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Amien B, Appleby C, Mills J, Sandhu K, Harrington D. Acute Aortic Regurgitation After Transcatheter Aortic Valve Implantation Procedure. Cureus 2023; 15:e50345. [PMID: 38149064 PMCID: PMC10750444 DOI: 10.7759/cureus.50345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/28/2023] Open
Abstract
This study reports the case of a 75-year-old woman who developed aortic regurgitation (AR) a few hours after transcatheter aortic valve implantation (TAVI). The patient underwent the TAVI procedure for aortic stenosis and became hypotensive in recovery. A transthoracic echo revealed cardiac tamponade and around 1500 ml of blood was drained over several hours. Further advice was sought from the surgical team, and a transoesophageal echo revealed significant AR, which was confirmed by a transthoracic echo performed the next day. The patient underwent an emergency surgical aortic valve replacement. This case study demonstrates one of the complications of the TAVI procedure, acute AR, which was diagnosed a few hours after the procedure.
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Affiliation(s)
- Bothayna Amien
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Clare Appleby
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Joe Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Kully Sandhu
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Deborah Harrington
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
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2
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Hufham J, Aversano J, Doleshal M, Harrington D. PP01.02 Molecular Recurrence Risk Profiles in Patients with Early-Stage NSCLC: Current Standard of Care Compared to a Prognostic and Predictive 14-gene Expression Assay. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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3
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Martin S, Searl T, Ohlander S, Harrington D, Stupp S, McVary K, Podlasek C. Sonic hedgehog signaling in corpora cavernosal cells from prostatectomy, diabetic, hypertension and Peyronie's patients with erectile dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Martin S, Searl T, Ohlander S, Harrington D, Stupp S, McVary K, Podlasek C. Sonic Hedgehog Signaling in Corpora Cavernosal Cells from Prostatectomy, Diabetic, Hypertension and Peyronie's Patients with Erectile Dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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5
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Toolan C, Oo S, Shaw M, Field M, Kuduvalli M, Harrington D, Nawaytou O. Reinterventions and new aortic events after aortic surgery in Marfan syndrome. Eur J Cardiothorac Surg 2021; 61:ezab491. [PMID: 35325086 DOI: 10.1093/ejcts/ezab491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Pre-emptive strategies to manage the aortic complications of Marfan syndrome have resulted in improved life expectancy yet, secondary to the variation of phenotypic expression, anticipating the risk and nature of future aortic events is challenging. We examine rates of new aortic events and reinterventions in a Marfan cohort following initial aortic presentation. METHODS Retrospective cohort study of Marfan patients with aortic pathology presenting to our institution 1998-2018. Patients were grouped according to index event: aortic dissection or root aneurysm. Patients with aortic dissection were classified according to Debakey criteria. Incidence of new aortic events and frequency of reintervention were analysed. RESULTS One hundred and twenty-six aortic procedures were performed in 74 Marfan patients with a median follow-up of 7 years. Forty-seven patients had an index event of root aneurysm and 27 had aortic dissection. Following operative intervention in the aneurysm group, 7 patients developed Debakey III dissections raising the overall number of patients who developed dissection within this cohort to 34. Reinterventions were more frequent in the dissection group with full replacement of the native aorta in 5 patients. CONCLUSIONS After operative intervention on the proximal aorta, a proportion will develop distal pathology. A greater focus on factors contributing to future events, such as mapping genotypes to clinical course, may lead the way for targeted operative techniques and surveillance.
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Affiliation(s)
- Caroline Toolan
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Shwe Oo
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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6
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Watson GE, Myers GJ, Thurston SW, Harrington D, Shamlaye CF, Strain JJ, Davidson PW, van Wijngaarden E. Neurodevelopmental outcomes in young children exposed to dental amalgam. Ann Epidemiol 2021. [DOI: 10.1016/j.annepidem.2021.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Harky A, Mason S, Othman A, Shaw M, Nawaytou O, Harrington D, Kuduvalli M, Field M. Outcomes of acute type A aortic dissection repair: Daytime versus nighttime. JTCVS Open 2021; 7:12-20. [PMID: 36003743 PMCID: PMC9390141 DOI: 10.1016/j.xjon.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022]
Abstract
Objective We sought to report our experience of repairing acute type A aortic dissection (ATAAD) over 21 years during in-hours versus out-of-hours before and after the establishment of specialized aortic service and rota. Methods A retrospective analysis of all patients who had ATAAD repair between November 1998 and December 2019 in our center. In-hours were defined as 08:00 to 19:59 hours and out of hours were defined as 20:00 to 07:59 hours. Results A total of 286 patients underwent repair of ATAAD. Eighty operations took place during the prerota period (43 operations in hours, 37 out of hours) and 206 operations during the specialized rota period (110 in hours, 96 out of hours). There was no difference in 30-day mortality between the in-hours and out-of-hours groups in either the prerota (23.3% vs 32.4%; P = .36) or specialized rota periods (11.6% vs 11.5%; P = .94). Mean number of cases per year increased by 83% between the prerota and specialized rota periods. Thirty-day mortality reduced in both the in-hours (23.3% vs 11.6%) and out-of-hours (32.4% vs 11.5%) groups since introduction of the specialized aortic rota. Conclusions Outcomes in repair of ATAAD during in-hours and out-of-hours periods are similar when operated on in a specialized unit with a dedicated aortic team. This emphasizes the current global trend of service centralization without particular attention to time of day to operate on such critical cohort patients.
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Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Sabrina Mason
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ahmed Othman
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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8
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Bamuya C, Correia JC, Brady EM, Beran D, Harrington D, Damasceno A, Crampin AM, Magaia A, Levitt N, Davies MJ, Hadjiconstantinou M. Use of the socio-ecological model to explore factors that influence the implementation of a diabetes structured education programme (EXTEND project) inLilongwe, Malawi and Maputo, Mozambique: a qualitative study. BMC Public Health 2021; 21:1355. [PMID: 34238258 PMCID: PMC8268266 DOI: 10.1186/s12889-021-11338-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes Self-Management Education and Support (DSMES) programmes are vital for type 2 diabetes mellitus (T2DM) management. However, they are limited in Sub-Saharan Africa (SSA). To address this gap, a DSMES, namedEXTEND was developed in Lilongwe (Malawi) and Maputo (Mozambique). This qualitative study aimed to explore factors that influence the implementation of DSMES in these settings. METHODS The Socio-ecological model was applied to explore factors influencing the implementation of DSMES in SSA. Data was analysed using the Framework method and constant comparative techniques. Sixty-six people participated in the study: people with T2DM who participated in the EXTEND programme; healthcare professionals (HCPs), EXTEND educators, EXTEND trainers, and stakeholders. RESULTS Our findings indicate that there is a need to develop an integrated and dedicated diabetes services in SSA healthcare systems, incorporating culturally adapted DSMES and tailored diabetes training to all professions involved in diabetes management. Traditional media and the involvement of community leaders were proposed as important elements to help engage and promote DSMES programmes in local communities. During the design and implementation of DSMES, it is important to consider individual and societal barriers to self-care. CONCLUSION Findings from this study suggest that multi-faceted factors play a significant role to the implementation of DSMES programmes in LICs. In the future, EXTEND could be incorporated in the development of diabetes training and dedicated diabetes services in SSA healthcare systems, acting as an educational tool for both people with T2DM and HCPs. This project was supported by the Medical Research Council GCRF NCDs Foundation Awards 2016 Development Pathway Funding.
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Affiliation(s)
- C Bamuya
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - J C Correia
- Unit of Patient Education, Division of Endocrinology, Diabetology, Nutrition and Patient Education, WHO Collaborating Center, Department of Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - E M Brady
- University Hospitals of Leicester NHS Trust, Leicester Diabetes Centre, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - D Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - D Harrington
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - A Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - A M Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Ana Magaia
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Naomi Levitt
- The University of Cape Town, Cape Town, South Africa
| | - M J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - M Hadjiconstantinou
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
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9
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Riordan S, Doleshal M, Orck J, Harrington D. P07.05 Characterization of Clinicopathologic Features and Molecular Recurrence Risk Profiles in Patients with Early-Stage NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Martin S, Searl T, Ohlander S, Harrington D, Stupp S, McVary K, Podlasek C. 084 Sonic Hedgehog Signaling in Corporal Cavernosal Cells from Prostatectomy, Diabetic, Hypertension and Peyronie's Patients with ED. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Elhassan MMO, Ali AM, Kehlet AB, Ali OHA, Harrington D. The Response of Broiler Chicks to Dietary Supplementation with a Probiotic, Acidifiers Blend, and Their Combination. Braz J Poult Sci 2021. [DOI: 10.1590/1806-9061-2021-1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - AM Ali
- King Faisal University, Saudi Arabia
| | | | - OHA Ali
- University of Khartoum, Sudan
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12
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Harky A, Othman A, Nistal De Paz C, Shaw M, Nawaytou O, Harrington D, Kuduvalli M, Field M. Systematic approach to diagnosis and management of infected prosthetic grafts in the proximal aorta. J Card Surg 2020; 36:145-152. [PMID: 33169445 PMCID: PMC7839687 DOI: 10.1111/jocs.15122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023]
Abstract
Objectives Management of infected prosthetic aortic grafts in the ascending and or root is complex and multifaceted. We report our diagnostic pathway, management and outcomes, identifying successful strategies. Methods This was a retrospective, single center, observational study. Consecutive patients who underwent management of infected aortic grafts in the ascending and/or root at our institution between October 1998 and December 2019 were included. The main outcome measures were: discharge from hospital alive with at least 1 year survival, operative mortality and success of primary treatment strategy. Results Twenty‐six patients presented with infection of proximal aortic grafts and were managed through a number of strategies with an overall hospital‐survival of 81% and 1 year survival of 69%. Twenty of them ultimately underwent redo surgery with 25% operative mortality (within 24 h of surgery). Five patients underwent washout and irrigation of which two were successfully treated and cured with adjunctive antibiotics and two went on to have staged explant and definitive surgery. Interval between surgery and infection was 42.5 ± 35.8 months. All patients had at least one major criterion and three minor criterions with no diagnostic uncertainty. The commonest primary strategy was 3a (definitive surgery), (13/26, 50%). Conclusions Adopting a systematic and flexible patient specific approach to the diagnosis and management of patients with proximal aortic graft infections results in reasonable overall 1 year survival. In the majority of patients surgery is ultimately required in an attempt to achieve a curative treatment; however this comes with high operative mortality risk.
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Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Center for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Ahmed Othman
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Carlos Nistal De Paz
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Center for Cardiovascular Science, University of Liverpool, Liverpool, UK
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13
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Theologou T, Harky A, Shaw M, Eltyeb H, Elbakbak W, Snosi M, Harrington D, Kuduvalli M, Oo A, Field M. Management of Lower Limb Ischemia During Operative Repair of Acute Type A Aortic Dissection by Distal Crossover Grafts: a Case Series. Braz J Cardiovasc Surg 2020; 35:607-613. [PMID: 33118723 PMCID: PMC7598955 DOI: 10.21470/1678-9741-2019-0259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective To describe our experience of nine patients with extra-anatomical bypass for clinically ischemic distal limb during repair of acute Type A aortic dissection (ATAAD). Methods We retrospectively examined a series of nine patients who underwent surgery for ATAAD. We identified a subset of the patients who presented with concomitant radiographic and clinical signs of lower limb ischemia. All but one patient (axillobifemoral bypass) underwent femorofemoral crossover grafting by the cardiac surgeon during cooling. Results One hundred eighty-one cases of ATAAD underwent surgery during the study period with a mortality of 19.3%. Nine patients had persistent clinical evidence of lower limb ischemia (4.9%) and underwent extra-anatomical bypass during cooling. Two patients underwent additional fasciotomies. Mean delay from symptoms to surgery in these nine patients was 9.5 hours. Two patients had bilateral amputations despite revascularisation and, of note, had long delays in presentation for surgery (> 12 hours). There were no mortalities during these inpatient episodes. Outpatient radiographic follow-up at the first opportunity demonstrated 100% patency. Conclusion Our experience suggests that, during complicated aortic dissection, limb ischemia may have a devastating outcome including amputation when diagnosis and referral are delayed. Early diagnosis and surgery are crucial in preventing this potentially devastating complication.
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Affiliation(s)
- Thomas Theologou
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Hazim Eltyeb
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Walid Elbakbak
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mostafa Snosi
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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14
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Harky A, Harrington D, Nawaytou O, Othman A, Fowler C, Owens G, Torella F, Kuduvalli M, Field M. COVID-19 and cardiac surgery: A perspective from United Kingdom. J Card Surg 2020; 36:1649-1658. [PMID: 32981073 PMCID: PMC7537188 DOI: 10.1111/jocs.15039] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 12/11/2022]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 in December 2019, presumed from the city of Wuhan, Hubei province in China, and the subsequent declaration of the disease as a pandemic by the World Health Organization as coronavirus disease 2019 (COVID‐19) in March 2020, had a significant impact on health care systems globally. Each country responded to this disease in different ways, however this was done broadly by fortifying and prioritizing health care provision as well as introducing social lockdown aiming to contain the infection and minimizing the risk of transmission. In the United Kingdom, a lockdown was introduced by the government on March 23, 2020 and all health care services were focussed to challenge the impact of COVID‐19. To do so, the United Kingdom National Health Service had to undergo widespread service reconfigurations and the so‐called “Nightingale Hospitals” were created de novo to bolster bed provision, and industries were asked to direct efforts to the production of ventilators. A government‐led public health campaign was publicized under the slogan of: “Stay home, Protect the NHS (National Health Service), Save lives.” The approach had a significant impact on the delivery of all surgical services but particularly cardiac surgery with its inherent critical care bed capacity. This paper describes the impact on provision for elective and emergency cardiac surgery in the United Kingdom, with a focus on aortovascular disease. We describe our aortovascular activity and outcomes during the period of UK lockdown and present a patient survey of attitudes to aortic surgery during COVID‐19 pandemic.
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Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ahmed Othman
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Francesco Torella
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Prescot Street, Liverpool, UK.,School of Physical Sciences, University of Liverpool, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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15
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McGillion M, Ouellette C, Good A, Bird M, Henry S, Clyne W, Turner A, Ritvo P, Ritvo S, Dvirnik N, Lamy A, Whitlock R, Lawton C, Walsh J, Paterson K, Duquette J, Sanchez Medeiros K, Elias F, Scott T, Mills J, Harrington D, Field M, Harsha P, Yang S, Peter E, Bhavnani S, Devereaux PJ. Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study. J Med Internet Res 2020; 22:e15548. [PMID: 32186521 PMCID: PMC7113803 DOI: 10.2196/15548] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
Background Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure. Objective As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip’s Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively. Methods Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews. Results A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems. Conclusions User testing indicated a high degree of user acceptance of Philips’ Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery.
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Affiliation(s)
- Michael McGillion
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | | | - Amber Good
- Population Health Research Institute, Hamilton, ON, Canada
| | - Marissa Bird
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Wendy Clyne
- Hope for the Community CIC, Coventry, United Kingdom
| | | | | | | | - Nazari Dvirnik
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Andre Lamy
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Richard Whitlock
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Jake Walsh
- Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Janine Duquette
- Cardiac and Vascular Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Fadi Elias
- Population Health Research Institute, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Ted Scott
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Joseph Mills
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Mark Field
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Bhavnani
- Scripps Clinic & Research Foundation, San Diego, CA, United States
| | - P J Devereaux
- Population Health Research Institute, Hamilton, ON, Canada.,Departments of Health Research Methods, Evidence, and Impact (HEI) and Medicine, McMaster University, Hamilton, ON, Canada
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Kalmanek E, Choe S, Harrington D, Stupp S, McVary K, Podlasek C. 172 Caspase Signalling in ED Patients and Animal Models. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Choe S, Kalmanek E, Harrington D, Stupp S, McVary K, Podlasek C. 174 Optimization of Sonic Hedgehog Delivery to the Penis from Self-assembling Nanofiber Hydrogels to Preserve Penile Morphology after Cavernous Nerve Injury. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Abdulsalam A, Nawaytou O, Mehta V, Harrington D, Kuduvalli M, Field M. The Effect of Zone Implantation on Outcomes in Cases of Frozen Elephant Trunk. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Theologou T, Harky A, Shaw M, Harrington D, Kuduvalli M, Oo A, Field M. Mitroflow and Perimount Magna 10 years outcomes a direct propensity match analysis to assess reintervention rates and long follow‐up mortality. J Card Surg 2019; 34:1279-1287. [DOI: 10.1111/jocs.14250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Theologou
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Amer Harky
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Matthew Shaw
- Department of Clinical Audit and Clinical QualityThe Liverpool Heart and Chest HospitalLiverpool UK
| | - Deborah Harrington
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Manoj Kuduvalli
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Aung Oo
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Mark Field
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
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Cerdeira AS, O'Sullivan J, Ohuma EO, Harrington D, Szafranski P, Black R, Mackillop L, Impey L, Greenwood C, James T, Smith I, Papageorghiou AT, Knight M, Vatish M. Randomized Interventional Study on Prediction of Preeclampsia/Eclampsia in Women With Suspected Preeclampsia: INSPIRE. Hypertension 2019; 74:983-990. [PMID: 31401877 PMCID: PMC6756298 DOI: 10.1161/hypertensionaha.119.12739] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. The ratio of maternal serum sFlt-1 (soluble fms-like tyrosine kinase 1) to PlGF (placental growth factor) has been used retrospectively to rule out the occurrence of preeclampsia, a pregnancy hypertensive disorder, within 7 days in women presenting with clinical suspicion of preeclampsia. A prospective, interventional, parallel-group, randomized clinical trial evaluated the use of sFlt-1/PlGF ratio in women presenting with suspected preeclampsia. Women were assigned to reveal (sFlt-1/PlGF result known to clinicians) or nonreveal (result unknown) arms. A ratio cutoff of 38 was used to define low (≤38) and elevated risk (>38) of developing the condition in the subsequent week. The primary end point was hospitalization within 24 hours of the test. Secondary end points were development of preeclampsia and other adverse maternal-fetal outcomes. We recruited 370 women (186 reveal versus 184 nonreveal). Preeclampsia occurred in 85 women (23%). The number of admissions was not significantly different between groups (n=48 nonreveal versus n=60 reveal; P=0.192). The reveal trial arm admitted 100% of the cases that developed preeclampsia within 7 days, whereas the nonreveal admitted 83% (P=0.038). Use of the test yielded a sensitivity of 100% (95% CI, 85.8–100) and a negative predictive value of 100% (95% CI, 97.1–100) compared with a sensitivity of 83.3 (95% CI, 58.6–96.4) and negative predictive value of 97.8 (95% CI, 93.7–99.5) with clinical practice alone. Use of the sFlt-1/PlGF ratio significantly improved clinical precision without changing the admission rate.
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Affiliation(s)
- Ana Sofia Cerdeira
- From the Nuffield Department of Women's Health and Reproductive Research (A.S.C., P.S., M.V.), University of Oxford, United Kingdom
| | - Joe O'Sullivan
- Merton College (J.O.), University of Oxford, United Kingdom
| | - Eric O Ohuma
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (E.O.O.), University of Oxford, United Kingdom.,Department of Obstetrics and Gynaecology, University of Toronto, Canada (E.O.O.)
| | - Deborah Harrington
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Pawel Szafranski
- From the Nuffield Department of Women's Health and Reproductive Research (A.S.C., P.S., M.V.), University of Oxford, United Kingdom
| | - Rebecca Black
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Lucy Mackillop
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Lawrence Impey
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Catherine Greenwood
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Tim James
- Department of Clinical Biochemistry (T.J., I.S.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Ian Smith
- Department of Clinical Biochemistry (T.J., I.S.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Aris T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, United Kingdom (A.T.P.)
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health (M.K.), University of Oxford, United Kingdom
| | - Manu Vatish
- From the Nuffield Department of Women's Health and Reproductive Research (A.S.C., P.S., M.V.), University of Oxford, United Kingdom
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21
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Dobbs R, Kalmanek E, Harrington D, Stupp S, McVary K, Podlasek C. 069 Sonic Hedgehog Regulation of Neurite Formation in Aged Pelvic Plexus. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Kalmanek E, Harrington D, Stupp S, McVary K, Podlasek C. 073 Bone Morphogenetic Protein 4 is Increased in Erectile Dysfunction Patients. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Malik A, Nawaytou O, Nasir A, Harrington D, Field M, Oo A, Kuduvali M. Staged Repair of Concomitant Aortic Regurgitation and Descending Thoracic Aortic Aneurysm. Aorta (Stamford) 2018; 6:95-97. [PMID: 30849776 PMCID: PMC6408246 DOI: 10.1055/s-0039-1679871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
Descending thoracic aortic (DTA) aneurysms causing left main bronchus compression can be surgically repaired under left heart bypass (LHB). Safe LHB requires a competent aortic valve. Some patients present with concomitant DTA aneurysms and severe aortic regurgitation (AR), precluding LHB as an adjunct for aortic surgery. The authors present such a case and outline the management. AR can safely be addressed first in an immediate staged surgical approach, providing adequate left ventricular function.
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Affiliation(s)
- Aamna Malik
- Medical School, University of Liverpool, Liverpool, United Kingdom
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Abdul Nasir
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvali
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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24
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Woolley A, Singh S, Mallidi H, Givertz M, Goldberg H, Mehra M, Coakley L, Kusztos A, Chen K, Fanikos J, Marty F, Harrington D, Camp P, Baden L. Transplanting Thoracic Organs from Hepatitis C Positive Donors to Hepatitis C Uninfected Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Blackwell V, Holdaway L, Hogan J, Gilbert J, Sinha S, Vrakas G, Reddy S, Friend P, Mackillop L, Harrington D, Greenwood C, Vaidya A, Allan PJ. Multidisciplinary care ensures successful pregnancy following intestinal transplantation: a case report. BJOG 2016; 124:825-828. [PMID: 27885776 DOI: 10.1111/1471-0528.14420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
- V Blackwell
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - L Holdaway
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - J Hogan
- Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - J Gilbert
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - S Sinha
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - G Vrakas
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - S Reddy
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - P Friend
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - L Mackillop
- Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - D Harrington
- Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - C Greenwood
- Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A Vaidya
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - P J Allan
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Abstract
BACKGROUND Acute type A aortic dissection repair is a surgical emergency associated with high mortality. In 2007, Liverpool Heart & Chest Hospital was the first institution in the United Kingdom to implement a thoracic aortic on-call dissection rota. We set out to investigate whether the dissection rota improved hospital quality outcomes and long-term survival. METHODS Data from a prospectively collected database was analysed following case note validation. Two hundred patients underwent acute type A aortic dissection repair between October 1998 and November 2015. To assess the effect of the post-dissection rota on operative and postoperative outcomes, propensity matching of pre- and post-dissection rota patients was used. RESULTS Eighty patients were identified from the pre-dissection rota era and 120 from the post-dissection rota era. Sixty patients from each era were then propensity matched. Comparative analyses showed that patients who underwent acute type A dissection repair in the post-dissection rota period were less likely to suffer in-hospital mortality in both the matched and unmatched groups (30% vs. 13.3%; P=0.004 and 28.3% vs. 11.7%; P=0.055, respectively). A similar improvement was shown in acute renal failure (26.3% vs. 14.2%; P=0.033 and 31.7% vs. 15.0%; P=0.044, respectively). However, cardiopulmonary bypass times and aortic cross clamp times were still significantly longer in the matched post-dissection rota cohort. There was a significant improvement in 5-year survival for the pre- and post-dissection rota in both the matched and unmatched patients (P=0.004 and P=0.034). CONCLUSIONS Reorganization of surgical expertise, activity and implementation of a dissection rota within our hospital have resulted in lower in-hospital mortality and better survival outcomes in this group of patients.
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Affiliation(s)
- Mohamad Bashir
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Matthew Shaw
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mark Field
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Manoj Kuduvalli
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Deborah Harrington
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mathew Fok
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Aung Y Oo
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
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Poon SS, Theologou T, Harrington D, Kuduvalli M, Oo A, Field M. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg 2016; 5:156-73. [PMID: 27386403 DOI: 10.21037/acs.2016.05.06] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection. METHODS A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. RESULT Fourteen retrospective studies met the inclusion criteria and 2,221 patients were included in the final analysis. Pooled analysis showed that hemiarch replacement was associated with a lower risk of post-operative renal dialysis [risk ratio (RR) =0.72; 95% confidence interval (CI): 0.56-0.94; P=0.02; I(2)=0%]. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I(2)=0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation. CONCLUSIONS Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.
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Affiliation(s)
- Shi Sum Poon
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Thomas Theologou
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Aung Oo
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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28
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Chilver K, Harrington D. Government rhetoric on NHS staffing does not match reality. Nurs Stand 2016; 30:28. [PMID: 27154112 DOI: 10.7748/ns.30.36.28.s36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The figures in your article 'Meagre uplift in nurse numbers is no match for surge in demand' (news, April 6) underestimate the problem.
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29
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Vidula H, Kutyifa V, Johnson B, Harrington D, Papernov A, Alexis J. Readmission During Long-Term Follow-Up After Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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30
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Harrington D, Sims M, Kehlet A. Effect of Bacillus subtilis supplementation in low energy diets on broiler performance. J APPL POULTRY RES 2016. [DOI: 10.3382/japr/pfv057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Ribeiro V, Albino L, Rostagno H, Barreto S, Hannas M, Harrington D, de Araujo F, Ferreira H, Ferreira M. Corrigendum to “Effects of the dietary supplementation of Bacillus subtilis levels on performance, egg quality and excreta moisture of layers” [Anim. Feed Sci. Technol. 195 (2014) 142–146]. Anim Feed Sci Technol 2015. [DOI: 10.1016/j.anifeedsci.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Liu W, Patel S, Harrington D, Stoker J, Ding X, Shen J, Wong W, Halyard M, Schild S, Ezzell G, Bues M. Correlation Study of Volumetric Modulated Arc Therapy Plan Robustness With Local Failure for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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33
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Harrington D, Schild S, Wong W, Vora S, Liu W. SU-E-T-642: PTV Is the Voxel-Wise Worst-Case of CTV in Prostate Photon Therapy. Med Phys 2015. [DOI: 10.1118/1.4925005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Liu W, Patel S, Shen J, Harrington D, Stoker J, Ding X, Hu Y, Wong W, Halyard M, Schild S, Ezzell G, Bues M. SU-E-T-618: Plan Robustness Study of Volumetric-Modulated Arc Therapy Vs. Intensity-Modulated Radiation Therapy for Head and Neck Cancer. Med Phys 2015. [DOI: 10.1118/1.4924981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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35
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Harrington D, Clouser E. SU-D-BRB-03: Planning Margin Implications for Multiple-Target, Single-Isocenter VMAT SRS Based On Image Guidance Tolerances. Med Phys 2015. [DOI: 10.1118/1.4923876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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36
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Jafarzadeh F, Oo A, Kuduvalli M, Harrington D, Bashir M, Field M, Desmond M. 253 * INTRAOPERATIVE MOTOR EVOKED POTENTIAL CHANGES, PROCEDURE ALTERATIONS AND NEUROLOGICAL OUTCOME IN THORACIC AND THORACO-ABDOMINAL AORTIC ANEURYSM REPAIR. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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37
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Fok M, Bashir M, Hammoud I, Harrington D, Kuduvalli M, Field M, Oo A. An apical left ventricular aneurysm rupture presenting as left breast mass 11 years after surgical repair. Ann R Coll Surg Engl 2014; 96:e6-7. [PMID: 25245713 DOI: 10.1308/003588414x13946184900561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition's natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis. We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died. With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications.
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Affiliation(s)
- M Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
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38
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Paulsen J, Long J, Ross C, Harrington D, Erwin C, Williams J, Westervelt H, Johnson H, Aylward E, Zhang Y, Bockholt J, Barker R. J01 Improving Prediction Of Huntington Disease Onset With Clinical And Imaging Measures: A 10-year Preopective Study Of Converters. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Bashir M, Shaw M, Fok M, Harrington D, Field M, Kuduvalli M, Oo A. Long-term outcomes in thoracoabdominal aortic aneurysm repair for chronic type B dissection. Ann Cardiothorac Surg 2014; 3:385-92. [PMID: 25133101 DOI: 10.3978/j.issn.2225-319x.2014.05.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/22/2014] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Open repair for chronic aortic dissection remains a challenging surgical option. Different centers report diverse experiences and outcomes pertaining to thoracoabdominal aortic aneurysm repair (TAAAR) for chronic type B dissection. We highlight our center's experience and results on a background of published literature and current evidence. METHODS We reviewed 214 open TAAAR performed between October 1998 and February 2014. Of these, chronic type B dissection was present in 62 (29.0%) patients. We reviewed these patients in terms of demographics, operative characteristics and outcomes. Thirteen (21.0%) patients had surgery on the descending thoracic aorta [Category A =2 (3.2%), B =0 (0%), C =11 (17.7%)] and 49 (79.0%) in the thoracoabdominal thoracic aorta [Crawford extent I =5 (8.1%), extent II =39 (62.9%), extent III =4 (6.5%), extent IV =1 (1.6%)]. Left heart bypass was used in 12 (19.4%) patients. RESULTS The composite in-hospital endpoint, adverse outcome-defined as operative death, renal failure necessitating dialysis at discharge, stroke, or permanent paraplegia or paraparesis-occurred after 28 (45.2%) procedures. There were 14 (22.6%) operative deaths. In-hospital mortality was seven (16.3%) out of 43 elective patients, and increased to seven (36.8%) of the 19 non-elective ones. Permanent paraplegia or paraparesis occurred after two (3.2%) cases, stroke occurred after seven (11.3%) and renal failure requiring dialysis occurred after 16 (25.8%). Mean follow-up time was 3.2 years and actuarial 5-year mortality was 27.4% [nine (14.5%) elective and eight (12.9%) non-elective patients]. CONCLUSIONS TAAAR in chronic type B dissection carries a substantial risk of early adverse outcomes. The results could be well alleviated with cases directed towards specialized regional and supra-regional centers. Although the endovascular approaches offer relatively low mortality and morbidity, there is a lack of long-term data and guidelines on their use. There is a need for a multidisciplinary international registry on the management of thoracoabdominal aortic aneurysms and dissection. This would provide a degree of guidance on relevant clinical and surgical judgments and outcomes.
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Affiliation(s)
- Mohamad Bashir
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Matthew Shaw
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Matthew Fok
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Deborah Harrington
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Mark Field
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Manoj Kuduvalli
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Aung Oo
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
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Bashir M, Fok M, Shaw M, Field M, Kuduvalli M, Desmond M, Harrington D, Rashid A, Oo A. Liverpool Aortic Surgery Symposium V: New Frontiers in Aortic Disease and Surgery. Aorta (Stamford) 2014; 2:100-9. [PMID: 26798724 DOI: 10.12945/j.aorta.2014.13-051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
Aortic aneurysm disease is a complex condition that requires a multidisciplinary approach in management. The innovation and collaboration among vascular surgery, cardiothoracic surgery, interventional radiology, and other related specialties is essential for progress in the management of aortic aneurysms. The Fifth Liverpool Aortic Surgery Symposium that was held in May 2013 aimed at bringing national and international experts from across the United Kingdom and the globe to deliver their thoughts, applications, and advances in aortic and vascular surgery. In this report, we present a selected short synopsis of the key topics presented at this symposium.
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Affiliation(s)
- Mohamad Bashir
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Michael Desmond
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Abbas Rashid
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Bashir M, Field M, Shaw M, Fok M, Harrington D, Kuduvalli M, Oo A. Influences on Early and Medium-Term Survival Following Surgical Repair of the Aortic Arch. Aorta (Stamford) 2014; 2:56-73. [PMID: 26798716 DOI: 10.12945/j.aorta.2014.13-040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 03/12/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES It is now well established by many groups that surgery on the aortic arch may be achieved with consistently low morbidity and mortality along with relatively good survival compared to estimated natural history for a number of aortic arch pathologies. The objectives of this study were to: 1) report, compare, and analyze our morbidity and mortality outcomes for hemiarch and total aortic arch surgery; 2) examine the survival benefit of hemiarch and total aortic arch surgery compared to age- and sex-matched controls; and 3) define factors which influence survival in these two groups and, in particular, identify those that are modifiable and potentially actionable. METHODS Outcomes from patients undergoing surgical resection of both hemiarch and total aortic arch at the Liverpool Heart and Chest Hospital between June 1999 and December 2012 were examined in a retrospective analysis of data collected for The Society for Cardiothoracic Surgeons (UK). RESULTS Over the period studied, a total of 1240 patients underwent aortic surgery, from which 287 were identified as having undergone hemi to total aortic arch surgery under deep or moderate hypothermic circulatory arrest. Twenty three percent of patients' surgeries were nonelective. The median age at the time of patients undergoing elective hemiarch was 64.3 years and total arch was 65.3 years (P = 0.25), with 40.1% being female in the entire group. A total of 140 patients underwent elective hemiarch replacement, while 81 underwent elective total arch replacement. Etiology of the aortic pathology was degenerative in 51.2% of the two groups, with 87.1% requiring aortic valve repair in the elective hemiarch group and 64.2% in the elective total arch group (P < 0.001). Elective in-hospital mortality was 2.1% in the hemiarch group and 6.2% (P = 0.15) in the total arch group with corresponding rates of stroke (2.9% versus 4.9%, P = 0.47), renal failure (4.3% versus 6.2%, P = 0.54), reexploration for bleeding (4.3% versus 4.9%, P > 0.99), and prolonged ventilation (8.6% versus 16.1%, P = 0.09). Overall mortality was 20.9% at 5 years, while it was 15.7% in the elective hemiarch and 25.9% in the total arch group (P = 0.065). Process control charts demonstrated stability of annualized mortality outcomes over the study period. Survival curve was flat and parallel compared to age- and sex-matched controls beyond 2 years. Multivariate analysis demonstrated the following independent factors associated with survival: renal dysfunction [hazard ratio (HR) = 3.11; 95% confidence interval (CI) = 1.44-6.73], New York Heart Association (NYHA) class ≥ III (HR = 2.25; 95% CI = 1.38-3.67), circulatory arrest time > 100 minutes (HR = 2.92; 95% CI = 1.57-5.43), peripheral vascular disease (HR = 2.44; 95% CI = 1.25-4.74), and concomitant coronary artery bypass graft operation (HR = 2.14; 95% CI = 1.20-3.80). CONCLUSIONS Morbidity, mortality, and medium-term survival were not statistically different for patients undergoing elective hemi-aortic arch and total aortic arch surgery. The survival curve in this group of patients is flat and parallel to sex- and age-matched controls beyond 2 years. Multivariate analysis identified independent influences on survival as renal dysfunction, NYHA class ≥ III, circulatory arrest time (> 100 min), peripheral vascular disease, and concomitant coronary artery bypass grafting. Focus on preoperative optimization of some of these variables may positively influence long-term survival.
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Affiliation(s)
- Mohamad Bashir
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Jafarzadeh F, Bashir M, Yan T, Harrington D, Field ML, Kuduvalli M, Oo A, Desmond M. Setting up and utilizing a service for measuring perioperative transcranial motor evoked potentials during thoracoabdominal aortic surgery and thoracic endovascular repair. Interact Cardiovasc Thorac Surg 2014; 18:748-56. [PMID: 24603163 DOI: 10.1093/icvts/ivu036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Paraplegia is a complication that may occur following surgery or endovascular stenting of thoracic and thoracoabdominal aortic pathology. Measuring transcranial motor evoked potentials (tcMEPs) has been shown to provide a reliable measure of spinal cord function during such procedures allowing interventions to protect cord function. In the spirit of sharing experience and eliminating the learning curve for others, this manuscript describes our experience of setting up a service for tcMEP monitoring as well as the documents and algorithms for measuring, recording and acting on the patient data, the so-called 'MEP Pathway'. METHODS Recording and interpretation of tcMEP during thoracoabdominal aortic intervention requires training of staff and close team working in the operating theatre and postoperative intensive care unit. Providing consistent, reliable, specific and sensitive information on spinal cord function and its safe and effective use to alter patient outcomes requires a protocol. The MEP pathway was developed by medical and paramedical staff at our institution based on clinical experience and literature reviews over a 1-year period (2012-2013). RESULTS The tcMEP pathway comprises six documents that guide staff in: (a) assessing suitability of patients, (b) setting up hardware, (c) preparing algorithms for management, (d) documenting intervention (left heart bypass, cardiopulmonary bypass or endovascular stenting) as well as (e) documenting postoperative intensive care processes. CONCLUSIONS The tcMEP pathway acts as a guide for safe introduction and use of tcMEPs in thoracoabdominal aortic interventions. tcMEP-led guidance of intraoperative and postoperative management in thoracic aortic surgery is an important adjunct in caring for this patient group.
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Affiliation(s)
- Fatemeh Jafarzadeh
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mohamad Bashir
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Tristan Yan
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark L Field
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Aung Oo
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Michael Desmond
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
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Collinger JL, Kryger MA, Barbara R, Betler T, Bowsher K, Brown EHP, Clanton ST, Degenhart AD, Foldes ST, Gaunt RA, Gyulai FE, Harchick EA, Harrington D, Helder JB, Hemmes T, Johannes MS, Katyal KD, Ling GSF, McMorland AJC, Palko K, Para MP, Scheuermann J, Schwartz AB, Skidmore ER, Solzbacher F, Srikameswaran AV, Swanson DP, Swetz S, Tyler-Kabara EC, Velliste M, Wang W, Weber DJ, Wodlinger B, Boninger ML. Collaborative approach in the development of high-performance brain-computer interfaces for a neuroprosthetic arm: translation from animal models to human control. Clin Transl Sci 2013; 7:52-9. [PMID: 24528900 DOI: 10.1111/cts.12086] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Our research group recently demonstrated that a person with tetraplegia could use a brain-computer interface (BCI) to control a sophisticated anthropomorphic robotic arm with skill and speed approaching that of an able-bodied person. This multiyear study exemplifies important principles in translating research from foundational theory and animal experiments into a clinical study. We present a roadmap that may serve as an example for other areas of clinical device research as well as an update on study results. Prior to conducting a multiyear clinical trial, years of animal research preceded BCI testing in an epilepsy monitoring unit, and then in a short-term (28 days) clinical investigation. Scientists and engineers developed the necessary robotic and surgical hardware, software environment, data analysis techniques, and training paradigms. Coordination among researchers, funding institutes, and regulatory bodies ensured that the study would provide valuable scientific information in a safe environment for the study participant. Finally, clinicians from neurosurgery, anesthesiology, physiatry, psychology, and occupational therapy all worked in a multidisciplinary team along with the other researchers to conduct a multiyear BCI clinical study. This teamwork and coordination can be used as a model for others attempting to translate basic science into real-world clinical situations.
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Affiliation(s)
- Jennifer L Collinger
- Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, USA; Department of Physical Medicine & Rehabilitation; Department of Bioengineering
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Duron V, Bii J, Mutai R, Ngetich J, Harrington D, Parker R, White R. Esophageal cancer awareness in Bomet district, Kenya. Afr Health Sci 2013; 13:122-8. [PMID: 23658578 DOI: 10.4314/ahs.v13i1.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Esophageal cancer is the most common malignancy in Western Kenya and patients present with advanced disease. OBJECTIVE To determine baseline level of knowledge of esophageal cancer in Bomet District in order to develop targeted and effective educational classes. METHODS A questionnaire with twelve questions testing knowledge about esophageal cancer and eight questions aimed at determining barriers to healthcare was conducted out of Tenwek Hospital from June to July 2010. RESULTS Eighty-one questionnaires were completed. 33% thought that cancer is a virus and 35% thought that it is contagious. 47% did not think that family history is a risk factor. 79% accurately claimed dysphagia as the most common symptom for esophageal cancer. 40% thought that herbal therapy is the optimal treatment for esophageal cancer. Cost and fear of diagnosis were cited as the most significant barriers to healthcare. Most participants had a monthly income of less than 3000 Kenyan schillings (37.5 US dollars); for 37% of participants, the cost of transport to the hospital represented a third of their monthly income. CONCLUSION The questionnaire provided population-specific information on cancer knowledge and aided in targeting barriers to healthcare access. These factors will be incorporated into the cancer education outreach program of Tenwek Hospital.
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Soller L, Fragapane J, Ben-Shoshan M, Harrington D, Alizadehfar R, Joseph L, St-Pierre Y, Godefroy S, Elliott S, Clarke A. Food Avoidance Following Physician Diagnosis Of Food Allergy: Results From A Canadian Study. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Harrington D, Robinson K, Guy J, Sparagano O. Characterization of the immunological response to Dermanyssus gallinae infestation in domestic fowl. Transbound Emerg Dis 2010; 57:107-10. [PMID: 20537120 DOI: 10.1111/j.1865-1682.2010.01109.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermanyssus gallinae is a haematophagous ectoparasite of birds, which adversely affects both production and welfare of commercial poultry. Poultry in commercial production systems chronically exposed to D. gallinae do not appear to develop immunity to the mite. The objective of the current study was to determine the initial immune response of domestic fowl following exposure to D. gallinae. Two groups of birds (11 birds/group) had mite chambers secured to their backs. Controls received no mites, while infested birds received 200 unfed female D. gallinae on day 0 which were then removed on day 1 or 2. Spleen samples were collected on days -1, 1, 2 and 5. The expression of Th1 (IFNgamma, CXCLi2, IL6 and IL18), Th2 (IL4, IL10 and IL13) cytokines/chemokines normalized against a reference gene, GAPDH, were determined by semi-quantitative RT-PCR. Although there were no significant differences between treatments, numerical trends were observed. Th2 cytokine expression was not detected in any birds on any day. IL6, CXCLi2, IFNgamma and IL18 expression was increased on day 1 in the infested group, while on day 2 CXCLi2 and IFNgamma were lower and IL6 and IL18 levels were similar between treatments. The IL18 expression was similar between treatments on day 5, while IL6 and IFNgamma levels were increased and CXCLi2 expression was decreased in the infested group. Data suggest that D. gallinae feeding stimulates Th1 and pro-inflammatory cytokines/chemokines initially (day 1) followed by their subsequent down regulation. This study is the first report of the characterization of the immunological response of the domestic fowl to controlled numbers of D. gallinae.
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Affiliation(s)
- D Harrington
- School of Agriculture, Food and Rural Development, Newcastle University, UK
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Horner K, Harrington D, Donnelly A, Shafat A. Gastric emptying, energy intake, body mass index and objectively measured sedentary levels in adolescent females. Obes Res Clin Pract 2010. [DOI: 10.1016/j.orcp.2010.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Loudon JAZ, Groom KM, Hinkson L, Harrington D, Paterson-Brown S. Changing trends in operative delivery performed at full dilatation over a 10-year period. J OBSTET GYNAECOL 2010; 30:370-5. [DOI: 10.3109/01443611003628411] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J. A. Z. Loudon
- Department of Obstetrics and Gynaecology, Institute for Reproductive and Developmental Biology, London, UK
| | - K. M. Groom
- Department of Obstetrics and Gynaecology, Institute for Reproductive and Developmental Biology, London, UK
| | - L. Hinkson
- Department of Obstetrics and Gynaecology, Institute for Reproductive and Developmental Biology, London, UK
| | - D. Harrington
- Department of Obstetrics and Gynaecology, Institute for Reproductive and Developmental Biology, London, UK
| | - S. Paterson-Brown
- Department of Obstetrics and Gynaecology, Institute for Reproductive and Developmental Biology, London, UK
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