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Article: Congenital Absence of Pericardium: A Case Report and Technical Considerations in Cardiac Surgery.

Balaji, Ayush / Makam, Rishab / Hussein, Nabil / Loubani, Mahmoud

2024 Volume 16, Issue 3, Page(s) e56885

Abstract: This case report describes a rare instance of left-sided congenital pericardial agenesis (CPA) encountered during coronary artery bypass grafting (CABG) in a 77-year-old male. In this unique case, the presence of an unusual strip of left pericardium ... ...

Abstract	This case report describes a rare instance of left-sided congenital pericardial agenesis (CPA) encountered during coronary artery bypass grafting (CABG) in a 77-year-old male. In this unique case, the presence of an unusual strip of left pericardium containing the phrenic nerve posed significant surgical challenges. Special attention was required for the graft lay, ensuring adequate filling of the heart during assessment before closure, as well as emphasis on the need for generous graft length. Additionally, the evaluation of graft positioning prior to cardiopulmonary bypass was crucial. Despite these complexities, CABG was successfully performed with no complications to note. This case underscores the importance of adaptability in surgical technique to manage the unique challenges posed by CPA, leading to a positive outcome despite the atypical cardiac anatomy.
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.56885
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Article ; Online: The negative pressure wound therapy for prevention of sternal wound infection: Can we reduce infection rate after the use of bilateral internal thoracic arteries? A systematic literature review and meta-analysis.

Elhassan, Hind / Amjad, Ridha / Palaniappan, Unna / Loubani, Mahmoud / Rose, David

Journal of cardiothoracic surgery

2024 Volume 19, Issue 1, Page(s) 87

Abstract: Background: Negative pressure wound therapy (NPWT) is traditionally used to treat postoperative wound infections. However, its use in closed wound sternotomy post cardiac surgery in high-risk patients has become increasingly popular. The potential ... ...

Abstract	Background: Negative pressure wound therapy (NPWT) is traditionally used to treat postoperative wound infections. However, its use in closed wound sternotomy post cardiac surgery in high-risk patients has become increasingly popular. The potential preventive benefit of reducing sternal wound infections has been recently acknowledged. Bilateral internal mammary artery (BIMA) grafts are used in coronary artery bypass grafting but have been associated with an increased risk of sternal wound infections (SWIs). Objectives: This systematic analysis examines whether NPWT can reduce the incidence of SWI following BIMA grafts, leading to more patients benefiting from the better survival outcome associated with BIMA grafting. Method: A comprehensive systematic search and meta-analysis were performed to identify studies on the use of NPWT in closed wound sternotomy. Ovid MEDLINE (in-process and other nonindexed citations and Ovid MEDLINE 1990 to present), Ovid EMBASE (1990 to present), and The Cochrane Library (Wiley), PubMed, and Google Scholar databases were searched from their inception to May 2022 using keywords and MeSH terms. Thirty-four articles from 1991 to May 2022 were selected. Result: Three studies reported on the outcome of NPWT following BIMA grafting. The pooled analysis did not show any significant difference in the incidence of sternal wound infection between NPWT and standard dressing (RR 0.48 95% CI 0.17-1.37; P = 0.17) with substantial heterogeneity (I Conclusion: The literature identified that NPWT significantly decreased the incidence of sternal wound complications when applied to sutured sternotomy incisions in high-risk patients, and in some cases, it eliminated the risk. However, the inadequate number of randomized controlled trials assessing the effectiveness of NPWT in BIMA grafting emphasizes the need for further, robust studies.
MeSH term(s)	Adult ; Humans ; Mammary Arteries ; Negative-Pressure Wound Therapy ; Wound Healing ; Surgical Wound Infection/prevention & control ; Surgical Wound Infection/epidemiology ; Surgical Wound Dehiscence/prevention & control
Language	English
Publishing date	2024-02-12
Publishing country	England
Document type	Systematic Review ; Meta-Analysis ; Journal Article ; Review
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-024-02589-y
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Article ; Online: Surgical site infection outcomes of two different closed incision negative pressure therapy systems in cardiac surgery: Systematic review and meta-analysis.

Loubani, Mahmoud / Cooper, Matthew / Silverman, Ronald / Bongards, Christine / Griffin, Leah

International wound journal

2024 Volume 21, Issue 1, Page(s) e14599

Abstract: Closed incision negative pressure therapy (ciNPT) system use compared with standard of care dressings (SOC) on surgical site infection (SSI) in cardiac surgery was assessed. A systematic literature review was conducted. Risk ratios (RR) and random ... ...

Abstract	Closed incision negative pressure therapy (ciNPT) system use compared with standard of care dressings (SOC) on surgical site infection (SSI) in cardiac surgery was assessed. A systematic literature review was conducted. Risk ratios (RR) and random effects models were used to assess ciNPT with foam dressing (ciNPT-F) or multilayer absorbent dressing (ciNPT-MLA) versus SOC. Health economic models were developed to assess potential per patient cost savings. Eight studies were included in the ciNPT-F analysis and four studies were included in the ciNPT-MLA analysis. For ciNPT-F, a significant reduction in SSI incidence was observed (RR: 0.507, 95% confidence interval [CI]: 0.362, 0.709; p < 0.001). High-risk study analysis reported significant SSI reduction with ciNPT-F use (RR: 0.390, 95% CI: 0.205, 0.741; p = 0.004). For ciNPT-MLA, no significant difference in SSI rates were reported (RR: 0.672, 95% CI: 0.276, 1.635; p = 0.381). Health economic modelling estimated a per patient cost savings of $554 for all patients and $3242 for the high-risk population with ciNPT-F use. Health economic modelling suggests ciNPT-F may provide a cost-effective solution for sternotomy incision management. However, limited high-quality literature exists. More high-quality evidence is needed to fully assess the impact of ciNPT use following cardiac surgery.
MeSH term(s)	Humans ; Surgical Wound Infection/prevention & control ; Surgical Wound Infection/epidemiology ; Surgical Wound/therapy ; Risk Factors ; Cardiac Surgical Procedures ; Risk Assessment ; Negative-Pressure Wound Therapy
Language	English
Publishing date	2024-01-25
Publishing country	England
Document type	Systematic Review ; Meta-Analysis ; Journal Article
ZDB-ID	2170920-8
ISSN	1742-481X ; 1742-4801
ISSN (online)	1742-481X
ISSN	1742-4801
DOI	10.1111/iwj.14599
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Article: Acute endocarditis in a pregnant patient requiring post-partum emergency mitral valve repair: a case report.

Ravishankar, Ramanish / Hussain, Azar / Loubani, Mahmoud / Chaudhry, Mubarak

Journal of surgical case reports

2023 Volume 2023, Issue 8, Page(s) rjad441

Abstract: A 37-year-old pregnant patient presented with symptoms of shortness of breath, cough and malaise at 36 weeks' gestation. Antibiotics were started because of suspected bilateral pneumonia. A lower segment caesarean section was undertaken and significant ... ...

Abstract	A 37-year-old pregnant patient presented with symptoms of shortness of breath, cough and malaise at 36 weeks' gestation. Antibiotics were started because of suspected bilateral pneumonia. A lower segment caesarean section was undertaken and significant desaturation lead to intubation of the patient. A CTPA confirmed bilateral pneumonia but also elements of heart failure with a 32 mm dilated pulmonary artery. Severe mitral regurgitation was confirmed with trans-thoracic and trans-oesophageal echocardiogram on Day 5 and emergency mitral valve repair was undertaken for possible infective endocarditis (IE) as per the modified Duke criteria, which was confirmed intra-operatively. The patient completed 4 weeks of antibiotics and suffered mild memory impairment post-operatively. She was discharged from complex rehabilitation after 6 weeks of hospital stay at her baseline state. This case presents IE in a pregnant patient with no significant risk factors with successful recovery because of prompt diagnosis and management.
Language	English
Publishing date	2023-08-08
Publishing country	England
Document type	Case Reports
ZDB-ID	2580919-2
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjad441
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Article ; Online: Reply to Bajona.

Loubani, Mahmoud

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

2014 Volume 45, Issue 4, Page(s) 764

MeSH term(s)	Clinical Competence/standards ; Education, Medical, Graduate/methods ; Humans ; Thoracic Surgery/education
Language	English
Publishing date	2014-04
Publishing country	Germany
Document type	Comment ; Letter
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezt352
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Article ; Online: Corrigendum To 'Is it time to incorporate hands-on simulation into the cardiothoracic surgery curriculum?'

Hussein, Nabil / Zientara, Alicja / Gollmann-Tepeköylü, Can / Loubani, Mahmoud

Interactive cardiovascular and thoracic surgery

2022 Volume 34, Issue 3, Page(s) 514

Language	English
Publishing date	2022-02-15
Publishing country	England
Document type	Published Erratum
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivab347
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Article ; Online: Permanent pacemaker post-valve surgery: Do valve type and position matter? A propensity score matching study.

Gatta, Francesca / Haqzad, Yama / Loubani, Mahmoud

Journal of clinical and translational research

2021 Volume 7, Issue 6, Page(s) 786–791

Abstract: Background and aim: This study evaluates whether aortic valve replacement (AVR) or mitral valve replacement (MVR) with biological versus mechanical prostheses is independent risk factors for permanent pacemaker (PPM) post-cardiac surgery, alongside ... ...

Abstract	Background and aim: This study evaluates whether aortic valve replacement (AVR) or mitral valve replacement (MVR) with biological versus mechanical prostheses is independent risk factors for permanent pacemaker (PPM) post-cardiac surgery, alongside traditionally accepted determinants. Methods: This study focused on single-centre retrospective analysis of 10 years of activity. Case-control 1-to-9 matching was performed for 7 pre-operative and 2 intraoperative confounding factors. Results: After matching, 617 patients were included for analysis: AVR (79.4% Conclusion: Valve position and valve type do not affect the likelihood of requiring permanent pacing in patients undergoing isolated aortic and MVR. Relevance for patients: A significant proportion of patients undergoing cardiac surgery develop arrhythmias and conduction disturbances postoperatively, often requiring the implantation of a PPM. Determining factors associated with an increase likelihood of permanent pacing would allow the optimization of per- and intra-operative care, with the aim of reducing the incidence of patients requiring post-operative PPM insertion.
Language	English
Publishing date	2021-11-29
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	3019815-X
ISSN	2424-810X ; 2382-6533
ISSN (online)	2424-810X
ISSN	2382-6533
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Article ; Online: Short-term and long-term impact of diagnosed and undiagnosed chronic obstructive pulmonary disease on coronary artery bypass grafting surgery.

Gatta, Francesca / Haqzad, Yama / Loubani, Mahmoud

Postgraduate medical journal

2021 Volume 98, Issue 1158, Page(s) 258–263

Abstract: Objectives: This study sought to compare clinical outcomes between three categories of patients: non-chronic obstructive pulmonary disease (COPD), diagnosed COPD and undiagnosed COPD in coronary artery bypass grafting surgery.: Methods: A single- ... ...

Abstract	Objectives: This study sought to compare clinical outcomes between three categories of patients: non-chronic obstructive pulmonary disease (COPD), diagnosed COPD and undiagnosed COPD in coronary artery bypass grafting surgery. Methods: A single-centred retrospective study from January 2010 to December 2019. Primary outcomes were postoperative complications, length of ITU admission and in-hospital staying. Secondary outcomes were reintervention rate, in-hospital and long-term mortality. Results: A total of 4020 patients were analysed and divided into three cohorts: non-COPD (group A) (74.55%, n=2997), diagnosed COPD (group B) (14.78%, n=594) and undiagnosed COPD (group C) (10.67%, n=429). The rate of respiratory complications was noted in this order: group B>group C>group A (p 0.00000002). Periooperative acute kidney injury and wound complications were higher in group B (p 0.0004 and p 0.03, respectively). Prolonged in-hospital staying (days) resulted in group B (p 0.0009). Finally, long-term mortality was statistically higher in group B and C compared with group A (p 0.0004). No difference in long-term mortality was noted in relation to the expected FEV1% in group B (p 0.29) and group C (p 0.82). Conclusions: In CABG surgery, COPD is a well-known independent risk factor for morbidity. Patients with preoperative spirometry results indicative of COPD result in the same outcomes of known patients with COPD. As a result of that, greater value should be given to the preoperative spirometry in the EuroSCORE. Finally, the expected FEV1% appears not be a predictor for long-term survival.
MeSH term(s)	Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/complications ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/surgery ; Humans ; Postoperative Complications/etiology ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Retrospective Studies ; Risk Factors ; Spirometry ; Treatment Outcome
Language	English
Publishing date	2021-01-12
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2020-139341
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Article ; Online: Is it time to incorporate hands-on simulation into the cardiothoracic surgery curriculum?

Hussein, Nabil / Zientara, Alicja / Gollmann-Tepeköylü, Can / Loubani, Mahmoud

Interactive cardiovascular and thoracic surgery

2021 Volume 34, Issue 4, Page(s) 564–565

Abstract: The COVID pandemic has had huge implications for training in cardiothoracic surgery. The reduction in training opportunities has led to concerns from trainees globally regarding the impact on their learning and their training progression. Surgical ... ...

Abstract	The COVID pandemic has had huge implications for training in cardiothoracic surgery. The reduction in training opportunities has led to concerns from trainees globally regarding the impact on their learning and their training progression. Surgical simulation is effective in the development of technical skills in cardiothoracic surgery with numerous examples of low and high-fidelity simulators. Despite this the incorporation of such methods into training curricula worldwide is seldom. Core fundamentals are required to successfully implement surgical simulation into training programmes, which includes; commitment from trainers, regular sessions and structured feedback. Few programmes have demonstrated the successful incorporation of surgical simulation and there is a growing acceptance of its place in the speciality. As we recover from this challenging period it may be the right opportunity to evolve how we train our current and future trainees by incorporating hands-on simulation as a fundamental part of the cardiothoracic curriculum.
MeSH term(s)	COVID-19 ; Clinical Competence ; Computer Simulation ; Curriculum ; Humans ; Specialties, Surgical
Language	English
Publishing date	2021-10-30
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivab290
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Article ; Online: The impact of antiarrhythmics on human pulmonary arteries: Ex vivo characterization.

Makam, Rishab / Tajmohamed, Nayla / Qadri, Syed / Chaudhry, Mubarak / Cowen, Michael / Loubani, Mahmoud / Hussain, Azar

Journal of clinical and translational research

2022 Volume 8, Issue 4, Page(s) 302–307

Abstract: Background and aim: The safety and efficacy of the antiarrhythmic agents, amiodarone, and digoxin, in patients with pulmonary hypertension (PH), is not described well in the literature, although their use is common practice. Our study aims to ... ...

Abstract	Background and aim: The safety and efficacy of the antiarrhythmic agents, amiodarone, and digoxin, in patients with pulmonary hypertension (PH), is not described well in the literature, although their use is common practice. Our study aims to investigate the effect of these drugs on pulmonary arteries (PA) which may have implications for their use in patients with PH. Methods: Human PAs were obtained from consenting patients undergoing lobectomies. Arterials rings (n=40 from ten patients) were dissected form the tissue and mounted onto a multiwire myograph. The rings were preconstricted using prostaglandin F2α before the addition of additive dilutions of amiodarone and digoxin. Finally, the reagents were washed out and the arterial rings' viability was confirmed using acetylcholine and potassium chloride. Results: Amiodarone had a slightly vasodilatory effect on the arterial rings, whereas digoxin had a relatively neutral effect. Amiodarone caused the greatest vasodilatory response at 100 µM with an active tension of -0.494 gram force with an EC50 of 9.42 µM. Digoxin produced no significant vasodilatory or vasoconstrictive response. Conclusions: This study demonstrated the ex vivo effects of amiodarone and digoxin on human pulmonary arterial tension. The results of the study showed that neither amiodarone nor digoxin had any vasoconstrictive effects. Amiodarone also exhibited vasodilatory properties and, therefore, may be used preferentially as it could help reduce the impact of PH. However, more studies need to be conducted before we can confirm the safety of these drugs. Relevance for patients: The ambivalence surrounding treatment of postoperative arrhythmias in patients with PH results is a significant disparity between individual cases. Our study takes the first step in elucidating, in which drugs may be a safer treatment for patients with the aim to resolve the doubts clinicians may have about using these treatments. The principal goal of our work is to ensure that we are providing patients with the most effective and, more importantly, safest treatment.
Language	English
Publishing date	2022-07-25
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	3019815-X
ISSN	2424-810X ; 2382-6533
ISSN (online)	2424-810X
ISSN	2382-6533
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