Publications
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Salmasi MY, Morris-Rosendahl D, Jarral OA, et al., 2022, Determining the genetic contribution in patients with non-syndromic ascending thoracic aortic aneurysms: Correlation with findings from computational pathology, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 366, Pages: 1-9, ISSN: 0167-5273
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- Citations: 1
Naruka V, Salmasi MY, Rad AA, et al., 2022, Use of Cytokine Filters During Cardiopulmonary Bypass: Systematic Review and Meta-Analysis, HEART LUNG AND CIRCULATION, Vol: 31, Pages: 1493-1503, ISSN: 1443-9506
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- Citations: 1
Rad AA, Naruka V, Vardanyan R, et al., 2022, Renal outcomes in valve-in-valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta-analysis, JOURNAL OF CARDIAC SURGERY, Vol: 37, Pages: 3743-3753, ISSN: 0886-0440
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- Citations: 2
Xanthopoulos A, Magouliotis DE, Tryposkiadis K, et al., 2022, Post-Implant Phosphodiesterase-5 Inhibitors in Patients with Left Ventricular Assist Device: A Systematic Review and Meta-Analysis., J Clin Med, Vol: 11, ISSN: 2077-0383
Background: Despite the improvement in left ventricular assist device (LVAD) technology and the advent of third-generation LVADs, hemocompatibility-related events remain a significant issue. Therefore, new pharmacological treatments are necessary to optimize patient management and to further reduce hemocompatibility-related events. The purpose of the present systematic review and meta-analysis was to summarize the existing data regarding the safety and efficacy of post-implant phosphodiesterase-5 inhibitors (PDE-5i) on hemocompatibility-related events. Methods: Among the 258 articles in Pubmed, Scopus, and CENTRAL that were retrieved (1990−2022), 15 studies were included in the qualitative synthesis, and 9 studies were included in the quantitative synthesis. The fixed-effects model was used because it is statistically sound for combining a very small number of studies. The primary endpoint of the study was all-cause mortality, whereas the secondary endpoints were ischemic stroke, pump thrombosis, and gastrointestinal bleeding. Results: Mortality was significantly lower in the PDE-5i group vs. the control group (OR: 0.92 [95% CI: 0.85, 0.98]; p = 0.02). The secondary endpoints ischemic stroke (OR: 0.87 [95% CI: 0.78, 0.98]; p = 0.02) and pump thrombosis (OR: 0.90 [95% CI: 0.82, 0.99]; p = 0.04) were also lower in the PDE-5i group. The incidence of gastrointestinal bleeding was significantly higher in patients with LVAD receiving PDE-5i (OR: 1.26 [95% CI: 1.11, 1.44]; p < 0.01). In the overall analysis, the heterogeneity of outcomes was low, except for pump thrombosis. Conclusions: The use of PDE-5i post-implant was associated with lower mortality and thrombotic events but with a higher risk of gastrointestinal bleeding.
Spanos K, Nana P, von Kodolitsch Y, et al., 2022, Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines., J Endovasc Ther, Vol: 29, Pages: 667-677
BACKGROUND: Ascending aorta and aortic arch diseases have an increasing interest among cardiovascular specialists regarding diagnosis and management. Innovations in endovascular surgery and evolution of open surgery have extended the indications for treatment in patients previously considered unfit for surgery. The aim of this systematic review of the literature was to present and analyze current cardiovascular guidelines for overlap and differences in their recommendations regarding ascending aorta and aortic arch diseases and the assessment of evidence. METHODS: The English medical literature was searched using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 2009 to December 2020. Recommendations on selected topics were analyzed, including issues from definitions and diagnosis (imaging and biomarkers) and indications for treatment to management, including surgical techniques, of the most important ascending aorta and aortic arch diseases. RESULTS: The initial search identified 2414 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from multidisciplinary, cardiovascular societies published between 2010 and 2019. The definition of non-A-non-B aortic dissection is lacking from most of the guidelines. There is a disagreement regarding the class of recommendation and level of evidence for the diameter of ascending aorta as an indication. The indication for treatment of aortic disease may be individualized in specific cases while the growth rate may also affect the decision making. The role of endovascular techniques has not been established in current guidelines except by 1 society. Supportive evidence level in the management of aortic arch diseases remains limited. CONCLUSION: In current recommendations of cardiovascular societies, the ascending aorta and aortic arch remain a domain of open surgery despite the introduction of endovascular techniques. Recommendations o
Sá MP, Jacquemyn X, Tasoudis PT, et al., 2022, Immediate and late outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in bicuspid valves: Meta-analysis of reconstructed time-to-event data., J Card Surg, Vol: 37, Pages: 3300-3310
BACKGROUND: Outcomes of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients with aortic stenosis and bicuspid aortic valve (BAV) must be better investigated. METHODS: A meta-analysis including studies published by January 2022 reporting immediate outcomes (in-hospital death, stroke, acute kidney injury [AKI], major bleeding, new permanent pacemaker implantation [PPI], paravalvular leakage [PVL]), mortality in the follow-up (with Kaplan-Meier curves for reconstruction of individual patient data). RESULTS: Five studies met our eligibility criteria. No statistically significant difference was observed for in-hospital death, stroke, AKI, and PVL. TAVI was associated with lower risk of major bleeding (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.12-0.69; p = .025), but higher risk of PPI (OR: 2.00; 95% CI: 1.05-3.77; p = .041). In the follow-up, mortality after TAVI was significantly higher in the analysis with the largest samples (HR: 1.24, 95% CI: 1.01-1.53, p = .043), but no statistically significant difference was observed with risk-adjusted populations (HR: 1.06, 95% CI: 0.86-1.32, p = .57). Landmark analyses suggested a time-varying risk with TAVI after 10 and 13 months in both largest and risk-adjusted populations (HR: 2.13, 95% CI: 1.45-3.12, p < .001; HR: 1.7, 95% CI: 1.11-2.61, p = .015, respectively). CONCLUSION: Considering the immediate outcomes and comparable overall survival observed in risk-adjusted populations, TAVI can be used safely in selected BAV patients. However, a time-varying risk is present (favoring SAVR over TAVI at a later timepoint). This finding was likely driven by higher rates of PPI with TAVI.
Magouliotis DE, Zotos P-A, Fergadi MP, et al., 2022, Meta-analysis of robot-assisted versus video-assisted McKeown esophagectomy for esophageal cancer., Updates Surg, Vol: 74, Pages: 1501-1510
We aim to review the available literature on patients with esophageal cancer treated with robot-assisted (RAME) or video-assisted McKeown's esophagectomy (VAME), to compare the efficacy and safety of the two approaches. Original research studies that evaluated perioperative and oncologic outcomes of RAME versus VAME were identified, from January 1990 to July 2022. The 90-day mortality, the R0 resection rate, the dissected lymph nodes, the perioperative parameters, and the complications were calculated according to a fixed and a random effect model. The Q statistics and I2 statistic were used to test for heterogeneity among the studies. Seven studies were included, incorporating a total of 1617 patients treated with RAME or VAME. The 90-day mortality was similar between the two groups. No difference was found regarding the R0 resection rate and the number of dissected lymph nodes. In addition, the perioperative parameters, along with the total complications were similar between RAME and VAME. Nonetheless, the incidence of postoperative pneumonia was higher in the VAME group (OR:0.67 [95% CI: 0.49, 0.93]; p = 0.02). Finally, our outcomes were further validated by sensitivity analysis including only studies performing propensity score-matched analysis. Our meta-analysis showed that RAME was equivalent to VAME in terms of safety, feasibility, and oncologic adequacy. These results should be interpreted with caution due to the small number of included studies. New Randomized Controlled trials, that are currently active, will provide further evidence with greater clarity to assess the effectiveness and safety of RAME for esophageal cancer.
Naruka V, Arjomandi Rad A, Subbiah Ponniah H, et al., 2022, Machine learning and artificial intelligence in cardiac transplantation: A systematic review, ARTIFICIAL ORGANS, Vol: 46, Pages: 1741-1753, ISSN: 0160-564X
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- Citations: 3
Salmasi MY, Sasidharan S, Frattolin J, et al., 2022, Regional variation in biomechanical properties of ascending thoracic aortic aneurysms, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 62, ISSN: 1010-7940
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- Citations: 2
Salmasi MYB, Morris-Rosendahl D, Jarral O, et al., 2022, Determining the genetic contribution in patients with non-syndromic ascending thoracic aortic aneurysms: Correlation with findings from computational pathology, International Journal of Cardiology, ISSN: 0167-5273
Pring ET, Malietzis G, Gould LE, et al., 2022, Tumour grade and stage are associated with specific body composition phenotypes with visceral obesity predisposing the host to a less aggressive tumour in colorectal cancer., Eur J Surg Oncol, Vol: 48, Pages: 1664-1670
BACKGROUND: Sarcopenia, myosteatosis and visceral obesity (VO) are known to negatively impact on outcomes from colorectal cancer (CRC). Little is known about tumour factors associated with these body composition (BC) phenotypes. We aimed to identify whether histopathological tumour characteristics were associated with various BC phenotypes. METHODS: A prospectively collected database of patients undergoing surgery for primary CRC at a tertiary referral unit in the United Kingdom was analysed. Sarcopenia, myosteatosis and VO were identified on preoperative CT. Binary logistic regression modelling was performed to determine significant associations between tumour stage, grade and BC phenotype. RESULTS: Final analysis included 795 patients; median age 69, 56% male, 65% were sarcopenic, 72% myosteatotic, 52% VO and 20% had sarcopenic obesity (SO). VO patients were significantly less likely to have advanced T Stage (T3-4) OR0.62(95%CI 0.44-0.86, p = 0.005); nodal metastases OR0.60(95%CI 0.44-0.82, p = 0.001); vascular invasion OR0.63(95%CI 0.46-0.88, p = 0.006) and poor tumour differentiation OR0.49(95%CI 0.28-0.86, p = 0.012). Myosteatotic patients were more likely to have metastatic disease OR2.31(95%CI 1.15-4.63, p = 0.018) but less likely to have poorly differentiated tumours OR0.48(95%CI 0.27-0.86, p = 0.013). SO patients were significantly more likely to have poorly differentiated tumours OR2.01(95%CI 1.04-3.87, p = 0.037). CONCLUSION: VO predisposes to earlier stage tumours with a less aggressive tumour phenotype. The SO group have adverse tumour characteristics which may be explained by differences in fat distribution. Myosteatosis relates to increased likelihood of distant metastasis that may be related to a systemic inflammatory response, despite the association with better differentiated tumours.
Tasoudis PT, Varvoglis DN, Vitkos E, et al., 2022, Mechanical versus bioprosthetic valve for aortic valve replacement: systematic review and meta-analysis of reconstructed individual participant data, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 62, ISSN: 1010-7940
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- Citations: 7
Monteagudo-Vela M, Krasopoulos G, Athanasiou T, et al., 2022, Impact of third-generation left ventricular assist devices on quality of life: Scoping review and meta-analysis., Artif Organs, Vol: 46, Pages: 1012-1018
OBJECTIVES: Development in device technology and the scarcity of donor's hearts have increased the number of patients with advanced heart failure receiving durable left ventricular assist devices (LVADs) as a bridge to transplantation and destination therapy, with improved prognosis compared with guideline-directed medical therapy. We sought to examine the impact of modern durable LVADs on the quality of life (QoL) of the recipients. METHODS: We carried out a systematic review of articles on QoL following the implantation of third-generation LVADs published between January 2010 and February 2021. Included studies were critically analyzed and evidence synthesis was carried out into a meta-analysis. RESULTS: The systematic search yielded 269 articles, 11 of which met the search predefined criteria. Three of them reported results of randomized trials and eight were retrospective and registry studies. Statistically significant QoL improvement from baseline was observed in all published reports. When using the EuroQol 5L questionnaire (scale 0-100) as a QoL tool 6 months post-LVAD implantation, a meta-analysis of four included studies demonstrated a mean difference increase of 28.9 points (95% confidence interval: 26.71-31.14). CONCLUSIONS: Third-generation LVADs confer a significant improvement in QoL and their use can be supported not only for prognosis but also for symptom control. Although methodological limitations should be considered, the available QoL outcomes can be a useful tool in patient selection and the decision-making process.
Al Ani M, Garas G, Hollingshead J, et al., 2022, Which electronic health record system should we use? A systematic review, Medical Principles and Practice, Vol: 31, Pages: 342-351, ISSN: 1011-7571
The UK government had intended to introduce a comprehensive EHRs system in England by 2020. These EHRs would run across primary, secondary, and social care linking data in a single digital platform. This systematic review's objectives were to identify studies that compare EHRs in terms of direct comparison between systems and evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching EMBASE and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and SQuaRE's eight characteristics: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After review of titles and abstracts, this was filtered down to 40 studies as per exclusion and inclusion criteria set out in our study selection. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE respectively. Nineteen studies addressed functional suitability, n=18 performance efficiency, n=12 compatibility, n=25 usability, n=6 reliability, n=2 security, n=16 maintainability, and n=13 portability. Epic was the most studied EHR system and one of the most implemented vendors in the USA market, and one of the top ten in UK. It is difficult to assess which is the most advantageous EHR system currently available when looking at them in accordance with SQuaRE's eight characteristics for software evaluation.
Tasoudis PT, Magouliotis DE, Varvoglis DN, et al., 2022, Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis, GENERAL THORACIC AND CARDIOVASCULAR SURGERY, Vol: 70, Pages: 315-328, ISSN: 1863-6705
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- Citations: 2
Manchester E, Pirola S, Salmasi MY, et al., 2022, Evaluation of computational methodologies for accurate prediction of wall shear stress and turbulence parameters in a patient-specific aorta, Frontiers in Bioengineering and Biotechnology, Vol: 10, ISSN: 2296-4185
Background: Recent studies suggest that blood flow in main arteries is intrinsically disturbed, even under healthy conditions. Despite this, many computational fluid dynamics (CFD) analyses of aortic haemodynamics make the assumption of laminar flow, and best practices surroundingappropriate modelling choices are lacking. This study aims to address this gap by evaluating different modelling and post-processing approaches in simulations of a patient-specific aorta. Methods: Magnetic resonance imaging (MRI) and 4D flow MRI from a patient with aortic valve stenosis were used to reconstruct the aortic geometry and derive patient-specific inlet and outlet boundary conditions. Three different computational approaches were considered based on assumed laminar or assumed disturbed flow states including low-resolution laminar (LR-laminar),high-resolution laminar (HR-Laminar) and large-eddy simulation (LES). Each simulation was ran for 30 cardiac cycles and post-processing was conducted on either the final cardiac cycle, or using a phase-averaged approach which utilised all 30 simulated cycles. Model capabilities were evaluated in terms of mean and turbulence-based parameters. Results: All simulation types, regardless of post-processing approach could correctly predict velocity values and flow patterns throughout the aorta. Lower resolution simulations could not accurately predict gradient-derived parameters including wall shear stress and viscous energy loss (largest differences up to 44.6% and 130.3%, respectively), although phase-averagingthese parameters improved predictions. The HR-Laminar simulation produced more comparable results to LES with largest differences in wall shear stress and viscous energy loss parameters up to 5.1% and 11.6%, respectively. Laminar-based parameters were better estimated thanturbulence-based parameters.Conclusions: Our findings suggest that well-resolved laminar simulations can accurately predict many laminar-based parameters in disturbed flo
Maesen B, van der Heijden CAJ, Bidar E, et al., 2022, Patient-reported quality of life after stand-alone and concomitant arrhythmia surgery: a systematic review and meta-analysis, INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, Vol: 34, Pages: 339-348, ISSN: 1569-9293
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- Citations: 3
Moscarelli M, Di Bari N, Nasso G, et al., 2022, Early safety performance of a modified technique of aorta replacement with sinotubular stabilization, ASIAN CARDIOVASCULAR & THORACIC ANNALS, Vol: 30, Pages: 171-176, ISSN: 0218-4923
Boyalla V, Harling L, Snell A, et al., 2022, Biomarkers as predictors of recurrence of atrial fibrillation post ablation: an updated and expanded systematic review and meta-analysis, Clinical Research in Cardiology, Vol: 111, Pages: 680-691, ISSN: 0300-5860
BackgroundA high proportion of patients undergoing catheter ablation (CA) for atrial fibrillation (AF) experience recurrence of arrhythmia. This meta-analysis aims to identify pre-ablation serum biomarker(s) associated with arrhythmia recurrence to improve patient selection before CA.MethodsA systematic approach following PRISMA reporting guidelines was utilised in libraries (Pubmed/Medline, Embase, Web of Science, Scopus) and supplemented by scanning through bibliographies of articles. Biomarker levels were compared using a random-effects model and presented as odds ratio (OR). Heterogeneity was examined by meta-regression and subgroup analysis.ResultsIn total, 73 studies were identified after inclusion and exclusion criteria were applied. Nine out of 22 biomarkers showed association with recurrence of AF after CA. High levels of N-Terminal-pro-B-type-Natriuretic Peptide [OR (95% CI), 3.11 (1.80–5.36)], B-type Natriuretic Peptide [BNP, 2.91 (1.74–4.88)], high-sensitivity C-Reactive Protein [2.04 (1.28–3.23)], Carboxy-terminal telopeptide of collagen type I [1.89 (1.16–3.08)] and Interleukin-6 [1.83 (1.18–2.84)] were strongly associated with identifying patients with AF recurrence. Meta-regression highlighted that AF type had a significant impact on BNP levels (heterogeneity R2 = 55%). Subgroup analysis showed that high BNP levels were more strongly associated with AF recurrence in paroxysmal AF (PAF) cohorts compared to the addition of non-PAF patients. Egger’s test ruled out the presence of publication bias from small-study effects.ConclusionRanking biomarkers based on the strength of association with outcome provides each biomarker relative capacity to predict AF recurrence. This will provide randomised controlled trials, a guide to choosing a priori tool for identifying patients likely to revert to AF, which are required to substantiate these findings.
Athanasiou T, Darzi A, Ye Oo A, 2022, Preface, Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions, Pages: v-vii
Athanasiou T, Darzi A, Ye Oo A, 2022, Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions, ISBN: 9783031098147
This book provides a guide to the assessment of patient reported outcomes measures and quality of life in cardiovascular interventions, which have become a fundamental component of decision making in bedside medicine, health policy, health economics, and public health. Cardiac surgery, cardiovascular interventions, vascular interventions, and the core principles of quality of life are all covered. This book is the first book to demonstrate how clinicians and policy makers can easily get access to a single source of quality of life and patient reported outcomes measures evidence to help them make the best informed decisions in the field of cardiovascular interventions. This is a rapidly emerging field and the book would be relevant to doctors, healthcare scientists, allied-health professionals, healthcare managers, medical statisticians, healthcare economists, and consultants working in healthcare.
Tan MKH, Jarral OA, Salmasi Y, et al., 2022, Thoracic Aortic Surgery, Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions, Pages: 49-81, ISBN: 9783031098147
Operating on the thoracic aorta is a challenging task, with historically high morbidity and mortality. While outcomes are improving in recent times, there is increased focus on patient-reported outcome measures, principle of which is health-related quality of life (HRQoL), a development beyond isolated markers of operative morbidity or mortality. This concept is especially relevant to aortic surgery due to the number of asymptomatic patients which are operated on (for prognostic reasons) and rapidly developing endovascular techniques that require more holistic assessment. This book chapter aims to provide an overview on the current literature describing HRQoL in patients undergoing both open and endovascular interventions on the thoracic aorta. While certain aspects of the literature were lacking, for example the lack of baseline HRQoL measurements in the majority of studies, most studies confirm that HRQoL after major elective and emergency aortic surgery is acceptable and is comparable to age- and gender-matched populations. This chapter also provides strategies for improving HRQoL in aortic surgery, including the requirement for operating surgeons to carefully plan cerebral protection methods (to avoid post-operative neurological complications) and operative strategies to avoid reoperation or reintervention, as these are risk factors which are associated with deterioration of long-term HRQoL. Future research should include randomised studies with baseline and follow-up HRQoL measured at specific predefined timepoints, with potential for other innovative research areas including correlation of HRQoL with biomarkers or aortic biomechanics such as aortic stiffness or wall shear stress to characterise disease progression and prognosis.
Magouliotis DE, Fergadi MP, Christodoulidis G, et al., 2022, In-depth bioinformatic study of the cadherin 5 interactome in patients with thoracic aortic aneurysm unveils 8 novel biomarkers, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 61, Pages: 11-18, ISSN: 1010-7940
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- Citations: 3
Whittaker G, Salmasi MY, Aydin A, et al., 2022, Recommendations for the use of coronary and valve simulators in cardiac surgical training: a systematic review, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 61, Pages: 1-10, ISSN: 1010-7940
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- Citations: 2
Fergadi MP, Magouliotis DE, Rountas C, et al., 2022, A meta-analysis evaluating the role of high-intensity focused ultrasound (HIFU) as a fourth treatment modality for patients with locally advanced pancreatic cancer., Abdom Radiol (NY), Vol: 47, Pages: 254-264
BACKGROUND: This study aimed to evaluate the outcomes of high-intensity focused ultrasound (HIFU) on patients with advanced pancreatic cancer. METHODS: A literature search was performed in PubMed, Scopus and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Difference, and 95% Confidence Interval were evaluated by means of the Random-Effects model. RESULTS: Nineteen articles met the inclusion criteria, incorporating 939 patients. This study reveals that patients in the HIFU group presented increased median overall survival (OS), along with higher OS at 6 and 12 months after treatment compared with the control group (p < 0.05). Furthermore, patients treated with HIFU in conjunction with chemotherapy presented reduced levels of pain (p < 0.05) compared to the traditional treatment group. In addition, HIFU contributed to significant tumor responsiveness, in terms of CA19-9 reduction (p < 0.05). Finally, HIFU was a considerably safe treatment modality with a low incidence of complications. CONCLUSION: These outcomes suggest that HIFU is a feasible and safe treatment modality for patients with advanced pancreatic cancer and provides enhanced outcomes regarding survival and quality of life. Given the lack of a significant number of randomized clinical trials, this meta-analysis represents the best currently available evidence. New randomized trials assessing HIFU are necessary to further evaluate their outcomes.
Salmasi MYB, Papa K, David M, et al., 2021, Converging rapid deployment prostheses with minimal access surgery: analysis of early outcomes, Journal of Cardiothoracic Surgery, Vol: 16, ISSN: 1749-8090
Background:Sutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS).Methods:A retrospective analysis of prospectively collected data was conducted for all isolated aortic valve replacement (AVR), using the Perceval valve, for severe aortic stenosis cases in the period 2014 to 2019. Patients undergoing concomitant valve or revascularisation surgery were excluded.Results:A total of 78 patients were included: MS group 41; MIS group 37. Operatively, bypass times were comparable between MS and MIS groups (mean 89.3 vs 83.4, p = 0.307), as were aortic cross clamp times (58.4 vs 55.9, p = 0.434). There were no operative deaths or new onset post-operative neurology. MIS was a predictor of reduced stay in the intensive care unit (coef − 3.25, 95% CI [− 4.93, − 0.59], p = 0.036) and hospital stay overall (p = 0.004). Blood transfusion units were comparable as were the incidence of heart block (n = 5 vs n = 3, p = 0.429) and new onset atrial fibrillation (n = 15 vs n = 9, p = 0.250). Follow-up echocardiography found a significant improvement in effective orifice area, left ventricular dimension and volume indices, and LVEF (p > 0.05) for all patients. Multivariate analysis found mini-sternotomy to be a predictor for reduced LV diastolic volume (coef − 0.35, 95% CI [− 1.02, − 0.05], p = 0.05).Conclusions:The combination of minimal access surgery and sutureless AVR may enhance patient recovery and provide early LV remodelling.
Drami I, Pring ET, Gould L, et al., 2021, Body Composition and Dose-limiting Toxicity in Colorectal Cancer Chemotherapy Treatment; a Systematic Review of the Literature. Could Muscle Mass be the New Body Surface Area in Chemotherapy Dosing?, CLINICAL ONCOLOGY, Vol: 33, Pages: E540-E552, ISSN: 0936-6555
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- Citations: 6
Sideris M, Emin EI, Hanrahan JG, et al., 2021, ABC of Surgical Teaching: Time to Consider a Global Blueprint for Holistic Education, JOURNAL OF INVESTIGATIVE SURGERY, Vol: 34, Pages: 1355-1365, ISSN: 0894-1939
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- Citations: 4
Salmasi MYB, Pirola S, Sasidharan S, et al., 2021, High wall shear stress can predict wall degradation in ascending aorticaneurysms: an integrated biomechanics study, Frontiers in Bioengineering and Biotechnology, Vol: 9, Pages: 1-13, ISSN: 2296-4185
Background: Blood flow patterns can alter material properties of ascending thoracic aortic aneurysms (ATAA) via vascular wall remodeling. This study examines the relationship between wall shear stress (WSS) obtained from image-based computational modelling with tissue-derived mechanical and microstructural properties of the ATAA wall using segmental analysis.Methods: Ten patients undergoing surgery for ATAA were recruited. Exclusions: bicuspid aortopathy, connective tissue disease. All patients had pre-operative 4-dimensional flow magnetic resonance imaging (4D-MRI), allowing for patient-specific computational fluid dynamics (CFD) analysis and anatomically precise WSS mapping of ATAA regions (6–12 segments per patient). ATAA samples were obtained from surgery and subjected to region-specific tensile and peel testing (matched to WSS segments). Computational pathology was used to characterize elastin/collagen abundance and smooth muscle cell (SMC) count.Results: Elevated values of WSS were predictive of: reduced wall thickness [coef −0.0489, 95% CI (−0.0905, −0.00727), p = 0.022] and dissection energy function (longitudinal) [−15,0, 95% CI (−33.00, −2.98), p = 0.048]. High WSS values also predicted higher ultimate tensile strength [coef 0.136, 95% CI (0 0.001, 0.270), p = 0.048]. Additionally, elevated WSS also predicted a reduction in elastin levels [coef −0.276, 95% (CI −0.531, −0.020), p = 0.035] and lower SMC count ([oef −6.19, 95% CI (−11.41, −0.98), p = 0.021]. WSS was found to have no effect on collagen abundance or circumferential mechanical properties.Conclusions: Our study suggests an association between elevated WSS values and aortic wall degradation in ATAA disease. Further studies might help identify threshold values to predict acute aortic events.
Moscarelli M, Santarpino G, Athanasiou T, et al., 2021, A pooled analysis of pacemaker implantation after Perceval sutureless aortic valve replacement, INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, Vol: 33, Pages: 501-509, ISSN: 1569-9293
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- Citations: 9
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