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

295 results found

Afoke J, Mohal J, Kanaganayagam GS, Casula R, Bruno V, Howard L, Gibbs S, Punjabi Pet al., 2023, Cardiopulmonary exercise testing augments watchful waiting in asymptomatic severe primary mitral regurgitation, PERFUSION-UK, ISSN: 0267-6591

Journal article

Rad AA, Fleet B, Zubarevich A, Nanchahal S, Naruka V, Ponniah HS, Vardanyan R, Nia PS, Loubani M, Moorjani N, Schmack B, Punjabi PP, Schmitto J, Ruhparwar A, Weymann Aet al., 2023, Left ventricular assist device implantation and concomitant mitral valve surgery: A systematic review and meta-analysis, ARTIFICIAL ORGANS, ISSN: 0160-564X

Journal article

Punjabi PP, 2023, Strength in numbers, Perfusion, Vol: 38, Pages: 1329-1329, 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., 2023, Instantaneous wave free ratio value impact on left internal mammary artery graft patency, PERFUSION-UK, Vol: 38, Pages: 1230-1239, ISSN: 0267-6591

Journal article

Rad AA, Zubarevich A, Shah V, Yilmaz O, Vardanyan R, Naruka V, Moorjani N, Ruhparwar A, Punjabi PP, Weymann Aet al., 2023, Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta-analysis, ARTIFICIAL ORGANS, Vol: 47, Pages: 1250-1261, ISSN: 0160-564X

Journal article

Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, McLean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili Aet al., 2023, Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries, British Journal of Surgery, Vol: 110, Pages: 804-817, ISSN: 0007-1323

BackgroundHealthcare 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.MethodsThis 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.ResultsIn 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.ConclusionThis is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Journal article

Weymann A, Foroughi J, Vardanyan R, Punjabi PPP, Schmack B, Aloko S, Spinks GMM, Wang CHH, Rad AA, Ruhparwar Aet al., 2023, Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure, ADVANCED MATERIALS, Vol: 35, ISSN: 0935-9648

Journal article

Punjabi PP, 2023, Strength in numbers, PERFUSION-UK, ISSN: 0267-6591

Journal article

Heys R, Angelini GD, Joyce K, Smartt H, Culliford L, Maishman R, de Jesus SE, Emanueli C, Suleiman M-S, Punjabi P, Rogers CA, Gibbison Bet 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

Journal article

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

Book

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

Journal article

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.

Book chapter

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.

Book chapter

Sahdev N, Hamid O, Kyriazis PG, Punjabi PPet 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.

Book chapter

Kyriazis PG, Khan H, Liu G, Punjabi PPet 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.

Book chapter

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.

Book chapter

Punjabi PP, Kyriazis PG, 2023, Preface, Essentials of Operative Cardiac Surgery, Second Edition, Pages: v-vi

Journal article

Kyriazis PG, Liu G, Sahdev N, Punjabi PPet 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.

Book chapter

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.

Book chapter

Naderi H, Abbara A, Viviano A, Asaria P, Pabari PA, Flora R, Punjabi PP, Rana BSet al., 2023, Re-emphasising the importance of histopathological diagnosis in suspected bacterial endocarditis, PERFUSION-UK, Vol: 38, Pages: 197-199, ISSN: 0267-6591

Journal article

Anwar M, Sarkar M, Chamorro-Jorganes A, Ford K, Angelini G, Punjabi P, Emanueli Cet 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

Conference paper

Vaja R, Ferreira P, Collins P, Rickman M, Punjabi PP, Kirkby N, Mitchell Jet 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

Conference paper

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

Mahesh B, Williams L, Punjabi PP, Katsaridis Set al., 2022, Novel strategy for improved outcomes of extra-corporeal membrane oxygenation as a treatment for refractory post cardiotomy cardiogenic shock in the current era: a refreshing new perspective, PERFUSION-UK, Vol: 37, Pages: 825-834, ISSN: 0267-6591

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

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

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: OXFORD UNIV PRESS, Pages: 3030-3030, ISSN: 0195-668X

Conference paper

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

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, 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

Journal article

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