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
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274 results found

NIHR Global Health Unit on Global Surgery, COVIDSurg Collaborative, 2022, Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries., The Lancet, Vol: 400, Pages: 1607-1617, ISSN: 0140-6736

BACKGROUND: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. METHODS: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. FINDINGS: In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness

Journal article

Nanchahal S, Rad AA, Naruka V, Chacko J, Liu G, Afoke J, Miller G, Malawana J, Punjabi Pet al., 2022, Mitral valve surgery assisted by virtual and augmented reality: Cardiac surgery at the front of innovation, PERFUSION-UK, ISSN: 0267-6591

Journal article

Weymann A, Foroughi J, Vardanyan R, Punjabi PP, Schmack B, Aloko S, Spinks GM, Wang C-H, Rad AA, Ruhparwar Aet al., 2022, Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure., Adv Mater

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, we review the present state and future direction of artificial muscle based soft robotic biomedical devices in supporting the inotropic function of the heart, focusing on the emerging electrothermally artificial heart muscles. 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 artificial heart muscles and biohybrid actuators using living cells or tissue embedded with artificial structures. Electrothermally actuated artificial heart muscles have demonstrated superior force generation while creating the prospect for fully soft robotic actuated ventricular assist devices. This review will critically analyse the limitations of currently available devices and discuss opportunities and directions for future research. Lastly, we will review and compare the properties of the cardiac muscle with those of different materials suitable for mechanical cardiac compression. This article is protected by copyright. All rights reserved.

Journal article

Punjabi PP, 2022, Braunwald's heart disease: A textbook of cardiovascular medicine, 12th ed, PERFUSION-UK, Vol: 37, Pages: 758-758, ISSN: 0267-6591

Journal article

Anastasiadis K, Antonitsis P, Murkin J, Serrick C, Gunaydin S, El-Essawi A, Bennett M, Erdoes G, Liebold A, Punjabi P, Theodoropoulos KC, Kiaii B, Wahba A, de Somer F, Bauer A, Kadner A, van Boven W, Argiriadou H, Deliopoulos A, Baker RA, Breitenbach I, Ince C, Starinieri P, Jenni H, Popov V, Moorjani N, Moscarelli M, Di Eusanio M, Cale A, Shapira O, Baufreton C, Condello I, Merkle F, Stehouwer M, Schmid C, Ranucci M, Angelini G, Carrel Tet al., 2022, 2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery, PERFUSION-UK, ISSN: 0267-6591

Journal article

Punjabi PP, 2022, Extracorporeal life support big boom in COVID, PERFUSION-UK, Vol: 37, Pages: 544-544, ISSN: 0267-6591

Journal article

Skeffington KL, Moscarelli M, Abdul-Ghani S, Fiorentino F, Emanueli C, Reeves BC, Punjabi PP, Angelini GD, Suleiman M-Set al., 2022, Pathology-related changes in cardiac energy metabolites, inflammatory response and reperfusion injury following cardioplegic arrest in patients undergoing open-heart surgery, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 9, ISSN: 2297-055X

Journal article

Patel K, li X, xu X, Lin S, maddalena A, Punjabi P, Purkayastha S, Peters NS, Ware JS, Ng FSet al., 2022, Increasing adiposity is associated with QTc interval prolongation and increased ventricular arrhythmic risk in the context of metabolic dysfunction: results from the UK Biobank, Frontiers in Cardiovascular Medicine, Vol: 9, Pages: 1-11, ISSN: 2297-055X

Background: Small-scale studies have linked obesity (Ob) and metabolic ill-health with proarrhythmic repolarisation abnormalities. Whether these are observed at a population-scale, modulated by individuals’ genetics and confer higher risks of ventricular arrhythmias (VA) are not known. Methods and Results: Firstly, using the UK Biobank, the association between adiposity and QTc interval was assessed in participants with resting 12-lead ECG (n=23,683), and a polygenic risk score was developed to investigate any modulatory effect of genetics. Participants were also categorised into four phenotypes according to presence (+) or absence (-) of Ob, and if they were metabolically unhealthy (MU+) or not (MU-). QTc was positively associated with body mass index, body fat, waist:hip ratio, and hip and waist girths. Individuals’ genetics had no significant modulatory effect on QTc-prolonging effects of increasing adiposity. QTc was comparably longer in those with metabolic perturbationwithout obesity (Ob-MU+) and obesity alone (Ob+MU-) compared to individuals with neither (Ob-MU-), and their co-existence (Ob+MU+) had an additive effect on QTc interval. Secondly, for 502,536 participants in the UK Biobank, odds ratios (OR) for ventricular arrhythmias (VA) were computed for the four clinical phenotypes above using their past medical records. Referenced to Ob-MU-, ORs for VA in Ob-MU+ males and females were 5.96 (95%CI: 4.70-7.55) and 5.10 (95%CI: 3.34-7.80), respectively. OR for Ob+MU+ were 6.99 (95%CI: 5.72-8.54) and 3.56 (95%CI: 2.66-4.77) in males and females, respectively. Conclusion: Adiposity and metabolic perturbation increase QTc to a similar degree, and their co-existence exerts an additive effect. These effects are not modulated by individuals’ genetics. Metabolic ill-health is associated with higher OR for VA than obesity.

Journal article

Ben-Aicha S, Anwar M, Punjabi P, Behmoaras J, Emanueli Cet al., 2022, Human pericardial fluid exosomes regulate macrophage immunophenotype: new prospective for cardiovascular immune response in coronary artery disease, Publisher: OXFORD UNIV PRESS, ISSN: 0008-6363

Conference paper

Abdul-Ghani S, Skeffington KL, Kim M, Moscarelli M, Lewis PA, Heesom K, Fiorentino F, Emanueli C, Reeves BC, Punjabi PP, Angelini GD, Suleiman M-Set al., 2022, Effect of cardioplegic arrest and reperfusion on left and right ventricular proteome/phosphoproteome in patients undergoing surgery for coronary or aortic valve disease, INTERNATIONAL JOURNAL OF MOLECULAR MEDICINE, Vol: 49, ISSN: 1107-3756

Journal article

Ben-Aicha S, Anwar M, Punjabi P, Behmoaras J, Emanueli Cet al., 2022, HUMAN MACROPHAGES ARE IMMUNOPROFILED BY PERICARDIAL FLUID SMALL EXTRACELLULAR VESICLES MODULATING LIPID METABOLISM MECHANISMS, Publisher: BMJ PUBLISHING GROUP, Pages: A160-A161, ISSN: 1355-6037

Conference paper

Fashina O, Abbasciano RG, McQueen LW, Ladak S, George SJ, Suleiman S, Punjabi PP, Angelini GD, Zakkar Met al., 2022, Large animal model of vein grafts intimal hyperplasia: A systematic review, PERFUSION-UK, ISSN: 0267-6591

Journal article

Ordiene R, Unikas R, Aldujeli A, Benetis R, Jakuska P, Ceponiene I, Jankauskas A, Plisiene J, Lenkutis T, Rudokaite G, Braukyliene R, Stonis M, Davies J, Punjabi PPet al., 2022, Instantaneous wave free ratio value impact on left internal mammary artery graft patency, PERFUSION-UK, ISSN: 0267-6591

Journal article

Punjabi PPP, 2022, Resilience and persistence now more than ever, PERFUSION-UK, Vol: 37, Pages: 330-330, ISSN: 0267-6591

Journal article

Naruka V, Zientara A, Hussein N, Punjabi PPet al., 2022, Digital communication platforms in cardiothoracic surgery during COVID-19 pandemic: keeping us connected or isolated?, INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, Vol: 35, ISSN: 1569-9293

Journal article

Punjabi P, 2022, ECLS-extracorporeal life support: Redefining life support systems, PERFUSION-UK, Vol: 37, Pages: 112-112, ISSN: 0267-6591

Journal article

Punjabi PP, 2022, Keeping Your Heart Healthy, PERFUSION-UK, Vol: 37, Pages: 216-216, ISSN: 0267-6591

Journal article

Ben-Aicha S, Buchanan J, Punjabi P, Emanueli C, Moscarelli Met al., 2022, Efficacy of treatments tested in COVID-19 patients with cardiovascular disease. A meta-analysis, PERFUSION-UK, ISSN: 0267-6591

Journal article

Punjabi PP, 2021, Editorial controls and obligations., Perfusion, Vol: 36, Pages: 775-776

Journal article

Ben-Aicha S, Anwar M, Behmoaras J, Punjabi P, Emanueli Cet al., 2021, Human pericardial fluid exosomes regulate macrophage immunophenotype: new prospective for cardiovascular myocardium-epicardium crosstalk in coronary artery disease, Publisher: OXFORD UNIV PRESS, Pages: 3223-3223, ISSN: 0195-668X

Conference paper

Murkin JM, Serrick C, Antonitsis P, Anastasiadis K, Punjabi PPet al., 2021, Virtual 4th MiECT Symposium: Innovation and Future, Perfusion (United Kingdom), Vol: 36, Pages: 654-655, ISSN: 1477-111X

Journal article

Ben-Aicha S, Buchanan J, Moscarelli M, Punjabi P, Emanueli Cet al., 2021, Meta-Analysis of COVID-19 treatments on patients with a previous diagnosis of cardiovascular disease, Publisher: OXFORD UNIV PRESS, Pages: 2412-2412, ISSN: 0195-668X

Conference paper

Jahangiri M, Bilkhu R, Embleton-Thirsk A, Dehbi H-M, Mani K, Anderson J, Avlonitis V, Baghai M, Birdi I, Booth K, Bose A, Briffa N, Buchan K, Bhudia S, Cale A, Deglurkar I, Farid S, Hadjinikolaou L, Jarvis M, Javadpour SH, Jeganathan R, Kuduvalli M, Lall K, Mascaro J, Mehta D, Ohri S, Punjabi P, Venkateswaran R, Ridley P, Satur C, Stoica S, Trivedi U, Zaidi A, Yiu P, Moorjani N, Kendall S, Freemantle Net al., 2021, Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database, BMJ OPEN, Vol: 11, ISSN: 2044-6055

Journal article

Afoke J, Punjabi PP, 2021, Commentary: Trends and patterns: The devil is in the details., JTCVS Open, Vol: 7, Pages: 270-271

Journal article

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

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