bluuebunny/crossref_metadata_2025_split huggingface dataset:
354 Thoracic Complex Case Review Meeting (CCRM): A Multidisciplinary Approach to Improving Patient Care and Service Efficiency
Authors: Rozwadowski S , Teh E , West D 
Published: October 2021

Abstract

Objectives
The profile of thoracic patients and the indications for surgery are becoming increasingly complex. A multidisciplinary perioperative approach can optimise patients, improve outcomes and prevent high-risk patients being inappropriately declined surgery. We aim to retrospectively review the first 100 patients discussed at the CCRM in 2016-17 with a primary outcome of number of on-the-day cancellations. Secondary outcomes include unplanned critical care (HDU) admissions, 30 and 90-day morbidity and mortality.

Method
Data was collected retrospectively for demographics, co-morbidities, lung-function and dynamic testing, diagnosis and proposed surgical approach. CCRM outcomes included need for HDU, requiring further optimisation, change in surgical strategy or patient deemed too high risk.

Results
Average age was 69 years (IQR 12.5) (65 M: 35 F). American Society of Anaesthesiologists’ classification of 3 with predicted of mortality of 2 % (IQR 0.8). Maximal oxygen uptake (VO2 max) was 18.6ml/kg/min (SD ± 4.2). 24 patients were recommended for optimisation and 34 to proceed with HDU. 14 were deemed too high-risk and 30 had a change in surgical strategy. Only 1 patient was cancelled on-the-day due to a recent deterioration in health. 30 and 90-day mortality rates were 1% and 2% respectively, and 2 patients required unplanned HDU.

Conclusions
CCRM is a simple approach to optimise high-risk patients and minimise unplanned HDU. No patients were cancelled on-the-day due to inadequate optimisation or unexpected need for HDU. Mortality was acceptable and lower than predicted. Our study established CCRM as a safe and effective way of selecting high-risk patients for further optimisation and appropriate perioperative care.
401 Conventional Aortic Valves Versus Rapidly Deployed Valves in The Elderly Population. A Comparative Study in A Single Centre Experience
Authors: Moawad N , McCrorie A , Aljanadi F , Jones M 
Published: October 2021

Abstract

Aim
Current recommendations favour TAVI over Surgical Aortic valve replacement (SAVR) for patients aged&gt;75 years. However, in current practice a significant proportion of patients in this group are offered SAVR. Rapidly deployed valves are of increasing popularity among surgeons as they shorten the procedure time, but their benefits are yet to be investigated.

Method
Patients aged &gt;75 years undergoing Aortic valve replacement with or without any concomitant procedure were included between January 2014 and January 2020 (total: 597). Patients were divided into two groups: Group A (495 patients) conventional Aortic valve and Group2 (102 patients) rapidly deployed valve.

Results
Preoperative variables including mean age, EuroScore II, and body mass index were of no statistical significance between the two groups. More females and Octogenarians were in the rapidly deployed valve group versus the conventional valve group, respectively. Bypass time and Cross-clamp times were shorter in rapidly deployed group. However, the length of ICU and hospital stay was not significant between the two groups. Early post-operative pacemaker implantation (Conventional 2% Vs RDV 7%) (P &lt; 0.05) differed significantly between groups. At follow up echocardiography, pressure gradients were comparable between groups. Thirty-day mortality and valve-related complications were insignificant.

Conclusions
RDVs show comparable early and medium-term outcomes and valve hemodynamics. RDVs are associated with shortened operative time and cross-clamp time but may carry an increased risk of need for permanent pacing.
403 Sutureless Sorin Perceval Versus Rapidly Deployed Edwards Intuity Elite: Short- And Medium-Term Outcomes Comparison in A Single Centre Experience
Authors: Moawad N , Aljanadi F , Jones M 
Published: October 2021

Abstract

Aim
Rapid deployment aortic valves (RDAV) are an alternative to conventional aortic valve replacement. This single-centre study compares surgical outcomes, and hemodynamic performance between the rapid deployment valves.

Method
A total of 120 consecutive patients receiving either a Sorin Perceval S (N = 61) or an Edwards INTUITY valve (N = 59) between January 2016 and September 2019 were included. Retrospective analysis of prospectively collected data from all patients undergoing isolated Aortic valve replacement or with any concomitant procedure were included. This study compared Preoperative characteristics, valve-related adverse events, post-operative complications, trans-valvular gradients and survival rates.

Results
Mean age, EuroSCORE II 2.78, body mass index and gender distribution were similar between the two studied groups. More Octogenarians received a Perceval valve than an Intuity valve (31 vs 9 P &gt; 0.05). Thirty-day mortality and valve-related complications including need for insertion of permanent pacemaker were comparable. At follow up echocardiography, peak or mean pressure gradients were comparable between groups. However, higher peak gradient was recorded when Perceval size S is compared to Intuity 21 (P &lt; 0.05) and Perceval size L is compared to Intuity 25 (P,0.05)

Conclusions
Both Perceval and Intuity rapid deployment valves had good early and medium-term surgical outcomes and valve hemodynamics, with relatively low valve-related complication rates. More Perceval valves were deployed through Mini-sternotomy incision but Intuity valves were used more often with double valve procedures. Intuity valves were associated with lower pressure gradients when compared with size matched Perceval valves.
458 Blood Loss Following First Time Coronary-Artery-Bypass-Graft (CABG)
Authors: Ishak L , Morcos K , Curry P 
Published: October 2021

Abstract

Introduction
Blood loss following cardiac surgery is a recognised complication associated with post-operative mortality and morbidity.

Aim
To identify parameters associated with blood loss and need for blood transfusion following first time coronary-artery-bypass-graft (CABG).

Method
Data was collected retrospectively on 50 patients who underwent a first time CABG between 12/02/2020 – 21/09/2020 at the Golden Jubilee National Hospital (GJNH). Parameters included pre-operative and post-operative haemoglobin, platelets, INR, calcium levels, patient age, body-mass-index (BMI), creatinine clearance (CrCl), presence of co-morbidities, anti-coagulant drug use, cross-clamp time, bypass time, re-exploration rates and number of grafts. Patients who required a blood transfusion post-operatively were compared with those who did not require transfusion.

Results
Seventeen of the 50 patients required a blood transfusion. This group had a lower mean post-operative haemoglobin levels (90.82 vs 107.82, p = &lt;0.001), lower mean post-operative platelet levels (138.47 vs 187.09, p = 0.02), higher post-operative INR (1.25 vs 1.15, p = 0.15), higher mean BMI (27.93 vs 30.433, p = 0.063), higher mean renal dysfunction severity grades (0.7 vs 0.3, p = 0.044) and lower mean CrCl (78 vs 97, p = 0.025). The transfused patient group had older mean age (68.29 vs 64.84, p = 0.065) and a longer mean post-operative hospital stay (9.38 vs 6.67 days, p = 0.043). More patients had pre-operative haemoglobin &lt;120 (p = 0.26), post-operative haemoglobin &lt;90 (p = &lt;0.0001) and post-operative platelets &lt;100 (p = 0.0029). One patient in the transfused group died post-operatively.

Conclusions
Sub-optimal peri-operative blood levels, renal dysfunction, patient age and patient BMI can influence blood loss and requirement for transfusion following first time CABG.
462 Factors Associated with Longer Post-Operative Hospital Stay Following First Time Coronary-Artery-Bypass-Graft (CABG)
Authors: Ishak L , Morcos K , Curry P 
Published: October 2021

Abstract

Prolonged post-operative hospital stay is associated with worse patient healthcare outcomes.

Aim
To identify parameters which correlate with longer post-operative hospital stay (POHS) following first time Coronary-Artery-Bypass-Graft (CABG)

Method
Data was collected retrospectively on 50 patients who underwent a first time CABG between 12/02/2020 – 21/09/2020 at the Golden Jubilee National Hospital (GJNH). Data included patient demographics, body-mass-index (BMI), presence of co-morbidities, peri-operative blood results, pre-operative renal dysfunction, left ventricular systolic dysfunction (LVSD), severity of left main stem disease, New York Heart Association (NYHA) Functional Classification score, number of grafts, cross-clamp time and bypass time.

Results
The mean POHS was 7.5 days. Patients with a POHS&gt;7.5 days had a total mean POHS twice as long (12.07 vs 5.7 days, p &lt; 0.001). They spent more time in intensive care unit (2.6 vs 0.97 days, P = 0.05), high dependency unit (2.5 vs 1.2 days, p = 0.005) and ward (7 vs 3.5 days, p = 0.001) compared to the shorter POHS group. They had a higher mean age (69 vs 65, p = 0.036), lower mean CrCl (80.32 vs 95.14, p = 0.141), higher mean renal dysfunction severity grades (0.8 vs 0.28, p = 0.014), higher mean LVSD severity grades (0.33 vs 0.17, p = 0.35) and higher mean NYHA scores (2.2 vs 1.88, p = 0.17). More of the patients had renal dysfunction (p = 0.01), were on ≥ 2 anticoagulants (p = 0.028), had sub-optimal pre-operative bloods (p = 0.075) and required blood transfusion post-operatively (p = 0.02). One patient in the longer POHS group died.

Conclusions
Longer POHS was associated with older age, worse renal function, presence of co-morbidities, sub-optimal peri-operative blood levels and requirement for post-operative blood transfusions.
772 Surgery for Bullous Lung Disease
Authors: Mohamed B , Awad Ahmed S , Hussein H , Ahmed M E A 
Published: October 2021

Abstract

Aim
The aim of this study to assess the surgical presentation and outcome for bullous lung disease in Sudanese patients.

Method
A cross sectional hospital based descriptive retrospective study. Procedures were conducted at Al-Shaab Teaching Hospital Sudan during the period from November 2009 to September 2012.

Results
11 patients had lung bullae in the given period. Smoking does not play an important role in the development of bullae in healthy young adults in our patients. Vanishing Lung syndrome (VLS) was seen in 18% of patients without history of smoking. The patients presenting in the fifth decade of life constituted (36.3%) of total number. symptoms of presentation were chest pain and SOB and half of them (45.5%) had exertional dyspnoea. The duration of symptoms before presentation was more than 2 months. Asthma was the only respiratory disease associated seen in 45%. HBV and HTN were the most associated diseases seen in 27% and 18% respectively without significant findings in the history. The diagnosis was made by highresolution CT. Chest in all patients. Bullectomy was done to majority of patients. Muscle sparing thoracotomy is the standard approach (Posterolateral Thoracotomy). improved regarding symptoms and signs (90.9%) and) and no death reported.

Conclusions
Bullous lung disease with bilateral lung involvement is common in our patients. However, there was no association between lung bullae and smoking in our population. lt's associated with other respiratory disease. The outcome was excellent, and no death was reported. To prevent the miss diagnosis we need sensitive and noninvasive investigation tools.
870 Surgical Outcomes of Primary and Two-Stage Atrioventricular Septal Defect (AVSD) Repair: A Single Institution Experience
Authors: Kwong J J , Hew C C , Haranal M 
Published: October 2021

Abstract

Objective
To examine the surgical outcomes of primary and two-stage repair of complete atrioventricular septal defect(AVSD).

Method
This retrospective study included 74 patients who underwent operation for balanced complete AVSD between January 2015 and December 2018 in National Heart Centre Kuala Lumpur. Patient demographics, types of procedure, post-op complications and follow-up atrioventricular (AV) valve function were analysed.

Results
Twenty-one patients (median age: 3 months(2.28-4.32months)), weight: 3.10kg( 2.7-3.82kg)) had Pulmonary Artery Banding (PAB) prior to complete AVSD repair. The post-banding weight of patients rose from 3.1kg to 6.4kg prior to complete repair. The rate of ventilator dependence decreased from 19.8 to 4.8%. There was no worsening of post-banding left AV valve insufficiency (5%) before the complete repair. There was no statistically significant difference in the outcomes after complete AVSD repair in both groups (mortality p = 0.133, morbidities p = 0.471). There was a trend towards higher left AV valve insufficiency in the PAB group over time (at discharge, 10 vs 12%; at 3-months, 12 vs 6%; at 1-year, 14 vs 11%). Similarly, the PAB group also demonstrated a trend towards higher rates of major post- operative complications (33 vs 21%) and in-hospital mortality (9.5 vs 1.9%).

Conclusions
PAB remained as an effective palliative procedure for patients who are not suitable for primary AVSD repair at the time of presentation. However, it is associated with a higher incidence of left AV valve insufficiency at follow up.
1097 17 Years of Treating Deep Sternal Wound Infections at A Single Institution: Outcomes and Lessons Learned
Authors: Argyriou A , Hasan R , Abunasra H , McLaughlin K , Bilal H , Sogliani F , Datta S 
Published: October 2021

Abstract

Introduction
Deep sternal wound infections (DSWI) are a serious complication following cardiac surgery that comprise of any infection penetrating the subcutaneous tissue of the sternum. DSWI have been found to increase mortality and worsen prognostic outcomes following surgery.

Method
We conducted a retrospective cohort study using hospital e-records from 2000 to 2017 of all adult patients operated on with a median sternotomy at our institution. Univariate and multivariate analysis along with mortality and Kaplan-Meier survival curves compared the DSWI population against the remaining study population, using SPSS-25 software.

Results
Of 15521 total patients in the study, 145 (0.9%) suffered a DSWI. Variables that were associated with DSWI included age at operation (p = 0.019), gender (p = 0.007), BMI (p = 0.001), diabetes (p &lt; 0.0001), renal disease (p = 0.008), operative urgency (p = 0.007), type of operation (p = 0.02), Euroscore (p = &lt;0.0001), bypass-time (p = 0.038) and crossclamp-time (p = 0.008). A logistic regression encompassing significant variables revealed that gender (p = 0.031 CI 1.45-1.96), BMI (p &lt; 0.0001 CI 1.03-1.10), diabetes (p = 0.007 CI 1.20-3.67) and type of operation (p = 0.018 CI 1.23-1.87) remained significant when covariate contribution was eliminated. DSWI subgroup mortality was insignificant at 30 days (3.4%vs2.9%, p = 0.68) but significantly worse at 90 days (8.3%vs3.7%, p = 0.004) and at 1 year (17.2%vs5.4%, p &lt; 0.0001). Kaplan-Meier analysis depicted a significantly worse survival distribution for the DSWI population compared to rest of study (Log-Rank&lt;0.05).

Conclusions
At our centre, DSWI are attributable to certain modifiable and set demographics and contribute heavily to medium-term mortality. A better understanding of DSWI risk factors may pinpoint those at risk and benefit the multidisciplinary team to ultimately reduce the rate of DSWI.
1258 Computational Modelling Of 3D Printed Scaffolds for Heart Valve Regeneration
Authors: Georgi M , Wu L , Ma H , Hamilton G , Song W 
Published: October 2021

Abstract

Aim
Prosthetic heart valve replacement remains the gold standard treatment for valvular heart disease. However, its durability is limited and there is thus a need to develop an understanding of the feasibility of alternative replacement therapies. 3-dimensional printing of heart valves has been explored due to its patient-specific design and control of desired biomechanical properties. Computational studies of the synthetic valves will contribute to optimisation of designs, as well as improved understanding of the biomechanical behaviour of the complex structures.

Method
Aortic valve dimensions at an average of 100mmHg were used for the computerised design of the valves. Fine Element Analysis modelling generated computational experiments alongside predicted results. Simulated radial pressures tests were conducted at pressures from 0mmHg to 140mmHg and compression tests were conducted at displacement levels between 0-10mm. A Young’s modulus of 0.5 MPa was used. All simulations were conducted in a quasi-static manner.

Results
As the radial pressure on the valves increased, the Mises stresses increased. The maxium Mises stress of the heart valve was 0.09MPa and 0.13MPa under the pressures of 90mmHg and 140mmHg respectively. As valve displacement increased, the Mises stress of the heart valves proportionally rose. In simulated radial pressures tests, the compressive force was 0.19N at 1mm compressive displacment and 1.8N at 10mm compressive displacment.

Conclusions
The simulations demonstrated that 3D-printed heart valve scaffolds can withstand simulated radial pressure and compression tests. A further mechanical tests of the printed scaffold and understanding of its response to hemodynamic dynamic flow is required for the continuity of further study.
1292 Aortic Valve Neocuspidization Using Glutaraldehyde-Treated Autologous Pericardium: A Literature Review
Authors: Chan J. , Basu A. , Di Scenza G. , Bartlett J. , Fan K. S. , Oo S. 
Published: October 2021

Abstract

Background
Aortic Valve Neocuspidization using glutaraldehyde-treated autologous pericardium was first performed by Ozaki et al. in 2007. This technique has become an alternative to tissue and mechanical valve as long-term anticoagulation is not required and shows promising midterm results and durability.

Method
A comprehensive search was performed on the major database using search terms “Ozaki technique” AND “Aortic Valve Neocuspidization” AND “AV Neocuspidization” AND “Autologous pericardium” AND “glutaraldehyde-treated autologous pericardium”. Articles up to 1st of August 2020 were included in this study.

Results
A total of 9 studies with a total of 1342 patients were included. The mean age was 67.36 and 54.23% were male. 66.32% and 23.92% of patients had aortic stenosis and aortic regurgitation, respectively. 66% of patients had a native tricuspid aortic valve and 31.37 % patients’ native aortic valve was bicuspid. Three studies reported their experience performing Aortic Valve Neocuspidization via mini sternotomy.

Conclusions
Aortic Valve Neocuspidization is an alternative to biological and mechanical prostheses for surgical aortic valve replacement. The short and mid-term outcome are comparable without the need for long term oral anticoagulation. Long term follow-up data is required for this novel approach to be widely adopted.
1355 Clinical Profile of Congenital Heart Diseases in Children in Khartoum, Sudan
Authors: Elhassan A B E , Salman M. Suliman T , Elkhidir I. Hassan E , Mohamed S. Omer O , Ibrahim A , Mohammed F , Abuzied A , Elhassan M 
Published: October 2021

Abstract

Aim
Congenital heart diseases (CHDs) are heart abnormalities that present at birth and are one of the most common birth defects in children. Few studies assessed the clinical profile of CHDs in Sudan, and they are almost outdated. The aim of this study was to provide a recent overview of the clinical profile of CHDs in Khartoum, Sudan.

Method
a descriptive cross-sectional hospital-based study was done in 2016 in 3 main pediatric tertiary care hospitals in Khartoum. Firstly, the authors included all patients presented with suspicion of cardiac diseases. From which only those diagnosed with CHDs were included. The total sample size was 112 patients, from which CHDs comprised 60 patients.

Results
among the 112 patients, 53.6% had CHDs, 25% had acquired diseases, and 21.4% were normal. Of those with CHD, 60% were having acyanotic CHD, and 21.7% were having cyanotic CHD, the remaining patients had other cardiac defects. VSD was the most predominant individual CHD (33%), followed by ASD (19%), PDA (16.8%) and TOF (16.8%). VSD was the most common acyanotic lesion, while TOF was the most common cyanotic lesion followed by TGA and pulmonary atresia (PA).

Conclusions
We have an updated overview of the clinical profile of CHDs in Khartoum, Sudan. CHDs were the most common form within all pediatric patients with cardiac disease. From these CHDs, acyanotic lesions were the most common ones. VSD was the most common acyanotic lesion followed by PDA. TOF was the most common cyanotic lesion. These findings are consistent with studies done regionally and internationally.
1608 Mitral Valve Disease Timing and Outcomes of Surgery
Authors: Mabon M A , Badran A , Ramadan T , Abuseedou R , Ohri S 
Published: October 2021

Abstract

Aim
Mitral valve disease (MVD) is a heart valvular defect associated with significant morbidity and mortality. Individual patient management depends on symptomatic disease, fitness and type of pathology. Surgical intervention remains the standard for definitive management. The optimal time to operate is debated and considerations for earlier surgical intervention include reduced risk of surgery and co-morbidity prevention. We aim to evaluate when patients with MVD receive treatment and if this is associated with patient outcome

Method
Patients who received surgery for MVD between 2018 and 2020 were included. Electronic records were examined, and a database was created of patient demographics, symptoms, surgery and outcomes.

Results
Our patient cohort consisted of n = 355, with n = 198 receiving elective intervention. There was a higher male to female ratio (58% vs 42% respectively). Mean intervention time was 157.6 days and mean age was 71 years (24-93). Cohort mortality rate was 6.5% (n = 23). The cohort was split into two groups; early surgical intervention (within 90 days from diagnosis) consisting of n = 59 and late surgical intervention (after 90 days) n = 139; demographics and comorbidities were similar in both groups. No significant associations were found between intervention time and our variables. There was no significant association between intervention time and 60-day mortality or with any complication.

Conclusions
There is no significant association found between timing of intervention and patient outcome. Early surgical intervention is no worse than later surgical intervention although the data supports patients were intervened at the most appropriate time according to clinical evaluation.
1623 Atrial Fibrillation Post Aortic Valve Replacement: Prevalence and Causative Factors
Authors: Baker S , Badran A , Naseer M , Ohri S 
Published: October 2021

Abstract

Aim
Atrial fibrillation (AF) is the most prevalent arrhythmia. Post-Operative AF (POAF) occurs in a third of patients post cardiac surgery. We aim to explore the incidence of AF post aortic valve replacement (AVR) and whether clinical and echocardiographic parameters can predict the likelihood of AF and therefore influence the management of patients.

Method
Our study consisted of 985 patients who underwent AVR between 2018 – 2019 from a single major cardiothoracic surgery centre in the UK. Data was collected from the electronic patient records retrospectively.

Results
Mean age of the cohort was 71.8 years (27-92). There were more males (68.2%, n = 672) than females (31.8%, n = 313). A majority of patients (51.8%, n = 510) developed an episode of AF in the post-operative period, of which 65.1% was new onset (n = 330). Incidence of post-operative AF was associated with more HTN (p = 0.007), poor left ventricular function as well as increased left atrial diameter (P = &lt;0.001).

Conclusions
There is a high incidence of AF following AVR surgery. Comorbidities as well as left atrial diameter have a statistically significant relationship with this incidence and could be used as predictors of postoperative atrial fibrillation.