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Article ; Online: Surgical pericardial heart valves: 50 Years of evolution.

Attia, Rizwan Q / Raja, Shahzad G

International journal of surgery (London, England)

2021 Volume 94, Page(s) 106121

Abstract: Valve disease carries a huge burden globally and the number of heart valve procedures are projected to increase from the current 300 000 to 800 000 annually by 2050. Since its genesis 50 years ago, pericardial heart valve has moved leaps and bounds to ... ...

Abstract	Valve disease carries a huge burden globally and the number of heart valve procedures are projected to increase from the current 300 000 to 800 000 annually by 2050. Since its genesis 50 years ago, pericardial heart valve has moved leaps and bounds to ever more ingenious designs and manufacturing methods with parallel developments in cardiology and cardiovascular surgical treatments. This feat has only been possible through close collaboration of many scientific disciplines in the fields of engineering, material sciences, basic tissue biology, medicine and surgery. As the pace of change continues to accelerate, we ask the readers to go back with us in time to understand developments in design and function of pericardial heart valves. This descriptive review seeks to focus on the qualities of pericardial heart valves, the advantages, successes and failures encapsulating the evolution of surgically implanted pericardial heart valves over the past five decades. We present the data on comparison of the pericardial heart valves to porcine valves, discuss structural valve deterioration and the future of heart valve treatments.
MeSH term(s)	Animals ; Aortic Valve/surgery ; Bioprosthesis ; Forecasting ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Pericardium/surgery ; Prosthesis Design ; Swine
Language	English
Publishing date	2021-09-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2021.106121
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Zs.A 6502: Show issues

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Article ; Online: Surgical management of misdeployed transcatheter aortic valve due to eccentric leaflet calcification.

Iqbal, Shahid / Salmasi, M Yousuf / Attia, Rizwan Q / Raja, Shahzad G

Journal of cardiac surgery

2021 Volume 36, Issue 11, Page(s) 4393–4395

Abstract: A serious complication of transcatheter valves is the mechanistic failure of the deployment system and prosthesis migration. We report the case of a transcatheter aortic valve implantation which failed during implantation resulting in dislodgement of the ...

Abstract	A serious complication of transcatheter valves is the mechanistic failure of the deployment system and prosthesis migration. We report the case of a transcatheter aortic valve implantation which failed during implantation resulting in dislodgement of the prosthesis. Emergency surgery to retrieve the deployment system and surgically replace the native valve was the only option to salvage the patient.
MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Calcinosis/diagnostic imaging ; Calcinosis/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Prosthesis Design ; Prosthesis Failure ; Transcatheter Aortic Valve Replacement/adverse effects
Language	English
Publishing date	2021-08-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.15913
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Zs.A 2221: Show issues

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Article ; Online: Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici, Maria / Salmasi, Mohammad Yousuf / Schulte, Katharina L / Raja, Shahzad G / Attia, Rizwan Q

Journal of cardiac surgery

2022 Volume 37, Issue 11, Page(s) 3776–3798

Abstract: Objectives: We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons.: Methods: EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 ... ...

Abstract	Objectives: We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. Methods: EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety-two results were obtained, 27 represented best evidence (2-meta-analyses, 1-RCT, and 24 retrospective cohort studies). Results: In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on-pump vs. 3206 off-pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty-nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high-risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in-hospital or midterm mortality out to 5-years. Discussion: Trainees can perform cardiothoracic surgery in dedicated high-volume units with outcomes comparable to those of fully trained surgeons.
MeSH term(s)	Cardiopulmonary Bypass ; Coronary Artery Bypass/methods ; Coronary Artery Bypass, Off-Pump/methods ; Humans ; Postoperative Complications/etiology ; Retrospective Studies ; Surgeons ; Treatment Outcome
Language	English
Publishing date	2022-09-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.16925
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Article ; Online: Do in-hospital outcomes of isolated coronary artery bypass grafting vary between male and female octogenarians?

Attia, Rizwan Q / Katumalla, Eve / Cyclewala, Shabnam / Rochon, Melissa / Marczin, Nandor / Raja, Shahzad G

Interactive cardiovascular and thoracic surgery

2021 Volume 34, Issue 6, Page(s) 958–965

Abstract: Objectives: Female gender and advanced age are regarded as independent risk factors for adverse outcomes after isolated coronary artery bypass grafting (CABG). There is paucity of evidence comparing outcomes of CABG between male and female octogenarians. ...

Abstract	Objectives: Female gender and advanced age are regarded as independent risk factors for adverse outcomes after isolated coronary artery bypass grafting (CABG). There is paucity of evidence comparing outcomes of CABG between male and female octogenarians. We aimed to analyse in-hospital outcomes of isolated CABG in this cohort. Methods: All octogenarians that underwent isolated CABG, from January 2000 to October 2017, were included. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. A propensity score was generated for each patient from a multivariable logistic regression model based on 25 pre-treatment covariates. A total of 156 matching pairs were derived. Results: Five hundred and sixty-seven octogenarians underwent isolated CABG. This included 156 females (mean age 82.1 [SD: 0.9]) and 411 males (mean age 82.4 [SD: 2.1 years]). More males were current smokers (P = 0.002) with renal impairment (P = 0.041), chronic obstructive pulmonary disease (P = 0.048), history of cerebrovascular accident (P = 0.039) and peripheral vascular disease (P = 0.027) while more females had New York Heart Association class 4 (P = 0.02), left ventricular ejection fraction 30-49% (P = 0.038) and left ventricular ejection fraction <30% (P = 0.049). On-pump, CABG was performed in 140 males and 52 females (P = 0.921). There was no difference in in-hospital mortality (5.4% vs 6.4%; P = 0.840), stroke (0.9% vs 1.3%; P = 0.689), need for renal replacement therapy (17.0% vs 13.5%; P = 0.732), pulmonary complications (9.5% vs 8.3%; P = 0.746) and sternal wound infection (2.7% vs 2.6%; P = 0.882). The outcomes were comparable for the propensity-matched cohorts. Conclusions: No gender difference in outcomes was seen in octogenarians undergoing isolated CABG.
MeSH term(s)	Aged, 80 and over ; Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/complications ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/surgery ; Female ; Hospitals ; Humans ; Male ; Octogenarians ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors ; Stroke/etiology ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left
Language	English
Publishing date	2021-10-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivab281
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Article ; Online: eReply: In patients with acute flail chest does surgical rib fixation improve outcomes in terms of morbidity and mortality?

Attia, Rizwan Q / Schulte, Katharina L / Whitaker, Donald C

Interactive cardiovascular and thoracic surgery

2016 Volume 23, Issue 2, Page(s) 319–320

Language	English
Publishing date	2016
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivw168
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Article ; Online: Outcomes of open and endovascular repair of Kommerell diverticulum.

Bloom, Jordan P / Attia, Rizwan Q / Sundt, Thoralf M / Cameron, Duke E / Hedgire, Sandeep S / Bhatt, Ami B / Isselbacher, Eric M / Srivastava, Sunita D / Kwolek, Christopher J / Eagleton, Matthew J / Mohebali, Jahan / Jassar, Arminder S

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2021 Volume 60, Issue 2, Page(s) 305–311

Abstract: Objectives: Kommerell diverticulum (KD) is a rare congenital vascular anomaly often associated with an aberrant subclavian artery (ASCA). Definitive indications for intervention remain unclear. We present open and endovascular (EV) operative outcomes in ...

Abstract	Objectives: Kommerell diverticulum (KD) is a rare congenital vascular anomaly often associated with an aberrant subclavian artery (ASCA). Definitive indications for intervention remain unclear. We present open and endovascular (EV) operative outcomes in a large contemporary series and propose a management algorithm. Methods: Between 2004 and 2020, 224 patients presented with ASCA and associated KD to our institution. Of the 43 (19.2%) patients who underwent operative repair, 31 (72.1%) had open surgical (OS) repair via thoracotomy and 12 (27.9%) had EV repair. Univariable and bivariable statistical analyses were conducted stratified by approach. The median follow-up time was 5.4 years (IQR, 2.9-9.7). Results: Patients in EV group were older (68 years vs 47 years, P < 0.001) and had larger aneurysms (base diameter 3.2 cm vs 21.5 cm, P = 0.007). All patients with dysphagia lusoria were treated with open surgery (n = 20). Asymptomatic patients with incidentally detected KD (50% vs 16.1%), those with chest or back pain (50% vs 19.4%) and patients who presented with an aortic emergency (25% vs 6.5%) were more likely to be treated endovascularly (P = 0.001). Carotid-to-subclavian bypass was used in 38 (88.4%) patients. There were no operative mortalities. In-hospital mortality was similar between groups (3.2% vs 16.7%, P = 0.121). Mid-term mortality was higher in the EV group [4 (33.8%) vs 0, P < 0.001]. There were 2 (15.4%) postoperative strokes in the EV group. There were no statistically significant differences in other postoperative complications or hospital length of stay between groups. Conclusions: KD can be managed using open or EV approaches with low morbidity and mortality. Treatment strategy should depend on clinical presentation and patient factors.
MeSH term(s)	Aorta, Thoracic/diagnostic imaging ; Aorta, Thoracic/surgery ; Blood Vessel Prosthesis Implantation ; Diverticulum/diagnostic imaging ; Diverticulum/surgery ; Endovascular Procedures ; Heart Defects, Congenital ; Humans ; Retrospective Studies ; Subclavian Artery/diagnostic imaging ; Subclavian Artery/surgery ; Treatment Outcome
Language	English
Publishing date	2021-02-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezab072
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Zs.A 2303: Show issues

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Article ; Online: Distribution of calcium in the ascending aorta in patients undergoing transcatheter aortic valve implantation and its relevance to the transaortic approach.

Bapat, Vinayak N / Attia, Rizwan Q / Thomas, Martyn

JACC. Cardiovascular interventions

2012 Volume 5, Issue 5, Page(s) 470–476

Abstract: Objectives: This study sought to identify how many patients suitable for transcatheter aortic valve implantation (TAVI) would have a contraindication for the transaortic (TAo) approach due to ascending aortic calcification.: Background: TAo is an ... ...

Abstract	Objectives: This study sought to identify how many patients suitable for transcatheter aortic valve implantation (TAVI) would have a contraindication for the transaortic (TAo) approach due to ascending aortic calcification. Background: TAo is an emerging approach for implantation of the Sapien valve through the ascending aorta. A "porcelain aorta" is often considered a contraindication for the TAo approach. This may not always be true, as the TAo procedure requires a small calcium-free area for the purse-string suture, usually in the upper outer quadrant of the distal ascending aorta, identified as the "TAo zone." Methods: A total of 237 patients underwent TAVI between February 2008 and June 2011. Multislice computed tomography scans (MSCT) were analyzed for distribution of calcium with special attention to the TAo zone. Each MSCT was interrogated in cross section and three dimensional (3D) reconstructions. Correlation between the calcium distribution on MSCT and the 3D reconstruction with the clinical findings was sought in patients undergoing the TAo procedure. Results: The vast majority of patients had calcification in the aortic arch (n = 154, 64.9%) and aortic root (n = 220, 92.8%). Of the 237 patients, only 1 patient had diffuse calcification in the ascending aorta, including the TAo zone, thus precluding a TAo procedure. MSCT and 3D reconstruction data in the 33 patients who underwent a TAo procedure, including 6 who were identified as having porcelain aorta preoperatively, correlated very well with the absence of calcium in the TAo zone during surgery. There were no post-procedure neurological events in this group. Conclusions: Conventionally defined porcelain aorta should not be considered a contraindication for performing TAVI by the TAo approach.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Aortic Diseases/complications ; Aortic Diseases/diagnostic imaging ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/therapy ; Aortography/methods ; Cardiac Catheterization ; Contraindications ; Female ; Heart Valve Prosthesis Implantation/methods ; Humans ; Imaging, Three-Dimensional ; London ; Male ; Middle Aged ; Multidetector Computed Tomography ; Patient Selection ; Predictive Value of Tests ; Radiographic Image Interpretation, Computer-Assisted ; Risk Assessment ; Risk Factors ; Treatment Outcome ; Vascular Calcification/complications ; Vascular Calcification/diagnostic imaging
Language	English
Publishing date	2012-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2012.03.006
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Zs.A 6669: Show issues

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Article ; Online: What is the best timing of surgery in patients with post-infarct ventricular septal rupture?

Papalexopoulou, Niovi / Young, Christopher P / Attia, Rizwan Q

Interactive cardiovascular and thoracic surgery

2012 Volume 16, Issue 2, Page(s) 193–196

Abstract: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in which patients with a post-infarct ventricular septal rupture (PIVSR) might immediate surgery give better results than delayed surgery ...

Abstract	A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in which patients with a post-infarct ventricular septal rupture (PIVSR) might immediate surgery give better results than delayed surgery in terms of mortality'? Altogether, 88 papers were found using the reported search criteria, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The recommendations are based on outcomes from 3238 patients undergoing surgery for PIVSR. Mean age was 67.5 ± 8.8 (40-88 years). Left ventricular function was compromised in most patients with mean ejection fraction of 40%. All papers carried out univariate and/or multivariate analyses of variables that contributed to different in-hospital mortalities. Early surgery, i.e. from >3 days to within 4 weeks after MI, had an overall in-hospital mortality of 52.4%; delayed surgery, typically from 1 week to after 4 weeks post-myocardial infarction, had an overall operative in-hospital mortality of 7.56%. Most authors observe that a shorter time between rupture and surgery is an unfavourable predictor of outcome independent of haemodynamic status. The consensus was that nearly all patients with PIVSR, particularly if >15 mm diameter with a significant shunt and resultant haemodynamic deterioration, should undergo early surgical repair. The precise timing of surgery depends on patients' haemodynamic status. Exclusion from surgery should be considered if life expectancy or quality is severely limited by another limiting underlying pathology. If the patient is in cardiogenic shock, due to pulmonary to systemic blood flow ratio shunt rather than infarct size, immediate surgery should follow resuscitation measures and cardiac support. If the patient is haemodynamically stable, surgery could be performed after 3-4 weeks of medical optimization with inotropic and mechanical cardiac support. If there is clinical deterioration, immediate surgery is indicated.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Benchmarking ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/mortality ; Evidence-Based Medicine ; Female ; Hemodynamics ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/complications ; Patient Selection ; Risk Assessment ; Risk Factors ; Stroke Volume ; Time Factors ; Time-to-Treatment ; Treatment Outcome ; Ventricular Function, Left ; Ventricular Septal Rupture/diagnosis ; Ventricular Septal Rupture/etiology ; Ventricular Septal Rupture/mortality ; Ventricular Septal Rupture/physiopathology ; Ventricular Septal Rupture/surgery
Language	English
Publishing date	2012-11-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivs444
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Article ; Online: Aspergillus endocarditis: a case of near complete left ventricular outflow obstruction.

Attia, Rizwan Q / Nowell, Justin L / Roxburgh, James C

Interactive cardiovascular and thoracic surgery

2012 Volume 14, Issue 6, Page(s) 894–896

Abstract: A 60-year old woman presented with dyspnoea and fatigue. She was frail and cachectic (BMI 17.5) with a pancytopenia. Previously she had received chemotherapy for chronic lymphatic leukaemia. She relapsed one year ago necessitating a reduced intensity ... ...

Abstract	A 60-year old woman presented with dyspnoea and fatigue. She was frail and cachectic (BMI 17.5) with a pancytopenia. Previously she had received chemotherapy for chronic lymphatic leukaemia. She relapsed one year ago necessitating a reduced intensity conditioning allogeneic haematopoietic cell transplantation. Subsequently, graft versus host disease required high-dose immunosuppressants. Computerized tomography on admission showed bilateral lung nodules and a suspicious cardiac mass. Bronchial biopsies demonstrated abundant hypae consistent with Aspergillus fumigatus infection. Echocardiography demonstrated a large fungus ball attached to the right coronary cusp of the aortic valve with near complete obliteration of the left ventricular outflow tract. Due to the high risk of embolization this was resected under cardiopulmonary bypass. The mass was attached subvalvularly to the ventricular septal free wall and eroding through it. It peeled off leaving intact aortic leaflets. Unresectable fungal deposits were discovered on the interventricular septum, the left ventricle free wall and posterior aortic wall. High-dose systemic antifungal therapy (Voriconazole and Amphoteracin B) was given for 4 months. After discharge she remained well till a 4-month follow-up, after which she eventually succumbed to her disease. We discuss the clinical difficulties in managing patients with fungal infective endocarditis and present a brief review of cardiac aspergillosis management.
MeSH term(s)	Antifungal Agents/therapeutic use ; Aspergillosis/diagnosis ; Aspergillosis/microbiology ; Aspergillosis/therapy ; Aspergillus fumigatus/isolation & purification ; Cardiac Surgical Procedures ; Echocardiography ; Endocarditis/diagnosis ; Endocarditis/microbiology ; Endocarditis/therapy ; Fatal Outcome ; Female ; Hematopoietic Stem Cell Transplantation/adverse effects ; Humans ; Immunosuppressive Agents/adverse effects ; Leukemia, Lymphocytic, Chronic, B-Cell/surgery ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome ; Ventricular Outflow Obstruction/diagnosis ; Ventricular Outflow Obstruction/microbiology ; Ventricular Outflow Obstruction/therapy
Chemical Substances	Antifungal Agents ; Immunosuppressive Agents
Language	English
Publishing date	2012-02-27
Publishing country	England
Document type	Case Reports ; Journal Article ; Review ; Video-Audio Media
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivr066
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Article ; Online: A case of pulmonary placental transmogrification.

Jenkins, Joanne M / Attia, Rizwan Q / Green, Anna / Cane, Paul / Pilling, John

Asian cardiovascular & thoracic annals

2016 Volume 24, Issue 8, Page(s) 811–813

Abstract: Pulmonary placental transmogrification is a rare lung lesion that microscopically resembles placenta with cystic spaces filled with papillary structures. Considered a histological variant of bullous emphysema, only 30 reported cases have been published ... ...

Abstract	Pulmonary placental transmogrification is a rare lung lesion that microscopically resembles placenta with cystic spaces filled with papillary structures. Considered a histological variant of bullous emphysema, only 30 reported cases have been published in the world's literature. We report a rare case of pulmonary placental transmogrification in a 72-year-old man, in whom the clinical presentation of the disease mimicked lung carcinoma. Histopathology of the surgically resected segment showed a complex bulla with squamous metaplasia and placental transmogrification. Whilst rare, pulmonary placental transmogrification must be ruled out in all patients presenting with unilateral bullous emphysema, without known risk factors.
MeSH term(s)	Aged ; Biopsy ; Blister/diagnostic imaging ; Blister/pathology ; Blister/surgery ; Cysts/diagnostic imaging ; Cysts/pathology ; Cysts/surgery ; Diagnosis, Differential ; Female ; Humans ; Incidental Findings ; Lung Neoplasms/pathology ; Male ; Placenta ; Pneumonectomy/methods ; Positron-Emission Tomography ; Predictive Value of Tests ; Pregnancy ; Pulmonary Emphysema/diagnostic imaging ; Pulmonary Emphysema/pathology ; Pulmonary Emphysema/surgery ; Solitary Pulmonary Nodule/diagnostic imaging ; Solitary Pulmonary Nodule/pathology ; Solitary Pulmonary Nodule/surgery ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2016-10
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1400468-9
ISSN	1816-5370 ; 0218-4923
ISSN (online)	1816-5370
ISSN	0218-4923
DOI	10.1177/0218492316661462
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