Publications
292 results found
Arjomandi Rad A, Zubarevich A, Shah V, et al., 2023, Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta-analysis., Artif Organs, Vol: 47, Pages: 1250-1261
BACKGROUND: Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection. RESULTS: Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed. CONCLUSION: LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.
National Institute for Health and Care Research Global Health Research Unit on Global Surgery, 2023, Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries., Br J Surg, Vol: 110, Pages: 804-817
BACKGROUND: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
Weymann A, Foroughi J, Vardanyan R, et al., 2023, Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure, ADVANCED MATERIALS, ISSN: 0935-9648
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
Hartley P, Kyriazis PG, Punjabi PP, 2023, Surgery for Mitral Valve Disease: Degenerative Repair, Essentials of Operative Cardiac Surgery, Second Edition, Pages: 107-115, ISBN: 9783031145568
Development of severe mitral regurgitation is derived by myxomatous degeneration leading to elongation or rapture of the chords. Structural abnormalities may also play a role in the disease of valve failure. The principles of the surgical management are to have a transeptal approach for access to mitral valve especially id concomitant tricuspid valve surgery is indicated, conduct a systematic assessment of the mitral valve once adequately exposed and reconstruct the posterior leaflet. This chapter covers all different techniques for this surgical intervention as well as a detailed description of the Mi-P repair along with supportive material to better understand the technique.
Sahdev N, Hamid O, Kyriazis PG, et al., 2023, Off Pump Coronary Artery Bypass Grafting, Essentials of Operative Cardiac Surgery, Second Edition, Pages: 89-95, ISBN: 9783031145568
Off-pump coronary artery bypass grafting (CABG) surgery is a widely performed approach in patients suffering from aortic disease and those at higher risk of complications from cardiopulmonary bypass (CPB). Benefits of avoiding CPB include lower risk of myocardial infarction, aortic dissection and arrhythmias. Additionally, since there’s reduced activation of the coagulation cascade, there is less risk of bleeding during surgery. Also, off-pump CABG is a more cost-effective approach compared to on pump CABG. However, off-pump CABG approach is followed by other challenges. This type of surgery requires very skilled surgeons as the risk of anastomotic bleeding and suboptimal revascularization is increased as well as restricted access to certain coronary vessels. To adopt the off-pump technique into the repertoire of a cardiothoracic unit it is vital for appropriate patient selection, individualized grafting strategy and graded clinical experience. This chapter discusses pre-operative considerations and operative techniques required for successful surgery.
Kyriazis PG, Khan H, Liu G, et al., 2023, Coronary Artery Bypass Graft with Cardiopulmonary Bypass, Essentials of Operative Cardiac Surgery, Second Edition, Pages: 79-88, ISBN: 9783031145568
Coronary artery bypass grafting (CABG) surgery improves blood flow to the heart muscle by bypassing the severely narrowed or blocked vessels affecting the normal heart function. Vessels are grafted if stenosis is more than 70% (50% in left main stem stenosis) or if occlusion occurred provided there is a distal vessel of reasonable size. The cardiopulmonary bypass (CPB) machine used during CABG allows surgeons to better control any bleeding and access all coronary arteries; however, the cross clamp duration is time sensitive to avoid stoke or neurological injury. Studies have shown less post-operative graft failure when CABG is performed with CPB. Even though off-pump CABG surgery is less expensive requiring less equipment and less staff, it does require more skilled staff compared to on-pump surgery. This chapter covers the operative techniques for a successful surgery.
Kyriazis PG, Macys A, Punjabi PP, 2023, Tricuspid Valve Repair/Replacement, Essentials of Operative Cardiac Surgery, Second Edition, Pages: 145-156, ISBN: 9783031145568
Tricuspid valve (TV) repair is indicated in the presence of significant tricuspid regurgitation (TR) or tricuspid annular dilatation during mitral valve surgery. TV replacement is suggested in patients with functional TR caused by left heart failure and secondary pulmonary hypertension among other causes. Even though TV pathology can be easily treated with TV repair most of the times there are cases where severe stenosis has occurred or other underlying causes making TV replacement the only course of action. This chapter covers the assessment and operative approaches and various techniques for both TV repair and replacement surgeries including the Tri-P repair.
Hartley P, Kyriazis PG, Punjabi PP, 2023, Surgery for Mitral Valve Disease: Degenerative Replacement, Essentials of Operative Cardiac Surgery, Second Edition, Pages: 117-120, ISBN: 9783031145568
Mitral valve repair is always the preferred surgical intervention compared to replacement surgery. Post-operative outcomes for repair surgery have been better when it comes to thromboembolism and risk of haemorrhagic events; however, mitral valve replacement is essential when repair is not an option, especially in the case of extensive calcification appeared typically in rheumatic valve disease. There are both mechanical and biological alternatives for valve replacement surgery. In one hand mechanical valve avoids structural degeneration, but requires lifelong anticoagulation medication; on the other hand biological valve prosthesis avoids the risk of anticoagulation, but structural failure on the valve may require reintervention. This chapter covers the decision making process, valve options and operative techniques for a successful surgery.
Punjabi PP, Kyriazis PG, 2023, Preface, Essentials of Operative Cardiac Surgery, Second Edition, Pages: v-vi
Kyriazis PG, Punjabi NP, Punjabi NP, 2023, Aortic Valve Repair/Replacement, Essentials of Operative Cardiac Surgery, Second Edition, Pages: 97-106, ISBN: 9783031145568
Degenerative calcified aortic stenosis is the most common indication for aortic valve replacement. Cannulation strategy for aortic valve surgery can be standard sternotomy or a mini sternotomy incision. There is a process following all the steps to reach the valve and conduct a repair or replacement surgery. Techniques to enlarge the aortic root i.e., Nick’s and Manouguian’s procedures are some of the techniques thoroughly described with supporting materials in this chapter provide an in depth perspective based on patient’s characteristics.
Kyriazis PG, Liu G, Sahdev N, et al., 2023, Basic Setup in Adult Cardiac Surgery, Essentials of Operative Cardiac Surgery, Second Edition, Pages: 69-78, ISBN: 9783031145568
Basic setup in cardiac operation following certain principles is necessary to have an efficient and accurate procedure allowing surgeons to carry out the surgery smoothly. The vast majority of cardiac operations are performed with a median sternotomy and in some cases patients require a secondor third redo sternotomy. In every instance, surgeons need to estimate the probability of significant cardiac injury and/or catastrophic haemorrhage along with the possibility of peripheral arterial and venous cannulation.The site for aortic cannulation should be within the pericardial reflection whenever possible as it is tougher and safer for cannulation. Most cardiac surgeries are performed on cardiopulmonary bypass and some procedures are performed off pump. This chapter discusses the foundation elements, practicalities and techniques in adult cardiac surgery.
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
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
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, Braunwald's heart disease: A textbook of cardiovascular medicine, 12th ed, PERFUSION-UK, Vol: 37, Pages: 758-758, 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
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