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Lotan C.,Hebrew University of Jerusalem | Meredith I.T.,Monash University | Jain A.,The London Chest Hospital | Feres F.,Dante Pazzanese Institute of Cardiology | And 3 more authors.
Arquivos Brasileiros de Cardiologia | Year: 2011

Background: Differences between geographic regions in patient characteristics and outcomes, particularly for acute coronary syndromes, have been demonstrated in clinical trials. Clinical outcomes after percutaneous coronary interventions with the zotarolimus-eluting stent in a real-world population were assessed over time. Objectives: The influence of geographic location on clinical outcomes with the zotarolimus-eluting stent was assessed in 3 regions: Asia Pacific, Europe, and Latin America. Methods A total of 8,314 patients (6,572 Europe, 1,522 Asia Pacific, and 220 Latin America) were followed for 1 year; 2,116 of these (1,613, 316, and 187, respectively) were followed for 2 years. Patient and lesion characteristics, dual antiplatelet therapy, and clinical outcomes were compared between Latin America and the other regions. Results: Patients in Latin America had the highest proportions of risk factors and prior myocardial infarction. Dual antiplatelet therapy usage rapidly declined in Latin America, from 44.9% at 6 months to 22.5% at 1 year and 7.8% at 2 years (Europe: 87.4%, 61.5%, 19.7%; Asia Pacific: 82.4%, 67.0%, 45.7%). There were no significant differences between Latin America and Europe or Asia Pacific for any outcome at either time point. The incidence of Academic Research Consortium definite and probable stent thrombosis was low (≤ 1.2%) among all patients at 1 year and 2 years. Conclusions: Clinical outcomes were comparable between patients in Latin America and Europe, and Latin America and Asia Pacific, despite less favorable clinical subsets in Latin America, a higher risk profile, and markedly lower use of dual antiplatelet therapy over time.

Skouras C.,Royal Infirmary | Jarral O.,The London Chest Hospital | Deshpande R.,North Manchester General Hospital | Zografos G.,National and Kapodistrian University of Athens | And 2 more authors.
International Journal of Surgery | Year: 2012

A best evidence topic was written according to a structured protocol. The question addressed was whether early laparoscopic cholecystectomy (ELC) in patients presenting with a short history of acute cholecystitis provides better post-operative outcomes than a delayed laparoscopic cholecystectomy (DLC). A total of 92 papers were found using the reported searches of which 10 represented the best evidence; 3 meta-analyses, 4 randomized control trials, 1 prospective controlled study and 2 retrospective cohort studies were included. The authors, date, journal, study type, population, main outcome measures and results were tabulated.No significant difference in complication or conversion rates were shown between the ELC and the DLC group, in the meta-analyses of Gurusamy et al, Lau et al and Siddiqui et al. The ELC group had a decreased hospital stay whereas the DLC group presented a considerable risk for subsequent emergency surgery during the interval period, with a high rate of conversion to open cholecystectomy. All three meta-analyses were based on the randomized control trials of Lo et al, Lai et al, Kolla et al and Johansson et al; the results of each study are summarized.We conclude that there is strong evidence that early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality. The operating time in ELC can be longer, however the incidence of serious complications (i.e. common bile duct injury), is comparable to the DLC group. Larger randomized studies are required before solid conclusions are reached. © 2012 Surgical Associates Ltd.

Frohlich G.M.,University College London | Lyon R.M.,London Air Ambulance Service HEMS | Sasson C.,Aurora University | Crake T.,University College London | And 5 more authors.
Current Cardiology Reviews | Year: 2013

Out-of-hospital cardiac arrest (OHCA) has attracted increasing attention over the past years because outcomes have improved impressively lately. The changes for neurological intact outcomes has been poor but several areas have achieved improving survival rates after adjusting their cardiac arrest care. The pre-hospital management is certainly key and decides whether a cardiac arrest patient can be brought back into a spontaneous circulation. However, the whole chain of resuscitation including the in-hospital care have improved also. This review describes aetiologies of OHCA, risk and potential protective factors and recent advances in the pre-hospital and in-hospital management of these patients. © 2013 Bentham Science Publishers.

Attaran S.,The London Chest Hospital | Somov P.,The London Chest Hospital | Awad W.I.,The London Chest Hospital
European Journal of Cardio-thoracic Surgery | Year: 2010

Background: Both cancer patients and patients undergoing surgery are thought to be at an increased risk of thrombo-embolic events. Consequently, low-molecular-weight heparin (LMWH) is administered to all such patients perioperatively. There is a lack of consensus in guidelines regarding the timing of administration and the dosage of thromboprophylactic agents. Studies have shown that thrombo-elastography (TEG) is a useful test in assessing global haemostatic function, and has been validated in monitoring the dosage of LMWH. In this study, we assess the coagulation status of patients undergoing thoracic surgery with TEG, and the effectiveness of administered LMWH for thromboprophylaxis. Methods: Thirty patients with primary lung cancer (LC) and 30 with benign lung disease (BL) were studied prospectively. Patients were randomised to receive subcutaneous LMWH 40 mg once or twice per day perioperatively. Their coagulation status was monitored with TEG preoperatively and postoperatively for 3 consecutive days. Results: Preoperative TEG parameters (k time, alpha angle and maximum amplitude (MA)) were within the normal range in both the LC and BL groups. Preoperative r time was prolonged in both the groups, but with no significant difference between the two groups (p > 0.05). Postoperatively, r time was prolonged in some patients receiving LMWH twice daily, suggesting a possible adequate thromboprophylaxis in these patients only. Conclusion: This study demonstrates that the majority of patients with LC are not hypercoagulable. We also showed that LMWH once or twice a day might not provide sufficient thromboprophylaxis. We advocate screening for patients demonstrating hypercoagulable states and ensuring adequate thromboprophylaxis in this group of patients with careful monitoring. © 2009 European Association for Cardio-Thoracic Surgery.

Sepehripour A.H.,Wythenshawe Hospital | Jarral O.A.,The London Chest Hospital | Shipolini A.R.,The London Chest Hospital | McCormack D.J.,The London Chest Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2011

A best evidence topic was written according to a structured protocol. The question addressed was whether harvesting the saphenous vein (SV) as a conduit for coronary artery bypass grafting (CABG) using a no-touch technique would result in better patency rates. This technique involves the harvest of the SV with a pedicle of peri-vascular tissue left intact and the avoidance of distension of the vein prior to anastomosis. A total of 405 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the ultrastructural and mechanical properties of the endothelium and vessel walls of the two harvesting techniques; the protein and enzymatic expression and activity observed; the early atherosclerotic changes detected; and the overall patency of the grafts during short-and long-term angiographical follow-up. Three small prospectively randomised studies compared the patency of grafts harvested using the two techniques and found significant improvements in graft patency using the no-touch harvesting technique in comparison to both the conventional technique and more importantly comparable to the left internal thoracic artery (LITA) patency. The most favourable difference was that of graft patency after 8.5 years of follow-up [90% vs. 76% (P=0.01), LITA patency 90%], and incidence of graft stenosis [11% vs. 25% (P=0.006)]. These findings were supported by the demonstrated improvements in the cellular integrity of the vessels and the reduction in the mechanisms leading to graft failure seen in the no-touch harvested SV grafts. These morphological and cellular analyses were carried by five small comparative studies, demonstrating improved endothelial integrity and reduced injury, decelerated atherosclerotic processes, intact adventitial collagen layers, increase in the total area of vasa vasorum, elevated endothelial nitric oxide synthase expression and activity, and increased peri-vascular leptin levels and activity. We conclude that there are clear enhancements in vessel wall properties at a cellular level and angiographical evidence of superior graft patency when the no-touch SV harvesting technique is employed. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

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