Publications
780 results found
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
Rad AA, Naruka V, Vardanyan R, et al., 2021, Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 60, Pages: 801-810, ISSN: 1010-7940
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- Citations: 5
Pring ET, Gould LE, Malietzis G, et al., 2021, BiCyCLE NMES-neuromuscular electrical stimulation in the perioperative treatment of sarcopenia and myosteatosis in advanced rectal cancer patients: design and methodology of a phase II randomised controlled trial, TRIALS, Vol: 22
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- Citations: 1
Fergadi MP, Magouliotis DE, Vlychou M, et al., 2021, A meta-analysis evaluating contrast-enhanced intraoperative ultrasound (CE-IOUS) in the context of surgery for colorectal liver metastases., Abdom Radiol (NY), Vol: 46, Pages: 4178-4188
BACKGROUND: This study aimed to assess the outcomes of contrast-enhanced intraoperative ultrasound (CE-IOUS) for patients with colorectal liver metastases (CRLMs) undergoing surgery. METHOD: A thorough 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 Random-Effects model. RESULTS: Eleven articles met the inclusion criteria and incorporated 497 patients. The present study shows that CE-IOUS is associated with higher sensitivity and accuracy compared with multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and intraoperative ultrasound (IOUS) in identifying CRLMs (p < 0.05). The positive predictive value was similar among the different modalities. Furthermore, new CRLMs were identified by CE-IOUS, thus affecting the surgical plan in 128 patients (51.8% of the patients with new CRLMs). Moreover, 91 patients (71%) underwent a more extensive hepatectomy and 15 patients (11.7%) were considered non-operable. Two alternative contrast agents, Sonazoid and Sonovue, were employed with similar sensitivity (p > 0.05). CONCLUSION: These outcomes suggest the superiority of the CE-IOUS over MDCT, MRI, and IOUS for the staging of patients with CRLMs undergoing surgery. However, they should be treated with caution given the small number of the included studies.
Salmasi MY, Ravishankar R, Abdullahi Y, et al., 2021, Predictors of outcome after CABG in the South-Asian community: a propensity matched analysis, Perfusion, Vol: 38, Pages: 75-84, ISSN: 0267-6591
Background:Ethnicity is not incorporated into standardized pre-operative risk-stratification tools for cardiac surgery. This study compared short-term outcomes following coronary artery bypass graft (CABG) surgery in South Asian and non-Asian patients.Methods:Consecutive patients undergoing isolated CABG surgery via sternotomy between the years 2011 and 2019 were retrospectively analyzed. Initially, 1957 patients were identified (799 South-Asian, 40.8%). The patient groups were then propensity matched according to 10 relevant pre-operative covariates (age, body mass index, pulmonary disease, renal failure, smoking, diabetes, ventricular function, renal failure): 675 non-Asian patients were matched against 675 Asian patients.Results:Operative mortality was 1.77% and similar between the two groups (p = 0.447). Multivariate regression analysis found predictors of operative mortality to be pre-operative serum creatinine, age, left ventricular (LV) impairment, and extent of coronary disease. The effect of creatinine on mortality was selective for South-Asian patients (p = 0.015). LV impairment was a predictor of mortality in non-Asian patients, however this effect did not exist in South-Asian patients. Predictors of short-term complications (composite of death, stroke, reoperation, hemofiltration, and pneumonia) were age and creatinine (coefficient 0.002, 95% CI 0.0004–0.004, p = 0.019) in the overall cohort. Subgroup analysis found age to remain a selective negative predictor of complications in South-Asian patients. Cox regression analysis found creatinine, age, and LVEF to influence 10-year survival, whilst ethnicity was not a predictor.Conclusion:This study highlights the cumulative risk associated with ethnicity and renal disease in predicting short-term outcomes following CABG. This warrants further investigations in larger populations, thus guiding pre-operative risk-stratification.
Garas G, Darzi A, Athanasiou T, et al., 2021, Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta-analysis, CLINICAL OTOLARYNGOLOGY, Vol: 46, Pages: 918-918, ISSN: 1749-4478
Pring ET, Malietzis G, Kendall SWH, et al., 2021, Crisis management for surgical teams and their leaders, lessons from the COVID-19 pandemic; A structured approach to developing resilience or natural organisational responses, INTERNATIONAL JOURNAL OF SURGERY, Vol: 91, ISSN: 1743-9191
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- Citations: 4
Kan X, Yuan X, Salmasi MYB, et al., 2021, Comprehensive Mechanical Modelling of Thoracic Endovascular Aortic Repair in Type A Aortic Dissection, Publisher: The Japanese Circulation Society, ISSN: 0047-1828
Li J, 2021, Roux-en-Y Gastric bypass-induced bacterial perturbation contributes to altered host-bacterial co-metabolic phenotype, Microbiome, Vol: 9, ISSN: 2049-2618
BACKGROUND: Bariatric surgery, used to achieve effective weight loss in individuals with severe obesity, modifies the gut microbiota and systemic metabolism in both humans and animal models. The aim of the current study was to understand better the metabolic functions of the altered gut microbiome by conducting deep phenotyping of bariatric surgery patients and bacterial culturing to investigate causality of the metabolic observations. METHODS: Three bariatric cohorts (n = 84, n = 14 and n = 9) with patients who had undergone Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) or laparoscopic gastric banding (LGB), respectively, were enrolled. Metabolic and 16S rRNA bacterial profiles were compared between pre- and post-surgery. Faeces from RYGB patients and bacterial isolates were cultured to experimentally associate the observed metabolic changes in biofluids with the altered gut microbiome. RESULTS: Compared to SG and LGB, RYGB induced the greatest weight loss and most profound metabolic and bacterial changes. RYGB patients showed increased aromatic amino acids-based host-bacterial co-metabolism, resulting in increased urinary excretion of 4-hydroxyphenylacetate, phenylacetylglutamine, 4-cresyl sulphate and indoxyl sulphate, and increased faecal excretion of tyramine and phenylacetate. Bacterial degradation of choline was increased as evidenced by altered urinary trimethylamine-N-oxide and dimethylamine excretion and faecal concentrations of dimethylamine. RYGB patients' bacteria had a greater capacity to produce tyramine from tyrosine, phenylalanine to phenylacetate and tryptophan to indole and tryptamine, compared to the microbiota from non-surgery, normal weight individuals. 3-Hydroxydicarboxylic acid metabolism and urinary excretion of primary bile acids, serum BCAAs and dimethyl sulfone were also perturbed following bariatric surgery. CONCLUSION: Altered bacterial composition and metabolism contribute to metabolic observations in biofluid
Salmasi MY, Jarral OA, Athanasiou T, 2021, What can we learn from outliers in cardiac surgery?, JOURNAL OF CARDIAC SURGERY, Vol: 36, Pages: 1832-1834, ISSN: 0886-0440
Moscarelli M, Lorusso R, Abdullahi Y, et al., 2021, The Effect of Minimally Invasive Surgery and Sternotomy on Physical Activity and Quality of Life, HEART LUNG AND CIRCULATION, Vol: 30, Pages: 882-887, ISSN: 1443-9506
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- Citations: 7
Manchester E, Pirola S, Salmasi M, et al., 2021, Analysis of turbulence effects in a patient-specific aorta with aortic valve stenosis, Cardiovascular Engineering and Technology, Vol: 12, Pages: 438-453, ISSN: 1869-408X
Blood flow in the aorta is often assumed laminar, however aortic valve pathologies may induce transition to turbulence and our understanding of turbulence effects is incomplete. The aim of the study was to provide a detailed analysis of turbulence effects in aortic valve stenosis (AVS).Methods:Large-eddy simulation (LES) of flow through a patient-specific aorta with AVS was conducted. Magnetic resonance imaging (MRI) was performed and used for geometric reconstruction and patient-specific boundary conditions. Computed velocity field was compared with 4D flow MRI to check qualitative and quantitative consistency. The effect of turbulence was evaluated in terms of fluctuating kinetic energy, turbulence-related wall shear stress (WSS) and energy loss.Results:Our analysis suggested that turbulence was induced by a combination of a high velocity jet impinging on the arterial wall and a dilated ascending aorta which provided sufficient space for turbulence to develop. Turbulent WSS contributed to 40% of the total WSS in the ascending aorta and 38% in the entire aorta. Viscous and turbulent irreversible energy losses accounted for 3.9 and 2.7% of the total stroke work, respectively.Conclusions:This study demonstrates the importance of turbulence in assessing aortic haemodynamics in a patient with AVS. Neglecting the turbulent contribution to WSS could potentially result in a significant underestimation of the total WSS. Further work is warranted to extend the analysis to more AVS cases and patients with other aortic valve diseases.
Arhi C, Askari A, Nachiappan S, et al., 2021, Stage at Diagnosis and Survival of Colorectal Cancer With or Without Underlying Inflammatory Bowel Disease: A Population-based Study, JOURNAL OF CROHNS & COLITIS, Vol: 15, Pages: 375-382, ISSN: 1873-9946
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- Citations: 10
Khader AA, Allaf M, Lu OW, et al., 2021, Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?, Journal of Cardiac Surgery, Vol: 36, Pages: 1103-1119, ISSN: 0886-0440
Background:Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR.Methods:A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies).Results:The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009).Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63−4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77–0.99]; p < .001) with considerable heterogeneity (I2 > 90%; p < .001).The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188−0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19−0.46]; p < .001) during midterm follow up. Long term survival (4–5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35−1.41]; p = .323).Conclusions:This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.
Abdullahi YS, Salmasi MY, Moscarelli M, et al., 2021, The Use of Frailty Scoring to Predict Early Physical Activity Levels After Cardiac Surgery, ANNALS OF THORACIC SURGERY, Vol: 111, Pages: 36-43, ISSN: 0003-4975
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- Citations: 5
Olchanyi MD, Sadikov A, Frattolin J, et al., 2020, Validation of markerless strain-field optical tracking approach for soft tissue mechanical assessment., Journal of Biomechanics, Vol: 116, Pages: 1-11, ISSN: 0021-9290
Strain measurement during tissue deformation is crucial to elucidate relationships between mechanical loading and functional changes in biological tissues. When combined with specified loading conditions, assessment of strain fields can be used to craft models that accurately represent the mechanical behavior of soft tissue. Inhomogeneities in strain fields may be indicative of normal or pathological inhomogeneities in mechanical properties. In this study, we present the validation of a modified Demons registration algorithm for non-contact, marker-less strain measurement of tissue undergoing uniaxial loading. We validate the algorithm on a synthetic dataset composed of artificial deformation fields applied to a speckle image, as well as images of aortic sections of varying perceptual quality. Initial results indicate that Demons outperforms recent Optical Flow and Digital Image Correlation methods in terms of accuracy and robustness to low image quality, with similar runtimes. Demons achieves at least 8% lower maximal deviation from ground truth on 50% biaxial and shear strain applied to aortic images. To illustrate utility, we quantified strain fields of multiple human aortic specimens undergoing uniaxial tensile testing, noting the formation of strain concentrations in areas of rupture. The modified Demons algorithm captured a large range of strains (up to 50%) and provided spatially resolved strain fields that could be useful in the assessment of soft tissue pathologies.
Al-Balah A, Naqvi D, Houbby N, et al., 2020, Comparison of outcomes following transfemoral versus trans-subclavian approach for transcatheter aortic valve Implantation: a meta-analysis, International Journal of Cardiology: Heart and Vasculature, Vol: 31, ISSN: 2352-9067
BackgroundThe subclavian artery is an alternative access route for transcatheter aortic valve implantation (TAVI), with a potential advantage in patients unsuitable for traditional access routes such as the femoral artery. This study aimed to determine the safety and efficacy of the trans-subclavian (TSc) compared to the trans-femoral (TF) approach.MethodsA systematic review was conducted on two online databases: Embase and Medline. The initial search returned 508 titles. Nine observational studies were included: n = 2938 patients (2382 TF and 556 TSc).ResultsBoth TSc and TF groups were comparable for: 30-day mortality (Odds ratio, OR 0.75, 95% CI 0.49 – 1.16, p = 0.195); in-hospital stroke (OR 1.05, 95% CI 0.60–1.85, p = 0.859); myocardial infarction (OR 1.97, 95% CI 0.74–5.23, p = 0.176); paravalvular leaks (OR 1.20, 95% CI 0.76–1.90, p = 0.439); rates of postoperative permanent pacemaker implantation (OR 1.49, 95% CI 0.92–2.41, p = 0.105); in-hospital bleeding and meta-analysis demonstrated no significant difference between access points (OR 3.44, 95% CI 0.35–34.22, p = 0.292). Procedural time was found to be longer in the TSc group (SMD 1.02; 95% CI 0.815–1.219, p < 0.001). Major vascular complications were significantly higher in the TF group (OR 0.55, 95% CI 0.32–0.94, p = 0.029). Meta regression found no influence of the covariates on the outcomes.ConclusionSubclavian access is both a safe and feasible alternative access route for TAVI with lower risks of major vascular complications. This study supports the use of subclavian access as a viable alternative in patient groups where transfemoral TAVI is contraindicated.
Salmasi M, Jarral OA, Pirola S, et al., 2020, In-vivo blood flow parameters can predict at-risk aortic aneurysms and dissection: a comprehensive biomechanics model, EUROPEAN HEART JOURNAL, Vol: 41, Pages: 2339-2339, ISSN: 0195-668X
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- Citations: 2
Salmasi MY, Panda A, Hartley P, et al., 2020, Aortic root replacement to treat type A aortic dissection: A comparison of midterm outcomes between composite valve grafts and porcine aortic roots., Journal of Cardiac Surgery, Vol: 35, Pages: 1840-1847, ISSN: 0886-0440
BACKGROUND: Porcine aortic roots (PAR) have been reported in the literature with acceptable short- and long-term outcomes for the treatment of aortic root aneurysms. However, their efficacy in type A aortic dissection (TAAD) is yet to be defined. METHODS: Using data from a locally collated aortic dissection registry, we compared the outcomes in patients undergoing aortic root replacement for TAAD using either of two surgical options: (a) PAR or (b) composite valve grafts (CVG). A retrospective analysis was conducted for all procedures in the period from 2005 to 2018. RESULTS: A total of 252 patients underwent procedures for TAAD in the time period. Sixty-five patients had aortic root replacements (PAR n = 30, CVG n = 35). Between-group comparisons identified a younger CVG group (50.5 vs 64.5, P < .05) although all other covariates were comparable. Operative parameters were comparable between the two groups. The use of PAR did not significantly impact operative mortality (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.22-3.61; P = .992), stroke (OR, 2.91, 0.25-34.09, P = .395), reoperation (OR, 0.91; 95% CI, 0.22-3.62; P = .882) or length of stay (coeff 2.33, -8.23 to 12.90; P = .659) compared to CVG. Five-year survival was similar between both groups (PAR 59% vs CVG 69%; P = .153) and reoperation was negligible. Echocardiography revealed significantly lower aortic valve gradients in the PAR group (8.69 vs 15.45mm Hg; P < .0001), and smaller left ventricular dimensions both at 6-week and 1-year follow-up (P < .05). CONCLUSIONS: This study highlights the comparable short- and midterm outcomes of PAR in cases of TAAD, in comparison to established therapy.
Naase H, Harling L, Kidher E, et al., 2020, Toll-like receptor 9 and the inflammatory response to surgical trauma and cardiopulmonary bypass, Journal of Cardiothoracic Surgery, Vol: 15, ISSN: 1749-8090
ObjectivesCardiac surgery can lead to post-operative end-organ complications secondary to activation of systemic inflammatory response. We hypothesize that surgical trauma or cardiopulmonary bypass (CPB) may initiate systemic inflammatory response via release of mitochondrial DNA (mtDNA) signaling Toll-like receptor 9 (TLR9) and interleukin-6 production (IL-6).Materials and methodsThe role of TLR9 in systemic inflammatory response in cardiac surgery was studied using a murine model of sternotomy and a porcine model of sternotomy and CPB. mtDNA and IL-6 were measured with and without TLR9-antagonist treatment. To study ischemia-reperfusion injury, we utilized an ex-vivo porcine kidney model.ResultsIn the rodent model (n = 15), circulating mtDNA increased 19-fold (19.29 ± 3.31, p < 0.001) and plasma IL-6 levels increased 59-fold (59.06 ± 14.98) at 1-min post-sternotomy compared to pre-sternotomy. In the murine model (n = 11), administration of TLR-9 antagonists lowered IL-6 expression post-sternotomy when compared to controls (59.06 ± 14.98 vs. 5.25 ± 1.08) indicating that TLR-9 is a positive regulator of IL-6 after sternotomy. Using porcine models (n = 10), a significant increase in circulating mtDNA was observed after CPB (Fold change 29.9 ± 4.8, p = 0.005) and along with IL-6 following renal ischaemia-reperfusion. Addition of the antioxidant sulforaphane reduced circulating mtDNA when compared to controls (FC 7.36 ± 0.61 vs. 32.0 ± 4.17 at 60 min post-CPB).ConclusionCPB, surgical trauma and ischemic perfusion injury trigger the release of circulating mtDNA that activates TLR-9, in turn stimulating a release of IL-6. Therefore, TLR-9 antagonists may attenuate this response and may provide a future therapeutic target whereby the systemic inflam
Slim N, Harraz A, Kheirabadi AN, et al., 2020, Innovating a Novel Brain Protection Device for Use in Cardiac Surgery and Cardiac Arrest: A Cool Solution Using Diffusion-Absorption-Refrigeration Technology, International Surgical Conference of the Association-of-Surgeons-in-Training, Publisher: WILEY, Pages: 38-38, ISSN: 0007-1323
Salmasi MY, Al-Saadi N, Hartley P, et al., 2020, The risk of misdiagnosis in acute thoracic aortic dissection: a review of current guidelines, HEART, Vol: 106, Pages: 885-891, ISSN: 1355-6037
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- Citations: 23
Garas G, Cingolani I, Patel V, et al., 2020, Surgical innovation in the era of global surgery: a network analysis, Annals of Surgery, Vol: 271, Pages: 868-874, ISSN: 0003-4932
OBJECTIVE: To present a novel network-based framework for the study of collaboration in surgery and demonstrate how this can be used in practice to help build and nurture collaborations that foster innovation. BACKGROUND: Surgical innovation is a social process that originates from complex interactions among diverse participants. This has led to the emergence of numerous surgical collaboration networks. What is still needed is a rigorous investigation of these networks and of the relative benefits of various collaboration structures for research and innovation. METHODS: Network analysis of the real-world innovation network in robotic surgery. Hierarchical mixed-effect models were estimated to assess associations between network measures, research impact and innovation, controlling for the geographical diversity of collaborators, institutional categories, and whether collaborators belonged to industry or academia. RESULTS: The network comprised of 1700 organizations and 6000 links. The ability to reach many others along few steps in the network (closeness centrality), forging a geographically diverse international profile (network entropy), and collaboration with industry were all shown to be positively associated with research impact and innovation. Closed structures (clustering coefficient), in which collaborators also collaborate with each other, were found to have a negative association with innovation (P < 0.05 for all associations). CONCLUSIONS: In the era of global surgery and increasing complexity of surgical innovation, this study highlights the importance of establishing open networks spanning geographical boundaries. Network analysis offers a valuable framework for assisting surgeons in their efforts to forge and sustain collaborations with the highest potential of maximizing innovation and patient care.
Askari A, Guillen LS, Millan M, et al., 2020, Colorectal tumour characteristics and oncological outcome in patients with inflammatory bowel disease, SURGICAL PRACTICE, Vol: 24, Pages: 60-68, ISSN: 1744-1625
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- Citations: 2
Jarral OA, Tan MKH, Salmasi MY, et al., 2020, Phase-contrast magnetic resonance imaging and computational fluid dynamics assessment of thoracic aorta blood flow: a literature review, European Journal of Cardio-Thoracic Surgery, Vol: 57, Pages: 438-446, ISSN: 1010-7940
The death rate from thoracic aortic disease is on the rise and represents a growing global health concern as patients are often asymptomatic before acute events, which have devastating effects on health-related quality of life. Biomechanical factors have been found to play a major role in the development of both acquired and congenital aortic diseases. However, much is still unknown and translational benefits of this knowledge are yet to be seen. Phase-contrast cardiovascular magnetic resonance imaging of thoracic aortic blood flow has emerged as an exceptionally powerful non-invasive tool enabling visualization of complex flow patterns, and calculation of variables such as wall shear stress. This has led to multiple new findings in the areas of phenotype-dependent bicuspid valve flow patterns, thoracic aortic aneurysm formation and aortic prosthesis performance assessment. Phase-contrast cardiovascular magnetic resonance imaging has also been used in conjunction with computational fluid modelling techniques to produce even more sophisticated analyses, by allowing the calculation of haemodynamic variables with exceptional temporal and spatial resolution. Translationally, these technologies may potentially play a major role in the emergence of precision medicine and patient-specific treatments in patients with aortic disease. This clinically focused review will provide a systematic overview of key insights from published studies to date.
Moscarelli M, Fattouch K, Gaudino M, et al., 2020, Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis, ANNALS OF THORACIC SURGERY, Vol: 109, Pages: 737-744, ISSN: 0003-4975
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- Citations: 26
Sideris M, Papalois V, Athanasiou T, et al., 2020, A Novel Multi-faceted Course Blueprint to Support Outcome-based Holistic Surgical Education: The Integrated Generation 4 Model (iG4), IN VIVO, Vol: 34, Pages: 503-509, ISSN: 0258-851X
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- Citations: 4
Salmasi MY, Hartley P, Hussein M, et al., 2020, Diagnosis and management of acute Type-A aortic dissection in emergency departments: Results of a UK national survey, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 300, Pages: 50-59, ISSN: 0167-5273
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- Citations: 10
Salmasi MY, Theodoulou I, Iyer P, et al., 2019, Comparing outcomes between valve-sparing root replacement and the Bentall procedure in proximal aortic aneurysms: systematic review and meta-analysis, INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, Vol: 29, Pages: 911-922, ISSN: 1569-9293
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- Citations: 8
Salmasi MY, Chien L, Hartley P, et al., 2019, What is the safety and efficacy of the use of automated fastener in heart valve surgery?, JOURNAL OF CARDIAC SURGERY, Vol: 34, Pages: 1598-1607, ISSN: 0886-0440
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- Citations: 7
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