Publications by authors named "Nikhil Prakash Patil"

28 Publications

  • Page 1 of 1

How to Do It - Implantation Technique for Newer-Generation Sutureless/Rapid-Deployment Aortic Valve Replacement.

J Heart Valve Dis 2016 03;25(2):227-229

Department of Cardiac Surgery, Harefield Hospital.

'Sutureless' or rapid-deployment (RD) aortic valve replacement (AVR) is an emerging alternative to standard AVR in elderly high-risk surgical patients. Here, the authors describe their implantation technique for the newer-generation Edwards INTUITY-Elite® valve (Edwards Lifesciences, Irvine, CA, USA), a balloon-expandable stented trileaflet bovine pericardial bioprosthesis that received CE Mark European approval in April 2014.
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March 2016

Central Extracorporeal Life Support With Left Ventricular Decompression to Berlin Heart Excor: A Reliable "Bridge to Bridge" Strategy in Crash and Burn Patients.

Artif Organs 2017 Jun 8;41(6):519-528. Epub 2016 Nov 8.

Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg.

The aim of this study was to compare patients with severe biventricular heart failure who underwent Berlin Heart Excor implantation with (cardiogenic shock [CS] status) or without the need for preoperative extracorporeal life support (ECLS) as a bridge to long-term device. A total of 40 consecutive patients with severe biventricular heart failure underwent Berlin Heart Excor implantation with (CS status, n = 20, 50%) or without (control, n = 20, 50%) the need for preoperative ECLS as a bridge to long-term device from March 2007 to May 2015 at our institution. Demographics and preoperative baseline characteristics as well as early and long-term outcomes including mortality and complication rates were retrospectively compared between the two groups. There were no statistically significant differences in terms of demographics and most preoperative clinical characteristics. The mean age in the ECLS (CS group) and control group was 43.5 ± 19.4 and 41.3 ± 16.4 (P = 0.705), whereas 20 and 25% of patients were females (P = 1.000). However, patients from the ECLS group had preoperatively higher lactate (P = 0.037), aspartate aminotransferase (P < 0.001), and alanine aminotransferase (P < 0.001) levels, all of them significantly decreased after surgery (P  = 0.004, P = 0.017, and P = 0.001, respectively) and did not show any statistical differences to the corresponding values from the control group (P = 0.597, P = 0.491, and P = 0.339, respectively). Postoperatively, patients from the control and ECLS groups had statistically similar incidences of liver failure (30 vs. 35%, P = 0.736), renal failure (45 vs. 70%, P = 0.110), need for reopening (35 vs. 60%, P = 0.113), major cerebrovascular events (35 vs. 30%, P = 0.736), sepsis (10 vs. 25%, P = 0.407), wound infection (20 vs. 30%, P = 0.716), abdominal ischemia requiring surgery (28.6 vs. 36.8%, P = 0.719), and acute respiratory distress syndrome (25 vs. 35.3%, P = 1.000). The proportion of patients who were bridged to transplantation was statistically similar between the ECLS and the control groups (40 vs. 52.6%, P = 0.429). Furthermore, there were no statistically significant differences in terms of early (Breslow [generalized Wilcoxon] P = 0.907) and long-term (log-rank [Mantel-Cox] P = 0.787) overall cumulative survival accounting for 30-day survival of 75 versus 75%, 6-month survival of 60 versus 55%, 1-year survival of 54 versus 40%, and 7-year survial of 47 versus 40% in the control and ECLS groups, respectively. ECLS in critical CS as a bridge to implantation of the Berlin Heart Excor ventricular assist device is safe and is associated with improvement in end-organ function leading to similar excellent early and long-term survival and incidences of major complications as in patients without the need for preoperative ECLS support.
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http://dx.doi.org/10.1111/aor.12792DOI Listing
June 2017

Comparison of Two Miniaturized Cardiopulmonary Bypass Systems Regarding Inflammatory Response.

Artif Organs 2017 Feb 22;41(2):139-145. Epub 2016 Sep 22.

Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.

Cardiopulmonary bypass (CPB) is a known mediator of systemic inflammatory response. Extracorporeal circulations are undergoing continuous modifications and optimizations to achieve better results. Hence we aim to compare the inflammatory response associated with two recent miniature extracorporeal circulation systems during normothermic CPB. We measured plasma levels of cytokines including interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor-α, migration inhibitory factor (MIF), receptor for advanced glycation endproduct, and cluster of differentiation 40 ligand in 60 consecutive patients during the first 24 h after CPB. The patients were prospectively randomized to one of three trial groups: patients in group A were operated with the minimal extracorporeal circulation circuit (MECC, Maquet, Rastatt, Germany), group B operated with the extracorporeal circulation circuit optimized (ECC.O, Sorin, Italy), and group C operated with a conventional extracorporeal circuit (CECC, Maquet). Arterial blood samples were collected at intervals before, 30 min after initiation, and after termination of CPB. Further samples were collected 6 and 24 h after CPB. IL-10 levels were significantly raised in the CECC group as compared with either of the mini ECC-circuits with a peak concentration at 6 h postoperatively. Human MIF concentrations were significantly higher in the CECC group starting 30 min after CPB and peaking at the end of CPB. The overall reduction in cytokine concentrations in the mini-ECC groups correlated with a lower need for blood transfusion in MECC and a shorter mechanical ventilation time for ECC.O. Normothermic CPB using minimally invasive extracorporeal circulation circuits can reduce the inflammatory response as measured by cytokine levels, which may be beneficial for perioperative preservation of pulmonary function and hemostasis in low risk patients.
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http://dx.doi.org/10.1111/aor.12750DOI Listing
February 2017

Mitral Repair for Decompensated Postinfarction Papillary Muscle Rupture.

Ann Thorac Surg 2016 Jun;101(6):2393

Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.

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http://dx.doi.org/10.1016/j.athoracsur.2016.01.059DOI Listing
June 2016

Concurrent Left Ventricular Assist Device (LVAD) Implantation and Percutaneous Temporary RVAD Support via CardiacAssist Protek-Duo TandemHeart to Preempt Right Heart Failure.

Med Sci Monit Basic Res 2016 May 5;22:53-7. Epub 2016 May 5.

Department of Cardiac Surgery, Heart Centre, University Hospital Heidelberg, Heidelberg, Germany.

Right ventricular failure (RVF) is an unfortunate complication that continues to limit outcomes following durable left ventricular assist device (LVAD) implantation. Despite several 'RVF risk scores' having been proposed, preoperative prediction of post-LVAD RVF remains a guesstimate at best. Current strategies for institution of temporary RVAD support are invasive, necessitate additional re-thoracotomy, restrict postoperative mobilization, and/or entail prolonged retention of prosthetic material in-situ. The authors propose a novel surgical strategy comprising simultaneous implantation of a permanent LVAD and percutaneous TandemHeart® plus ProtekDuo® to provide temporary RVAD support and preempt RVF in patients with impaired RV function.
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http://dx.doi.org/10.12659/MSMBR.898897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913730PMC
May 2016

Preoperative predictors and outcomes of right ventricular assist device implantation after continuous-flow left ventricular assist device implantation.

J Thorac Cardiovasc Surg 2015 Dec 1;150(6):1651-8. Epub 2015 Aug 1.

Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.

Objective: The outcomes of ventricular assist device therapy remain limited by right ventricular failure. We sought to define the predictors and evaluate the outcomes of right ventricular failure requiring right ventricular assist device support after long-term continuous-flow left ventricular assist device implantation.

Methods: Records of all continuous-flow left ventricular assist device recipients for the last 10 years were analyzed, including patients on preoperative intra-aortic balloon pump, extracorporeal membrane oxygenation, and short-term ventricular assist device support. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of continuous-flow left ventricular assist device recipients requiring right ventricular assist device support (right ventricular assist device group) were compared with the rest of the patient cohort (control group).

Results: Between July 2003 and June 2013, 152 patients underwent continuous-flow left ventricular assist device implantation as a bridge to transplantation. The overall postoperative incidence of right ventricular assist device support was 23.02% (n = 35). Right ventricular assist device implantation did not significantly affect eventual transplantation (P = .784) or longer-term survival (P = .870). Preoperative right ventricular diameter (P < .001), tricuspid annular plane systolic excursion (P < .001), previous sternotomy (P = .002), preoperative short-term mechanical support (P = .005), left atrial diameter (P = .014), female gender (P = .020), age (P = .027), and preoperative bilirubin levels (P = .031) were univariate predictors of right ventricular assist device implantation. Multivariate analysis revealed lesser tricuspid annular plane systolic excursion (P = .013; odds ratio, 0.613; 95% confidence interval, 0.417-0.901) and smaller left atrial diameter (P = .007; odds ratio, 0.818; 95% confidence interval, 0.707-0.947) as independent predictors of right ventricular assist device implantation. Receiver operating characteristic curve of tricuspid annular plane systolic excursion yielded an area under the curve of 0.85 (95% confidence interval, 0.781-0.923), with cutoff tricuspid annular plane systolic excursion less than 12.5 mm having 84% sensitivity and 75% specificity.

Conclusions: Lesser tricuspid annular plane systolic excursion and smaller left atrial diameter are independent predictors of the need for right ventricular assist device support after continuous-flow left ventricular assist device implantation. Right ventricular assist device implantation does not adversely affect eventual transplantation or survival after continuous-flow left ventricular assist device implantation.
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http://dx.doi.org/10.1016/j.jtcvs.2015.07.090DOI Listing
December 2015

Does postoperative blood pressure influence development of aortic regurgitation following continuous-flow left ventricular assist device implantation?†.

Eur J Cardiothorac Surg 2016 Mar 23;49(3):788-94. Epub 2015 Jun 23.

Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.

Objectives: The true impact of postoperative blood pressure (BP) control on development of aortic regurgitation (AR) following continuous-flow left ventricular assist device (CF-LVAD) implantation remains uncertain. This study examines the influence of BP in patients with de novo AR following CF-LVAD implantation.

Methods: All patients with no or
Results: Median duration of CF-LVAD support was 575 days (range: 98-2433 days). Forty-eight patients (53.3%) developed mild AR over a median duration of 126 days. BP readings (median values, mmHg) between AR and non-AR groups showed statistically significant differences: at 3 months-systolic 99.5 vs 92.5 (P = 0.038), diastolic 81.5 vs 66 (P < 0.001), mean 86.5 vs 74 (P < 0.001) and at 6 months-diastolic 73 vs 62 (P = 0.044), mean 83 vs 74.5 (P = 0.049), respectively. Systolic BP at 3 months (P = 0.047, 95% CI 0.453-0.994, OR 0.671), aortic valve (AoV) closure (P = 0.01, 95% CI 0.002-0.429, OR 0.029) and duration of support (P = 0.04, 95% CI 1.000-1.009, OR 1.004) were found to be independent predictors of AR following CF-LVAD implantation.

Conclusions: BP readings at 3 months and 6 months showed a statistically significant association with ≥mild AR following CF-LVAD implantation, with systolic blood pressure at 3 months, aortic valve closure and longer support duration being independent predictors. Clinical implications of these data may warrant consideration of aggressive early control of BP to protect against the development/progress of AR following CF-LVAD implantation.
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http://dx.doi.org/10.1093/ejcts/ezv221DOI Listing
March 2016

Minimally invasive left ventricular assist device implantation: at the crossroads.

J Thorac Dis 2015 Apr;7(4):564-5

Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Greater London, UK.

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http://dx.doi.org/10.3978/j.issn.2072-1439.2015.03.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419290PMC
April 2015

Perfusion-Decellularization of Porcine Lung and Trachea for Respiratory Bioengineering.

Artif Organs 2015 Dec 20;39(12):1024-32. Epub 2015 Apr 20.

Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.

Decellularization of native organs may provide an acellular tissue platform for organ regeneration. However, decellularization involves a trade-off between removal of immunogenic cellular elements and preservation of biomechanical integrity. We sought to develop a bioartificial scaffold for respiratory tissue engineering by decellularization of porcine lungs and trachea while preserving organ architecture and vasculature. Lung-trachea preparations from 25 German Landrace pigs were perfused in a modified Langendorff circuit and decellularized by an SDC (sodium deoxycholate)-based perfusion protocol. Decellularization was evaluated by histology and fluorescence microscopy, and residual DNA quantified spectrophotometrically and compared with controls. Airway compliance was evaluated by endotracheal intubation and mechanical ventilation to simulate physiological breathing-induced stretch. Structural integrity was evaluated by bronchoscopy and biomechanical stress/strain analysis by measuring passive tensile strength, all compared with controls. Decellularized lungs and trachea lacked intracellular components but retained specific collagen fibers and elastin. Quantitative DNA analysis demonstrated a significant reduction of DNA compared with controls (32.8 ± 12.4 μg DNA/mg tissue vs. 179.7 ± 35.8 μg DNA/mg tissue, P < 0.05). Lungs and trachea decellularized by our perfusion protocol demonstrated increased airway compliance but preserved biomechanical integrity as compared with native tissue. Whole porcine lungs-tracheae can be successfully decellularized to create an acellular scaffold that preserves extracellular matrix and retains structral integrity and three-dimensional architecture to provide a bioartifical platform for respiratory tissue engineering.
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http://dx.doi.org/10.1111/aor.12481DOI Listing
December 2015

Resolution of heart block after surgical correction of failed transcatheter aortic valve implantation.

Ann Thorac Surg 2015 Apr;99(4):1437-9

Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.

Surgical aortic valve replacement is the gold standard therapy for severe aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly employed in "high-risk" patients. Atrioventricular block and aortic regurgitation are frequent complications of nitinol-based stented valves. We report a case of successful, but complex reoperative surgery 13 days after failed TAVI with iatrogenic aortic and mitral regurgitation and new-onset heart block. Removal of a CoreValve prosthesis (Medtronic Inc, Minneapolis, MN) with standard aortic valve replacement resulted in restoration of sinus rhythm and valvular competencies.
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http://dx.doi.org/10.1016/j.athoracsur.2014.06.102DOI Listing
April 2015

Left Ventricular Assist Device Implantation With Dor Procedure via Bilateral Limited Thoracotomy.

Artif Organs 2015 Jul 21;39(7):641-2. Epub 2015 Mar 21.

Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.

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http://dx.doi.org/10.1111/aor.12429DOI Listing
July 2015

Modified technique using Novalung as bridge to transplant in pulmonary hypertension.

Ann Thorac Surg 2015 Feb;99(2):719-21

Department of Cardiothoracic Transplantation and Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, London, United Kingdom.

Patients with idiopathic pulmonary artery hypertension in refractory right ventricular failure may decompensate acutely and die while on the lung transplantation waiting list. We describe such a patient bridged to lung transplantation with a modified surgical technique for left pulmonary artery-to-left atrium bypass using Novalung, a low-resistance diffusion membrane device.
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http://dx.doi.org/10.1016/j.athoracsur.2014.09.061DOI Listing
February 2015

Minimally invasive HeartWare LVAD implantation through single left thoracotomy.

J Artif Organs 2015 Jun 8;18(2):170-2. Epub 2015 Jan 8.

Department of Cardiothoracic Transplantation and Mechanical Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Hill End Road, London, UB9 6JH, UK,

Left ventricular assist device (LVAD) is now a routine therapy for advanced heart failure. Authors demonstrate a novel technique of LVAD implantation through a single left thoracotomy with anastomosis of outflow graft to the arch of aorta. The technique avoids sternotomy or additional right thoracotomy, keeps ascending aorta clear and puts outflow graft away from the sternum.
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http://dx.doi.org/10.1007/s10047-014-0815-8DOI Listing
June 2015

Chest X-ray in cardiac illness: a tale of four decades.

Eur Heart J 2016 Apr 10;37(15):1243. Epub 2014 Dec 10.

Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London UB9 6JH, UK.

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http://dx.doi.org/10.1093/eurheartj/ehu472DOI Listing
April 2016

Does CircuLite Synergy assist device as partial ventricular support have a place in modern management of advanced heart failure?

Expert Rev Med Devices 2015 Jan 2;12(1):49-60. Epub 2014 Dec 2.

Department of Cardiothoracic Transplantation and Mechanical support, Royal Brompton and Harefield NHS Foundation Trust, London, UK.

The discrepancy between the number of patients on the waiting list and available donor hearts has led to the successful development of left ventricular assist devices (LVAD) as a bridge to transplantation. The conventional LVADs are designed to provide full hemodynamic support for the end-stage failing heart. However, full-support LVAD implantation requires major surgery, sternotomy and cardiopulmonary bypass in majority of cases. The Synergy Micro-pump is the smallest implantable LVAD and provides partial flow support up to 3 l/min. It was shown that early intervention with this device can provide substantial benefits to patients with severe heart failure not yet sick enough for a full-support LVAD. Due the small dimensions it can be implanted without cardiopulmonary bypass or a sternotomy. The purpose of this article is to review the clinical use of the Synergy Micro-pump as partial hemodynamic support.
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http://dx.doi.org/10.1586/17434440.2015.985208DOI Listing
January 2015

Bioartificial heart: a human-sized porcine model--the way ahead.

PLoS One 2014 3;9(11):e111591. Epub 2014 Nov 3.

Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, Heidelberg, Germany.

Background: A bioartificial heart is a theoretical alternative to transplantation or mechanical left ventricular support. Native hearts decellularized with preserved architecture and vasculature may provide an acellular tissue platform for organ regeneration. We sought to develop a tissue-engineered whole-heart neoscaffold in human-sized porcine hearts.

Methods: We decellularized porcine hearts (n = 10) by coronary perfusion with ionic detergents in a modified Langendorff circuit. We confirmed decellularization by histology, transmission electron microscopy and fluorescence microscopy, quantified residual DNA by spectrophotometry, and evaluated biomechanical stability with ex-vivo left-ventricular pressure/volume studies, all compared to controls. We then mounted the decellularized porcine hearts in a bioreactor and reseeded them with murine neonatal cardiac cells and human umbilical cord derived endothelial cells (HUVEC) under simulated physiological conditions.

Results: Decellularized hearts lacked intracellular components but retained specific collagen fibers, proteoglycan, elastin and mechanical integrity; quantitative DNA analysis demonstrated a significant reduction of DNA compared to controls (82.6±3.2 ng DNA/mg tissue vs. 473.2±13.4 ng DNA/mg tissue, p<0.05). Recellularized porcine whole-heart neoscaffolds demonstrated re-endothelialization of coronary vasculature and measurable intrinsic myocardial electrical activity at 10 days, with perfused organ culture maintained for up to 3 weeks.

Conclusions: Human-sized decellularized porcine hearts provide a promising tissue-engineering platform that may lead to future clinical strategies in the treatment of heart failure.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0111591PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4218780PMC
August 2015

Gender differences in continuous-flow left ventricular assist device therapy as a bridge to transplantation: a risk-adjusted comparison using a propensity score-matching analysis.

Artif Organs 2015 Mar 29;39(3):212-9. Epub 2014 Aug 29.

Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Department of Cardiac Surgery, Heart Center, University of Heidelberg, Heidelberg, Germany.

The purpose of this study was to evaluate gender differences regarding outcome after continuous-flow left ventricular assist device (cfLVAD) implantation. The study was a retrospective review of prospectively collected data. Included were 24 consecutive female cfLVAD recipients and 24 male recipients (62.5% HeartMate II, 37.5% HeartWare) who received their devices between July 2007 and May 2013. Subjects were matched using propensity score analysis based on age, diagnosis, body surface area, preoperative mechanical circulatory support, heart failure severity score (INTERMACS class), and comorbidities. Female patients were significantly sicker before operation. After propensity score matching, there were no statistically significant differences in demographics or clinical baseline characteristics between male and female LVAD recipients. Also, there was a trend towards a longer postoperative intensive care unit stay in the female group (median 9 days [interquartile range 5-17] versus 15 days [interquartile range 8-33]; P < 0.061) and higher postoperative bilirubin values (median 14 mmol/L [interquartile range 10-17] versus 21 mmol/L [interquartile range 13-30]). However, there were no significant differences between the two groups in terms of outcome (P < 0.569). The overall survival was comparable between the two groups (log rank P < 0.389). Half (50%) of female patients required inotropic support for more than 7 days compared with 21.7% in the male group (P < 0.048). Half (50%) of female recipients required short-term postoperative right ventricular assist device implantation compared with 16.7% in the male group (P < 0.014). In conclusion, cfLVAD implantation as a bridge to transplantation is associated with longer duration of inotropic support and higher requirement for postoperative mechanical right ventricular support in women with similar survival rates. Further studies are required to identify additional demographic and clinical factors that modulate outcomes and will enhance the ability to risk-stratify cfLVAD recipients.
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http://dx.doi.org/10.1111/aor.12361DOI Listing
March 2015

De novo aortic regurgitation after continuous-flow left ventricular assist device implantation.

Ann Thorac Surg 2014 Sep 25;98(3):850-7. Epub 2014 Jul 25.

Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.

Background: Significant aortic regurgitation (AR) after continuous-flow left ventricular assist device (cf-LVAD) placement affects device performance and patient outcomes. This study examined the development of AR and long-term results after implantation of cf-LVADs.

Methods: The study included all patients with no or less than mild AR who underwent HeartMate II (58 [62%]; Thoratec Corp, Pleasanton, CA) or HeartWare (35 [38%]; HeartWare International, Framingham, MA) implantation at our institute from July 2006 to July 2012. Serial echocardiograms were obtained preoperatively, at 1, 3 and 6 months postoperatively, and then at a minimum of 4-month intervals in patients with longer-term support. Kaplan-Meier estimates for freedom from moderate or greater AR were generated. Logistic regression analysis was used to define independent predictors of AR after cf-LVAD implantation.

Results: Median duration of LVAD support was 527 days (25(th), 75(th): 289, 907; range, 60 to 2,433 days). Mild AR developed in 48 patients (51.6%) over a median duration of 126 days, with progression to moderate AR in 13 (14%) over 493 days and to severe AR in 2 (2.1%) over 1,231 days. The incidence of mild or greater AR was 43.1% in HeartMate II vs 65.7% in HeartWare recipients (p = 0.035). Overall freedom from moderate or greater AR was 94.7% ± 2.6% at 1 year, 86.9% ± 4.5% at 2 years, 82.8% ± 5.9% at 3 years, and 31% ± 16.9% at 4 years. Independent predictors of AR were duration of support (odds ratio, 1.002; 95% confidence interval, 1.000 to 1.004; p = 0.017) and a persistently closed aortic valve (odds ratio, 0.193; 95% confidence interval, 0.097 to 0.382; p < 0.001).

Conclusions: AR is associated with longer cf-LVAD support duration and persistent aortic valve closure. Incidence of moderate or greater AR after cf-LVAD implantation increases significantly after 3 years. The clinical implications of these data may warrant consideration of prophylactic aortic valve replacement at the time of cf-LVAD implantation, particularly with expected longer duration of support and in patients with preexisting AR that is more than mild.
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http://dx.doi.org/10.1016/j.athoracsur.2014.05.030DOI Listing
September 2014

Ex vivo lung perfusion to evaluate donor lungs after high-pressure pulmonoplegia.

J Thorac Cardiovasc Surg 2014 Mar 19;147(3):e28-9. Epub 2013 Nov 19.

Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom.

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http://dx.doi.org/10.1016/j.jtcvs.2013.09.062DOI Listing
March 2014

Pyramid heart: uncommon sequel of a common disease.

J Cardiovasc Med (Hagerstown) 2015 Jan;16 Suppl 1:S31-2

aDepartment of CTVS, G.B. Pant Hospital, New Delhi bDepartment of Anatomy, Tagore Medical College, Chennai cDepartment of Cardiology, GB Pant Hospital, New Delhi, India.

A 40-year-old woman presented 19 years after ring-annuloplastyfor rheumatic mitral regurgitation. Long-standing rheumatic heartdisease resulted in an unusual finding on her chest radiograph.
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http://dx.doi.org/10.2459/JCM.0b013e328358cc56DOI Listing
January 2015

Double outlet right ventricle with single coronary artery.

Cardiovasc Pathol 2013 Jan-Feb;22(1):112. Epub 2012 May 1.

Department of CTVS, GB Pant Hospital, New Delhi 110002, India.

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http://dx.doi.org/10.1016/j.carpath.2012.03.003DOI Listing
May 2013

Left main coronary artery atresia with tetralogy of Fallot: a novel association.

J Thorac Cardiovasc Surg 2012 Sep 12;144(3):e87-9. Epub 2012 Apr 12.

Department of CTVS, G. B. Pant Hospital, New Delhi, India.

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http://dx.doi.org/10.1016/j.jtcvs.2012.03.037DOI Listing
September 2012

The Thebesian valve: Gatekeeper to the coronary sinus.

Clin Anat 2012 Apr 18;25(3):379-85. Epub 2011 Aug 18.

Department of Anatomy, SGT Medical College, Gurgaon, India.

Clinical cardiac procedures such as electrophysiology studies, catheter ablation of arrhythmias, retrograde cardioplegia delivery, cardiac resynchronization therapy and, more recently, percutaneous mitral annuloplasty, involve cannulation of the coronary sinus (CS). The presence of a membrane closing the orifice of the CS may cause difficulties during these interventions. Thus, detailed knowledge of the variations and anomalies of the valve of the CS, or the Thebesian valve, now has practical significance. To improve our understanding of this structure, classic anatomical dissection of 50 hearts from dissection room cadavers was performed. A Thebesian valve was present in the overwhelming majority (88%) of cases. Its morphology varied widely, from a few small strands of tissue, to a membrane covering more than half the CS ostium. A significant number (20%) of valves occluded >65% of the ostium, making them "potential complicating factors" in cannulation of the CS. An understanding of these anatomical variations may help in identifying and overcoming potential difficulties during clinical cardiac interventions.
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http://dx.doi.org/10.1002/ca.21236DOI Listing
April 2012

Cardiac myxomas: experience over one decade.

J Card Surg 2011 Jul;26(4):355-9

Department of CTVS, GB Pant Hospital, New Delhi, India.

Background: This single-center study reviews our experience with cardiac myxomas over the past decade.

Methods: Sixty-two patients (23 male) with median age 38 years (range: 8 to 69 years) underwent excision of primary or recurrent cardiac myxomas between 2000 and 2009. Patients were evaluated with echocardiography preoperatively and annually postoperatively. Follow-up is current for all survivors (range 13 months to 10 years).

Results: Fifty-two patients had left atrial myxomas, seven right atrial, two biatrial, and one right ventricular. Three cases were familial. Maximum number of myxomas in a single patient was four. Symptom duration ranged from two to eight months. Two early deaths were due to low cardiac output and embolic cerebrovascular accident; one late death was due to a noncardiac cause. Actuarial survival was 96.8 ± 1.8% at 10 years. Most patients were asymptomatic following surgery. No sporadic, multiple, or biatrial myxomas recurred. Recurrence occurred in two familial cases, both with single, left atrial myxoma. Freedom from reoperation was 98.4 ± 1.3% at five years and 96.8 ± 1.8% at 10 years.

Conclusions: Biatrial involvement or multiplicity of myxomas does not mandate recurrence. Surgical excision has excellent overall survival and freedom from reoperation rates, but annual follow-up including echocardiographic surveillance is recommended as familial cases tend to recur. 
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http://dx.doi.org/10.1111/j.1540-8191.2011.01271.xDOI Listing
July 2011

Chronic mitral stenosis.

Circulation 2011 Jun;123(24):2897

Department of Cardiothoracic and Vascular Surgery, G.B. Pant Hospital, New Delhi 110002, India.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.111.030353DOI Listing
June 2011

Unusual papillary muscle hypertrophy in a septuagenarian.

J Thorac Cardiovasc Surg 2011 Sep 31;142(3):704-5. Epub 2011 Mar 31.

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September 2011

Cardiac myxoma: echocardiography may not suffice!

J Thorac Cardiovasc Surg 2011 Aug 31;142(2):453-4. Epub 2011 Mar 31.

Department of CTVS, G.B. Pant Hospital, New Delhi, India.

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http://dx.doi.org/10.1016/j.jtcvs.2011.02.031DOI Listing
August 2011

Aortic pseudoaneurysm following valve replacement.

J Card Surg 2011 Mar 22;26(2):219-20. Epub 2010 Dec 22.

Department of CTVS, G.B. Pant Hospital, New Delhi, India.

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March 2011
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