Publications
281 results found
Heys R, Angelini GD, Joyce K, et al., 2023, Efficacy of propofol-supplemented cardioplegia on biomarkers of organ injury in patients having cardiac surgery using cardiopulmonary bypass: A protocol for a randomised controlled study (ProMPT2), PERFUSION-UK, ISSN: 0267-6591
Punjabi PP, Kyriazis PG, 2023, Essentials of Operative Cardiac Surgery, Publisher: Springer, ISBN: 9783031145568
“The life so short, the craft so long to learn.”—Hippocrates of Kos (460–370 BC)aka Father of Medicine was a Greek physician, one of the most outstanding figuresin the history of MedicineAccording to the World Health Organization, around 7.2 million men andwomen die every year from coronary heart disease (CHD), which is the leadingcause of cardiovascular death worldwide [1, 2]. In Europe, CHD accountsto approximately 1.95 million deaths yearly of which over 66,000 are in theUK and over 53,000 of those are in England alone [1–3]. It has also beenestimated that 2.3 million people live with CHD in the UK of which 1.9 millionpeople are in England [1, 3]. Considering the UK has a population ofapproximately 67 million, it has been deduced that 3.7% of the UK populationis suffering from CHD.The number of heart disease cases accelerated in early 2000, thereafterrecent advances in primary prevention coupled with percutaneous interventionfor acute myocardial infarction which stabilised and gradually declinedthe morbidity rate [3]. Associated with this decline, a rise in valvular heartdisease has compensated in maintaining the total number of cardiac surgeryprocedures in adults. Multiple studies and guidelines have recommendedongoing improvement of techniques minimising risks to maintain andenhance safety. Currently, it is estimated that more than one million cardiacoperations are performed each year worldwide with the use of the heart-lungmachine, more specifically in the UK 35,158 cardiac surgeries were performedin 2015 [4]. In most cases, the operative mortality is quite low,approaching 1% for some operations [5].Inspired by cardiac surgery and driven to simplify the charm of surgicalprinciples, the goal of this book is to provide surgeons the necessary toolswith review of techniques along with tips and tricks to finetune and exceltheir skills in an ever-expanding field of adult cardiac surgery. The secondedition offers the readership an opport
Punjabi P, 2023, United Kingdom National Health Service: the past, the present and hopefully the future, Perfusion (United Kingdom), Vol: 38, Pages: 1-3, ISSN: 1477-111X
Anwar M, Sarkar M, Chamorro-Jorganes A, et al., 2022, CircRNA-miRNA-mRNA Networks Regulate Endothelial Function in Ischemic Heart Disease, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Vaja R, Ferreira P, Collins P, et al., 2022, The Effects of Celecoxib on Endothelial Function in Healthy Volunteers; A Double Blind, Placebo Controlled Randomised Trial, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
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
Nanchahal S, Rad AA, Naruka V, et al., 2022, Mitral valve surgery assisted by virtual and augmented reality: Cardiac surgery at the front of innovation, PERFUSION-UK, ISSN: 0267-6591
Weymann A, Foroughi J, Vardanyan R, et 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.
Ben-Aicha S, Anwar M, Punjabi P, et al., 2022, Human macrophages are immunoprofiled by pericardial fluid small extracellular vesicles modulating lipid metabolism mechanisms, Publisher: OXFORD UNIV PRESS, Pages: 3030-3030, ISSN: 0195-668X
Punjabi PP, 2022, Braunwald's heart disease: A textbook of cardiovascular medicine, 12th ed, PERFUSION-UK, Vol: 37, Pages: 758-758, ISSN: 0267-6591
Anastasiadis K, Antonitsis P, Murkin J, et 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
Punjabi PP, 2022, Extracorporeal life support big boom in COVID, PERFUSION-UK, Vol: 37, Pages: 544-544, ISSN: 0267-6591
Skeffington KL, Moscarelli M, Abdul-Ghani S, et 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, Pages: 1-14, ISSN: 2297-055X
Introduction: Changes in cardiac metabolites in adult patients undergoing open-heart surgery using ischemic cardioplegic arrest have largely been reported for non-ventricular tissue or diseased left ventricular tissue, with few studies attempting to assess such changes in both ventricular chambers. It is also unknown whether such changes are altered in different pathologies or linked to the degree of reperfusion injury and inflammatory response. The aim of the present work was to address these issues by monitoring myocardial metabolites in both ventricles and to establish whether these changes are linked to reperfusion injury and inflammatory/stress response in patients undergoing surgery using cold blood cardioplegia for either coronary artery bypass graft (CABG, n = 25) or aortic valve replacement (AVR, n = 16).Methods: Ventricular biopsies from both left (LV) and right (RV) ventricles were collected before ischemic cardioplegic arrest and 20 min after reperfusion. The biopsies were processed for measuring selected metabolites (adenine nucleotides, purines, and amino acids) using HPLC. Blood markers of cardiac injury (Troponin I, cTnI), inflammation (IL- 6, IL-8, Il-10, and TNFα, measured using Multiplex) and oxidative stress (Myeloperoxidase, MPO) were measured pre- and up to 72 hours post-operatively.Results: The CABG group had a significantly shorter ischemic cardioplegic arrest time (38.6 ± 2.3 min) compared to AVR group (63.0 ± 4.9 min, p = 2 x 10−6). Cardiac injury (cTnI release) was similar for both CABG and AVR groups. The inflammatory markers IL-6 and Il-8 were significantly higher in CABG patients compared to AVR patients. Metabolic markers of cardiac ischemic stress were relatively and significantly more altered in the LV of CABG patients. Comparing diabetic and non-diabetic CABG patients shows that only the RV of diabetic patients sustained major ischemic stress during reperfusion and that diabetic patients had a significantly
Patel K, li X, xu X, et 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.
Ben-Aicha S, Anwar M, Punjabi P, et 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
Ben-Aicha S, Anwar M, Punjabi P, et 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
Abdul-Ghani S, Skeffington KL, Kim M, et 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, Pages: 1-14, ISSN: 1107-3756
Our earlier work has shown inter‑disease and intra‑disease differences in the cardiac proteome between right (RV) and left (LV) ventricles of patients with aortic valve stenosis (AVS) or coronary artery disease (CAD). Whether disease remodeling also affects acute changes occuring in the proteome during surgical intervention is unknown. This study investigated the effects of cardioplegic arrest on cardiac proteins/phosphoproteins in LV and RV of CAD (n=6) and AVS (n=6) patients undergoing cardiac surgery. LV and RV biopsies were collected during surgery before ischemic cold blood cardioplegic arrest (pre) and 20 min after reperfusion (post). Tissues were snap frozen, proteins extracted, and the extracts were used for proteomic and phosphoproteomic analysis using Tandem Mass Tag (TMT) analysis. The results were analysed using QuickGO and Ingenuity Pathway Analysis softwares. For each comparision, our proteomic analysis identified more than 3,000 proteins which could be detected in both the pre and Post samples. Cardioplegic arrest and reperfusion were associated with significant differential expression of 24 (LV) and 120 (RV) proteins in the CAD patients, which were linked to mitochondrial function, inflammation and cardiac contraction. By contrast, AVS patients showed differential expression of only 3 LV proteins and 2 RV proteins, despite a significantly longer duration of ischaemic cardioplegic arrest. The relative expression of 41 phosphoproteins was significantly altered in CAD patients, with 18 phosphoproteins showing altered expression in AVS patients. Inflammatory pathways were implicated in the changes in phosphoprotein expression in both groups. Inter‑disease comparison for the same ventricular chamber at both timepoints revealed differences relating to inflammation and adrenergic and calcium signalling. In conclusion, the present study found that ischemic arrest and reperfusion trigger different changes in the proteomes and phosphoproteomes of LV and RV of
Fashina O, Abbasciano RG, McQueen LW, et al., 2022, Large animal model of vein grafts intimal hyperplasia: A systematic review, PERFUSION-UK, ISSN: 0267-6591
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Ordiene R, Unikas R, Aldujeli A, et al., 2022, Instantaneous wave free ratio value impact on left internal mammary artery graft patency, PERFUSION-UK, ISSN: 0267-6591
Punjabi PPP, 2022, Resilience and persistence now more than ever, PERFUSION-UK, Vol: 37, Pages: 330-330, ISSN: 0267-6591
Naruka V, Zientara A, Hussein N, et al., 2022, Digital communication platforms in cardiothoracic surgery during COVID-19 pandemic: keeping us connected or isolated?, Interactive Cardiovascular and Thoracic Surgery, Vol: 35, Pages: 1-3, ISSN: 1569-9285
During the COVID-19 pandemic, performing a surgeon’s duties has become challenging while adhering to social distancing mandates. To aid in the continuity of healthcare services, rapid implementation of digital communication tools became a necessity. This is an account of experiences using digital communication platforms, namely Microsoft Teams and Zoom, for clinical and educative purposes in the field of Cardiothoracic Surgery in the UK. While enabling ongoing virtual clinical meetings, conferences and learning opportunities for residents with little face-to-face contact, are these digital communication platforms keeping us connected or isolated?
Punjabi P, 2022, ECLS-extracorporeal life support: Redefining life support systems, PERFUSION-UK, Vol: 37, Pages: 112-112, ISSN: 0267-6591
Punjabi PP, 2022, Keeping Your Heart Healthy, PERFUSION-UK, Vol: 37, Pages: 216-216, ISSN: 0267-6591
Ben-Aicha S, Buchanan J, Punjabi P, et al., 2022, Efficacy of treatments tested in COVID-19 patients with cardiovascular disease. A meta-analysis, Perfusion (United Kingdom), Pages: 1-11, ISSN: 1477-111X
BackgroundThe COVID-19 pandemic has spread globally infecting and killing millions. Those with cardiovascular disease (CVD) are at higher risk of increased disease severity and mortality. We performed a systematic review and meta-analysis to estimate the rate of in-hospital mortality following different treatments on COVID-19 in patients with CVD.MethodsPertinent articles were identified from the PubMed, Google Scholar, Ovid MEDLINE, and Ovid EMBASE databases. This study protocol was registered under PROSPERO with the identifier CRD42020183057.ResultsOf the 1673 papers scrutinized, 46 were included in the review. Of the 2553 patients (mean age 63.9 ± 2.7 years/o; 57.2% male), the most frequent CVDs were coronary artery disease (9.09%) and peripheral arterial disease (5.4%) and the most frequent cardiovascular risk factors were hypertension (86.7%) and diabetes (23.7%). Most patients were on multiple treatments. 14 COVID-19 treatments were compared with controls. The pooled event rate for in-hospital mortality was 20% (95% confidence interval (CI): 11–33%); certain heterogeneity was observed across studies.ConclusionsCOVID-19 is associated with a high in-hospital mortality rate in patients with CVD. This study shows that previous CVD determines mortality, regardless of the type of COVID-19 administered therapy. Treatments for at-risk patients should be administered carefully and monitored closely until further data are available.
Punjabi PP, 2021, Editorial controls and obligations., Perfusion, Vol: 36, Pages: 775-776
Ben-Aicha S, Anwar M, Behmoaras J, et 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
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Murkin JM, Serrick C, Antonitsis P, et al., 2021, Virtual 4th MiECT Symposium: Innovation and Future, Perfusion (United Kingdom), Vol: 36, Pages: 654-655, ISSN: 1477-111X
Ben-Aicha S, Buchanan J, Moscarelli M, et 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
Jahangiri M, Bilkhu R, Embleton-Thirsk A, et 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, Pages: 1-10, ISSN: 2044-6055
Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed.Setting 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis.Participants 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG.Results In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60–75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes.Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results sho
Afoke J, Punjabi PP, 2021, Commentary: Trends and patterns: the devil is in the details, JTCVS Open, Vol: 7, Pages: 270-271, ISSN: 2666-2736
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