty of Medicine, King's College London, London, UK
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Vardanyan R, Arjomandi Rad A, Wilson F. Chronic lymphocytic leukaemia in COVID-19. Int J Lab Hematol 2020; 42. [PMID: 32881278 PMCID: PMC7436881 DOI: 10.1111/ijlh.13307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/25/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Robert Vardanyan
- Department of MedicineFaculty of MedicineImperial College LondonLondonUK
- General Intensive Care UnitImperial College Healthcare NHS TrustHammersmith HospitalLondonUK
| | | | - Florence Wilson
- Department of MedicineFaculty of MedicineImperial College LondonLondonUK
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Arjomandi Rad A, Vardanyan R. Surgery in the COVID-19 era: implications for patient's mental health and practical recommendations for surgeons. Br J Surg 2020; 107:e388. [PMID: 32720713 PMCID: PMC7929318 DOI: 10.1002/bjs.11829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Affiliation(s)
- A Arjomandi Rad
- Imperial College London, Faculty of Medicine, Department of Medicine, London, United Kingdom
| | - R Vardanyan
- Imperial College London, Faculty of Medicine, Department of Medicine, London, United Kingdom.,Cardiothoracic Intensive Care Unit, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
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Arjomandi Rad A, Vardanyan R, Mohamed SA, Punjabi PP. Book review: Atlas of Cardiac Surgical Techniques. Perfusion 2020. [DOI: 10.1177/0267659119872189] [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: 11/15/2022]
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Arjomandi Rad A, Vardanyan R, Mohamed SA, Punjabi PP. Book review: Case Studies in Clinical Cardiac Electrophysiology. Perfusion 2020. [DOI: 10.1177/0267659119871898] [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: 11/17/2022]
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