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Laskar N, Bayliss CD, Kirmani BH, Chambers JB, Maier R, Briffa NP, Cartwright N, Kendall S, Shah BN, Akowuah E. Antithrombotic therapy after heart valve surgery, contemporary practice in the United Kingdom. Interdiscip Cardiovasc Thorac Surg 2024:ivae089. [PMID: 38704867 DOI: 10.1093/icvts/ivae089] [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] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES There is a lack of high-quality data informing the optimal antithrombotic drug strategy following bioprosthetic heart valve replacement or valve repair. Disparity in recommendations from international guidelines reflects this. This study aimed to document current patterns of antithrombotic prescribing after heart valve surgery in the UK. METHODS All UK consultant cardiac surgeons were e-mailed a custom-designed survey. The use of oral anticoagulant (OAC) and/or antiplatelet drugs following bioprosthetic aortic (AVR) or mitral valve replacement (MVR), or mitral valve repair (MVrep), for patients in sinus rhythm, without additional indications for antithrombotic medication, was assessed. Additionally, we evaluated anticoagulant choice following MVrep in patients with atrial fibrillation (AF). RESULTS We identified 260 UK consultant cardiac surgeons from 36 units, of whom 103 (40%) responded, with 33 units (92%) having at least one respondent. The greatest consensus was for patients undergoing bioprosthetic AVR, in which 76% of surgeons favour initial antiplatelet therapy and 53% prescribe lifelong treatment. Only 8% recommend initial OAC. After bioprosthetic MVR, 48% of surgeons use an initial OAC strategy (versus 42% antiplatelet), with 66% subsequently prescribing lifelong antiplatelet therapy. After MVrep, recommendations were lifelong antiplatelet agent alone (34%) or following 3 months OAC (20%), no antithrombotic agent (20%), or 3 months OAC (16%). After MVrep for patients with established AF, surgeons recommend warfarin (38%), a direct oral anticoagulant (37%) or have no preference between the two (25%). CONCLUSIONS There is considerable variation in the use of antithrombotic drugs after heart valve surgery in the UK and a lack of high-quality evidence to guide practice, underscoring the need for randomized studies.
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Affiliation(s)
- Nabila Laskar
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Christopher D Bayliss
- Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Bilal H Kirmani
- Department of Cardiac Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - John B Chambers
- Department of Cardiology, Guys & St Thomas' Hospitals, London, UK
| | - Rebecca Maier
- Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Norman P Briffa
- Department of Cardiac Surgery, Northern General Hospital, Sheffield, UK
| | - Neil Cartwright
- Department of Cardiac Surgery, Northern General Hospital, Sheffield, UK
| | - Simon Kendall
- Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Benoy Nalin Shah
- Wessex Cardiac Centre, Southampton General Hospital, Southampton, UK
| | - Enoch Akowuah
- Newcastle University and the Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
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2
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Abbasciano RG, Olivieri GM, Chubsey R, Gatta F, Tyson N, Easwarakumar K, Fudulu DP, Marsico R, Kofler M, Elshafie G, Lai F, Loubani M, Kendall S, Zakkar M, Murphy GJ. Prophylactic corticosteroids for cardiopulmonary bypass in adult cardiac surgery. Cochrane Database Syst Rev 2024; 3:CD005566. [PMID: 38506343 PMCID: PMC10952358 DOI: 10.1002/14651858.cd005566.pub4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Cardiac surgery triggers a strong inflammatory reaction, which carries significant clinical consequences. Corticosteroids have been suggested as a potential perioperative strategy to reduce inflammation and help prevent postoperative complications. However, the safety and effectiveness of perioperative corticosteroid use in adult cardiac surgery is uncertain. This is an update of the 2011 review with 18 studies added. OBJECTIVES Primary objective: to estimate the effects of prophylactic corticosteroid use in adults undergoing cardiac surgery with cardiopulmonary bypass on the: - co-primary endpoints of mortality, myocardial complications, and pulmonary complications; and - secondary outcomes including atrial fibrillation, infection, organ injury, known complications of steroid therapy, prolonged mechanical ventilation, prolonged postoperative stay, and cost-effectiveness. SECONDARY OBJECTIVE to explore the role of characteristics of the study cohort and specific features of the intervention in determining the treatment effects via a series of prespecified subgroup analyses. SEARCH METHODS We used standard, extensive Cochrane search methods to identify randomised studies assessing the effect of corticosteroids in adult cardiac surgery. The latest searches were performed on 14 October 2022. SELECTION CRITERIA We included randomised controlled trials in adults (over 18 years, either with a diagnosis of coronary artery disease or cardiac valve disease, or who were candidates for cardiac surgery with the use of cardiopulmonary bypass), comparing corticosteroids with no treatments. There were no restrictions with respect to length of the follow-up period. All selected studies qualified for pooling of results for one or more endpoints. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were all-cause mortality, and cardiac and pulmonary complications. Secondary outcomes were infectious complications, gastrointestinal bleeding, occurrence of new post-surgery atrial fibrillation, re-thoracotomy for bleeding, neurological complications, renal failure, inotropic support, postoperative bleeding, mechanical ventilation time, length of stays in the intensive care unit (ICU) and hospital, patient quality of life, and cost-effectiveness. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS This updated review includes 72 randomised trials with 17,282 participants (all 72 trials with 16,962 participants were included in data synthesis). Four trials (6%) were considered at low risk of bias in all the domains. The median age of participants included in the studies was 62.9 years. Study populations consisted mainly (89%) of low-risk, first-time coronary artery bypass grafting (CABG) or valve surgery. The use of perioperative corticosteroids may result in little to no difference in all-cause mortality (risk with corticosteroids: 25 to 36 per 1000 versus 33 per 1000 with placebo or no treatment; risk ratio (RR) 0.90, 95% confidence interval (CI) 0.75 to 1.07; 25 studies, 14,940 participants; low-certainty evidence). Corticosteroids may increase the risk of myocardial complications (68 to 86 per 1000) compared with placebo or no treatment (66 per 1000; RR 1.16, 95% CI 1.04 to 1.31; 25 studies, 14,766 participants; low-certainty evidence), and may reduce the risk of pulmonary complications (risk with corticosteroids: 61 to 77 per 1000 versus 78 per 1000 with placebo/no treatment; RR 0.88, 0.78 to 0.99; 18 studies, 13,549 participants; low-certainty evidence). Analyses of secondary endpoints showed that corticosteroids may reduce the incidence of infectious complications (risk with corticosteroids: 94 to 113 per 1000 versus 123 per 1000 with placebo/no treatment; RR 0.84, 95% CI 0.76 to 0.92; 28 studies, 14,771 participants; low-certainty evidence). Corticosteroids may result in little to no difference in incidence of gastrointestinal bleeding (risk with corticosteroids: 9 to 17 per 1000 versus 10 per 1000 with placebo/no treatment; RR 1.21, 95% CI 0.87 to 1.67; 6 studies, 12,533 participants; low-certainty evidence) and renal failure (risk with corticosteroids: 23 to 35 per 1000 versus 34 per 1000 with placebo/no treatment; RR 0.84, 95% CI 0.69 to 1.02; 13 studies, 12,799; low-certainty evidence). Corticosteroids may reduce the length of hospital stay, but the evidence is very uncertain (-0.5 days, 0.97 to 0.04 fewer days of length of hospital stay compared with placebo/no treatment; 25 studies, 1841 participants; very low-certainty evidence). The results from the two largest trials included in the review possibly skew the overall findings from the meta-analysis. AUTHORS' CONCLUSIONS A systematic review of trials evaluating the organ protective effects of corticosteroids in cardiac surgery demonstrated little or no treatment effect on mortality, gastrointestinal bleeding, and renal failure. There were opposing treatment effects on cardiac and pulmonary complications, with evidence that corticosteroids may increase cardiac complications but reduce pulmonary complications; however, the level of certainty for these estimates was low. There were minor benefits from corticosteroid therapy for infectious complications, but the evidence on hospital length of stay was very uncertain. The inconsistent treatment effects across different outcomes and the limited data on high-risk groups reduced the applicability of the findings. Further research should explore the role of these drugs in specific, vulnerable cohorts.
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Affiliation(s)
| | | | - Rachel Chubsey
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Francesca Gatta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nathan Tyson
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
| | | | - Daniel P Fudulu
- Department of Cardiac Surgery, University Hospital Bristol NHS Trust, Bristol, UK
| | | | | | - Ghazi Elshafie
- Department of Cardiothoracic Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Florence Lai
- Leicester Clinical Trials Unit, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - Mustafa Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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3
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Armstrong RA, Soar J, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Cook TM. Peri-operative cardiac arrest: epidemiology and clinical features of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:18-30. [PMID: 37972476 DOI: 10.1111/anae.16156] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. Here we report the results of the 12-month registry, from 16 June 2021 to 15 June 2022, focusing on epidemiology and clinical features. We reviewed 881 cases of peri-operative cardiac arrest, giving an incidence of 3 in 10,000 anaesthetics (95%CI 3.0-3.5 per 10,000). Incidence varied with patient and surgical factors. Compared with denominator survey activity, patients with cardiac arrest: included more males (56% vs. 42%); were older (median (IQR) age 60.5 (40.5-80.5) vs. 50.5 (30.5-70.5) y), although the age distribution was bimodal, with infants and patients aged > 66 y overrepresented; and were notably more comorbid (73% ASA physical status 3-5 vs. 27% ASA physical status 1-2). The surgical case-mix included more weekend (14% vs. 11%), out-of-hours (19% vs. 10%), non-elective (65% vs. 30%) and major/complex cases (60% vs. 28%). Cardiac arrest was most prevalent in orthopaedic trauma (12%), lower gastrointestinal surgery (10%), cardiac surgery (9%), vascular surgery (8%) and interventional cardiology (6%). Specialities with the highest proportion of cases relative to denominator activity were: cardiac surgery (9% vs. 1%); cardiology (8% vs. 1%); and vascular surgery (8% vs. 2%). The most common causes of cardiac arrest were: major haemorrhage (17%); bradyarrhythmia (9%); and cardiac ischaemia (7%). Patient factors were judged a key cause of cardiac arrest in 82% of cases, anaesthesia in 40% and surgery in 35%.
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Armstrong RA, Cook TM, Kane AD, Kursumovic E, Nolan JP, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Cordingley J, Davies MT, Dorey J, Finney SJ, Kendall S, Kunst G, Lucas DN, Mouton R, Nickols G, Pappachan VJ, Patel B, Plaat F, Scholefield BR, Smith JH, Varney L, Wain E, Soar J. Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:31-42. [PMID: 37972480 DOI: 10.1111/anae.16157] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12-month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri-operative cardiac arrest, the initial rhythm was non-shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non-elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri-operative cardiac arrest in UK practice for the first time.
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Al-Zubaidi F, Pufulete M, Sinha S, Kendall S, Moorjani N, Caputo M, Angelini GD, Vohra HA. Mitral repair versus replacement: 20-year outcome trends in the UK (2000-2019). Interdiscip Cardiovasc Thorac Surg 2023; 36:ivad086. [PMID: 37208195 PMCID: PMC10250075 DOI: 10.1093/icvts/ivad086] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Using a large national database, we sought to describe outcome trends in mitral valve surgery between 2000 and 2019. METHODS The study cohort was split into mitral valve repair (MVr) or replacement, including all patients regardless of concomitant procedures. Patients were grouped by four-year admission periods into groups (A to E). The primary outcome was in hospital mortality and secondary outcomes were return to theatre, postoperative stroke and postoperative length of stay. We investigated trends over time in patient demographics, comorbidities, intraoperative characteristics and postoperative outcomes. We used a multivariable binary logistic regression model to assess the relationship between mortality and time. Cohorts were further stratified by sex and aetiology. RESULTS Of the 63 000 patients in the study cohort, 31 644 had an MVr and 31 356 had a replacement. Significant demographic shifts were observed. Aetiology has shifted towards degenerative disease; endocarditis rates in MVr dropped initially but are now rising (period A = 6%, period C = 4%, period E = 6%; P < 0.001). The burden of comorbidities has increased over time. In the latest time period, women had lower repair rates (49% vs 67%, P < 0.001) and higher mortality rates when undergoing repair (3% vs 2%, P = 0.001) than men. Unadjusted postoperative mortality dropped in MVr (5% vs 2%, P < 0.001) and replacement (9% vs 7%, P = 0.015). Secondary outcomes have improved. Time period was an independent predictor for reduced mortality in both repair (odds ratio: 0.41, 95% confidence interval: 0.28-0.61, P < 0.001) and replacement (odds ratio: 0.50, 95% confidence interval: 0.41-0.61, P < 0.001). CONCLUSIONS In-hospital mortality has dropped significantly over time for mitral valve surgery in the UK. MVr has become the more common procedure. Sex-based discrepancies in repair rates and mortality require further investigation. Endocarditis rates in MVS are rising.
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Affiliation(s)
- Fadi Al-Zubaidi
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Maria Pufulete
- Faculty of Health Sciences, University of Bristol, Bristol Heart Institute, Bristol, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Simon Kendall
- Department of Cardiac Surgery, South Tees Hospital, Newcastle, UK
| | - Narain Moorjani
- Department of Cardiac Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
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6
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Arjomandi Rad A, Naruka V, Vardanyan R, Salmasi MY, Tasoudis PT, Kendall S, Casula R, Athanasiou T. Renal outcomes in valve-in-valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2022; 37:3743-3753. [PMID: 36040611 PMCID: PMC9804591 DOI: 10.1111/jocs.16890] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality. RESULTS Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). CONCLUSION Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.
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Affiliation(s)
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Robert Vardanyan
- Department of Medicine, Imperial College LondonFaculty of MedicineLondonUK
| | | | | | - Simon Kendall
- Department of Cardiothoracic SurgeryJames Cook University HospitalMiddlesboroughUK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK,Department of Surgery and CancerImperial College LondonLondonUK
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7
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Archbold A, Akowuah E, Banning AP, Baumbach A, Braidley P, Cooper G, Kendall S, MacCarthy P, O'Kane P, O'Keeffe N, Shah BN, Watt V, Ray S. Getting the best from the Heart Team: guidance for cardiac multidisciplinary meetings. Heart 2022; 108:e2. [PMID: 35396217 DOI: 10.1136/heartjnl-2021-320510] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this document is to update the existing joint British Societies recommendations on multidisciplinary meetings (MDMs) published in 2015 to reflect changes in practice. We aim to provide guidance on the structure and function of MDMs which should be taking place in every cardiac surgical centre. Out of scope are MDMs that do not require the routine presence of a cardiac surgeon such as electrophysiology MDMs and those which are not provided in every centre, such as complex aortic surgery.
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Affiliation(s)
| | - Enoch Akowuah
- Cardiac Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Adrian P Banning
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andreas Baumbach
- Cardiology, Queen Mary University of London, London, UK.,Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Peter Braidley
- Cardiac Surgery, Northern General Hospital, Sheffield, UK
| | - Graham Cooper
- Cardiac Surgery, Northern General Hospital, Sheffield, UK
| | - Simon Kendall
- Cardiac Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Philip MacCarthy
- Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Peter O'Kane
- Cardiology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Niall O'Keeffe
- Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, UK
| | - Benoy Nalin Shah
- Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Victoria Watt
- Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Simon Ray
- Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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8
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Strange GA, Stewart S, Curzen N, Ray S, Kendall S, Braidley P, Pearce K, Pessotto R, Playford D, Gray HH. Uncovering the treatable burden of severe aortic stenosis in the UK. Open Heart 2022; 9:e001783. [PMID: 35082136 PMCID: PMC8739674 DOI: 10.1136/openhrt-2021-001783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To estimate the population prevalence and treatable burden of severe aortic stenosis (AS) in the UK. METHODS We adapted a contemporary model of the population profile of symptomatic and asymptomatic severe AS in Europe and North America to estimate the number of people aged ≥55 years in the UK who might benefit from surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). RESULTS With a point prevalence of 1.48%, we estimate that 291 448 men and women aged ≥55 years in the UK had severe AS in 2019. Of these, 68.3% (199 059, 95% CI 1 77 201 to 221 355 people) would have been symptomatic and, therefore, more readily treated according to their surgical risk profile; the remaining 31.7% of cases (92 389, 95% CI 70 093 to 144 247) being asymptomatic. Based on historical patterns of intervention, 58.4% (116 251, 95% CI 106 895 to 1 25 606) of the 199 059 symptomatic cases would qualify for SAVR, with 7208 (95% CI 7091 to 7234) being assessed as being in a high, preoperative surgical risk category. Among the remaining 41.6% (82 809, 95% CI 73 453 to 92 164) of cases potentially unsuitable for SAVR, an estimated 61.7% (51 093, 95% CI 34 780 to 67 655) might be suitable for TAVI. We estimate that 172 859 out of 291 448 prevalent cases of severe AS (59.3%) will subsequently die within 5 years without proactive management. CONCLUSIONS These data suggest a high burden of severe AS in the UK requiring surgical or transcatheter intervention that challenges the ongoing capacity of the National Health Service to meet the needs of those affected.
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Affiliation(s)
- Geoffrey A Strange
- School of Medicine, University of Notre Dame, Freemantle, Western Australia, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Simon Stewart
- Centre for Cardiopulmonary Health, Torrens University Australia, Adelaide, South Australia, Australia
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Nick Curzen
- Consultant Cardiologist, Faculty of Medicine, University of Southampton & Wessex Cardiothoracic Unit, University Hospital Southampton NHS Trust, Southampton, UK
| | - Simon Ray
- Consultant Cardiologist, Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Simon Kendall
- President, Society of Cardiothoracic Surgeons of Great Britain & Ireland, UK
| | - Peter Braidley
- Consultant Cardiothoracic Surgeon, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Keith Pearce
- Consultant Cardiac Scientist, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Renzo Pessotto
- Consultant Cardiac Surgeon, Royal Infirmary, Edinburgh, UK
| | - David Playford
- School of Medicine, University of Notre Dame, Freemantle, Western Australia, Australia
| | - Huon H Gray
- Emeritus National Clinical Director for Heart Disease, NHS England, UK
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9
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Jones JM, Loubani M, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Cardiac surgery in older patients: hospital outcomes during a 15-year period from a complete national series. Interact Cardiovasc Thorac Surg 2021; 34:532-539. [PMID: 34788460 PMCID: PMC8972229 DOI: 10.1093/icvts/ivab320] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- James Mark Jones
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Mahmoud Loubani
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Jahangiri M, Bilkhu R, Embleton-Thirsk A, Dehbi HM, Mani K, Anderson J, Avlonitis V, Baghai M, Birdi I, Booth K, Bose A, Briffa N, Buchan K, Bhudia S, Cale A, Deglurkar I, Farid S, Hadjinikolaou L, Jarvis M, Javadpour SH, Jeganathan R, Kuduvalli M, Lall K, Mascaro J, Mehta D, Ohri S, Punjabi P, Venkateswaran R, Ridley P, Satur C, Stoica S, Trivedi U, Zaidi A, Yiu P, Moorjani N, Kendall S, Freemantle N. Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database. BMJ Open 2021; 11:e046491. [PMID: 34711589 PMCID: PMC8557283 DOI: 10.1136/bmjopen-2020-046491] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore 'real-world' practice. DESIGN Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants' demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. SETTING 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. PARTICIPANTS 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. RESULTS In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60-75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. CONCLUSIONS Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.
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Affiliation(s)
| | - Rajdeep Bilkhu
- Department of Cardiac Surgery, St Thomas' Hospital, London, UK
| | | | - Hakim-Moulay Dehbi
- University College London Institute of Clinical Trials and Methodology, London, UK
| | - Krishna Mani
- Department of Cardiac Surgery, St George's Hospital, London, UK
| | - Jon Anderson
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Max Baghai
- Department of Cardiac Surgery, King's College Hospital, London, UK
| | - Inderpaul Birdi
- Department of Cardiac Surgery, Essex Cardiothoracic Centre, Basildon, UK
| | - Karen Booth
- Department of Cardiac Surgery, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Amal Bose
- Department of Cardiac Surgery, Lancashire Cardiac Centre, Blackpool, UK
| | - Norman Briffa
- Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre, Sheffield, UK
| | - Keith Buchan
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Alex Cale
- Department of Cardiac Surgery, Castle Hill Hospital, Cottingham, UK
| | - Indu Deglurkar
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Shakil Farid
- Department of Cardiac Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Leonidas Hadjinikolaou
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin Jarvis
- Department of Cardiac Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Kulvinder Lall
- Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Jorge Mascaro
- Department of Cardiac Surgery, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Dheeraj Mehta
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Sunil Ohri
- Department of Cardiac Surgery, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Prakash Punjabi
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Paul Ridley
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Christopher Satur
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Serban Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Uday Trivedi
- Royal Sussex County Hospital Sussex Cardiac Centre, Brighton, UK
| | - Afzal Zaidi
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Patrick Yiu
- Department of Cardiac Surgery, New Cross Hospital, Wolverhampton, UK
| | - Narain Moorjani
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Simon Kendall
- Department of Cardiac Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, University College London Institute of Clinical Trials and Methodology, London, UK
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11
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Benedetto U, Sinha S, Dimagli A, Cooper G, Mariscalco G, Uppal R, Moorjani N, Krasopoulos G, Kaura A, Field M, Trivedi U, Kendall S, Angelini GD, Akowuah EF, Tsang G. Decade-long trends in surgery for acute Type A aortic dissection in England: A retrospective cohort study. Lancet Reg Health Eur 2021; 7:100131. [PMID: 34557840 PMCID: PMC8454541 DOI: 10.1016/j.lanepe.2021.100131] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Little is known about variations in care and outcomes of patients undergoing surgical repair for type A aortic dissection(TAAD). We aim to investigate decade-long trends in TAAD surgical repair in England. Methods Retrospective review of the National Adult Cardiac Surgery Audit, which prospectively collects demographic and peri‑operative information for all major adult cardiac surgery procedures performed in the UK. We identified patients undergoing surgery for TAAD from January 2009-December 2018, reviewed trends in operative frequency, patient demographics, and mortality. Findings Over the 10-year period,3,680 TAAD patients underwent surgical repair in England. A doubling in the overall number of operations conducted in England was observed (235 cases in 2009 to 510 in 2018). Number of procedures per hospital per year also doubled(9 in 2009 to 23 in 2018). Overall, in-hospital mortality was 17.4% with a trend toward lower mortality in recent years(23% in 2009 to 14.7% in 2018). There was a significant variation in operative mortality between hospitals and surgeons. We also found that most patients presented towards the middle of the week and during winter. Interpretation Surgery is the only treatment for acute TAAD but is associated with high mortality. Prompt diagnosis and referral to a specialist center is paramount. The number of operations conducted in England has doubled in 10 years and the associated survival has improved. Variations exist in service provision with a trend towards better survival in high volume centers. Funding British Heart Foundation and NIHR Biomedical Research center(University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol).
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | | | | | | | | | | | - Amit Kaura
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Mark Field
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Simon Kendall
- The James Cook University Hospital, Middlesbrough, UK
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
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12
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Grant SW, Kendall S, Goodwin AT, Cooper G, Trivedi U, Page R, Jenkins DP. Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016. JTCVS Open 2021; 7:259-269. [PMID: 36003724 PMCID: PMC9390523 DOI: 10.1016/j.xjon.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Objectives Cardiac surgery has evolved significantly since the turn of the century. The objective of this study was to investigate trends in cardiac surgery activity and outcomes in the United Kingdom utilizing a mandatory national cardiac surgical clinical database in the context of a comprehensive public health care system (ie, the UK National Health Service). Methods Data for all cardiac surgery procedures performed between 2002 and 2016 were extracted from the UK National Adult Cardiac Surgery Audit database. Data are validated and cleaned using reproducible algorithms. Trends in activity and outcomes were analyzed by fiscal year using linear regression. Results A total of 534,067 procedures were performed during the study period with the number of cases per year peaking in 2008/2009 at 41,426. Despite an increase in patient age and mean logistic European System for Cardiac Operative Risk Evaluation score, the in-hospital mortality rate for all cardiac surgery has fallen from 4.0% to 2.8% (P < .001). The number of isolated coronary artery bypass graft procedures has steadily declined but the total number of valve procedures has steadily increased (both P values < .001). The number of thoracic aortic procedures performed each year has doubled (P < .001), but the incidence of redo procedures has steadily declined. The proportion of emergency and salvage procedures has remained stable. Conclusions This study, which covers all cardiac surgery procedures performed in the United Kingdom for fiscal years between 2002 and 2016, demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality. A number of other markers associated with quality have also improved.
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Affiliation(s)
- Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Simon Kendall
- James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Graham Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Uday Trivedi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Richard Page
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - David P Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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13
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Ohri SK, Benedetto U, Luthra S, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Coronary artery bypass surgery in the UK, trends in activity and outcomes from a 15-year complete national series. Eur J Cardiothorac Surg 2021; 61:449-456. [PMID: 34448848 DOI: 10.1093/ejcts/ezab391] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/20/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to review the UK national trends in activity and outcome in coronary artery bypass graft (CABG) over a 15-year period (2002-2016). METHODS Validated data collected (2002-2016) and uploaded to National Institute for Cardiovascular Outcomes Research were used to generate summary data from the National Adult Cardiac Surgery Audit Database for the analysis. Logistic European System of Cardiac Operative Risk Evaluation was used for risk stratification with recalibration applied for governance. Data were analysed by financial year and presented as numerical, categorical, %, mean and standard deviation where appropriate. Mortality was recorded as death in hospital at any time after index CABG operation. RESULTS A total of 347 626 CABG procedures (282 883 isolated CABG, 61 109 CABG and valve and 4132 redo CABG) were recorded. Over this period annual activity reduced from 66.6% of workload to 41.7%. The mean age for isolated CABG was 65.7 years. The mean log European System of Cardiac Operative Risk Evaluation was 3.1, 5.9 and 23.2 for elective, urgent and emergency isolated CABG, respectively. There was a decline in the observed mortality for all procedures. Overall mortality for isolated CABG surgery is now 1.0% and only 0.6% for elective operations. CONCLUSIONS Quality of care and risk-adjusted mortality rates have consistently improved over the last 15 years despite the increasing risk profile of patients. There have been a consistent decline in overall case volumes and a three-fold increase in elderly cases.
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Affiliation(s)
- Sunil K Ohri
- Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Umberto Benedetto
- Division of Cardiac Surgery, University of Bristol and Bristol Royal Infirmary, Bristol, UK
| | - Suvitesh Luthra
- Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, James Cook University Hospital, Middlesborough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, James Cook University Hospital, Middlesborough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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14
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Kendall S. RESPONSE: Left-Handedness as an Example of Progress. J Am Coll Cardiol 2021; 77:100-101. [PMID: 33413930 DOI: 10.1016/j.jacc.2020.11.053] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Simon Kendall
- President, Society for Cardiothoracic Surgery Great Britain and Ireland, London, United Kingdom.
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15
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Baghai M, Wendler O, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Aortic valve surgery in the UK, trends in activity and outcomes from a 15-year complete national series. Eur J Cardiothorac Surg 2021; 60:1353-1357. [PMID: 34021313 DOI: 10.1093/ejcts/ezab199] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Since the turn of the century, cardiac surgery has evolved quite notably. This study sought to investigate the trends in aortic valve surgery activity and subsequent outcomes in the UK by using a mandatory national cardiac surgical clinical database within the context of a comprehensive public healthcare system (National Health Service). METHODS The UK National Adult Cardiac Surgery Audit database provided data for aortic valve surgery procedures performed between 2002 and 2016, and the data were validated and cleaned using reproducible algorithms. The findings and trends in in activity and outcomes were then analysed by financial year. RESULTS During the study period, a total of 148 862 procedures were performed, with the number of cases per year peaking in 2014/2015 at 12 483. The mean in-hospital mortality rate for all aortic valve surgery has fallen from 5.6% to 3.4%, despite an increase in patient age and mean logistic EuroSCORE. While the number of isolated aortic valve replacements has remained stable at around 5000 per year, aortic valve replacement and coronary artery bypass graft have increased to over 3200 with transcatheter aortic valve implantation activity continuing to increase. CONCLUSIONS This study demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality within all aortic valve surgery procedures performed in the UK over a 15-year period. Increasing catheter-based interventions have not yet resulted in a significant decrease in surgical aortic valve replacements in the UK.
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Affiliation(s)
- Max Baghai
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Olaf Wendler
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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16
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Benedetto U, Dimagli A, Cooper G, Uppal R, Mariscalco G, Krasopoulos G, Goodwin A, Trivedi U, Kendall S, Sinha S, Fudulu D, Angelini GD, Tsang G, Akowuah E. Neuroprotective strategies in acute aortic dissection: an analysis of the UK National Adult Cardiac Surgical Audit. Eur J Cardiothorac Surg 2021; 60:1437-1444. [PMID: 33963362 PMCID: PMC8643475 DOI: 10.1093/ejcts/ezab192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/11/2021] [Accepted: 03/30/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The risk of brain injury following surgery for type A aortic dissection (TAAD) remains substantial and no consensus has still been reached on which neuroprotective technique should be preferred. We aimed to investigate the association between neuroprotective strategies and clinical outcomes following TAAD repair. METHODS Using the UK National Adult Cardiac Surgical Audit, we identified 1929 patients undergoing surgery for TAAD (2011-2018). Deep hypothermic circulatory arrest (DHCA) only, unilateral (uACP), bilateral antegrade cerebral perfusion (bACP) and retrograde cerebral perfusion were used in 830, 117, 760 and 222 patients, respectively. The primary end point was a composite of death and/or cerebrovascular accident (CVA). Generalized linear mixed model was used to adjust the effect of neuroprotective strategies for other confounders. RESULTS The use of bACP was associated with longer circulatory arrest (CA) compared to other strategies. There was a trend towards lower incidence of death and/or CVA using uACP only for shorter CA. In particular, primary end point rate was 27.7% overall and 26.5%, 12.5%, 28.0% and 22.9% for CA <30 min and 28.6%, 30.4%, 33.3% and 33.0% for CA ≥30 min with DHCA only, uACP, bACP and retrograde cerebral perfusion, respectively. The use of DHCA only was associated with five-fold [odds ratio (OR) 5.35, 95% confidence interval (CI) 1.36-21.02] and two-fold (OR 1.77, 95% CI 1.01-3.09) increased risk of death and/or CVA compared to uACP and bACP, respectively, but the effect of uACP was significantly associated with CA duration (hazard ratio 0.97, 95% CI 0.94-0.99; P = 0.04). CONCLUSIONS In TAAD repair, the use of uACP and bACP was associated with a lower adjusted risk of death and/or CVA when compared to DHCA. uACP can offer some advantage but only for a shorter CA duration.
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Affiliation(s)
| | | | - Graham Cooper
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Rakesh Uppal
- Barts Heart Centre, William Harvey Research Institute, London, UK
| | | | | | | | - Uday Trivedi
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Geoffrey Tsang
- Wessex Cardiothoracic Center, University Hospital Southampton NHS Trust, Southampton, UK
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17
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Arjomandi Rad A, Naruka V, Vardanyan R, Viviano A, Salmasi MY, Magouliotis D, Kendall S, Casula R, Athanasiou T. Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis. Eur J Cardiothorac Surg 2021; 60:801-810. [PMID: 33880496 PMCID: PMC8535527 DOI: 10.1093/ejcts/ezab178] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.
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Affiliation(s)
- Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | | | - Dimitris Magouliotis
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesborough, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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18
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Maier RH, Kasim AS, Zacharias J, Vale L, Graham R, Walker A, Laskawski G, Deshpande R, Goodwin A, Kendall S, Murphy GJ, Zamvar V, Pessotto R, Lloyd C, Dalrymple-Hay M, Casula R, Vohra HA, Ciulli F, Caputo M, Stoica S, Baghai M, Niranjan G, Punjabi PP, Wendler O, Marsay L, Fernandez-Garcia C, Modi P, Kirmani BH, Pullan MD, Muir AD, Pousios D, Hancock HC, Akowuah E. Minimally invasive versus conventional sternotomy for Mitral valve repair: protocol for a multicentre randomised controlled trial (UK Mini Mitral). BMJ Open 2021; 11:e047676. [PMID: 33853807 PMCID: PMC8054102 DOI: 10.1136/bmjopen-2020-047676] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure.The UK Mini Mitral trial will provide definitive evidence comparing patient, NHS and clinical outcomes in adult patients undergoing MVr surgery. It will establish the best surgical approach for MVr, setting a standard against which emerging percutaneous techniques can be measured. Findings will inform optimisation of cost-effective practice. METHODS AND ANALYSIS UK Mini Mitral is a multicentre, expertise based randomised controlled trial of minimally invasive thoracoscopically guided right minithoracotomy versus conventional sternotomy for MVr. The trial is taking place in NHS cardiothoracic centres in the UK with established minimally invasive mitral valve surgery programmes. In each centre, consenting and eligible patients are randomised to receive surgery performed by consultant surgeons who meet protocol-defined surgical expertise criteria. Patients are followed for 1 year, and consent to longer term follow-up.Primary outcome is physical functioning 12 weeks following surgery, measured by change in Short Form Health Survey (SF-36v2) physical functioning scale. Early and 1 year echo data will be reported by a core laboratory. Estimates of key clinical and health economic outcomes will be reported up to 5 years.The primary economic outcome is cost effectiveness, measured as incremental cost per quality-adjusted life year gained over 52 weeks following index surgery. ETHICS AND DISSEMINATION A favourable opinion was given by Wales REC 6 (16/WA/0156). Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer reviewed publication. TRIAL REGISTRATION NUMBER ISRCTN13930454.
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Affiliation(s)
- Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joseph Zacharias
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Richard Graham
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Antony Walker
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Grzegorz Laskawski
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ranjit Deshpande
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Goodwin
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Simon Kendall
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Vipin Zamvar
- Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Renzo Pessotto
- Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Clinton Lloyd
- Cardiothoracic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Roberto Casula
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Hunaid A Vohra
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Franco Ciulli
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Serban Stoica
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Max Baghai
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gunaratnam Niranjan
- Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Prakash P Punjabi
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Olaf Wendler
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Leanne Marsay
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paul Modi
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Bilal H Kirmani
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Mark D Pullan
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Andrew D Muir
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dimitrios Pousios
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Enoch Akowuah
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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19
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Sanders J, Akowuah E, Cooper J, Kirmani BH, Kanani M, Acharya M, Jeganathan R, Krasopoulos G, Ngaage D, Deglurkar I, Yiu P, Kendall S, Oo AY. Cardiac surgery outcome during the COVID-19 pandemic: a retrospective review of the early experience in nine UK centres. J Cardiothorac Surg 2021; 16:43. [PMID: 33752706 PMCID: PMC7983084 DOI: 10.1186/s13019-021-01424-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Early studies conclude patients with Covid-19 have a high risk of death, but no studies specifically explore cardiac surgery outcome. We investigate UK cardiac surgery outcomes during the early phase of the Covid-19 pandemic. METHODS This retrospective observational study included all adult patients undergoing cardiac surgery between 1st March and 30th April 2020 in nine UK centres. Data was obtained and linked locally from the National Institute for Cardiovascular Outcomes Research Adult Cardiac Surgery database, the Intensive Care National Audit and Research Centre database and local electronic systems. The anonymised datasets were analysed by the lead centre. Statistical analysis included descriptive statistics, propensity score matching (PSM), conditional logistic regression and hierarchical quantile regression. RESULTS Of 755 included individuals, 53 (7.0%) had Covid-19. Comparing those with and without Covid-19, those with Covid-19 had increased mortality (24.5% v 3.5%, p < 0.0001) and longer post-operative stay (11 days v 6 days, p = 0.001), both of which remained significant after PSM. Patients with a pre-operative Covid-19 diagnosis recovered in a similar way to non-Covid-19 patients. However, those with a post-operative Covid-19 diagnosis remained in hospital for an additional 5 days (12 days v 7 days, p = 0.024) and had a considerably higher mortality rate compared to those with a pre-operative diagnosis (37.1% v 0.0%, p = 0.005). CONCLUSIONS To mitigate against the risks of Covid-19, particularly the post-operative burden, robust and effective pre-surgery diagnosis protocols alongside effective strategies to maintain a Covid-19 free environment are needed. Dedicated cardiac surgery hubs could be valuable in achieving safe and continual delivery of cardiac surgery.
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Affiliation(s)
- Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7DN, UK.
- William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Enoch Akowuah
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Jackie Cooper
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Bilal H Kirmani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mazyar Kanani
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Metesh Acharya
- Department of Cardiothoracic Surgery, Glenfield Hospital, University Hospitals Leicester NHS Foundation Trust, Leicester, UK
| | - Reuben Jeganathan
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dumbor Ngaage
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - Indu Deglurkar
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, Wales, UK
| | - Patrick Yiu
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Aung Ye Oo
- St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7DN, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
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20
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Khader AA, Allaf M, Lu OW, Lazopoulos G, Moscarelli M, Kendall S, Salmasi MY, Athanasiou T. Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation? J Card Surg 2021; 36:1103-1119. [PMID: 33428247 DOI: 10.1111/jocs.15298] [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] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR. METHODS A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies). RESULTS The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009). Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63-4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77-0.99]; p < .001) with considerable heterogeneity (I2 > 90%; p < .001). The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188-0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19-0.46]; p < .001) during midterm follow up. Long term survival (4-5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35-1.41]; p = .323). CONCLUSIONS This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.
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Affiliation(s)
- Ashiq A Khader
- Department of Medicine, Imperial College London, London, UK
| | - Mohammed Allaf
- Department of Medicine, Imperial College London, London, UK
| | - Oscar W Lu
- Division of Biosciences, University College London, London, UK.,Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - George Lazopoulos
- Department of Cardio-thoracic Surgery, University Hospital of Heraklion, Crete, Greece
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Simon Kendall
- Deparment of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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21
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Kendall S, O'Keeffe N. Strategies to eradicate resternotomy after cardiac surgery from clinical practice. Anaesthesia 2020; 76:3-5. [PMID: 32683678 DOI: 10.1111/anae.15182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Society for Cardiothoracic Surgery Great Britain, and Ireland, Middlesbrough, UK
| | - N O'Keeffe
- Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, Association for Cardiothoracic Anaesthesia and Critical Care, Manchester, UK
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22
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Caruana EJ, Patel A, Kendall S, Rathinam S. Impact of coronavirus 2019 (COVID-19) on training and well-being in subspecialty surgery: A national survey of cardiothoracic trainees in the United Kingdom. J Thorac Cardiovasc Surg 2020; 160:980-987. [PMID: 32605730 PMCID: PMC7262521 DOI: 10.1016/j.jtcvs.2020.05.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/15/2022]
Abstract
Objectives The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care systems and disrupted routine care internationally. Health care workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity. We sought to establish the impact of the COVID-19 pandemic on the well-being, practice, and progression of all trainees in cardiothoracic surgery in the United Kingdom. Methods A 31-item questionnaire was designed, validated, and disseminated via e-mail and an instant-messaging platform. Results In total, 76 (of 118, 64%) cardiothoracic surgical trainees responded, representing all training grades and programs nationally; 48 (63%) and 24 (32%) were concerned about their physical and mental health, respectively, 25 (33%) had taken time off work due to COVID-19, 65 (86%) had treated patients with COVID-19, 36 of whom (55%) were wearing satisfactory personal protective equipment at the time, 41 (54%) remain concerned about personal protective equipment provision at their institution, 42 (55%) had been redeployed to cover other specialties, and 23 (30%) had encountered ethical dilemmas related to care of patients. There was a significant impact on time spent in outpatient clinics (44% reduction), multidisciplinary team meetings (79% reduction), and operating theaters (78% reduction). In total, 67 (88%) of respondents were concerned about the impact on their training, and 54 (71%) felt that the deviation may require an extension in their planned training time. Conclusions The duration and impact of the current pandemic is, as yet, uncertain. Timely sharing of experiences, concerns, and expectations will inform health care and education policy and influence practice in the pandemic era and beyond.
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Affiliation(s)
- Edward J Caruana
- Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom; NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom.
| | - Akshay Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesborough, United Kingdom
| | - Sridhar Rathinam
- Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
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23
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Benedetto U, Goodwin A, Kendall S, Uppal R, Akowuah E. A nationwide survey of UK cardiac surgeons' view on clinical decision making during the coronavirus disease 2019 (COVID-19) pandemic. J Thorac Cardiovasc Surg 2020; 160:968-973. [PMID: 32505456 PMCID: PMC7235560 DOI: 10.1016/j.jtcvs.2020.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND No firm recommendations are currently available to guide decision making for patients requiring cardiac surgery during the coronavirus disease 2019 (COVID-19) pandemic. Systematic appraisal of senior surgeons' consensus can be used to generate interim recommendations until data from clinical observations become available. Hence, we aimed to collect and quantitatively appraise nationwide UK consultants' opinions on clinical decision making for patients requiring cardiac surgery during the COVID-19 pandemic. METHODS We E-mailed a Web-based questionnaire to all consultant cardiac surgeons through the Society for Cardiothoracic Surgery in Great Britain and Ireland mailing list on the April 17, 2020, and we predetermined to close the survey on the April 21, 2020. This survey was primarily designed to gather information on UK surgeons' opinions using 12 items. Strong consensus was predefined as an opinion shared by at least 60% of responding consultants. RESULTS A total of 86 consultant surgeons undertook the survey. All UK cardiac units were represented by at least 1 consultant. Strong consensus was achieved for the following key questions: (1) before any hospital admission for cardiac surgery, nasopharyngeal swab, polymerase chain reaction, and computed tomography of the chest should be performed; (2) the use of full personal protective equipment should to be adopted in every case by the theater team regardless of the patient's COVID-19 status; (3) the risk of COVID-19 exposure for patients undergoing heart surgery should be considered moderate to high and likely to increase mortality if it occurs; and (4) cardiac procedures should be decided based on a rapidly convened multidisciplinary team discussion for every patient. The majority believed that both aortic and mitral surgery should be considered in selected cases. The role of coronary artery bypass graft surgery during the pandemic was controversial. CONCLUSIONS In this unprecedented pandemic period, this survey provides information for generating interim recommendations until data from clinical observations become available.
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Affiliation(s)
- Umberto Benedetto
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
| | - Andrew Goodwin
- South Tees Hospitals NHS Trust, Middlesbrough, United Kingdom
| | - Simon Kendall
- South Tees Hospitals NHS Trust, Middlesbrough, United Kingdom
| | - Rakesh Uppal
- Barts Heart Centre, William Harvey Research Institute, London, United Kingdom
| | - Enoch Akowuah
- South Tees Hospitals NHS Trust, Middlesbrough, United Kingdom
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24
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Kendall S, Lighton S, Sherwood J, Baldry E, Sullivan EA. Incarcerated aboriginal women's experiences of accessing healthcare and the limitations of the 'equal treatment' principle. Int J Equity Health 2020; 19:48. [PMID: 32245479 PMCID: PMC7118909 DOI: 10.1186/s12939-020-1155-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Colonization continues in Australia, sustained through institutional and systemic racism. Targeted discrimination and intergenerational trauma have undermined the health and wellbeing of Australia’s Aboriginal and Torres Strait Islander population, leading to significantly poorer health status, social impoverishment and inequity resulting in the over-representation of Aboriginal people in Australian prisons. Despite adoption of the ‘equal treatment’ principle, on entering prison in Australia entitlements to the national universal healthcare system are revoked and Aboriginal people lose access to health services modelled on Aboriginal concepts of culturally safe healthcare available in the community. Incarcerated Aboriginal women experience poorer health outcomes than incarcerated non-Indigenous women and Aboriginal men, yet little is known about their experiences of accessing healthcare. We report the findings of the largest qualitative study with incarcerated Aboriginal women in New South Wales (NSW) Australia in over 15 years. Methods We employed a decolonizing research methodology, ‘community collaborative participatory action research’, involving consultation with Aboriginal communities prior to the study and establishment of a Project Advisory Group (PAG) of community expert Aboriginal women to guide the project. Forty-three semi-structured interviews were conducted in 2013 with Aboriginal women in urban and regional prisons in NSW. We applied a grounded theory approach for the data analysis with guidance from the PAG. Results Whilst Aboriginal women reported positive and negative experiences of prison healthcare, the custodial system created numerous barriers to accessing healthcare. Aboriginal women experienced institutional racism and discrimination in the form of not being listened to, stereotyping, and inequitable healthcare compared with non-Indigenous women in prison and the community. Conclusions ‘Equal treatment’ is an inappropriate strategy for providing equitable healthcare, which is required because incarcerated Aboriginal women experience significantly poorer health. Taking a decolonizing approach, we unpack and demonstrate the systems level changes needed to make health and justice agencies culturally relevant and safe. This requires further acknowledgment of the oppressive transgenerational effects of ongoing colonial policy, a true embracing of diversity of worldviews, and critically the integration of Aboriginal concepts of health at all organizational levels to uphold Aboriginal women’s rights to culturally safe healthcare in prison and the community.
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Affiliation(s)
- S Kendall
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia
| | - S Lighton
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia
| | - J Sherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
| | - E Baldry
- School of Social Sciences, UNSW Sydney, Sydney, 2052, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia. .,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
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25
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Rahman IA, Kendall S. Cardiac surgery in the very elderly: it isn't all about survival. Br J Cardiol 2020; 27:05. [PMID: 35747424 PMCID: PMC8793928 DOI: 10.5837/bjc.2020.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Simon Kendall
- Consultant Cardiac Surgeon and President Elect SCTS Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW
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26
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Mugweni E, Goodliffe S, Adams C, Walker M, Kendall S. "I'll look after the kids while you go and have a shower": an evaluation of a service to address mild to moderate maternal perinatal mental health problems. J Ment Health 2019; 28:324-330. [PMID: 30964358 DOI: 10.1080/09638237.2019.1581347] [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] [Indexed: 10/27/2022]
Abstract
BACKGROUND Perinatal mental health (PMH) problems are a major public health concern because they may impair parenting ability which potentially has an immediate and long-term impact on the physical, cognitive and emotional health of the child. AIMS We evaluated a Perinatal Support Service (PSS) which supports positive attachment between mothers with PMH problems and their child, to evidence its impact on maternal mental health and maternal-infant interaction. METHOD Using a mixed-methods approach, anonymised pre- and post-service outcomes data from 123 clients, 14 interviews and a focus group discussion were analysed. RESULTS We found significant improvement in anxiety (t (55) = 6.96, p < 0.01, 95% CI [3.15, 5.70]), and depression (t (55) = 6.58, p < 0.01, 95% CI [3.03, 5.68]) on the HADS, and on the GAD-7 (t (12) = 4.541, p = 0.001, 95% CI [3.48, 9.90]) after the PSS. Anxiety post service (M = 9.08, SD = 4.96) was lower than baseline anxiety (M = 15.77, SD = 4.68). Receiving emotional and practical support contributed to improvements in mental health and mother-child interaction. CONCLUSION Given the paucity of PMH services in the UK, it is imperative that services such as the PSS continue to receive funding to address unmet PMH needs.
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Affiliation(s)
- Esther Mugweni
- a Institute of Health Visiting c/o Royal Society for Public Health , London , UK
| | - S Goodliffe
- a Institute of Health Visiting c/o Royal Society for Public Health , London , UK
| | - C Adams
- a Institute of Health Visiting c/o Royal Society for Public Health , London , UK
| | - M Walker
- a Institute of Health Visiting c/o Royal Society for Public Health , London , UK
| | - S Kendall
- a Institute of Health Visiting c/o Royal Society for Public Health , London , UK.,b Centre for Health Services Studies , University of Kent , Kent , UK
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27
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Scriven JE, Scobie A, Verlander NQ, Houston A, Collyns T, Cajic V, Kon OM, Mitchell T, Rahama O, Robinson A, Withama S, Wilson P, Maxwell D, Agranoff D, Davies E, Llewelyn M, Soo SS, Sahota A, Cooper MA, Hunter M, Tomlins J, Tiberi S, Kendall S, Dedicoat M, Alexander E, Fenech T, Zambon M, Lamagni T, Smith EG, Chand M. Mycobacterium chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases. Clin Microbiol Infect 2018; 24:1164-1170. [PMID: 29803845 DOI: 10.1016/j.cmi.2018.04.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Mycobacterium chimaera infection following cardiac surgery, due to contaminated cardiopulmonary bypass heater-cooler units, has been reported worldwide. However, the spectrum of clinical disease remains poorly understood. To address this, we report the clinical and laboratory features, treatment and outcome of the first 30 UK cases. METHODS Case note review was performed for cases identified retrospectively through outbreak investigations and prospectively through ongoing surveillance. Case definition was Mycobacterium chimaera detected in any clinical specimen, history of cardiothoracic surgery with cardiopulmonary bypass, and compatible clinical presentation. RESULTS Thirty patients were identified (28 with prosthetic material) exhibiting a spectrum of disease including prosthetic valve endocarditis (14/30), sternal wound infection (2/30), aortic graft infection (4/30) and disseminated (non-cardiac) disease (10/30). Patients presented a median of 14 months post surgery (maximum 5 years) most commonly complaining of fever and weight loss. Investigations frequently revealed lymphopenia, thrombocytopenia, liver cholestasis and non-necrotizing granulomatous inflammation. Diagnostic sensitivity for a single mycobacterial blood culture was 68% but increased if multiple samples were sent. In all, 27 patients started macrolide-based combination treatment and 14 had further surgery. To date, 18 patients have died (60%) a median of 30 months (interquartile range 20-39 months) after initial surgery. Survival analysis identified younger age, mitral valve surgery, mechanical valve replacement, higher serum sodium concentration and lower C-reactive protein as factors associated with better survival. CONCLUSIONS Mycobacterium chimaera infection following cardiac surgery is associated with a wide spectrum of disease. The diagnosis should be considered in all patients who develop an unexplained illness following cardiac surgery.
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Affiliation(s)
- J E Scriven
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK; National Infection Service, Public Health England, Colindale, London, UK.
| | - A Scobie
- National Infection Service, Public Health England, Colindale, London, UK
| | - N Q Verlander
- Statistics Unit, National Infection Service, Public Health England, Colindale, London, UK
| | - A Houston
- Department of Infection, St Georges Universities NHS Foundation Trust, London, UK
| | - T Collyns
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - V Cajic
- Department of Infection, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - O M Kon
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - T Mitchell
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - O Rahama
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - A Robinson
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - S Withama
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - P Wilson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Maxwell
- Department of Respiratory Medicine, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - D Agranoff
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - E Davies
- Public Health Wales Microbiology, Cardiff, UK
| | - M Llewelyn
- Department of Infectious Diseases, Royal Gwent Hospital, Newport, UK
| | - S-S Soo
- Department of Microbiology, Nottingham University Hospitals NHS Trust, QMC Campus, Nottingham, UK
| | - A Sahota
- Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M A Cooper
- Department of Microbiology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - M Hunter
- Department of Infectious Diseases, Royal Victoria Hospital, Belfast, UK
| | - J Tomlins
- Department of Infection, St Georges Universities NHS Foundation Trust, London, UK
| | - S Tiberi
- Division of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK; Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - S Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK; South Tees Hospitals Foundation NHS Trust, Middlesbrough, UK
| | - M Dedicoat
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - E Alexander
- National Infection Service, Public Health England, Colindale, London, UK
| | | | - M Zambon
- National Infection Service, Public Health England, Colindale, London, UK
| | - T Lamagni
- National Infection Service, Public Health England, Colindale, London, UK
| | - E G Smith
- National Infection Service, Public Health England, Colindale, London, UK
| | - M Chand
- National Infection Service, Public Health England, Colindale, London, UK; National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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28
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Bloem C, Gomes D, Kendall S, Kaufman B, Thomas V, Aluisio A. 196EMF Evaluation of the Utilization and Impact of Point-of-Care Ultrasound in Acute Obstetrical Care in the North East Region of Haiti. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.223] [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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29
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Tunstall C, Laing P, Limaye R, Walker C, Kendall S, Lavalette D, Mackenney P, Adedapo A, Al-Maiyah M. 1st metatarso-phalangeal joint arthroplasty with ROTO-glide implant. Foot Ankle Surg 2017; 23:153-156. [PMID: 28865582 DOI: 10.1016/j.fas.2017.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/11/2016] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total joint replacement of the 1st metatarso-phalangeal Joint (MTPJ) has been controversial as arthrodesis remains a good option for patients with end stage 1st MTPJ arthritis. We present a multi centre service evaluation of the ROTO-glide device METHODS: 33 ROTO-glide procedures were carried out in 30 patients across 7 sites within the UK. Exclusion criteria - hallux valgus and arthritis, age below 45 years and over 80 years, inflammatory joint disease. Patient assessed pre and post operatively with AOFAS and Oxford forefoot (MOXFQ) scores and plain radiographs. All patients carried out the same post operative protocol RESULTS: Average age at patients was 58.6 years (45-77). Follow up average was 16.9 months (12-29). Pre-op AOFAS scores average 41.4 (17-67) and post op average 76 (29-100) and the MOXFQ summary index decreased from an average of 43 (20-64) pre op to an average of 17 (0-51) post op. Average total range of motion pre operatively was 32° and post operatively was 61°. There were 2 post operative complications but no revisions were necessary. CONCLUSIONS The early results of this multi centre service evaluation of the ROTO-glide 1st MTPJ replacement support its continued use and evaluation of the prosthesis further.
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Affiliation(s)
- C Tunstall
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, Shropshire SY10 7AG, United Kingdom.
| | - P Laing
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, Shropshire SY10 7AG, United Kingdom; Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, United Kingdom
| | - R Limaye
- North Tees and Hartlepool NHS Foundation Hospital Trust, Hardwick Road, Stockton-on-Tees, Cleveland TS19 8PE, United Kingdom
| | - C Walker
- Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside L7 8XP, United Kingdom
| | - S Kendall
- New Victoria Hospital, 184-188 Coombe Lane West, Kingston-upon-Thames, Surrey KT2 7EG, United Kingdom
| | - D Lavalette
- Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire HG2 7SX, United Kingdom
| | - P Mackenney
- South Tees University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom
| | - A Adedapo
- South Tees University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom
| | - M Al-Maiyah
- South Tees University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom
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Martignetti J, Nair N, Vanegas O, Rykunov D, Dashkoff M, Camacho S, Harkins T, Schumacher C, Irish J, Pereira E, Kendall S, Kalir T, Sebra R, Reva B, Dottino P. Mutation profiling of uterine lavage fluid detects early-stage endometrial cancers and discovers a prevalent landscape of driver mutations in women without cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.294] [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: 10/19/2022]
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Preece R, Srivastava V, Akowuah E, Kendall S. Should limb revascularization take priority over dissection repair in type a aortic dissection presenting as isolated acute limb ischaemia. Interact Cardiovasc Thorac Surg 2017; 25:643-646. [DOI: 10.1093/icvts/ivx169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/26/2017] [Indexed: 11/14/2022] Open
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Katale BZ, Mbugi EV, Siame KK, Keyyu JD, Kendall S, Kazwala RR, Dockrell HM, Fyumagwa RD, Michel AL, Rweyemamu M, Streicher EM, Warren RM, van Helden P, Matee MI. Isolation and Potential for Transmission of Mycobacterium bovis at Human-livestock-wildlife Interface of the Serengeti Ecosystem, Northern Tanzania. Transbound Emerg Dis 2017; 64:815-825. [PMID: 26563417 PMCID: PMC5434928 DOI: 10.1111/tbed.12445] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Indexed: 11/30/2022]
Abstract
Mycobacterium bovis, the causative agent of bovine tuberculosis (bTB), is a multihost pathogen of public health and veterinary importance. We characterized the M. bovis isolated at the human-livestock-wildlife interface of the Serengeti ecosystem to determine the epidemiology and risk of cross-species transmission between interacting hosts species. DNA was extracted from mycobacterial cultures obtained from sputum samples of 472 tuberculosis (TB) suspected patients and tissue samples from 606 livestock and wild animal species. M. bovis isolates were characterized using spoligotyping and Mycobacterial Interspersed Repetitive Units-Variable Tandem Repeats (MIRU-VNTR) on 24 loci. Only 5 M. bovis were isolated from the cultured samples. Spoligotyping results revealed that three M. bovis isolates from two buffaloes (Syncerus caffer) and 1 African civet (Civettictis civetta) belonged to SB0133 spoligotype. The two novel strains (AR1 and AR2) assigned as spoligotype SB2290 and SB2289, respectively, were identified from indigenous cattle (Bos indicus). No M. bovis was detected from patients with clinical signs consistent with TB. Of the 606 animal tissue specimens and sputa of 472 TB-suspected patients 43 (7.09%) and 12 (2.9%), respectively, yielded non-tuberculous mycobacteria (NTM), of which 20 isolates were M. intracellulare. No M. avium was identified. M. bovis isolates from wildlife had 45.2% and 96.8% spoligotype pattern agreement with AR1 and AR2 strains, respectively. This finding indicates that bTB infections in wild animals and cattle were epidemiologically related. Of the 24 MIRU-VNTR loci, QUB 11b showed the highest discrimination among the M. bovis strains. The novel strains obtained in this study have not been previously reported in the area, but no clear evidence for recent cross-species transmission of M. bovis was found between human, livestock and wild animals.
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Affiliation(s)
- B. Z. Katale
- Department of Microbiology and ImmunologySchool of MedicineMuhimbili University of Health and Allied Sciences (MUHAS)Dar es SalaamTanzania
- Tanzania Wildlife Research Institute (TAWIRI)ArushaTanzania
| | - E. V. Mbugi
- Department of Microbiology and ImmunologySchool of MedicineMuhimbili University of Health and Allied Sciences (MUHAS)Dar es SalaamTanzania
| | - K. K. Siame
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergCape TownSouth Africa
| | - J. D. Keyyu
- Tanzania Wildlife Research Institute (TAWIRI)ArushaTanzania
| | - S. Kendall
- Centre for Emerging, Endemic and Exotic diseasesRoyal Veterinary College (RVC)Hawkshead LaneNorth MymmsHatfieldHertfordshireUK
| | - R. R. Kazwala
- Department of Veterinary Medicine and Public HealthFaculty of Veterinary MedicineSokoine University of Agriculture (SUA)MorogoroTanzania
| | - H. M. Dockrell
- Department of Immunology and InfectionLondon School of Hygiene and Tropical Medicine (LSHTM)LondonUK
| | - R. D. Fyumagwa
- Tanzania Wildlife Research Institute (TAWIRI)ArushaTanzania
| | - A. L. Michel
- Department Veterinary Tropical DiseasesFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortSouth Africa
| | - M. Rweyemamu
- Southern African Centre for Infectious Diseases Surveillance (SACIDS)Sokoine University of Agriculture (SUA)Chuo KikuuMorogoroTanzania
| | - E. M. Streicher
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergCape TownSouth Africa
| | - R. M. Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergCape TownSouth Africa
| | - P. van Helden
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergCape TownSouth Africa
| | - M. I. Matee
- Department of Microbiology and ImmunologySchool of MedicineMuhimbili University of Health and Allied Sciences (MUHAS)Dar es SalaamTanzania
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Villanueva C, Tsugawa K, Toyama T, Noh W, Jeong J, Cardoso F, Sriuranpong V, Srimuninnimit V, Ozguroglu M, Kendall S, Falkson C, Cianfrocca M, Manlius C, Lin JCJ, Ringeisen F, Ridolfi A, Royce M. Abstract P2-11-08: Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-11-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Stomatitis is the most frequent adverse event reported in trials of mTOR-inhibitors, including EVE. In the pivotal phase 3 BOLERO-2 study, stomatitis incidence in the EVE + exemestane (EXE) arm was 59%. The BOLERO-4 study (NCT01698918) evaluated the efficacy and safety of first-line EVE + LET in postmenopausal pts with HR+, HER2− metastatic or locally advanced breast cancer (ABC). BOLERO-4 also assessed the effectiveness of an alcohol-free dexamethasone (0.5 mg/ 5ml; DEX) oral rinse for treating stomatitis in a subset of pts (USA).
Methods
Postmenopausal pts with HR+, HER2− ABC previously untreated for advanced disease received EVE (10 mg/day) + LET (2.5 mg/day).At disease progression, pts were offered EVE (10 mg/day) + EXE (25 mg/day). Pts who had at least one episode of stomatitis received oral stomatitis daily questionnaire (OSDQ), which is a 6 question pt-reported outcome (PRO) survey (Stiff et al, JCO. 2006). A subset of these pts (USA) was randomized (1:1) to receive DEX or standard of care (SOC). The primary objective of investigator-assessed progression-free survival in the first-line setting for ABC was presented previously. A secondary objective was to evaluate the effectiveness of the DEX oral rinse in reducing the severity and duration of stomatitis, using OSDQ data.
Results
Of the total 202 pts enrolled in this study, 52 pts were enrolled in USA, of which, 24 (46.2%) were randomized to receive DEX (n=11) or SOC (n=13), upon confirmation of stomatitis. The median duration of first stomatitis episode was longer per OSDQ (DEX, not estimable vs SOC, 13.7 wk) compared with physician-reported duration (DEX, 1.6 wk vs SOC, 1.9 wk). PRO OSDQ results were similar in both arms.
Among the 202 pts enrolled, 89 (44.1%) filled the OSDQ at their first stomatitis episode. The median time from treatment initiation to first stomatitis episode was 1.7 wk; median duration of stomatitis was 13.7 wk (OSDQ) vs 2.1 wk (physician reported). The majority of pts experiencing stomatitis had moderate/little/no soreness, moderate/low/no pain, and stomatitis had low/no effect on daily activities (Table 1).
Table 1. OSDQ Key Results (N=87)Questions (Score)First Day of Stomatitis Episode, n (%)End of First Stomatitis Episode, n (%)Overall healthPoor (0-4)20 (23.0)23 (26.4)Moderate (5-7)40 (46.0)32 (36.8)Perfect (8-10)27 (31.0)32 (36.8)Mouth and throat sorenessNo/a little/moderate (0-2)64 (73.6)84 (96.6)A lot or extreme (3-4)23 (26.4)3 (3.4)Mouth pain severityNo/low/moderate (0-4)51 (58.6)73 (83.9)Severe (5-7)24 (27.6)10 (11.5)Unbearable (8-10)12 (13.8)4 (4.6)Effect on daily activitiesNo/low (0-4)70 (80.5)78 (89.7)Moderate (5-7)11 (12.6)4 (4.6)High (8-10)6 (6.9)5 (5.7)
Conclusions
Overall, patient-reported median duration of stomatitis was longer than that reported by physicians, most likely due to differences in perceptions and the challenges in collecting and cleaning PRO data. Overall good health score was maintained in the majority of pts experiencing stomatitis and stomatitis had low/no effect on daily activities. However, these results, especially in the randomized subset need to be interpreted with caution owing to the small sample size, missing data and lack of commercially available DEX in most countries.
Citation Format: Villanueva C, Tsugawa K, Toyama T, Noh W, Jeong J, Cardoso F, Sriuranpong V, Srimuninnimit V, Ozguroglu M, Kendall S, Falkson C, Cianfrocca M, Manlius C, Lin JCJ, Ringeisen F, Ridolfi A, Royce M. Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-08.
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Affiliation(s)
- C Villanueva
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - K Tsugawa
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - T Toyama
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - W Noh
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - J Jeong
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - F Cardoso
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - V Sriuranpong
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - V Srimuninnimit
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Ozguroglu
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - S Kendall
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - C Falkson
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Cianfrocca
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - C Manlius
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - JCJ Lin
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - F Ringeisen
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - A Ridolfi
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
| | - M Royce
- CHU de Besançon, Besançon, France; St. Marianna University School of Medicine, Kawasaki, Japan; Nagoya City University Hospital, Nagoya, Japan; Korea Cancer Center Hospital, Seoul, Korea; Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea; Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal; Chulalongkorn Hospital, Bangkok, Thailand; Siriraj Hospital, Bangkok, Thailand; Cerrahpasa Medical School, Istanbul, Turkey; Utah Cancer Specialists, Salt Lake, UT; University of Alabama Comprehensive Cancer Center, Birmingham, AL; Banner MD Anderson Cancer Center, Gilbert, AZ; Novartis Pharma AG, Basel, Switzerland; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Novartis Pharma S.A.S, Paris, France; University of New Mexico Cancer Center, Albuquerque, NM
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Howe A, Mathie E, Munday D, Cowe M, Goodman C, Keenan J, Kendall S, Poland F, Staniszewska S, Wilson P. Learning to work together - lessons from a reflective analysis of a research project on public involvement. Res Involv Engagem 2017; 3:1. [PMID: 29062545 PMCID: PMC5611599 DOI: 10.1186/s40900-016-0051-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/14/2016] [Indexed: 05/09/2023]
Abstract
PLAIN ENGLISH SUMMARY Patient and public involvement (PPI) in research is very important, and funders and the NHS all expect this to happen. What this means in practice, and how to make it really successful, is therefore an important research question. This article analyses the experience of a research team using PPI, and makes recommendations on strengthening PPI in research. There were different PPI roles in our study - some people were part of the research team: some were on the advisory group; and there were patient groups who gave specific feedback on how to make research work better for their needs. We used minutes, other written documents, and structured individual and group reflections to learn from our own experiences over time. The main findings were:- for researchers and those in a PPI role to work in partnership, project structures must allow flexibility and responsiveness to different people's ideas and needs; a named link person can ensure support; PPI representatives need to feel fully included in the research; make clear what is expected for all roles; and ensure enough time and funding to allow meaningful involvement. Some roles brought more demands but also more rewards than others - highlighting that it is important that people giving up their time to help with research experience gains from doing so. Those contributing to PPI on a regular basis may want to learn new skills, rather than always doing the same things. Researchers and the public need to find ways to develop roles in PPI over time. We also found that, even for a team with expertise in PPI, there was a need both for understanding of different ways to contribute, and an evolving 'normalisation' of new ways of working together over time, which both enriched the process and the outputs. ABSTRACT Background Patient and public involvement (PPI) is now an expectation of research funders, in the UK, but there is relatively little published literature on what this means in practice - nor is there much evaluative research about implementation and outputs. Policy literature endorses the need to include PPI representation at all stages of planning, performing and research dissemination, and recommends resource allocation to these roles; but details of how to make such inputs effective in practice are less common. While literature on power and participation informs the debate, there are relatively few published case studies of how this can play out through the lived experience of PPI in research; early findings highlight key issues around access to knowledge, resources, and interpersonal respect. This article describes the findings of a case study of PPI within a study about PPI in research. Methods The aim of the study was to look at how the PPI representatives' inputs had developed over time, key challenges and changes, and lessons learned. We used realist evaluation and normalisation process theory to frame and analyse the data, which was drawn from project documentation, minutes of meetings and workshops, field notes and observations made by PPI representatives and researchers; documented feedback after meetings and activities; and the structured feedback from two formal reflective meetings. Results Key findings included the need for named contacts who support, integrate and work with PPI contributors and researchers, to ensure partnership working is encouraged and supported to be as effective as possible. A structure for partnership working enabled this to be enacted systematically across all settings. Some individual tensions were nonetheless identified around different roles, with possible implications for clarifying expectations and deepening understandings of the different types of PPI contribution and of their importance. Even in a team with research expertise in PPI, the data showed that there were different phases and challenges to 'normalising' the PPI input to the project. Mutual commitment and flexibility, embedded through relationships across the team, led to inclusion and collaboration. Conclusion Work on developing relationships and teambuilding are as important for enabling partnership between PPI representatives and researchers as more practical components such as funding and information sharing. Early explicit exploration of the different roles and their contributions may assist effective participation and satisfaction.
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Affiliation(s)
- A. Howe
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - E. Mathie
- Centre for Primary and Community Care at the University of Hertfordshire, Hatfield, UK
| | - D. Munday
- Centre for Primary and Community Care at the University of Hertfordshire, Hatfield, UK
| | - M. Cowe
- Centre for Primary and Community Care at the University of Hertfordshire, Hatfield, UK
| | - C. Goodman
- Centre for Primary and Community Care at the University of Hertfordshire, Hatfield, UK
| | - J. Keenan
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - S. Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - F. Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - S. Staniszewska
- RCN Research Institute at Warwick Medical School, Coventry, UK
| | - P. Wilson
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Chand M, Lamagni T, Kranzer K, Hedge J, Moore G, Parks S, Collins S, Del Ojo Elias C, Ahmed N, Brown T, Smith EG, Hoffman P, Kirwan P, Mason B, Smith-Palmer A, Veal P, Lalor MK, Bennett A, Walker J, Yeap A, Isidro Carrion Martin A, Dolan G, Bhatt S, Skingsley A, Charlett A, Pearce D, Russell K, Kendall S, Klein AA, Robins S, Schelenz S, Newsholme W, Thomas S, Collyns T, Davies E, McMenamin J, Doherty L, Peto TEA, Crook D, Zambon M, Phin N. Insidious Risk of Severe Mycobacterium chimaera Infection in Cardiac Surgery Patients. Clin Infect Dis 2016; 64:335-342. [PMID: 27927870 DOI: 10.1093/cid/ciw754] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/14/2016] [Accepted: 11/11/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands. METHODS Parallel investigations were pursued: (1) identification of cardiopulmonary bypass-associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates. RESULTS Eighteen probable cases of cardiopulmonary bypass-associated M. chimaera infection were identified; all except one occurred in adults. Patients had undergone valve replacement in 11 hospitals between 2007 and 2015, a median of 19 months prior to onset (range, 3 months to 5 years). Risk to patients increased after 2010 from <0.2 to 1.65 per 10000 person-years in 2013, a 9-fold rise for infections within 2 years of surgery (rate ratio, 9.08 [95% CI, 1.81-87.76]). Endocarditis was the most common presentation (n = 11). To date, 9 patients have died. Investigations identified aerosol release through breaches in heater-cooler tanks. Mycobacterium chimaera and other pathogens were recovered from water and air samples. Phylogenetic analysis found close clustering of strains from probable cases. CONCLUSIONS We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection.
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Affiliation(s)
- Meera Chand
- National Infection Service, Public Health England.,Guy's and St Thomas' NHS Foundation Trust, and.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London
| | | | | | - Jessica Hedge
- Nuffield Department of Medicine, University of Oxford
| | - Ginny Moore
- National Infection Service, Public Health England
| | - Simon Parks
- National Infection Service, Public Health England
| | | | | | - Nada Ahmed
- National Infection Service, Public Health England
| | - Tim Brown
- National Infection Service, Public Health England
| | - E Grace Smith
- National Infection Service, Public Health England.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London
| | | | - Peter Kirwan
- National Infection Service, Public Health England
| | | | | | - Philip Veal
- Health Protection Service, Public Health Agency Northern Ireland, Belfast, United Kingdom
| | | | | | - James Walker
- National Infection Service, Public Health England
| | - Alicia Yeap
- National Infection Service, Public Health England
| | - Antonio Isidro Carrion Martin
- National Infection Service, Public Health England.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Gayle Dolan
- National Infection Service, Public Health England.,Field Epidemiology Service, Public Health England, Newcastle
| | - Sonia Bhatt
- National Infection Service, Public Health England
| | | | | | - David Pearce
- National Infection Service, Public Health England
| | | | - Simon Kendall
- South Tees Hospitals Foundation NHS Trust, Middlesbrough.,Society for Cardiothoracic Surgery in Great Britain and Ireland, London
| | - Andrew A Klein
- Papworth Hospital NHS Foundation Trust, Cambridge.,Association of Cardiothoracic Anaesthetists, London
| | | | - Silke Schelenz
- Royal Brompton and Harefield NHS Foundation Trust, London
| | | | - Stephanie Thomas
- University Hospital South Manchester NHS Foundation Trust, Manchester
| | - Tim Collyns
- Leeds Teaching Hospitals NHS Trust, Leeds, and
| | - Eleri Davies
- Public Health Wales NHS Trust, Cardiff.,Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Jim McMenamin
- Vaccine Preventable Diseases, Health Protection Scotland, Glasgow, and
| | - Lorraine Doherty
- Health Protection Service, Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford
| | - Derrick Crook
- National Infection Service, Public Health England.,Nuffield Department of Medicine, University of Oxford
| | - Maria Zambon
- National Infection Service, Public Health England.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London
| | - Nick Phin
- National Infection Service, Public Health England
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Burdett C, Dunning J, Goodwin A, Theakston M, Kendall S. Left-handed cardiac surgery: tips from set up to closure for trainees and their trainers. J Cardiothorac Surg 2016; 11:139. [PMID: 27580858 PMCID: PMC5007814 DOI: 10.1186/s13019-016-0523-y] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
There are certain obstacles which left-handed surgeons can face when training but these are not necessary and often perpetuated by a lack of knowledge. Most have been encountered and overcome at some point but unless recorded and disseminated they will have to be resolved repeatedly by each trainee and their trainers. This article highlights difficulties that the left-hander may encounter in cardiac surgery and gives practical operative advice for both trainees and their trainers to help overcome them.
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Affiliation(s)
- Clare Burdett
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Andrew Goodwin
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Maureen Theakston
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
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Martignetti J, Reva B, Elena P, Camacho-Vanegas O, Rykunov D, Kendall S, Shah H, Nair N, Strahl M, Hamou W, Kalir T, Schadt E, Sebra R, Dottino P. A pre-operative, diagnostic gene panel for guiding primary treatment choices in endometrial cancer: Advancing beyond the decades-old technology of dilation and curettage (D&C). Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61103-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Burdett C, Dunning J, Goodwin A, Theakston M, Kendall S. Left-handed Cardiac Surgery: Tips from set up to closure for Trainees and their Trainers. J Cardiothorac Surg 2015. [PMCID: PMC4693649 DOI: 10.1186/1749-8090-10-s1-a43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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39
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40
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Srivastava V, Mishra PK, Akowuah E, Dunning J, Ferguson J, Goodwin A, Kendall S, Owens A, White R. A survey of contemporary usage of epicardial pacing wires among UK cardiothoracic surgeons: A call for a more conservative approach. J Cardiothorac Surg 2015. [PMCID: PMC4695714 DOI: 10.1186/1749-8090-10-s1-a342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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41
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Srivastava V, Yap CH, Burdett C, Smailes T, Kendall S, Akowuah E. Thermoreactive clips do not reduce sternal infection: a propensity-matched comparison with sternal wires. Interact Cardiovasc Thorac Surg 2015; 21:699-704. [PMID: 26346231 DOI: 10.1093/icvts/ivv238] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/23/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Sternal stability is essential to prevent serious infective complications after sternotomy. This paper examines whether nitinol thermoreactive clips reduce sternal wound infection rates in obese patients [body mass index (BMI) ≥30] compared with sternal wires. METHODS All patients with BMI ≥30 undergoing cardiac surgery via median sternotomy between February 2008 and February 2013 in our institution were divided into two groups depending on sternal closure technique-sternal wires or thermoreactive clips. Comparison was made using propensity-matched analysis with sternal wound infection as the primary outcome. RESULTS Of 1371 patients, 826 (60%) had thermoreactive clips and 545 (40%) sternal wires. The sternal wires group was older (mean age 66.62 ± 10.1 vs 64.35 ± 9.8 years, P = 0.00) with a greater proportion of females (39 vs 26%, P = 0.00). In unmatched group comparison, both superficial sternal wound infection (thermoreactive clips 4% vs wires 3%) and deep infection (thermoreactive clips 3% vs wires 0.6%, P = 0.00) were more common in the thermoreactive clips group. More patients in the thermoreactive clips group required debridement and a larger number had vacuum-assisted closure [thermoreactive clips 10 patients (1%) vs sternal wires 2 (0.4%)]. Propensity-matching yielded two groups of 356 patients. There was no difference in sternal wound infection rates [thermoreactive clips 19 patients (5%) vs sternal wires 15 (4%), P = 0.58] or deep sternal infection rates [thermoreactive clips 9 patients (3%) vs sternal wires 3 (1%), P = 0.11]. CONCLUSIONS Thermoreactive clips did not have an advantage in the prevention of superficial or deep sternal wound infection in obese patients undergoing sternotomy.
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Affiliation(s)
- Vivek Srivastava
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Cheng-Hon Yap
- Department of Cardiothoracic Surgery, Barwon Health, Geelong, VIC, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Clare Burdett
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Tracey Smailes
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Enoch Akowuah
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Grant SW, Hickey GL, Ludman P, Moat N, Cunningham D, de Belder M, Blackman DJ, Hildick-Smith D, Uppal R, Kendall S, Bridgewater B. Activity and outcomes for aortic valve implantations performed in England and Wales since the introduction of transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2015; 49:1164-73. [PMID: 26276837 DOI: 10.1093/ejcts/ezv270] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 02/25/2015] [Accepted: 06/30/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The first transcatheter aortic valve implantation (TAVI) in England and Wales was performed in 2007. This study presents the subsequent national activity and outcomes for both TAVI and aortic valve replacement (AVR). METHODS Data for all AVR and TAVI procedures between January 2006 and December 2012 in England and Wales were included. The number of procedures, patient characteristics, in-hospital and 30-day mortality, postoperative length of stay (PLOS) and survival were analysed separately for: isolated AVR; AVR + coronary artery bypass graft (CABG) surgery; AVR + other surgery and TAVI. RESULTS The number of TAVIs increased from 66 in 2007 (0.8% of all implants) to 1186 in 2012 (10.9% of all implants). AVR activity also increased over the study period. TAVI patients were older and had a higher mean logistic EuroSCORE than all AVR groups. The 30-day mortality rates were 2.1% for isolated AVR, 3.9% for AVR + CABG, 7.7% for AVR + other surgery and 6.2% for TAVI. In-hospital mortality has significantly improved for all groups. The 5-year survival rates were 82.6% for isolated AVR, 81.7% for AVR + CABG, 74.5% for AVR + other surgery and 46.1% for TAVI. The median PLOS after TAVI was similar to that of isolated AVR but shorter than that of the other AVR groups. CONCLUSIONS Since the introduction of TAVI, there has been an increase in both TAVI and AVR activity. TAVIs now represent over 10% of all aortic valve implants. There are distinct differences between procedural groups with respect to patient risk factors. Outcomes for all procedural groups have improved, but long-term TAVI results are required before its role in the treatment of aortic stenosis can be fully defined.
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Affiliation(s)
- Stuart W Grant
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, Manchester, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK
| | - Graeme L Hickey
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, The Farr Institute @ HeRC, Liverpool, UK
| | - Peter Ludman
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Neil Moat
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - David Cunningham
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK
| | - Mark de Belder
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiothoracic Services, The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Rakesh Uppal
- Department of Cardiothoracic Surgery, Barts Health, St Bartholomew's Hospital, London, UK William Harvey Research Institute and NIHR Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine, London, UK
| | - Simon Kendall
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiothoracic Services, The James Cook University Hospital, Middlesbrough, UK
| | - Ben Bridgewater
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, Manchester, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK
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Sharkey A, Ariyaratnam P, Anikin V, Belcher E, Kendall S, Lim E, Naidu B, Parry W, Loubani M. Thoracoscore and European Society Objective Score Fail to Predict Mortality in the UK. World J Oncol 2015; 6:270-275. [PMID: 29147415 PMCID: PMC5649945 DOI: 10.14740/wjon897w] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Accepted: 02/25/2015] [Indexed: 11/11/2022] Open
Abstract
Background Thoracoscore and the European Society Objective Score (ESOS.01) are two scoring systems used in thoracic surgery to estimate operative mortality risk. We aimed to evaluate if these are valid tools for use in the UK population. Methods A multi-center, prospective study was carried out on patients undergoing lung resection at six UK centers. Data were submitted electronically using our online data collection tool. Data were analyzed to determine the factors affecting mortality. A receiver operating characteristic analysis determined the ability of the thoracoscore and ESOS.01 to predict in-hospital mortality. Results Data were complete for 2,245 patients. The observed in-hospital mortality was 31 patients (1.38%). Mean thoracoscore was 2.66 (SD ± 3.21). Gender (P = 0.004, hazard ratio 4.786) and co-morbidity score (P = 0.005, hazard ratio 3.289) were identified as risk factors for mortality. A sub-analysis was performed using data from 1,912 patients with complete data for ESOS.01. In this group, mean thoracoscore was 2.55 (SD ± 2.94), mean ESOS.01 was 2.11(SD ± 1.41), and these were statistically significantly different (P < 0.0001). The observed in-hospital mortality was 28 patients (1.46%). The c-index for thoracoscore was 0.705, and for ESOS.01 was 0.739. Conclusions Both thoracoscore and ESOS.01 overestimated mortality in the UK population. There is a continued need to develop an appropriate risk prediction system for the UK.
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Affiliation(s)
- Annabel Sharkey
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, HU16 5JQ, UK
| | | | - Vladimir Anikin
- Department of Thoracic Surgery, Harefield Hospital Hill End Road, Harefield, Middlesex UB9 6JH, UK
| | - Elizabeth Belcher
- Department of Thoracic Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Simon Kendall
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Great Ayton, TS9 6BJ, UK
| | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, SW3 6NP, UK
| | - Babu Naidu
- Department of Thoracic Surgery, Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Wyn Parry
- Norfolk and Norwich University Hospital Thoracic Surgical Unit, Colney Lane, Norwich, NR4 7UY, UK
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, HU16 5JQ, UK
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Hickey GL, Grant SW, Bridgewater B, Kendall S, Bryan AJ, Kuo J, Dunning J. A comparison of outcomes between bovine pericardial and porcine valves in 38 040 patients in England and Wales over 10 years. Eur J Cardiothorac Surg 2014; 47:1067-74. [DOI: 10.1093/ejcts/ezu307] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/04/2014] [Indexed: 11/15/2022] Open
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Young GA, Kendall S, Brownjohn AM. D-Amino acids in chronic renal failure and the effects of dialysis and urinary losses. Amino Acids 2013; 6:283-93. [PMID: 24189736 DOI: 10.1007/bf00813748] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/1993] [Accepted: 09/06/1993] [Indexed: 12/01/2022]
Abstract
Total D-amino acids were measured in plasma for 20 non-dialysed patients (creatinine clearance < 12 ml/minute), 20 on CAPD, 20 on haemodialysis and 20 normals. Plasma D-tyrosine and D-phenylalanine were measured in 8 of each group by HPLC. Total D-amino acids, D-tyrosine and D-phenylalanine were significantly greater for patients than normals. D-amino acids and D-tyrosine correlated with creatinine and were decreased during HD. During dialysis, the mean losses for D-tyrosine and D-phenylalanine were similar, about 0.2 mg/CAPD exchange and 3 mg/4 hour haemodialysis (i.e. 2% of the total amino acid, as in plasma). Clearance was unaffected by stereochemical configuration. Urinary losses/24 hour in the non-dialysed patients were 0.35 mg D-tyrosine and 0.25 mg D-phenylalanine. Clearance for D-phenylalanine was greater than for the L-enantiomer. Increases in D-amino acids in renal failure are probably due to depletion of D-amino acid oxidase, but may be enhanced by a D-amino acid rich diet, peptide antibiotics and D-amino acid oxidase inhibiting drugs and metabolites. Possible toxic effects need further investigation.
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Affiliation(s)
- G A Young
- Renal Research Unit, Institute of Pathology, D Floor, Clarendon Wing, General Infirmary, LS1 3EX, Leeds, United Kingdom
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Abstract
BACKGROUND The calibration of several cardiac clinical prediction models has deteriorated over time. We compare different model fitting approaches for in-hospital mortality after cardiac surgery that adjust for cross-sectional case mix in a heterogeneous patient population. METHODS AND RESULTS Data from >300 000 consecutive cardiac surgery procedures performed at all National Health Service and some private hospitals in England and Wales between April 2001 and March 2011 were extracted from the National Institute for Cardiovascular Outcomes Research clinical registry. The study outcome was in-hospital mortality. Model approaches included not updating, periodic refitting, rolling window, and dynamic logistic regression. Covariate adjustment was made in each model using variables included in the logistic European System for Cardiac Operative Risk Evaluation model. The association between in-hospital mortality and some variables changed with time. Notably, the intercept coefficient has been steadily decreasing during the study period, consistent with decreasing observed mortality. Some risk factors, such as operative urgency and postinfarct ventricular septal defect, have been relatively stable over time, whereas other risk factors, such as left ventricular function and surgery on the thoracic aorta, have been associated with lower risk relative to the static model. CONCLUSIONS Dynamic models or periodic model refitting is necessary to counteract calibration drift. A dynamic modeling framework that uses contemporary and available historic data can provide a continuously smooth update mechanism that also allows for inferences to be made on individual risk factors. Better models that withstand the effects of time give advantages for governance, quality improvement, and patient-level decision making.
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Affiliation(s)
- Graeme L Hickey
- University of Manchester, Centre for Health Informatics, Manchester, United Kingdom
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47
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Sharkey AJ, Ariyaratnam P, Belcher E, Kendall S, Naidu B, Parry W, Loubani M. 255 * THORACOSCORE AND EUROPEAN SOCIETY OBJECTIVE SCORE FAIL TO PREDICT MORTALITY IN A UNITED KINGDOM MULTICENTRE STUDY. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.255] [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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49
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Bibiloni Lage I, Khan K, Kaabneh A, Kendall S. Late coronary artery and tricuspid valve injury post pectus excavatum surgery. Interact Cardiovasc Thorac Surg 2013; 17:748-50. [PMID: 23832922 DOI: 10.1093/icvts/ivt280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the surgical case of a 25-year old man admitted because of progressive dyspnoea and stabbing chest pain, who had undergone a pectus excavatum correction using a retrosternal strut 8 years previously. The computerized tomography scan showed that the right tip of the pectus bar had migrated across his right ventricle and tricuspid valve into the right atrium. Intraoperatively, it was confirmed that in its path, the right coronary artery and the posterior leaflet of the tricuspid valve had been damaged. After removing the bar and repairing the tricuspid valve, the patient made a full recovery.
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Affiliation(s)
- Ignacio Bibiloni Lage
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Bull M, Kendall S, Spencer N. P59 Poster Exploring the professional support needs of patients with atrial fibrillation. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-51511160041-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Bull
- South London Cardiac and Stroke Network, London, United Kingdom
| | - S. Kendall
- University of Hertfordshire, Hatfield, United Kingdom
| | - N. Spencer
- University of Hertfordshire, Hatfield, United Kingdom
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