Wolverhampton, United Kingdom
Wolverhampton, United Kingdom

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Southey D.,Cardiothoracic Unit | Mishra P.K.,Cardiothoracic Unit | Nevill A.,University of Wolverhampton | Aktuerk D.,Cardiothoracic Unit | Luckraz H.,Cardiothoracic Unit
Asian Cardiovascular and Thoracic Annals | Year: 2014

Conclusion: The introduction of the nurse practitioner grade to provide continuity in patient care including at weekends has been confirmed to improve patient outcomes including survival after cardiac surgery.Objectives: There have been recent reports on increased mortality in British National Health Service hospitals during weekends. This study aimed to assess the impact on patient care following the introduction of nurse practitioner cover for the cardiothoracic ward, including weekends.Methods: Prospectively collected and validated data of patients operated on from January 2005 to October 2011 were analyzed. The patients were grouped according to era: before (n = 2385) and after (n=3910) the introduction of nurse practitioners in October 2007.Results: There were no significant differences in preoperative patient characteristics such as age, logistic EuroSCORE, sex, smoking, and extracardiac vascular problems. There were more patients from an Asian background (p<0.01), more with noninsulin-dependent diabetes (p<0.01), and more requiring urgent cardiac surgery (p<0.01) in the later era. Following the introduction of nurse practitioner grade, there was a decrease in the rate of cardiac intensive care unit readmission from 2.6% to 1.9% (p=0.05) and length of hospital stay from 10 to 8 days (p<0.01). There was a significant improvement in overall survival after cardiac surgery from 96.5% to 98.0% (p<0.01). Logistic regression analysis confirmed that the presence of nurse practitioners on the ward was the strongest predictor of survival with an odds ratio of 1.9 (95% confidence interval: 1.23-3.01). ©The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.


PubMed | Heart & Lung Center, Cardiothoracic Unit and University of Birmingham
Type: Journal Article | Journal: Heart Asia | Year: 2016

A heart team approach has been recommended for managing patients with coronary artery disease. Although this seems to be a new concept, we have been developing such a practice for over 8years. In this report, the enactment of the heart team decision is reviewed and possible improvement is discussed.Review of 1000 heart team decisions over a 1-year period for patients with coronary artery disease. These decisions were recorded contemporaneously at the time of the team discussion. Thereafter, patients notes were reviewed 6 months following the heart team meeting to assess whether the decision was enacted and, if not, what were the reasons for aberration.The heart team decision was enacted in 95.5% of patients. The reasons for aberration in the remaining 45 patients included patients choice (refusal), unrecognised comorbidities at the time of the heart team discussion, change in patients clinical condition requiring urgent intervention and death while awaiting procedure, among others.The decision of a well set-up heartteam meeting is carried out for most patients. Aberration is uncommon and usually due to unknown factors at the time of the discussion. The heart team approach ensures that patients receive best available care (most likely evidence-based), and demonstrates transparency.


Thekkudan J.,Cardiothoracic Unit | Luckraz H.,Cardiothoracic Unit | Ng A.,Heart and Lung Center | Norell M.,Heart and Lung Center
Interactive Cardiovascular and Thoracic Surgery | Year: 2012

Blunt trauma to the chest is associated with significant morbidity and mortality. The latter is usually due to an aortic transection, whereas the former is related to myocardial contusion, cardiac valve injury, coronary artery disruption and intracardiac shunts due to the formation of septal defects. The main mechanisms causing these injuries are due to the sudden deceleration force and compression within the chest cavity. Moreover, there is also the sudden increase in intravascular pressure due to a mechanical compression effect and a hormonal adrenergic surge during the event. We report a case of a tricuspid valve injury caused by the deployment of the airbag during a high-speed impact car accident and the subsequent damage to the tricuspid valve chordal mechanism. The patient's management and the pathophysiological mechanisms involved in the injury are reviewed. © 2012 The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


Aktuerk D.,Cardiothoracic Unit | Mishra P.K.,Cardiothoracic Unit | Luckraz H.,Cardiothoracic Unit | Garnham A.,Heart and Lung Center | Khazi F.M.,Heart and Lung Center
Annals of Cardiac Anaesthesia | Year: 2016

Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study. © 2016 Annals of Cardiac Anaesthesia.


Mishra P.K.,Cardiothoracic Unit | Ashoub A.,Wessex Cardiothoracic Center | Salhiyyah K.,Wessex Cardiothoracic Center | Aktuerk D.,Cardiothoracic Unit | And 3 more authors.
Journal of Cardiothoracic Surgery | Year: 2014

Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics.However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance.We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward.Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection. © 2014 Mishra et al.; licensee BioMed Central Ltd.


PubMed | University Putra Malaysia and Cardiothoracic Unit
Type: | Journal: Computational and mathematical methods in medicine | Year: 2015

Medical image fusion is the procedure of combining several images from one or multiple imaging modalities. In spite of numerous attempts in direction of automation ventricle segmentation and tracking in echocardiography, due to low quality images with missing anatomical details or speckle noises and restricted field of view, this problem is a challenging task. This paper presents a fusion method which particularly intends to increase the segment-ability of echocardiography features such as endocardial and improving the image contrast. In addition, it tries to expand the field of view, decreasing impact of noise and artifacts and enhancing the signal to noise ratio of the echo images. The proposed algorithm weights the image information regarding an integration feature between all the overlapping images, by using a combination of principal component analysis and discrete wavelet transform. For evaluation, a comparison has been done between results of some well-known techniques and the proposed method. Also, different metrics are implemented to evaluate the performance of proposed algorithm. It has been concluded that the presented pixel-based method based on the integration of PCA and DWT has the best result for the segment-ability of cardiac ultrasound images and better performance in all metrics.


PubMed | Cardiothoracic Unit
Type: Journal Article | Journal: Nigerian journal of clinical practice | Year: 2015

Bronchial carcinoid tumors (BCTs) are an uncommon group of lung tumors. They commonly affect the young adults and the middle aged, the same age group affected by other more common chronic lung conditions such as pulmonary tuberculosis. Diagnosis is commonly missed or delayed due to a low index of suspicion. Surgery is the mainstay of treatment with an excellent outcome. There are many reports of this rare group of tumors in the Western and Asian regions. The only report around our sub-region is a post mortem report of an atypical variant. We wish to report a case of the typical variant and increase our index of suspicion. A 25-year-old male presented with a 4 years history of cough and haemoptysis. He was repeatedly treated for bronchial asthma and pulmonary tuberculosis with no improvement of symptoms. Chest X-ray and chest computed tomography scan revealed a left upper lobe tumor. Histology reported a typical variant of BCT which was confirmed by immunohistochemistry. He had a left upper lobectomy and has done excellently well thereafter. A high index of suspicion is needed to reduce the risk of missing or delaying the diagnosis.


PubMed | University Putra Malaysia and Cardiothoracic Unit
Type: | Journal: Journal of cardiothoracic surgery | Year: 2015

Computerized tomographic angiography (3D data representing the coronary arteries) and X-ray angiography (2D X-ray image sequences providing information about coronary arteries and their stenosis) are standard and popular assessment tools utilized for medical diagnosis of coronary artery diseases. At present, the results of both modalities are individually analyzed by specialists and it is difficult for them to mentally connect the details of these two techniques. The aim of this work is to assist medical diagnosis by providing specialists with the relationship between computerized tomographic angiography and X-ray angiography.In this study, coronary arteries from two modalities are registered in order to create a 3D reconstruction of the stenosis position. The proposed method starts with coronary artery segmentation and labeling for both modalities. Then, stenosis and relevant labeled artery in X-ray angiography image are marked by a specialist. Proper control points for the marked artery in both modalities are automatically detected and normalized. Then, a geometrical transformation function is computed using these control points. Finally, this function is utilized to register the marked artery from the X-ray angiography image on the computerized tomographic angiography and get the 3D position of the stenosis lesion.The result is a 3D informative model consisting of stenosis and coronary arteries information from the X-ray angiography and computerized tomographic angiography modalities. The results of the proposed method for coronary artery segmentation, labeling and 3D reconstruction are evaluated and validated on the dataset containing both modalities.The advantage of this method is to aid specialists to determine a visual relationship between the correspondent coronary arteries from two modalities and also set up a connection between stenosis points from an X-ray angiography along with their 3D positions on the coronary arteries from computerized tomographic angiography. Moreover, another benefit of this work is that the medical acquisition standards remain unchanged, which means that no calibration in the acquisition devices is required. It can be applied on most computerized tomographic angiography and angiography devices.


PubMed | Cardiothoracic Unit
Type: Journal Article | Journal: Annals of cardiac anaesthesia | Year: 2016

Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another.A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies.This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc.,) were taken.The study shows good clinical outcome with the use of NIRS. This is our work in progress, and we aim to conduct a larger study.


Sidestream dark field (SDF) imaging allows direct visualization of microvascular architecture and function. We examine the role of an SDF imaging device in visualizing the sub-lingual microvasculature as a surrogate for splanchnic microperfusion. We demonstrate good correlation between current monitoring techniques and the SDF imaging device in a rare case of vancomycin-resistant enterococcal (VRE) sepsis along with heparin-induced thrombocytopenia (HIT). To the best of our knowledge, VRE endocarditis with concurrent HIT has not been described in literature. The role of SDF imaging may predict the earlier need for escalation of care, improving morbidity and mortality.

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