Imperial College London

Mr Prakash P Punjabi

Faculty of MedicineNational Heart & Lung Institute

Professor of Practice (Cardiothoracic Surgery)
 
 
 
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Contact

 

+44 (0)20 3313 2026p.punjabi Website

 
 
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Location

 

BN2/25 B BlockHammersmith HospitalHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

246 results found

Naderi H, Abbara A, Viviano A, Asaria P, Pabari PA, Flora R, Punjabi PP, Rana BSet al., 2021, Re-emphasising the importance of histopathological diagnosis in suspected bacterial endocarditis, PERFUSION-UK, ISSN: 0267-6591

Journal article

Salmasi MY, Ravishankar R, Abdullahi Y, Hartley P, Kyriazis PG, Athanasiou T, Punjabi Pet al., 2021, Predictors of outcome after CABG in the South-Asian community: a propensity matched analysis, PERFUSION-UK, ISSN: 0267-6591

Journal article

Hartley A, El-Sayed A, Abbara A, Henderson J, Ghazy A, Davies F, Price JR, Punjabi P, Anderson J, Casula R, Naderi H, Asaria P, Sutaria N, Malik I, Pabari P, Rana Bet al., 2021, Restricted use of echocardiography in suspected endocarditis during COVID-19 lockdown: a multidisciplinary team approach, Cardiology Research and Practice, Vol: 2021, Pages: 1-4, ISSN: 2090-0597

Background:Infective endocarditis (IE) is challenging to manage in the COVID-19 lockdown climate, in part given its reliance on echocardiography for diagnosis and management, and the associated virus transmission risks to patients and healthcare workers. This study assesses utilisation of the endocarditis team (ET) in limiting routine echocardiography, especially transoesophageal echocardiography (TOE), in patients with suspected IE, and explores the effect on clinical outcomes.Methods:All patients discussed at the ET meeting at Imperial College Healthcare NHS Trust during the first lockdown in the UK (23rd March – 8th July 2020) were prospectively included and analysed in this observational study.Results:In total, 38 patients were referred for ET review (71% male, median age 54 [interquartile range 48, 65.5] years). At the time of ET discussion, 21% had no echo imaging, 16% had point-of-care ultrasound only and 63% had formal TTE. In total, only 16% underwent TOE. The ability of echocardiography, in those where it was performed, to affect IE diagnosis according to the Modified Duke Criteria was significant (p=0.0099), however, sensitivity was not affected. All-cause mortality was 17% at 30-days and 25% at 12-months from ET discussion in those with confirmed IE.Conclusion:Limiting echocardiography in patients with a low pre-test probability (not probable or definite IE according to the Modified Duke Criteria) did not affect the diagnostic ability of the Modified Duke Criteria to rule out IE in this small study. Moreover, restricting non-essential echocardiography, and importantly TOE, in patients with suspected IE through use of the ET did not impact all-cause mortality.

Journal article

Modaragamage Dona AC, Afoke J, Punjabi PP, Kanaganayagam GSet al., 2021, Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: a systematic review, Journal of Cardiac Surgery, Vol: 36, Pages: 2458-2466, ISSN: 0886-0440

BackgroundPrimary mitral regurgitation (PMR) results in adverse remodeling changes and left ventricular (LV) dysfunction. Assessing LV function has prognostic value in predicting morbidity and mortality. Indications for surgery include parameters such as LV ejection fraction (LVEF) and systolic dimensions. Current guidelines are limited in identifying patients at optimal time for surgery. Impaired postoperative LVEF indicates poor prognostic outcomes and subsequent heart failure. Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) presents as a promising parameter to detect subclinical dysfunction in asymptomatic patients.MethodsFollowing PRISMA guidelines, a literature search was conducted with Cochrane Library, PudMed, SCOPUS, and Web of Science. Key MeSH terms included “mitral regurgitation,” “mitral valve insufficiency,” “global longitudinal strain,” “deformation,” “LV‐GLS,” and “GLS.” Inclusion criteria included (1) patients with severe PMR, (2) mixed population of symptomatic and asymptomatic patients, (3) standardized methods in assessing LV systolic function using 2D‐STE, (4) valve repair or replacement surgery, and (5) patient outcomes measured after surgery. Search returned 234 papers, 12 of which met the inclusion criteria and were subsequently reviewed.ResultsBaseline GLS is an independent predictor of postoperative outcomes, ranging from −17.9 to −21.7% GLS. A significant negative correlation was observed between preoperative GLS and postoperative LVEF. Impaired baseline GLS was associated with higher mortality rates. Better long‐term survival rates were seen in patients who underwent early surgery.ConclusionGLS shows sensitivity in predicting long‐term postoperative outcomes. Further analysis is required to determine preoperative GLS threshold to identify asymptomatic patients at the optimal time for mitral valve surgery.

Journal article

Whitlock RP, Belley-Cote EP, Paparella D, Healey JS, Brady K, Sharma M, Reents W, Budera P, Baddour AJ, Fila P, Devereaux PJ, Bogachev-Prokophiev A, Boening A, Teoh KHT, Tagarakis GI, Slaughter MS, Royse AG, McGuinness S, Alings M, Punjabi PP, Mazer CD, Folkeringa RJ, Colli A, Avezum A, Nakamya J, Balasubramanian K, Vincent J, Voisine P, Lamy A, Yusuf S, Connolly SJet al., 2021, Left atrial appendage occlusion during cardiac surgery to prevent stroke, New England Journal of Medicine, Vol: 384, Pages: 1-10, ISSN: 0028-4793

BACKGROUNDSurgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedure can be performed during cardiac surgery undertaken for other reasons.METHODSWe conducted a multicenter, randomized trial involving participants with atrial fibrillation and a CHA2DS2-VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating greater risk of stroke) who were scheduled to undergo cardiac surgery for another indication. The participants were randomly assigned to undergo or not undergo occlusion of the left atrial appendage during surgery; all the participants were expected to receive usual care, including oral anticoagulation, during follow-up. The primary outcome was the occurrence of ischemic stroke (including transient ischemic attack with positive neuroimaging) or systemic embolism. The participants, research personnel, and primary care physicians (other than the surgeons) were unaware of the trial-group assignments.RESULTSThe primary analysis population included 2379 participants in the occlusion group and 2391 in the no-occlusion group, with a mean age of 71 years and a mean CHA2DS2-VASc score of 4.2. The participants were followed for a mean of 3.8 years. A total of 92.1% of the participants received the assigned procedure, and at 3 years, 76.8% of the participants continued to receive oral anticoagulation. Stroke or systemic embolism occurred in 114 participants (4.8%) in the occlusion group and in 168 (7.0%) in the no-occlusion group (hazard ratio, 0.67; 95% confidence interval, 0.53 to 0.85; P=0.001). The incidence of perioperative bleeding, heart failure, or death did not differ significantly between the trial groups.CONCLUSIONSAmong participants with atrial fibrillation who had undergone cardiac surgery, most of whom continued to receive ongoing antithrombotic therapy, the risk of ischemic stroke or systemic embolism was lower with co

Journal article

Punjabi PP, 2021, Opie's Cardiovascular Drugs: A Companion to Braunwald's Heart Disease, 9th ed., PERFUSION-UK, ISSN: 0267-6591

Journal article

Punjabi PP, 2021, Valvular Heart Disease: A Companion to Braunwald's Heart Disease, 5th ed., PERFUSION-UK, Vol: 36, Pages: 647-647, ISSN: 0267-6591

Journal article

Narodden S, 2021, Shockwave for the abrogation of heart failure in myocardial ischaemia-reperfusion injury

Thesis dissertation

Punjabi PP, Rana BS, 2021, Mitral annular disjunction: Is MAD 'normal'., European Heart Journal - Cardiovascular Imaging, Vol: 22, Pages: 623-625, ISSN: 2047-2412

Journal article

Punjabi PP, 2021, Worldwide vaccinations: are we there yet?, PERFUSION-UK, Vol: 36, Pages: 328-329, ISSN: 0267-6591

Journal article

Maier RH, Kasim AS, Zacharias J, Vale L, Graham R, Walker A, Laskawski G, Deshpande R, Goodwin A, Kendall S, Murphy GJ, Zamvar V, Pessotto R, Lloyd C, Dalrymple-Hay M, Casula R, Vohra HA, Ciulli F, Caputo M, Stoica S, Baghai M, Niranjan G, Punjabi PP, Wendler O, Marsay L, Fernandez-Garcia C, Modi P, Kirmani BH, Pullan MD, Muir AD, Pousios D, Hancock HC, Akowuah Eet al., 2021, Minimally invasive versus conventional sternotomy for Mitral valve repair: protocol for a multicentre randomised controlled trial (UK Mini Mitral)., BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055

INTRODUCTION: Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure.The UK Mini Mitral trial will provide definitive evidence comparing patient, NHS and clinical outcomes in adult patients undergoing MVr surgery. It will establish the best surgical approach for MVr, setting a standard against which emerging percutaneous techniques can be measured. Findings will inform optimisation of cost-effective practice. METHODS AND ANALYSIS: UK Mini Mitral is a multicentre, expertise based randomised controlled trial of minimally invasive thoracoscopically guided right minithoracotomy versus conventional sternotomy for MVr. The trial is taking place in NHS cardiothoracic centres in the UK with established minimally invasive mitral valve surgery programmes. In each centre, consenting and eligible patients are randomised to receive surgery performed by consultant surgeons who meet protocol-defined surgical expertise criteria. Patients are followed for 1 year, and consent to longer term follow-up.Primary outcome is physical functioning 12 weeks following surgery, measured by change in Short Form Health Survey (SF-36v2) physical functioning scale. Early and 1 year echo data will be reported by a core laboratory. Estimates of key clinical and health economic outcomes will be reported up to 5 years.The primary economic outcome is cost effectiveness, measured as incremental cost per quality-adjusted life year gained over 52 weeks following index surgery. ETHICS AND DISSEMINATION: A favourable opinion was given by Wales R

Journal article

Punjabi PP, 2021, Vaccine is health and health is wealth, Perfusion (United Kingdom), Vol: 36, Pages: 221-221, ISSN: 1477-111X

Journal article

Punjabi PP, 2021, Practical Cardiology Principles and Approaches, 2nd ed, PERFUSION-UK, Vol: 36, Pages: 538-538, ISSN: 0267-6591

Journal article

Punjabi PP, 2021, Handbook of Structural Heart Interventions, PERFUSION-UK, Vol: 36, Pages: 539-539, ISSN: 0267-6591

Journal article

Cox-Smith A, Cooper T, Punjabi P, Barton C, Levy S, Plymen C, Cole Get al., 2021, LACK OF EVIDENCE FOR REDUCED EFFICACY OF MEDICAL THERAPY FOR HEART FAILURE IN OLDER ADULTS, Publisher: OXFORD UNIV PRESS, ISSN: 0002-0729

Conference paper

Punjabi PP, 2021, Long COVID - Education, Science, Innovation and Training, PERFUSION-UK, Vol: 36, Pages: 111-112, ISSN: 0267-6591

Journal article

Moscarelli M, Angelini GD, Emanueli C, Suleiman S, Pepe M, Contegiacomo G, Punjabi PPet al., 2021, Remote ischemic preconditioning in isolated valve intervention. A pooled meta-analysis, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 324, Pages: 146-151, ISSN: 0167-5273

Journal article

Punjabi P, 2020, The second coming: Deluge, surge, vaccinate, wane, dwindle, overcome, PERFUSION-UK, Vol: 35, Pages: 716-716, ISSN: 0267-6591

Journal article

Afoke J, Kanaganayagam GS, Casula R, Bruno VD, Howard L, Gibbs JSR, Punjabi Pet al., 2020, Cardiopulmonary exercise testing as a guideline indicator for mitral valve intervention, Publisher: OXFORD UNIV PRESS, Pages: 2003-2003, ISSN: 0195-668X

Conference paper

Whitlock R, Belley-Cote EP, Healey J, Devereaux PJ, Eikelboom J, Lamy A, Brady K, Marsella B, Tagarakis G, Paparella D, Reents W, Punjabi P, Connolly Set al., 2020, Vitamin K antagonists versus direct oral anticoagulants after cardiac surgery: a 31-country cohort study, European Society of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 655-655, ISSN: 0195-668X

Conference paper

Chaubey S, Hussain A, Zakai SB, Butt S, Punjabi P, Desai Jet al., 2020, Concomitant cardiac surgery and liver transplantation: an alternative approach in patients with end stage liver failure?, PERFUSION-UK, ISSN: 0267-6591

Journal article

Punjabi PP, 2020, COVID19: ethnic, cardiovascular and renal: pandemic causing pandemonium, PERFUSION-UK, Vol: 35, Pages: 451-451, ISSN: 0267-6591

Journal article

Angelini GD, Reeves BC, Evans J, Culliford LA, Collett L, Rogers CA, Stokes E, Anastasiadis K, Antonitsis P, Carrel T, Keller D, Liebold A, Ashkanani F, El-Essawi A, Breitenbach I, Lloyd C, Bennett M, Cale A, Mclean L, Gunaydin S, Gunertem E, Oueida F, Yassin I, Serrick C, Rao V, Moscarelli M, Condello I, Punjabi P, Rajakaruna C, Bone D, Lansdown W, Moorjani N, Dennis Set al., 2020, Conventional versus minimally invasive extracorporeal circulation in patients undergoing cardiac surgery: protocol for a randomised controlled trial (COMICS), Perfusion (United Kingdom), Vol: 36, Pages: 388-394, ISSN: 1477-111X

Introduction:Despite low mortality, cardiac surgery patients may experience serious life-threatening post-operative complications, often due to extracorporeal circulation and reperfusion. Miniaturised cardiopulmonary bypass (minimally invasive extracorporeal circulation) has been developed aiming to reduce the risk of post-operative complications arising with conventional extracorporeal circulation.Methods:The COMICS trial is a multi-centre, international, two-group parallel randomised controlled trial testing whether type II, III or IV minimally invasive extracorporeal circulation is effective and cost-effective compared to conventional extracorporeal circulation in patients undergoing elective or urgent coronary artery bypass grafting, aortic valve replacement or coronary artery bypass grafting + aortic valve replacement. Randomisation (1:1 ratio) is concealed and stratified by centre and surgical procedure. The primary outcome is a composite of 12 serious complications, objectively defined or adjudicated, 30 days after surgery. Secondary outcomes (at 30 days) include other serious adverse events (primary safety outcome), use of blood products, length of intensive care and hospital stay and generic health status (also at 90 days).Status of the trial:Two centres started recruiting on 08 May 2018; 10 are currently recruiting and 603 patients have been randomised (11 May 2020). The recruitment rate from 01 April 2019 to 31 March 2020 was 40-50 patients/month. About 80% have had coronary artery bypass grafting only. Adherence to allocation is good.Conclusions:The trial is feasible but criteria for progressing to a full trial were not met on time. The Trial Steering and Data Monitoring Committees have recommended that the trial should currently continue.

Journal article

Constantinou C, Miranda Almeida A, Chaves Guerrero P, Bellahcene M, Massaia A, Cheng K, Samari S, Rothery S, Chandler A, Schwarz R, Harding S, Punjabi P, Schneider MD, Noseda Met al., 2020, Human pluripotent stem cell-derived cardiomyocytes as a targetplatform for paracrine protection by cardiac mesenchymal stromalcells, Scientific Reports, Vol: 10, ISSN: 2045-2322

Ischemic heart disease remains the foremost cause of death globally, with survivors at risk for subsequent heart failure. Paradoxically, cell therapies to offset cardiomyocyte loss after ischemic injury improve long-term cardiac function despite a lack of durable engraftment. An evolving consensus, inferred preponderantly from non-human models, is that transplanted cells benefit the heart via early paracrinesignals. Here, we tested the impact of paracrine signals on human cardiomyocytes, using human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) as the target of mouse and human cardiac mesenchymal stromal cells (cMSC) with progenitor-like features. In co-culture and conditioned medium studies, cMSCs markedly inhibited human cardiomyocyte death. Little or no protection was conferred by mouse tail tip or human skin fibroblasts. Consistent with the results of transcriptomic profiling, functional analyses showed that the cMSC secretome suppressed apoptosis and and preserved cardiac mitochondrial transmembrane potential. Protection was independent of exosomes under the conditions tested. In mice, injecting cMSC-conditioned media into the infarct border zone reduced apoptotic cardiomyocytes >70% locally. Thus, hPSC-CMs provide an auspicious, relevant human platform to investigate extracellular signals for cardiac muscle survival, substantiating human cardioprotection by cMSCs, and suggesting the cMSC secretome or its components as potential cell-free therapeutic products.

Journal article

Shearn AIU, Aday S, Ben-Aicha S, Carnell-Morris P, Siupa A, Angelini GD, Clayton A, Boulanger C, Punjabi P, Emanueli C, Biglino Get al., 2020, Analysis of neat biofluids obtained during cardiac surgery using nanoparticle tracking analysis: methodological considerations, Frontiers in Cell and Developmental Biology, Vol: 8, Pages: 1-14, ISSN: 2296-634X

Small extracellular vesicles (sEVs) are those nanovesicles 30–150 nm in size with a role in cell signalling and potential as biomarkers of disease. Nanoparticle tracking analysis (NTA) techniques are commonly used to measure sEV concentration in biofluids. However, this quantification technique can be susceptible to sample handing and machine settings. Moreover, some classes of lipoproteins are of similar sizes and could therefore confound sEV quantification, particularly in blood-derived preparations, such serum and plasma. Here we have provided methodological information on NTA measurements and systematically investigated potential factors that could interfere with the reliability and repeatability of results obtained when looking at neat biofluids (i.e., human serum and pericardial fluid) obtained from patients undergoing cardiac surgery and from healthy controls. Data suggest that variables that can affect vesicle quantification include the level of contamination from lipoproteins, number of sample freeze/thaw cycles, sample filtration, using saline-based diluents, video length and keeping the number of particles per frame within defined limits. Those parameters that are of less concern include focus, the “Maximum Jump” setting and the number of videos recorded. However, if these settings are clearly inappropriate the results obtained will be spurious. Similarly, good experimental practice suggests that multiple videos should be recorded. In conclusion, NTA is a perfectible, but still commonly used system for sEVs analyses. Provided users handle their samples with a highly robust and consistent protocol, and accurately report these aspects, they can obtain data that could potentially translate into new clinical biomarkers for diagnosis and monitoring of cardiovascular disease.

Journal article

Punjabi PP, Belohlavek J, Punjabi PP, Belohlavek Jet al., 2020, Perfusion and EuroELSO: A Revolution In Evolution - Indeed an ongoing evolvement - Online adaptation, PERFUSION-UK, Vol: 35, Pages: 4-4, ISSN: 0267-6591

Journal article

Punjabi PP, 2020, Primum non nocere - 'first do no harm', PERFUSION-UK, Vol: 35, Pages: 277-277, ISSN: 0267-6591

Journal article

Abdul Khader A, Khan H, Stowell C, Liu G, Sameh M, Punjabi Pet al., 2020, Retrospective analysis of tricuspid valve repair using a novel surgical technique: A 7-year single-surgeon experience., Perfusion, Pages: 267659120910373-267659120910373, ISSN: 1477-111X

OBJECTIVES: Tricuspid annuloplasty is the optimal surgical repair technique for tricuspid regurgitation which improves mortality and morbidity. Ring annuloplasties is the techniques of choice. Here, we evaluate the efficacy and durability of a new method of interrupted pledgeted suture annuloplasty. METHODS: Between 2011 and 2018, 39 eligible patients underwent tricuspid valve repair using this novel technique. Indication for repair was a grade of regurgitation at moderate or greater, or an annular diameter >40 mm. Patients were assessed both preoperatively and postoperatively by echocardiogram. Follow-up results were split into the first postoperative echocardiogram and most recent postoperative echocardiogram undertaken. RESULTS: There were two in-hospital mortalities and two patients required permanent pacemaker implantation following surgery. At the time of the first postoperative echocardiogram undertaken (median 3 months postoperatively), freedom from moderate-severe regurgitation was 92.3%. At the time of the most recent postoperative echocardiogram undertaken (median 11 months postoperatively); none or mild regurgitation was detected in 24 patients (61.5%), mild-moderate in 11 (28.2%) and moderate-severe in 4 (10.3%) patients. Freedom from moderate-severe regurgitation was 89.7%. Postoperative grade of regurgitation was significantly reduced from preoperative grades (p < 0.001). CONCLUSION: Initial and midterm results of our technique show a good durability of repair. We have demonstrated recurrence rates of regurgitation equal and superior to current forms of suture annuloplasty published in the literature. This novel method of suture annuloplasty can be considered in the surgical repertoire of tricuspid valve repair techniques.

Journal article

Rad AA, Vardanyan R, Mohamed SA, Punjabi PPet al., 2020, Atlas of Cardiac Surgical Techniques, 2nd edition, PERFUSION-UK, Vol: 35, Pages: 177-178, ISSN: 0267-6591

Journal article

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