Publications
782 results found
Suliman A, Dialynas M, Ashrafian H, et al., 2010, Acute Complex Type A Dissection associated with peripheral malperfusion syndrome treated with a staged approach guided by lactate levels, Journal of Cardiothoracic Surgery, Vol: 5, ISSN: 1749-8090
Acute type A aortic dissection can be complicated by visceral malperfusion and is associated with a significant surgical morbidity and mortality. We describe a case of successful management of a complex acute type A dissection with mesenteric and lower limb ischemia treated with endovascular thoracic stenting and femoro-femoral crossover bypass grafting followed by aortic arch repair. To accomplish this, we applied a staged therapeutic approach using serial lactate measurements to assess the adequacy of peripheral perfusion and metabolic status prior to surgical repair of the proximal dissection.
Saso S, Vecht JA, Rao C, et al., 2010, Statin therapy may influence the incidence of postoperative atrial fibrillation: what is the evidence?, Texas Heart Institute Journal, Vol: 36, Pages: 521-529, ISSN: 1526-6702
Atrial fibrillation is the most common postoperative arrhythmia in patients who undergo cardiac surgery. We sought to determine whether the administration of statins reduces the incidence of postoperative atrial fibrillation in cardiac surgery patients. We performed a meta-analysis on all studies published between 2004 and 2008 that reported comparisons between statin treatment or nontreatment in these patients. Our primary focus was the incidence of postoperative atrial fibrillation. Random-effects modeling and sensitivity analysis were used to evaluate the consistency of the calculated treatment effect. Ten qualifying studies generated a total of 4,459 patients. The incidence of postoperative atrial fibrillation was 22.6% (622/2,758) in the statin-treated group and 29.8% (507/1,701) in the untreated group. Using the random-effects model, we calculated an odds ratio (OR) of 0.60 (95% confidence interval [CI], 0.48-0.76). When we considered only the 4 randomized studies (919 patients) in order to reduce the effects of heterogeneity, this significant reduction in the incidence of postoperative atrial fibrillation in the statin group was maintained (OR, 0.55; 95% CI, 0.41-0.73) with no heterogeneity (chi2 of heterogeneity, 2.96; P = 0.4). In studies wherein only coronary artery bypass grafting was performed, statin treatment decreased postoperative atrial fibrillation (OR, 0.64; 95% CI, 0.43-0.95). We conclude that statin administration results in a reduction in the incidence of atrial fibrillation in patients who undergo cardiac surgery. Further research into the underlying mechanism can elucidate possible relationships between the dosage and type of statin used.
Ali E, Saso S, Ashrafian H, et al., 2010, Does a skeletonized or pedicled left internal thoracic artery give the best graft patency?, INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, Vol: 10, Pages: 97-104, ISSN: 1569-9293
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- Citations: 24
Nagpal K, Ahmed K, Vats A, et al., 2010, Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis, Surg Endosc
INTRODUCTION: Open esophagectomy for cancer is a major oncological procedure, associated with significant morbidity and mortality. Recently, thoracoscopic procedures have offered a potentially advantageous alternative because of less operative trauma compared with thoracotomy. The aim of this study was to utilize meta-analysis to compare outcomes of open esophagectomy with those of minimally invasive esophagectomy (MIE) and hybrid minimally invasive esophagectomy (HMIE). METHODS: Literature search was performed using Medline, Embase, Cochrane Library, and Google Scholar databases for comparative studies assessing different techniques of esophagectomy. A random-effects model was used for meta-analysis, and heterogeneity was assessed. Primary outcomes of interest were 30-day mortality and anastomotic leak. Secondary outcomes included operative outcomes, other postoperative outcomes, and oncological outcomes in terms of lymph nodes retrieved. RESULTS: A total of 12 studies were included in the analysis. Studies included a total of 672 patients for MIE and HMIE, and 612 for open esophagectomy. There was no significant difference in 30-day mortality; however, MIE had lower blood loss, shorter hospital stay, and reduced total morbidity and respiratory complications. For all other outcomes, there was no significant difference between the two groups. CONCLUSION: Minimally invasive esophagectomy is a safe alternative to the open technique. Patients undergoing MIE may benefit from shorter hospital stay, and lower respiratory complications and total morbidity compared with open esophagectomy. Multicenter, prospective large randomized controlled trials are required to confirm these findings in order to base practice on sound clinical evidence.
Wetzel CM, Black SA, Hanna GB, et al., 2010, The effects of stress and coping on surgical performance during simulations., Ann Surg, Vol: 251, Pages: 171-176
OBJECTIVE: This study investigates the effects of surgeons' stress levels and coping strategies on surgical performance during simulated operations. METHODS: Thirty surgeons carried out each a non-crisis and a crisis scenario of a simulated operation. Surgeons' stress levels were assessed by several measures: self-assessments and observer ratings of stress, heart rate, heart rate variability, and salivary cortisol. Coping strategies were explored qualitatively and quantified to a coping score. Experience in surgery was included as an additional predictor. Outcome measures consisted of technical surgical skills using Objective Structured Assessment of Technical Skill (OSATS), nontechnical surgical skills using Observational Teamwork Assessment for Surgery (OTAS), and the quality of the operative end product using End Product Assessment (EPA). Uni- and multivariate linear regression were used to assess the independent effects of predictor variables on each performance measure. RESULTS: During the non-crisis simulation, a high coping score and experience significantly enhanced EPA (beta1, 0.279; 0.009-0.460; P= 0.04; beta2, 0.571; 4.328-12.669, P< 0.001; respectively). During the crisis simulation, a significant beneficial effect of the interaction of high experience and low stress on all performance measures was found (EPA: beta, 0.537; 2.079-8.543; OSATS: beta, 0.707; 8.708-17.860; OTAS: beta, 0.654; 13.090-30.483; P< 0.01). Coping significantly enhanced nontechnical skills (beta, 0.302; 0.117-1.624, P= 0.03). CONCLUSIONS: Clinicians' stress and coping influenced surgical performance during simulated operations. Hence, these are critical factors for the quality of health care.
Ahmed K, Keeling AN, Fakhry M, et al., 2010, Role of Virtual Reality Simulation in Teaching and Assessing Technical Skills in Endovascular Intervention, J Vasc Interv Radiol, Vol: 21
Athanasiou T, Debas HT, Darzi A, 2010, Key Topics in Surgical Research and Methodology, Publisher: Springer, ISBN: 9783540719151
Key Topics in Surgical Research and Methodology represents a comprehensive reference text accessible to the surgeon embarking on an academic career. Key themes emphasize and summarize the text. Four key elements are covered, i.e.
Ashrafian H, Mayer E, Athanasiou T, 2010, Monitoring Trial Effects, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Pages: 67-73
Mayer E, Darzi LA, Athanasiou T, 2010, The Role of Volume-Outcome Relationship in Surgery, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Pages: 195-206
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- Citations: 2
Ahmed K, Rowland S, Patel V, et al., 2010, Is the structure of anatomy curriculum adequate for safe medical practice?, Surgeon, Vol: 8, Pages: 318-324, ISSN: 1479-666X
INTRODUCTION: Anatomy has been considered a core subject within the medical education curriculum. In the current setting of ever-changing diagnostic and treatment modalities, the opinion of both students and trainers is crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. METHODS: Medical students, trainees and specialist trainee doctors and specialists from the London (England) area were surveyed to investigate the how curriculum changes have affected the relevance of anatomical knowledge to clinical practice and to identify recommendations for optimum teaching methods. The survey employed 5-point Likert scales and multiple-choice questions. Where the effect of training level was statistically significant (p < 0.05), post-hoc analysis was carried out using Mann-Whitney U tests. Significance levels were modified according to the Bonferroni method. RESULTS: Two hundred and twenty-eight individuals completed the survey giving a response rate of 53%. Medical students, trainees and specialists all agreed (mean Likert score 4.51, 4.79, 4.69 respectively) that knowledge of anatomy is important for medical practice. Most of the trainees (88.4%) and specialists (81.3%) used dissection to learn anatomy, but only 61.4% of medical students used this approach. Dissection was the most commonly recommended approach for learning anatomy across all the groups (41.7%-69.3%). CONCLUSIONS: Knowledge of anatomy is perceived to be important for safe clinical practice. Anatomy should be taught with other relevant system or clinical modules. Newer tools for anatomy teaching need further validation before incorporation into the curriculum.
Ashrafian H, Athanasiou T, 2010, How to Read a Paper, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Editors: Athanasiou, Debas, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 545-555, ISBN: 978-3-540-71914-4
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- Citations: 1
Ashrafian H, Rowland S, Athanasiou T, 2010, How to Recruit Patients in Surgical Studies, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Pages: 75-81
Leff DR, Lovegrove RE, Darzi LA, et al., 2010, Data Collection, Database Development and Quality Control: Guidance for Clinical Research Studies, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Editors: Athanasiou, Debas, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 305-320, ISBN: 978-3-540-71914-4
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- Citations: 1
Ashrafian H, Ahmed K, Athanasiou T, 2010, The Ethics of Animal Research, Key Topics in Surgical Research and Methodology, Editors: Athanasiou, Debas, Darzi, Publisher: Springer, ISBN: 9783540719144
Rao C, Athanasiou T, 2010, Value of Information Analysis, Key Topics in Surgical Research and Methodology, Editors: Athanasiou, Debas, Darzi, Berlin Heidelberg, Publisher: Springer-Verlag, Pages: 421-428, ISBN: 978-3-540-71914-4
Rao C, Athanasiou T, 2010, How to Write a Book Proposal, Key Topics in Surgical Research and Methodology, Editors: Athanasiou, Debas, Darzi, Berlin Heidelberg, Publisher: Springer-Verlag, Pages: 611-614, ISBN: 978-3-540-71914-4
Hanna ARG, Rao C, Athanasiou T, 2010, Graphs in Statistical Analysis, Key Topics in Surgical Research and Methodology, Editors: Athanasiou, Debas, Darzi, Berlin Heidelberg, Publisher: Springer-Verlag, Pages: 441-476, ISBN: 978-3-540-71914-4
Rao C, Athanasiou T, 2010, Cost-Effectiveness Analysis, Key Topics in Surgical Research and Methodology, Editors: Athanasiou, Debas, Darzi, Berlin Heidelberg, Publisher: Springer-Verlag, Pages: 411-420, ISBN: 978-3-540-71914-4
Rao C, Athanasiou T, 2010, Decision Analysis, Key Topics in Surgical Research and Methodology, Editors: Athanasiou, Debas, Darzi, Berlin Heidelberg, Publisher: Springer-Verlag, Pages: 399-410, ISBN: 978-3-540-71914-4
Ashrafian H, Mortlock A, Athanasiou T, 2010, A Primer for Grant Applications, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Editors: Athanasiou, Debas, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 579-586, ISBN: 978-3-540-71914-4
Mayer EK, Bottle A, Darzi A, et al., 2010, Risk-adjusted funnel plot analysis of radical cystectomy outcomes across English NHS Trusts, Annual Meeting of the British-Association-of-Urological-Surgeons, Publisher: WILEY-BLACKWELL PUBLISHING, INC, Pages: 29-29, ISSN: 1464-4096
Chow A, Mayer E, Darzi LA, et al., 2010, Patient Satisfaction in Surgery, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Pages: 165-173
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- Citations: 1
Mayer E, Chow A, Darzi LA, et al., 2010, How can we Assess Quality of Care in Surgery?, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Pages: 151-164
Ashrafian H, Rao C, Athanasiou T, 2009, Too much benchmarking Reply, LANCET, Vol: 374, Pages: 1963-1963, ISSN: 0140-6736
Kidher ES, Perera R, Rao C, et al., 2009, A rare case of suture material obstructing the closure mechanism of a prosthetic aortic valve: a case report, Cases Journal, Vol: 2, ISSN: 1757-1626
Prosthetic aortic valve dysfunction presenting as aortic regurgitation is a complication of mechanical valve replacement. We describe a case of late valve dysfunction caused by an annular suture of excessive length obstructing the closure mechanism of a bileaflet prosthetic valve.We present this rare cause of valve dysfunction in an 80-year-old male patient who presented with haemolysis and dyspnoea. At the time of operation it was found that a long vertically positioned annular valve suture was interfering with the normal closure mechanism of one of the prosthetic leaflets causing eccentric regurgitation jets. These findings were misdiagnosed as paravalvular leaks on the preoperative transoesophageal echo. No paravalvular leak was identified intraoperatively. After removal of the responsible suture normal prosthetic valve function was restored.Whilst early aortic valve dysfunction caused by suture material has previously been reported, this is the first report of suture material causing late dysfunction.
Kokotsakis J, Lazopoulos G, Ashrafian H, et al., 2009, Thoracoabdominal aneurysm repair using a four-branched thoracoabdominal graft: A case series, Cases Journal, Vol: 2, ISSN: 1757-1626
Revascularization of the visceral arteries during thoracoabdominal aneurysm repair is usually performed sequentially by an anastomosis between a prosthetic graft and an aortic patch. There are immediate operative risks such as bleeding and distortion. In the longer term, aneurysm, pseudoaneurysm and rupture may occur. These require reoperation and are associated with significant morbidity and mortality. We present our experience with Crawford IV thoracoabdominal aneurysm repair in four patients, using a prefabricated four-branched graft (Coselli graft). At two years there were no deaths, no complications and no vessel abnormalities on computed tomography. We recommend its use as the graft of choice in young patients with an aortic tissue disorder requiring total resection of the aortic wall at the level of the visceral vessels. © 2009 Kokotsakis et al; licensee Cases Network Ltd.
Yakoub D, Athanasiou T, Tekkis P, et al., 2009, Laparoscopic assisted distal gastrectomy for early gastric cancer: Is it an alternative to the open approach?, SURGICAL ONCOLOGY-OXFORD, Vol: 18, Pages: 322-333, ISSN: 0960-7404
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- Citations: 90
Ashrafian H, Bueter M, Ahmed K, et al., 2009, Metabolic surgery: an evolution through bariatric animal models, Obes Rev
Saso S, Vecht JA, Rao C, et al., 2009, Statin Therapy May Influence the Incidence of Postoperative Atrial Fibrillation What Is the Evidence?, TEXAS HEART INSTITUTE JOURNAL, Vol: 36, Pages: 521-529, ISSN: 0730-2347
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- Citations: 10
Stanbridge R, Elkin SL, Suliman A, et al., 2009, 10-YEAR SURVIVAL FOR ROUTINE LUNG CANCER RESECTION BY A MINIMALLY INVASIVE ANTERIOR APPROACH: COMPARISON WITH OPEN STANDARD THORACOTOMY, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A67-A68, ISSN: 0040-6376
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