Imperial College London

Professor Thanos Athanasiou MD PhD MBA FECTS FRCS

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Cardiovascular Sciences
 
 
 
//

Contact

 

t.athanasiou

 
 
//

Location

 

1022Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

//

Summary

 

Publications

Publication Type
Year
to

777 results found

Magouliotis DE, Xanthopoulos A, Athanasiou T, 2024, Y-incision aortic annular enlargement and the golden ratio: Nature leads the way., J Thorac Cardiovasc Surg

Journal article

Bourazana A, Xanthopoulos A, Briasoulis A, Magouliotis D, Spiliopoulos K, Athanasiou T, Vassilopoulos G, Skoularigis J, Triposkiadis Fet al., 2024, Artificial Intelligence in Heart Failure: Friend or Foe?, Life (Basel), Vol: 14, ISSN: 2075-1729

In recent times, there have been notable changes in cardiovascular medicine, propelled by the swift advancements in artificial intelligence (AI). The present work provides an overview of the current applications and challenges of AI in the field of heart failure. It emphasizes the "garbage in, garbage out" issue, where AI systems can produce inaccurate results with skewed data. The discussion covers issues in heart failure diagnostic algorithms, particularly discrepancies between existing models. Concerns about the reliance on the left ventricular ejection fraction (LVEF) for classification and treatment are highlighted, showcasing differences in current scientific perceptions. This review also delves into challenges in implementing AI, including variable considerations and biases in training data. It underscores the limitations of current AI models in real-world scenarios and the difficulty in interpreting their predictions, contributing to limited physician trust in AI-based models. The overarching suggestion is that AI can be a valuable tool in clinicians' hands for treating heart failure patients, as far as existing medical inaccuracies have been addressed before integrating AI into these frameworks.

Journal article

Magouliotis DE, Arjomandi Rad A, Kourliouros A, Viviano A, Koulouroudias M, Salmasi MY, Briasoulis A, Triposkiadis F, Skoularigis J, Athanasiou Tet al., 2023, Transcriptomic Analysis of Tight Junction Proteins Demonstrates the Aberrant Expression and Function of Zona Occludens 2 (ZO-2) Protein in Stanford Type A Aortic Dissection., J Pers Med, Vol: 13, ISSN: 2075-4426

OBJECTIVE: Thoracic aortic aneurysm dissection (TAAD) represents a cardiac surgery emergency characterized by the disrupted integrity of the aortic wall and is associated with poor prognosis. In this context, the identification of biomarkers implicated in the pathobiology of TAAD is crucial. Our aim in the present original in silico study is to assess the differential gene expression profile of the tight junction proteins (TJPs) in patients with TAAD and to propose novel biomarkers for the diagnosis and prognosis of this disease. METHODS: We implemented bioinformatics methodology in order to construct the gene network of the TJPs family, identify the differentially expressed genes (DEGs) in pathologic aortic tissue excised from patients with TAAD as compared to healthy aortic tissue, and assess the related biological functions and the associated miRNA families. RESULTS: Data regarding the transcriptomic profile of selected genes were retrieved and incorporated from three microarray datasets, including 23 TAAD and 20 healthy control samples. A total of 32 TJPs were assessed. The zona occludens 2 (ZO-2) protein encoded by the gene TJP2 was significantly under-expressed in patients with TAAD compared to the control group (p = 0.009). ZO-2 was associated with fair discrimination and calibration traits in predicting the TAAD presentation. CpG islands of ZO-2 were demonstrated. No important difference was found regarding ZO-2 expression between aneurysmal non-dissected and healthy control aortic tissue. Finally, we performed gene set enrichment analysis (GSEA) and uncovered the major biological functions and miRNA families (hsa-miR-155-5p, hsa-miR-1-3p, hsa-miR-2118-5p, hsa-miR-4691-3p, and hsa-miR-1229-3p) relevant to ZO-2. CONCLUSIONS: These outcomes demonstrated the important role of ZO-2 in the pathobiology of TAAD.

Journal article

Whittaker G, Ghita I-A, Taylor M, Salmasi MY, Granato F, Athanasiou Tet al., 2023, Current Status of Simulation in Thoracic Surgical Training, ANNALS OF THORACIC SURGERY, Vol: 116, Pages: 1107-1115, ISSN: 0003-4975

Journal article

Koulouroudias M, Velissarios K, Kokotsakis J, Magouliotis DE, Tsipas P, Arjomandi Rad A, Viviano A, Kourliouros A, Athanasiou Tet al., 2023, Sizing the Frozen Elephant Trunk Based on Aortic Pathology and the Importance of Pre-Operative Imaging., J Clin Med, Vol: 12, ISSN: 2077-0383

The frozen elephant trunk is a formidable tool for the aortovascular surgeon. An appreciation of how to size the graft in different pathologies is key in achieving optimal results. Herein, we demonstrate worked examples of how imaging can be used to plan for a frozen elephant trunk and discuss the nuisances and uncertainties of sizing using three index cases: Type A aortic dissection, distal thoracic aortic aneurysm and chronic dissection.

Journal article

Triposkiadis F, Briasoulis A, Sarafidis P, Magouliotis D, Athanasiou T, Paraskevaidis I, Skoularigis J, Xanthopoulos Aet al., 2023, The Sympathetic Nervous System in Hypertensive Heart Failure with Preserved LVEF., J Clin Med, Vol: 12, ISSN: 2077-0383

The neurohormonal model of heart failure (HF) pathogenesis states that a reduction in cardiac output caused by cardiac injury results in sympathetic nervous system (SNS) activation, that is adaptive in the short-term and maladaptive in the long-term. This model has proved extremely valid and has been applied in HF with a reduced left ventricular (LV) ejection fraction (LVEF). In contrast, it has been undermined in HF with preserved LVEF (HFpEF), which is due to hypertension (HTN) in the vast majority of the cases. Erroneously, HTN, which is the leading cause of cardiovascular disease and premature death worldwide and is present in more than 90% of HF patients, is tightly linked with SNS overactivity. In this paper we provide a contemporary overview of the contribution of SNS overactivity to the development and progression of hypertensive HF (HHF) as well as the clinical implications resulting from therapeutic interventions modifying SNS activity. Throughout the manuscript the terms HHF with preserved LVEF and HfpEF will be used interchangeably, considering that the findings in most HFpEF studies are driven by HTN.

Journal article

Salmasi MY, Pirola S, Asimakopoulos G, Nienaber C, Athanasiou Tet al., 2023, Risk prediction for thoracic aortic dissection: Is it time to go with the flow?, JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol: 166, Pages: 1034-1042, ISSN: 0022-5223

Journal article

Mai DVC, Drami I, Pring T, Gould L, Lung P, Popuri K, Mirza B, Athanasiou T, Jenkins JTet al., 2023, A systematic review of automated segmentation of 3D computed-tomography scans for volumetric body composition analysis, Journal of Cachexia, Sarcopenia and Muscle, Vol: 14, Pages: 1973-1986, ISSN: 2190-5991

INTRODUCTION Automated CT scan segmentation (labelling of pixels according to tissue type) is now possible. This technique is being adapted to achieve three-dimensional (3D) segmentation of computed tomography (CT) scans, opposed to single L3-slice alone. This systematic review evaluates feasibility and accuracy of automated segmentation of 3D CT scans for volumetric body composition (BC) analysis, as well as current limitations and pitfalls clinicians and researchers should be aware of.METHODS OVID Medline, Embase and grey literature databases up to October 2021 were searched. Original studies investigating automated SM, visceral and subcutaneous AT segmentation from CT were included. RESULTS Seven of 92 studies met inclusion criteria. Variation existed in expertise and numbers of humans performing ground-truth segmentations used to train algorithms. There was heterogeneity in patient characteristics, pathology and CT phases that segmentation algorithms were developed upon. Reporting of anatomical CT coverage varied, with confusing terminology. Six studies covered volumetric regional slabs rather than the whole body. One study stated the use of whole-body CT but it was not clear whether this truly meant head-to-fingertip-to-toe.Two studies used conventional computer algorithms. The latter five used deep learning (DL), an artificial intelligence technique where algorithms are similarly organised to brain neuronal pathways. Six of seven reported excellent segmentation performance (Dice similarity coefficients > 0.9 per tissue). Internal testing on unseen scans was performed for only four of seven algorithms, whilst only three were tested externally. Trained DL algorithms achieved full CT segmentation in 12 to 75 seconds versus 25 minutes for non-DL techniques.CONCLUSION Deep learning enables opportunistic, rapid, and automated volumetric BC analysis of CT performed for clinical indications. However, most CT scans do not cover head-to-fingertip-to-toe; further rese

Journal article

Triposkiadis F, Briasoulis A, Kitai T, Magouliotis D, Athanasiou T, Skoularigis J, Xanthopoulos Aet al., 2023, The sympathetic nervous system in heart failure revisited., Heart Fail Rev

Several attempts have been made, by the scientific community, to develop a unifying hypothesis that explains the clinical syndrome of heart failure (HF). The currently widely accepted neurohormonal model has substituted the cardiorenal and the cardiocirculatory models, which focused on salt-water retention and low cardiac output/peripheral vasoconstriction, respectively. According to the neurohormonal model, HF with eccentric left ventricular (LV) hypertrophy (LVH) (systolic HF or HF with reduced LV ejection fraction [LVEF] or HFrEF) develops and progresses because endogenous neurohormonal systems, predominantly the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS), exhibit prolonged activation following the initial heart injury exerting deleterious hemodynamic and direct nonhemodynamic cardiovascular effects. However, there is evidence to suggest that SNS overactivity often preexists HF development due to its association with HF risk factors, is also present in HF with preserved LVEF (diastolic HF or HFpEF), and that it is linked to immune/inflammatory factors. Furthermore, SNS activity in HF may be augmented by coexisting noncardiac morbidities and modified by genetic factors and demographics. The purpose of this paper is to provide a contemporary overview of the complex associations between SNS overactivity and the development and progression of HF, summarize the underlying mechanisms, and discuss the clinical implications as they relate to therapeutic interventions mitigating SNS overactivity.

Journal article

Magouliotis DE, Athanasiou T, Zacharoulis D, 2023, Surgery and Reason: The End of History and the Last Surgeon., J Clin Med, Vol: 12, ISSN: 2077-0383

Arguably, Georg Wilhelm Friedrich Hegel has been one of the most influential philosophers of the 19th century [...].

Journal article

Ansaripour A, Arjomandi Rad A, Koulouroudias M, Angouras D, Athanasiou T, Kourliouros Aet al., 2023, Sarcopenia Adversely Affects Outcomes following Cardiac Surgery: A Systematic Review and Meta-Analysis., J Clin Med, Vol: 12, ISSN: 2077-0383

BACKGROUND: Sarcopenia is a degenerative condition characterised by the loss of skeletal muscle mass and strength. Its impact on cardiac surgery outcomes remains poorly investigated. This meta-analysis aims to provide a comprehensive synthesis of the available evidence to determine the effect of sarcopenia on cardiac surgery outcomes. METHODS: A systematic review and meta-analysis followed PRISMA guidelines from inception to April 2023 in EMBASE, MEDLINE, Cochrane database, and Google Scholar. Twelve studies involving 2717 patients undergoing cardiac surgery were included. Primary outcomes were early and late mortality; secondary outcomes included surgical time, infection rates, and functional outcomes. Statistical analyses were performed using appropriate methods. RESULTS: Sarcopenic patients (906 patients) had a significantly higher risk of early mortality (OR: 2.40, 95% CI: 1.44 to 3.99, p = 0.0007) and late mortality (OR: 2.65, 95% CI: 1.57 to 4.48, p = 0.0003) compared to non-sarcopenic patients (1811 patients). There were no significant differences in overall surgical time or infection rates. However, sarcopenic patients had longer ICU stays, higher rates of renal dialysis, care home discharge, and longer intubation times. CONCLUSION: Sarcopenia significantly increases the risk of early and late mortality following cardiac surgery, and sarcopenic patients also experience poorer functional outcomes.

Journal article

Triposkiadis F, Sarafidis P, Briasoulis A, Magouliotis DE, Athanasiou T, Skoularigis J, Xanthopoulos Aet al., 2023, Hypertensive Heart Failure., J Clin Med, Vol: 12, ISSN: 2077-0383

Despite overwhelming epidemiological evidence, the contribution of hypertension (HTN) to heart failure (HF) development has been undermined in current clinical practice. This is because approximately half of HF patients have been labeled as suffering from HF with preserved left ventricular (LV) ejection fraction (EF) (HFpEF), with HTN, obesity, and diabetes mellitus (DM) being considered virtually equally responsible for its development. However, this suggestion is obviously inaccurate, since HTN is by far the most frequent and devastating morbidity present in HFpEF. Further, HF development in obesity or DM is rare in the absence of HTN or coronary artery disease (CAD), whereas HTN often causes HF per se. Finally, unlike HTN, for most major comorbidities present in HFpEF, including anemia, chronic kidney disease, pulmonary disease, DM, atrial fibrillation, sleep apnea, and depression, it is unknown whether they precede HF or result from it. The purpose of this paper is to provide a contemporary overview on hypertensive HF, with a special emphasis on its inflammatory nature and association with autonomic nervous system (ANS) imbalance, since both are of pathophysiologic and therapeutic interest.

Journal article

Frisiras A, Giannas E, Bobotis S, Kanella I, Arjomandi Rad A, Viviano A, Spiliopoulos K, Magouliotis DE, Athanasiou Tet al., 2023, Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis., J Clin Med, Vol: 12, ISSN: 2077-0383

OBJECTIVE: Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies. METHODS: We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel-Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes. RESULTS: Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population. CONCLUSIONS: The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary.

Journal article

Magouliotis DE, Xanthopoulos A, Zotos P-A, Arjomandi Rad A, Tatsios E, Bareka M, Briasoulis A, Triposkiadis F, Skoularigis J, Athanasiou Tet al., 2023, The Emerging Role of "Failure to Rescue" as the Primary Quality Metric for Cardiovascular Surgery and Critical Care., J Clin Med, Vol: 12, ISSN: 2077-0383

We conducted a thorough literature review on the emerging role of failure to rescue (FTR) as a quality metric for cardiovascular surgery and critical care. For this purpose, we identified all original research studies assessing the implementation of FTR in cardiovascular surgery and critical care from 1992 to 2023. All included studies were evaluated for their quality. Although all studies defined FTR as mortality after a surgical complication, a high heterogeneity has been reported among studies regarding the included complications. There are certain factors that affect the FTR, divided into hospital- and patient-related factors. The identification of these factors allowed us to build a stepwise roadmap to reduce the FTR rate. Recently, FTR has further evolved as a metric to assess morbidity instead of mortality, while being also evaluated in the context of interventional cardiology. All these advances are further discussed in the current review, thus providing all the necessary information to surgeons, anesthesiologists, and physicians willing to implement FTR as a metric of quality in their establishment.

Journal article

Hanna L, Gibbs RGJ, London Aortic Mechanobiology Working Group, 2023, Type II Endoleaks and Culprit Vessels: Will 4D MRI Change the Paradigm?, Eur J Vasc Endovasc Surg, Vol: 66

Journal article

Tasoudis PT, Varvoglis DN, Vitkos E, Ikonomidis JS, Athanasiou Tet al., 2023, Unilateral versus bilateral anterograde cerebral perfusion in acute type A aortic dissection repair: A systematic review and meta-analysis., Perfusion, Vol: 38, Pages: 931-938

OBJECTIVES: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). METHODS: A systematic review of the MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7th, 2021) was performed according to the PRISMA statement. Studies directly comparing UACP versus BACP for ATAAD were included. Random-effects meta-analyses were performed. RESULTS: Eight retrospective cohort studies were identified, incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically significant difference was observed regarding in-hospital mortality (odds ratio [OR]:1.05 [95% Confidence Interval (95% CI):0.70-1.57]), permanent neurological deficit (PND) (OR: 0.94 [95% CI: 0.52-1.70]), transient neurological deficit (TND) (OR: 1.37 [95% CI: 0.98-1.92]), renal failure (OR: 0.96 [95% CI: 0.70-1.32]), and re-exploration for bleeding (OR: 0.77 [95% CI: 0.48-1.22]). Meta-regression analysis revealed that PND and TND were not influenced by differences in rates of total arch repair, Bentall procedure, and concomitant CABG in UACP and BACP groups. Cardiopulmonary bypass time (Standard Mean Difference [SMD]: -0.11 [95% CI: -0.22, 0.44]), Cross clamp time (SMD: -0.04 [95% CI: -0.38, 0.29]), and hypothermic circulatory arrest time (SMD: -0.12 [95% CI: -0.55, 0.30]) were comparable between UACP and BACP. Intensive care unit stay was shorter in BACP arm (SMD:0.16 [95% CI: 0.01, 0.31]); however, length of hospital stay was shorter in UACP arm (SMD: -0.25 [95% CI: -0.45, -0.06]). CONCLUSIONS: UACP and BACP had similar results in terms of in-hospital mortality, PND, TND, renal failure, and re-exploration for bleeding rate in patients with ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the UACP arm.

Journal article

Salmasi MY, Pirola S, Mahuttanatan S, Fisichella SM, Sengupta S, Jarral OA, Oo A, O'Regan D, Xu XY, Athanasiou Tet al., 2023, Geometry and flow in ascending aortic aneurysms are influenced by left ventricular outflow tract orientation: Detecting increased wall shear stress on the outer curve of proximal aortic aneurysms, JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol: 166, Pages: 11-+, ISSN: 0022-5223

Journal article

Umeojiako W, Hurndall KH, Mansuri A, Rao Cet al., 2023, The Role of Patient Reported Outcomes Measures (PROMS) and Health-Related Quality-of-Life (HRQoL) in Economic Analysis, Patient Reported Outcomes and Quality of Life in Surgery, Editors: Patel, Athanasiou, Darzi, Publisher: Springer, ISBN: 9783031275968

In this chapter the importance of quality-of-life estimates in the prevailing paradigm for economic evaluation is discussed. Empirical methods for measuring quality-of-life are described. Finally, the generic and disease-specific PROMS used to derive estimates of quality-of-life in economic evaluation are discussed.

Book chapter

Rad AA, Nia PS, Athanasiou T, 2023, ChatGPT: revolutionizing cardiothoracic surgery research through artificial intelligence, INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY, Vol: 36

Journal article

Saitta S, Maga L, Armour C, Votta E, O'Regan DP, Salmasi MY, Athanasiou T, Weinsaft JW, Xu XY, Pirola S, Redaelli Aet al., 2023, Data-driven generation of 4D velocity profiles in the aneurysmal ascending aorta., Computer Methods and Programs in Biomedicine, Vol: 233, Pages: 1-8, ISSN: 0169-2607

BACKGROUND AND OBJECTIVE: Numerical simulations of blood flow are a valuable tool to investigate the pathophysiology of ascending thoratic aortic aneurysms (ATAA). To accurately reproduce in vivo hemodynamics, computational fluid dynamics (CFD) models must employ realistic inflow boundary conditions (BCs). However, the limited availability of in vivo velocity measurements, still makes researchers resort to idealized BCs. The aim of this study was to generate and thoroughly characterize a large dataset of synthetic 4D aortic velocity profiles sampled on a 2D cross-section along the ascending aorta with features similar to clinical cohorts of patients with ATAA. METHODS: Time-resolved 3D phase contrast magnetic resonance (4D flow MRI) scans of 30 subjects with ATAA were processed through in-house code to extract anatomically consistent cross-sectional planes along the ascending aorta, ensuring spatial alignment among all planes and interpolating all velocity fields to a reference configuration. Velocity profiles of the clinical cohort were extensively characterized by computing flow morphology descriptors of both spatial and temporal features. By exploiting principal component analysis (PCA), a statistical shape model (SSM) of 4D aortic velocity profiles was built and a dataset of 437 synthetic cases with realistic properties was generated. RESULTS: Comparison between clinical and synthetic datasets showed that the synthetic data presented similar characteristics as the clinical population in terms of key morphological parameters. The average velocity profile qualitatively resembled a parabolic-shaped profile, but was quantitatively characterized by more complex flow patterns which an idealized profile would not replicate. Statistically significant correlations were found between PCA principal modes of variation and flow descriptors. CONCLUSIONS: We built a data-driven generative model of 4D aortic inlet velocity profiles, suitable to be used in computational stu

Journal article

Magouliotis DE, Bareka M, Rad AA, Christodoulidis G, Athanasiou Tet al., 2023, Demystifying the Value of Minimal Clinically Important Difference in the Cardiothoracic Surgery Context., Life (Basel), Vol: 13, ISSN: 2075-1729

The aim of this review is to describe the different statistical methods used in estimating the minimal clinically important difference (MCID) for the assessment of quality of life (QOL)-related and clinical improvement interventions, along with their implementation in cardiothoracic surgery. A thorough literature search was performed in three databases (PubMed/Medline, Scopus, Google Scholar) for relevant articles from 1980 to 2022. We included articles that implemented and assessed statistical methods used to estimate the concept of MCID in cardiothoracic surgery. MCID has been successfully implemented in several medical specialties. Anchor-based and distribution-based methods are the most common approaches when evaluating the MCID. Nonetheless, we found only five studies investigating the MCID in the context of cardiothoracic surgery. Four of them used anchor-based approaches, and one used both anchor-based and distribution-based methods. MCID values were very variable depending on the methods applied, as was the clinical context of the study. The variables of interest were certain QOL measuring questionnaires, used as anchors. Multiple anchors and methods were applied, leading to different estimations of MCID. Since cardiothoracic surgery is related to important perioperative morbidity, MCID might represent an important and efficient adjunct tool to interpret clinical outcomes. The need for MCID methodology implementation is even higher in patients with heart failure undergoing cardiac surgery. More studies are needed to validate different MCID methods in this context.

Journal article

Rizzo V, Salmasi MY, Sabetai M, Primus C, Sandoe J, Lewis M, Woldman S, Athanasiou Tet al., 2023, Infective endocarditis: do we have an effective risk score model? A systematic review, Frontiers in Cardiovascular Medicine, Vol: 10, Pages: 1-12, ISSN: 2297-055X

BackgroundInfective endocarditis (IE) is a rare, highly morbid condition with 17% in-hospital mortality. 25-30% require surgery and there is ongoing debate with regard to markers predicting patient outcomes and guiding intervention. This systematic review aims to evaluate all IE risk scores currently available. Methods Standard methodology (PRISMA guideline) was used. Papers with risk score analysis for IE patients were included, with attention to studies reporting area under the receiver-operating characteristic curve(AUC/ROC). Qualitative analysis was carried out, including assessment of validation processes and comparison of these results to original derivation cohorts where available. Risk-of-bias analysis illustrated according to PROBAST guidelines. Results Of 75 articles initially identified, 32 papers were analysed for a total of 20 proposed scores, (range 66-13,000 patients), 14 of which were specific for IE. The number of variables per score ranged from 3 to 14 with only 50% including microbiological variables and 15% including biomarkers. The following scores had good performance (AUC>0.8) in studies proposing the score (often the derivation cohort); however fared poorly when applied to a new cohort: PALSUSE, DeFeo, ANCLA, RISK-E, EndoSCORE, MELD-XI, COSTA, SHARPEN. DeFeo score demonstrated the largest discrepancy with initial AUC of 0.88, compared to 0.58 when applied to different cohorts.The inflammatory response in IE has been well documented and CRP has been found to be an independent predictor for worse outcomes. There is ongoing investigation on alternate inflammatory biomarkers which may assist in IE management. Of the scores identified in this review, only 3 have included a biomarker as a predictor.ConclusionDespite the variety of available scores, their development has been limited by small sample size, retrospective collection of data and short-term outcomes, with lack of external validation, limiting their transportability. Future population

Journal article

Arjomandi Rad A, Kapadia S, Zubarevich A, Nanchahal S, Van den Eynde J, Vardanyan R, Bareka M, Krasopoulos G, Quarto C, Ruhparwar A, Athanasiou T, Weymann Aet al., 2023, Sex disparities in left ventricular assist device implantation outcomes: A systematic review and meta-analysis of over 50 000 patients., Artif Organs, Vol: 47, Pages: 273-289

BACKGROUND: Left ventricular assist devices (LVAD) represent an important therapeutic option for patients progressing to end-stage heart failure. Women have been historically underrepresented in LVAD studies, and have been reported to have worse outcomes despite technological optimisation. We aimed to systematically explore the evidence on sex disparities in the use and outcomes of LVAD implantation. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles of men versus women undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to July 2022. Primary outcomes were stroke (haemorrhagic and ischaemic) and early/overall mortality. Secondary outcomes were LVAD thrombosis, right VAD implantation, major bleeding, kidney dysfunction, and device/driveline infection. RESULTS: Our search yielded 137 relevant studies, including 22 meeting the inclusion criteria with a total of 53 227 patients (24.2% women). Overall mortality was higher in women (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.05-1.62, p = 0.02), as was overall stroke (OR 1.32, 95%CI 1.06-1.66, p = 0.01), including ischemic (OR 1.80, 95%CI 1.22-2.64, p = 0.003) and haemorrhagic (OR 1.72, 95%CI 1.09-2.70, p = 0.02). Women had more frequent right VAD implantation (OR 2.11, 95%CI 1.24-3.57, p = 0.006) and major bleeding (OR 1.40, 95%CI 1.06-1.85, p = 0.02). Kidney dysfunction, LVAD thrombosis, and device/driveline infections were comparable between sexes. CONCLUSIONS: Our analysis suggests that women face a greater risk of adverse events and mortality post-LVAD implantation. Although the mechanisms remain unclear, the difference in outcomes is thought to be multifactorial. Further research, that includes comprehensive pre-operative characteristics and post-operative outcomes, is encouraged.

Journal article

Magouliotis DE, Fergadi MP, Zotos P-A, Rad AA, Xanthopoulos A, Bareka M, Spiliopoulos K, Athanasiou Tet al., 2023, Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses., Gen Thorac Cardiovasc Surg, Vol: 71, Pages: 77-89

OBJECTIVE: We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG). METHODS: Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA) and radial artery (RA) as a second arterial conduit was the secondary endpoint. Subgroup analyses were performed regarding patients older than 70 years, with diabetes mellitus, and females. A sensitivity analysis was performed with the leave-one-out method. RESULTS: Forty-four studies were included in the qualitative and thirty-nine in the quantitative synthesis. After pooling data from 180 to 459 patients, the MAG group demonstrated a higher OS (HR, 0.589; 95% CI, 0.58-0.60; p < 0.0001) and event-free OS compared with the SAG group (HR, 0.828; 95% CI, 0.80-0.86; p < 0.0001). In addition, RITA was associated with superior OS compared with RA as a second arterial conduit (HR, 0.936; 95% CI, 0.89-0.98; p = 0.009). MAG was also superior to SAG in patients over 70 years, females, and patients with diabetes mellitus. Sensitivity analysis demonstrated a small-size study effect on the female subgroup analysis. CONCLUSION: The present meta-analysis indicates that MAG is associated with enhanced survival outcomes compared to SAG for patients undergoing isolated CABG.

Journal article

Athanasiou T, Patel V, Darzi A, 2023, Patient Reported Outcomes and Quality of Life in Surgery, ISBN: 9783031275968

This book provides a guide to the assessment of quality of life and patient reported outcomes measures in general surgery. The rapidly emerging field helps contextualise patients and helps the decision-making process within health economics, bedside medicine, public health, and health policy. All subspecialties of general surgery are covered, as well as the core principles of quality of life. The book aims to demonstrate how clinicians and policymakers can easily get access to a single source of patient reported outcomes measures and quality of life evidence to help them make the best-informed decisions in the field of general surgery. This book is relevant to healthcare managers, doctors, allied health professionals, healthcare scientists, consultants, healthcare economists, and medical statisticians working in healthcare.

Book

Salmasi MY, Alwis S, Cyclewala S, Jarral OA, Mohamed H, Mozalbat D, Nienaber CA, Athanasiou T, Morris-Rosendahl D, Members of the London Aortic Mechanobiology Working Groupet al., 2023, The genetic basis of thoracic aortic disease: The future of aneurysm classification?, Hellenic Journal of Cardiology, Vol: 69, Pages: 41-50, ISSN: 1109-9666

The expansion in the repertoire of genes linked to thoracic aortic aneurysms (TAA) has revolutionised our understanding of the disease process. The clinical benefits of such progress are numerous, particularly helping our understanding of non-syndromic hereditary causes of TAA (HTAAD) and further refinement in the subclassification of disease. Furthermore, the understanding of aortic biomechanics and mechanical homeostasis has been significantly informed by the discovery of deleterious mutations and their effect on aortic phenotype. The drawbacks in genetic testing in TAA lie with the inability to translate genotype to accurate prognostication in the risk of thoracic aortic dissection (TAD), which is a life-threatening condition. Under current guidelines, there are no metrics by which those at risk for dissection with normal aortic diameters may undergo preventive surgery. Future research lies with more advanced genetic diagnosis of HTAAD and investigation of the diverse pathways involved in its pathophysiology, which will i) serve to improve our understanding of the underlying mechanisms, ii) improve guidelines for treatment and iii) prevent complications for HTAAD and sporadic aortopathies.

Journal article

Magouliotis DE, Zotos P-A, Karamolegkou AP, Tatsios E, Spiliopoulos K, Athanasiou Tet al., 2022, Long-Term Survival after Extended Sleeve Lobectomy (ESL) for Central Non-Small Cell Lung Cancer (NSCLC): A Meta-Analysis with Reconstructed Time-to-Event Data., J Clin Med, Vol: 12, ISSN: 2077-0383

OBJECTIVE: We conducted a thorough literature search on patients with central non-small cell lung cancer (NSCLC) undergoing either extended sleeve lobectomy (ESL) or pneumonectomy (PN). METHODS: We identified all original research studies that compared the long-term survival of ESL versus PN from 1990 to 2022. The primary endpoints were the median overall survival (OS) and disease-free survival (DFS). Complications, operative mortality, and the reoperation rate were the secondary endpoints. Regarding the primary endpoints, independent patient data were extracted from the included studies, and pooled Kaplan-Meier curves were constructed. A sensitivity analysis was performed using the leave-one-out method. RESULTS: Nine studies were included in the qualitative and seven in the quantitative synthesis, including 431 patients. Patients in the ESL group demonstrated a significantly higher OS compared with the PN group (HR, 0.63; 95% CI, 0.46-0.87; p = 0.005). In addition, patients undergoing ESL presented a significantly higher DFS compared to the PN group (HR, 0.57; 95% CI, 0.40-0.80; p = 0.004). These findings were further validated with a sensitivity analysis. The most common complications in the ESL group were bronchopleural fistula (4.6%), stricture (3.1%), prolonged air leakage (7.3%), sputum retention (4.6%), pneumonia (7.7%), and pulmonary vein thrombosis (1.5%). ESL was associated with a low reoperation rate (1.5%) and operative mortality (1.2%). CONCLUSIONS: The present meta-analysis indicates that ESL is associated with enhanced survival outcomes compared to PN for patients with central NSCLC. Further randomized controlled trials are necessary to validate our findings.

Journal article

Magouliotis DE, Zotos P-A, Rad AA, Koukousaki D, Vasilaki V, Portesi I, Spiliopoulos K, Athanasiou Tet al., 2022, Meta-analysis of survival after extrapleural pneumonectomy (EPP) versus pleurectomy/decortication (P/D) for malignant pleural mesothelioma in the context of macroscopic complete resection (MCR)., Updates Surg, Vol: 74, Pages: 1827-1837

OBJECTIVE: We reviewed the available literature on patients with MPM undergoing either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). METHODS: Original research studies that evaluated long-term outcomes of P/D versus EPP were identified, from January 1980 to February 2022. The 30-days and 90-day mortality, along with the 1-, 2-, 3-, 5-year survival, the median overall survival, the macroscopic complete resection (MCR) rate, and the complications were calculated according to both a fixed and a random effect model. The Q and I2 statistic were used to test for heterogeneity among the studies. Sensitivity analysis was performed including only studies that incorporated the MCR concept. RESULTS: Eighteen studies were included, incorporating a total of 4,852 patients treated with EPP and P/D. The 30-day mortality was significantly higher in the EPP group (OR: 2.79 [95% CI 1.30, 6.01]; p = 0.009). The median overall survival was higher in the P/D group (WMD:-4.55 [-6.05, -3.04]; p < 0.001). No differences were found regarding the 90-day mortality, MCR rate, and the 1-, 2-,3-, 5-year survival between the EPP and P/D groups. These findings were validated by the sensitivity analysis. The incidence of atrial fibrillation, hemorrhage, pulmonary embolism, air leak, and reoperation was significantly increased in the EPP group (p < 0.05). CONCLUSIONS: The present meta-analysis indicates that P/D is associated with enhanced outcomes regarding 30-day mortality, median overall survival, and complications. The P/D approach should be preferred when technically feasible. However, the procedure of choice should be decided based on the goal of MCR in the safest approach for the patient.

Journal article

Salmasi MY, Morris-Rosendahl D, Jarral OA, Rosendahl U, Asimakopoulos G, Raja S, Aragon-Martin JA, Child A, Pepper J, Oo A, Athanasiou Tet al., 2022, Determining the genetic contribution in patients with non-syndromic ascending thoracic aortic aneurysms: Correlation with findings from computational pathology, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 366, Pages: 1-9, ISSN: 0167-5273

Journal article

Naruka V, Salmasi MY, Rad AA, Marczin N, Lazopoulos G, Moscarelli M, Casula R, Athanasiou Tet al., 2022, Use of Cytokine Filters During Cardiopulmonary Bypass: Systematic Review and Meta-Analysis, HEART LUNG AND CIRCULATION, Vol: 31, Pages: 1493-1503, ISSN: 1443-9506

Journal article

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

Request URL: http://wlsprd.imperial.ac.uk:80/respub/WEB-INF/jsp/search-html.jsp Request URI: /respub/WEB-INF/jsp/search-html.jsp Query String: respub-action=search.html&id=00484886&limit=30&person=true