104 results on '"Livesey SA"'
Search Results
2. Management options for aorto-oesophageal fistula: case histories and review of the literature
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Göbölös, L, primary, Miskolczi, S, additional, Pousios, D, additional, Tsang, GM, additional, Livesey, SA, additional, Barlow, CW, additional, Kaarne, M, additional, Shambrook, J, additional, Lipnevicius, A, additional, and Ohri, SK, additional
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- 2013
- Full Text
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3. Unoperated severe aortic stenosis: decision making in an adult UK-based population
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Badran, AA, primary, Vohra, HA, additional, and Livesey, SA, additional
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- 2012
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4. Cryopreservation of single-donor platelets with a reduced dimethyl sulfoxide concentration by the addition of second-messenger effectors: enhanced retention of in vitro functional activity
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Currie, LM, primary, Livesey, SA, additional, Harper, JR, additional, and Connor, J, additional
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- 1998
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5. Recovery of in vitro functional activity of platelet concentrates stored at 4 degrees C and treated with second-messenger effectors
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Connor, J, primary, Currie, LM, additional, Allan, H, additional, and Livesey, SA, additional
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- 1996
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6. Mitral valve reconstruction in the presence of infection.
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Livesey SA
- Abstract
Reconstruction of the mitral valve offers an alternative to replacement in the treatment of active infective endocarditis, with long term benefits for the patient. [ABSTRACT FROM AUTHOR]
- Published
- 2006
7. Case reports. Aortic rupture as a result of low velocity crush.
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Reid C, Livesey SA, and Egleston CV
- Abstract
A case of aortic disruption in a 35 year old lorry driver is described. This occurred as a result of a low velocity crushing force. Clinicians should be aware that this mechanism of injury may result in aortic disruption as well as the more commonly mentioned severe deceleration force. [ABSTRACT FROM AUTHOR]
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- 1999
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8. Postinfarction ventricular septal rupture: The Wessex experience
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Dalrymple-Hay, MJ, Monro, JL, Livesey, SA, and Lamb, RK
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- 1998
9. Corrigendum to 'Long-term outcome following repair of acute type A aortic dissection after previous cardiac surgery' [Interact CardioVasc Thorac Surg 2011;13:386-391].
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Modi A, Vohra HA, Kaarne M, Haw MP, Barlow CW, Ohri SK, Livesey SA, and Tsang GMK
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- 2019
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10. Anterior mitral valve perforation in the absence of acute infection: Diagnosis by two-dimensional and three-dimensional transesophageal echocardiography.
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Mashicharan M, Cowburn PJ, Livesey SA, and Shah BN
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- Echocardiography, Doppler, Color methods, Heart Valve Diseases pathology, Heart Valve Diseases surgery, Humans, Male, Middle Aged, Mitral Valve surgery, Rupture, Spontaneous diagnostic imaging, Rupture, Spontaneous pathology, Rupture, Spontaneous surgery, Echocardiography, Three-Dimensional methods, Echocardiography, Transesophageal methods, Heart Valve Diseases diagnostic imaging, Mitral Valve diagnostic imaging, Mitral Valve pathology
- Abstract
Anterior mitral valve leaflet (AMVL) perforation is most commonly seen in the setting of infective endocarditis. We present a case of AMVL perforation in a previously healthy 62-year-old male who presented with a six-month history of worsening dyspnea and peripheral edema. Blood cultures, inflammatory markers, and autoimmune profile were negative. Transthoracic echocardiography demonstrated severe mitral regurgitation (MR) with a possible AMVL perforation, which was confirmed by three-dimensional transesophageal echocardiography as a well-circumscribed hole in the A2 segment. The patient made a successful recovery from mitral valve repair surgery., (© 2017, Wiley Periodicals, Inc.)
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- 2017
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11. Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis.
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Roubelakis A, Karangelis D, Sadeque S, Yanagawa B, Modi A, Barlow CW, Livesey SA, and Ohri SK
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- Aged, Endocarditis mortality, Female, Heart Valve Prosthesis Implantation adverse effects, Hospital Mortality, Humans, Male, Middle Aged, Retrospective Studies, Aortic Valve surgery, Bioprosthesis, Endocarditis surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods, Mitral Valve surgery
- Abstract
Introduction: The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement., Methods: Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days)., Results: There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre-discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis., Conclusions: Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort.
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- 2017
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12. Invited Commentary.
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Livesey SA
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- 2017
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13. The dynamics of adult haematopoiesis in the bone and bone marrow environment.
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Ho MS, Medcalf RL, Livesey SA, and Traianedes K
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- Adult, Hematopoietic Stem Cells cytology, Humans, Bone Marrow physiology, Extracellular Matrix physiology, Hematopoiesis physiology, Hematopoietic Stem Cells physiology, Stem Cell Niche physiology
- Abstract
This review explores the dynamic relationship between bone and bone marrow in the genesis and regulation of adult haematopoiesis and will provide an overview of the haematopoietic hierarchical system. This will include the haematopoietic stem cell (HSC) and its niches, as well as discuss emerging evidence of the reciprocal interplay between bone and bone marrow, and support of the pleiotropic role played by bone cells in the regulation of HSC proliferation, differentiation and function. In addition, this review will present demineralized bone matrix as a unique acellular matrix platform that permits the generation of ectopic de novo bone and bone marrow and provides a means of investigating the temporal sequence of bone and bone marrow regeneration. It is anticipated that the utilization of this matrix-based approach will help researchers in gaining deeper insights into the major events leading to adult haematopoiesis in the bone marrow. Furthermore, this model may potentially offer new avenues to manipulate the HSC niche and hence influence the functional output of the haematopoietic system., (© 2015 John Wiley & Sons Ltd.)
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- 2015
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14. Hemodynamic performance of Trifecta: single-center experience of 400 patients.
- Author
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Modi A, Budra M, Miskolczi S, Velissaris T, Kaarne M, Barlow CW, Livesey SA, Ohri SK, and Tsang GM
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- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency mortality, Aortic Valve Insufficiency physiopathology, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, England, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Postoperative Complications mortality, Postoperative Complications surgery, Prosthesis Design, Reoperation, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Ultrasonography, Aortic Valve surgery, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Hemodynamics
- Abstract
Objective: To evaluate postoperative hemodynamic gradients and early outcomes of aortic valve replacement with the Trifecta bioprosthesis., Methods: Between 2011 and 2013, 400 patients underwent aortic valve replacement with a Trifecta bioprosthesis. Gradients were calculated by transthoracic echocardiography before discharge. Data were collected retrospectively; patients with postoperative severe left ventricular dysfunction or > mild mitral regurgitation were excluded., Results: The mean age was 75.9 ± 8.5 years, 197 (49.25%) patients were male, and 140 (35%) were >80-years old. Concomitant procedures were performed in 207 (51.75%) patients, and 30 (7.5%) had redo procedures. Supraannular aortoplasty with bovine pericardium was necessary in 25 (6.25%) cases. Hospital mortality was 2.75% (11 patients). Postoperative peak and mean gradients were 21.7 ± 9.3 and 11.1 ± 4.3 mm Hg for 19-mm valves (n = 29); 19.5 ± 7 and 9.7 ± 3.6 mm Hg for 21-mm valves (n = 158); 17.3 ± 6.6 and 8.7 ± 3.2 mm Hg for 23-mm valves (n = 134); 15.1 ± 6.1 and 7.8 ± 3.3 mm Hg for 25-mm valves (n = 56); 13.2 ± 3.7 and 6.9 ± 2.6 mm Hg for 27-mm valves (n = 11). Nine patients had trivial and one had mild transvalvular regurgitation. Mean follow-up was 1 ± 0.62 years; no patient required reoperation. Kaplan-Meier survival at 1 and 2 years was 94.3% ± 1.3% and 93.7% ± 1.4%., Conclusion: Early postoperative gradients are low after Trifecta implantation. Significant transvalvular regurgitation was not observed, but the incidence of supraannular aortoplasty may be increased., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)
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- 2015
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15. Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register.
- Author
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Hickey GL, Grant SW, Freemantle N, Cunningham D, Munsch CM, Livesey SA, Roxburgh J, Buchan I, and Bridgewater B
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- Adult, Aged, Clinical Competence, Consultants, Coronary Artery Bypass, Female, Heart Valves surgery, Humans, Logistic Models, Male, Medical Audit, Middle Aged, Odds Ratio, Registries, Retrospective Studies, Risk Assessment, Time Factors, United Kingdom, Cardiac Surgical Procedures mortality, Hospital Mortality, Physicians classification, Thoracic Surgery
- Abstract
Objectives: To explore the relationship between in-hospital mortality following adult cardiac surgery and the time since primary clinical qualification for the responsible consultant cardiac surgeon (a proxy for experience)., Design: Retrospective analysis of prospectively collected national registry data over a 10-year period using mixed-effects multiple logistic regression modelling. Surgeon experience was defined as the time between the date of surgery and award of primary clinical qualification., Setting: UK National Health Service hospitals performing cardiac surgery between January 2003 and December 2012., Participants: All patients undergoing coronary artery bypass grafts and/or valve surgery under the care of a consultant cardiac surgeon., Main Outcome Measures: All-cause in-hospital mortality., Results: A total of 292,973 operations performed by 273 consultant surgeons (with lengths of service from 11.2 to 42.0 years) were included. Crude mortality increased approximately linearly until 33 years service, before decreasing. After adjusting for case-mix and year of surgery, there remained a statistically significant (p=0.002) association between length of service and in-hospital mortality (odds ratio 1.013; 95% CI 1.005-1.021 for each year of 'experience')., Conclusions: Consultant cardiac surgeons take on increasingly complex surgery as they gain experience. With this progression, the incidence of adverse outcomes is expected to increase, as is demonstrated in this study. After adjusting for case-mix using the EuroSCORE, we observed an increased risk of mortality in patients operated on by longer serving surgeons. This finding may reflect under-adjustment for risk, unmeasured confounding or a real association. Further research into outcomes over the time course of surgeon's careers is required., (© The Royal Society of Medicine.)
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- 2014
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16. The outcomes of triple-valve surgery: eleven years' experience from a single center.
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Nikolaidis N, Roubelakis A, Karangelis D, Hanratty M, Barlow CW, Tsang GM, Livesey SA, and Ohri SK
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- Adult, Aged, Aged, 80 and over, Aortic Valve surgery, England, Female, Heart Valve Diseases diagnosis, Heart Valve Diseases mortality, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mitral Valve surgery, Multivariate Analysis, Postoperative Complications mortality, Postoperative Complications therapy, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Tricuspid Valve surgery, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Heart Valves surgery
- Abstract
Background and Aim of the Study: Triple-valve surgery is a challenging and complex procedure with significant risk, even at centers experienced at performing such operations. The study aim was to investigate the early and late outcomes of this surgery, performed at a single center for the past 11 years., Methods: A total of 45 consecutive patients (19 males, 26 females; mean age 69.42 +/- 12.72 years) underwent triple-valve surgery at the authors' institution between 2000 and 2011. The mean logistic EuroSCORE was 22.46 +/- 12.8%. The most common aortic valve pathology was calcific degeneration (40%), while the mitral valves were mostly rheumatic (31%) or degenerative (26%). The tricuspid valve pathology was functional regurgitation in 64% of patients. The aortic valve procedures were all replacements, while the mitral valves were either repaired (n = 20) or replaced (n = 25). The tricuspid valves were almost exclusively repaired (n = 43). Univariate and multivariate analyses were performed to highlight predictors of mortality. A Kaplan-Meier analysis was also performed., Results: The operative mortality was 8.9% (n = 4). Survival at one, three, and five years was 91%, 85.5% and 66.4%, respectively. Morbidity was not particularly high: the incidence of all postoperative neurological complications was 13%, that of transient renal impairment was 18%, and pacemaker implantation 8.9%., Conclusion: The results of triple-valve surgery were considerably improved compared to historical reports. Early mortality was close to that occurring after less complex procedures, while late survival was comparable to that after single-valve surgery. It is believed that the best results are achieved by centers experienced in valve procedures. Compared to older studies, rheumatic disease was not the most frequent requirement for of triple-valve surgery among the present patients.
- Published
- 2014
17. Successful transmitral repair of an inferobasal postinfarct pseudoaneurysm.
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Göbölös L, Livesey SA, Peebles C, and Haw MP
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- Animals, Biocompatible Materials, Cattle, Heart Valve Prosthesis, Heart Ventricles surgery, Humans, Male, Middle Aged, Aneurysm, False complications, Aneurysm, False surgery, Mitral Valve surgery, Mitral Valve Annuloplasty, Myocardial Infarction complications
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- 2013
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18. Mitral valve repair for severe mitral regurgitation secondary to lone atrial fibrillation.
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Vohra HA, Whistance RN, Magan A, Sadeque SA, and Livesey SA
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- Aged, Aged, 80 and over, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Elective Surgical Procedures, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency etiology, Postoperative Complications, Preoperative Care, Retrospective Studies, Treatment Outcome, Ultrasonography, Atrial Fibrillation complications, Heart Valve Prosthesis Implantation, Mitral Valve Annuloplasty, Mitral Valve Insufficiency surgery
- Abstract
Objectives: Significant mitral regurgitation (MR) may arise from isolated annular dilatation secondary to lone atrial fibrillation (AF) and associated atrial remodelling. The aim of the present study is to assess the outcome of surgery for this condition., Methods: Between November 2007 and July 2011, 20 patients underwent mitral valve (MV) repair for severe MR secondary to AF. The median age of patients was 77.5 years (45-82 years) and the mean pre-operative duration of AF was 84.6 ± 92 months. The left ventricle was moderately (ejection fraction 30-50%; n = 6) or severely (<30%; n = 1) impaired in seven patients pre-operatively. Mean logistic EuroSCORE was 8.1 ± 5.9 and mean follow-up was 18.0 ± 12.5 months., Results: All operations were elective. Concomitant anti-arrhythmic procedures (maze procedure, pulmonary vein isolation) or left atrial (LA) appendage amputation were performed in all patients; tricuspid valve repair was undertaken in 12 patients and coronary artery bypass grafting in 2 patients. Ring annuloplasty was performed in all patients. The median ring size was 30 mm (range 24-36 mm). On-table transoesophageal echocardiography post-repair showed mild residual MR in two patients and no MR in the remainder. There were no cases of systolic anterior motion. There was one re-exploration for bleeding. No patients required haemofiltration or suffered from stroke and deep sternal wound infections. There was no in-hospital mortality. At discharge mean left ventricular (LV) end-diastolic diameter was 4.8 ± 0.7 cm compared with 5.6 ± 0.7 cm pre-operatively (P < 0.005), while mean LV end-systolic diameter was 3.2 ± 0.8 cm when compared with 4.0 ± 0.7 cm pre-operatively (P < 0.005). The mean LA size was 5.2 ± 1.0 cm when compared with 6.1 ± 1.6 cm pre-operatively (P = 0.03). There was mild MR in two patients, but none in the rest. The mean MV area was 3.0 ± 0.7 cm(2). The mean systolic pulmonary artery pressure was 40.4 ± 15.5 mmHg when compared with 54.1 ± 12.2 mmHg pre-operatively (P = 0.02). Seventeen patients (85%) were in NYHA class I/II at latest follow-up (P < 0.0001 vs pre-operatively). During follow-up, there were no thrombo-embolic complications, re-operation, endocarditis or deaths., Conclusions: MV annuloplasty for annular dilatation secondary to AF has a good mid-term outcome.
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- 2012
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19. Outcome after redo-mitral valve replacement in adult patients: a 10-year single-centre experience.
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Vohra HA, Whistance RN, Roubelakis A, Burton A, Barlow CW, Tsang GM, Livesey SA, and Ohri SK
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- Adult, Aged, Aged, 80 and over, Aortic Valve surgery, England, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Postoperative Complications etiology, Postoperative Complications mortality, Postoperative Complications surgery, Proportional Hazards Models, Prosthesis Design, Reoperation, Retrospective Studies, Risk Assessment, Risk Factors, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, Young Adult, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve surgery
- Abstract
The aim of this study was to investigate the overall outcome of adult patients undergoing redo-mitral valve replacement (redo-MVR) at our institution. Forty-nine patients (24 males) underwent redo-MVR with either bioprosthetic (n = 24) or mechanical valves (n = 25) between January 2000 and 2010. Median age of patients was 63 years (range 21-80 years), and the mean additive EuroSCORE was 12 ± 4. Median time to re-operation was 8.2 ± 6.6 years for first time redo-MVR and 6.4 ± 5.6 years for second-time redo-MVR. Indications included prosthetic endocarditis (n = 22), para-prosthetic leak (n = 12), structural valve degeneration (n = 8), prosthetic valve thrombosis (n = 6) and malignancy (n = 1). The mean follow-up was 47.5 ± 37.0 months (range 0.1-112.3 months). In-hospital mortality was 12% (n = 6). Mean hospital stay was 17 ± 11 days (range 8-50 days). Actuarial survival at 1 and 5 years was 81 ± 5% and 72 ± 6%, respectively. Three patients required re-intervention: two for prosthetic valve endocarditis and one for para-prosthetic leak. Multivariate analysis showed that overall survival was associated with the LVEF < 50% (P < 0.001), concomitant AVR (P < 0.001) and urgent surgery (P = 0.03).
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- 2012
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20. Repair of acute type A aortic dissection: results in 100 patients.
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Vohra HA, Modi A, Barlow CW, Ohri SK, Livesey SA, and Tsang GM
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- Acute Disease, Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Aortic Dissection mortality, Aortic Aneurysm, Thoracic mortality, Female, Follow-Up Studies, Heart Arrest, Induced methods, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate trends, Time Factors, Treatment Outcome, United Kingdom epidemiology, Aortic Dissection surgery, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Vascular Surgical Procedures methods
- Abstract
To determine short- and long-term outcomes after repair of type A aortic dissection, we reviewed data of 100 consecutive patients (64 men; mean age, 63 ± 12.2 years) who underwent acute type A aortic dissection repair between January 2000 and June 2008. They were divided into group A, open anastomosis (circulatory arrest; n = 59) and group B, closed anastomosis (no circulatory arrest; n = 41). Aortic valve re-suspension or replacement was performed in 77 patients, aortic root replacement in 29, and aortic arch procedures in 31. The median follow-up was 2.8 years (range, 0-8.6 years). The 30-day mortality was 14%; 16.9% in group A and 9.8% in group B. None of the 23 variables analyzed to determine predictors of death or stroke was significant on multivariate analysis. Postoperatively, there was no difference between the 2 groups with respect to stroke, sepsis, renal failure, multiorgan failure, or reoperation. Overall actuarial survival at 1, 3, 5, and 8 years was not significantly different between the 2 groups. Considerable morbidity is still associated with repair of type A aortic dissection, despite a significant improvement in mortality.
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- 2012
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21. Aortic valve replacement in patients with previous coronary artery bypass grafting: 10-year experience.
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Vohra HA, Pousios D, Whistance RN, Haw MP, Barlow CW, Ohri SK, Livesey SA, and Tsang GM
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- Adult, Aged, Aged, 80 and over, Cardiopulmonary Bypass methods, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Preoperative Period, Prognosis, Reoperation methods, Retrospective Studies, Treatment Outcome, Vascular Patency, Aortic Valve surgery, Coronary Artery Bypass methods, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation methods
- Abstract
Unlabelled: OBJECTIVES; This study aimed to investigate the early and late outcomes of patients undergoing aortic valve replacement (AVR) with previous coronary artery bypass grafting (CABG) and patent grafts., Methods: Between January 2000 and March 2010, 104 patients (87 males) with previous CABG ± concomitant surgery and patent grafts underwent AVR. The median age of the patients was 75 years (range: 37-90 years; inter-quartile range: 69-79 years) and the mean logistic EuroScore was 25.37 ± 16.8. The median time since the previous operation was 9 years (range 1-25; inter-quartile range: 7-14 years). The left internal mammary artery (LIMA) had been used in 75 patients (72.1%) and remained patent in 72 cases (96.0%)., Results: Thirty-day mortality was 7.7% (n = 8), which is less than the predicted mean logistic EuroScore. Isolated AVR was performed in 66 patients (63.5%). The LIMA was dissected and isolated (clamped or blocked with balloon) in 60 patients. The median hospital stay was 10 days (range: 4-183 days; inter-quartile range: 7-15.25 days). Nineteen patients (18.3%) had pulmonary complications, while 12 (11.5%) had acute kidney injury. Seven patients (6.7%) required permanent pacemaker. Six LIMAs (8.3%) were injured and repaired. Prolonged aortic cross-clamp (AXC) time (P = 0.038) and the presence of a previous LIMA graft (P = 0.045) were identified as independent predictors of 30-day mortality. The actuarial survival at 1 and 5 years was 89.4 ± 0.3 and 81.5 ± 0.5%, respectively. Perioperative intra-aortic balloon pump use (P = 0.036), prolonged AXC time (P = 0.004) and prolonged cardiopulmonary bypass time (P = 0.022) were associated with worse long-term overall survival on multivariate analysis., Conclusions: AVR post-CABG with patent grafts can be performed in high-risk patients with excellent short- and long-term outcomes and appears to be superior to published catheter-based interventions. In the absence of randomized trial data, we believe that open AVR remains the treatment of choice for aortic valve disease following prior CABG.
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- 2012
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22. Aorto-atrial fistula in the absence of infective endocarditis: diagnosis by 2- and 3-dimensional transesophageal echocardiography.
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Shah BN, Livesey SA, and Rakhit DJ
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- Aortic Diseases etiology, Aortic Diseases surgery, Female, Fistula etiology, Fistula surgery, Heart Atria diagnostic imaging, Heart Diseases etiology, Heart Diseases surgery, Humans, Middle Aged, Predictive Value of Tests, Aortic Diseases diagnostic imaging, Blood Vessel Prosthesis Implantation adverse effects, Echocardiography, Doppler, Color, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Fistula diagnostic imaging, Heart Diseases diagnostic imaging, Heart Valve Prosthesis Implantation adverse effects
- Published
- 2012
23. Surgery for non-rheumatic calcific mitral stenosis.
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Vohra HA, Whistance RN, Bezuska L, and Livesey SA
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- Aged, Aged, 80 and over, Female, Humans, Male, Heart Valve Prosthesis Implantation methods, Mitral Valve Stenosis surgery
- Abstract
During recent years there has been an increase in the referral pattern for surgery for non-rheumatic calcific mitral stenosis (CMS). Valve replacement for this condition presents some unique challenges, yet the management of CMS remains inadequately described. Herein are discussed the techniques and outcomes of surgery for CMS.
- Published
- 2011
24. Long-term outcome following repair of acute type A aortic dissection after previous cardiac surgery.
- Author
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Modi A, Vohra HA, Kaarne M, Haw MP, Barlow CW, Ohri SK, Livesey SA, and Tsang GM
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- Acute Disease, Acute Kidney Injury etiology, Acute Kidney Injury therapy, Adult, Aged, Aged, 80 and over, Aortic Dissection mortality, Aortic Aneurysm mortality, Chi-Square Distribution, England, Female, Hemofiltration, Hospital Mortality, Hospitals, University, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Patient Selection, Postoperative Hemorrhage etiology, Postoperative Hemorrhage surgery, Reoperation, Retrospective Studies, Risk Assessment, Risk Factors, Stroke etiology, Time Factors, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Cardiac Surgical Procedures
- Abstract
We evaluated the outcome after repair for acute spontaneous type A aortic dissection in patients with previous cardiac surgery. From January 2000 to December 2009, 114 patients underwent emergency repair for acute spontaneous type A dissection at Southampton University Hospital. Eleven (median age 64 years; range 36-83 years; two females) patients (9.8%) had undergone previous cardiac surgery and were included in this study. Aortic root replacement was performed in three patients (27%), aortic arch replacement in four patients (36%) and two patients (18%) required aortic valve re-suspension. The elephant trunk operation was performed in two patients (18%). There were two hospital deaths (18%). Two patients (18%) suffered a stroke, two needed re-opening for bleeding (18%) and two patients (18%) required haemofiltration postoperatively. Median length of hospital stay was 16 days (range 6-34 days). Actuarial survival at five and eight years for redo compared to first-time surgery was 68±3.63% vs. 81±5.34% and 51±3.8% vs. 61±5.4%, respectively (P=0.365). In conclusion, acute type A aortic dissection repair in patients with previous cardiac surgery has an acceptable mortality and comparable long-term outcome to first-time surgery.
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- 2011
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25. Long-term outcomes in octogenarians following aortic valve replacement.
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Nikolaidis N, Pousios D, Haw MP, Kaarne M, Barlow CW, Livesey SA, Tsang GM, and Ohri SK
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- Age Factors, Aged, 80 and over, Female, Follow-Up Studies, Heart Valve Diseases mortality, Heart Valve Prosthesis Implantation mortality, Hospital Mortality trends, Humans, Male, Retrospective Studies, Risk Factors, Survival Rate trends, Time Factors, Treatment Outcome, United Kingdom epidemiology, Aortic Valve surgery, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation methods
- Abstract
Background: The aging of the population has resulted in an increasing number of elderly patients undergoing cardiac operations. We reviewed our experience in patients over the age of 80 undergoing primary aortic valve replacement (AVR) with or without CABG., Methods: Between 2000 and 2008, 345 patients (226 male) ≥80 years underwent primary AVR in our unit. The notes of these patients were retrospectively reviewed and follow-up information was obtained from their general practitioners. They had a mean age of 82.9 ± 2.3 years and a median logistic EuroSCORE of 13.4 (IQR 9.4, 19.1). Isolated AVR was performed in 161 patients (45.5%), and 184 (51.6%) patients underwent combined AVR and CABG. A quality of life questionnaire was sent to all survivors., Results: Hospital mortality occurred in 17 patients (4.9%), which was significantly lower than the mortality predicted by logistic EuroSCORE (16.2%, p < 0.01). Hospital mortality was comparable between patients undergoing isolated AVR and those undergoing additional CABG (4.3% vs. 5.4%, respectively). Actuarial survival at one and five years was 90.1 ± 1.6% and 77.2 ± 2.9%, respectively. There was a 62% response on the questionnaire showing 70% of the patients were NYHA I and 83.7% were satisfied with the operation outcome., Conclusions: AVR can be undertaken with excellent results in octogenarians and the current risk is significantly lower than what is predicted with conventional risk-scoring systems. Patients with advanced age should not necessarily be excluded from being candidates for AVR. , (© 2011 Wiley Periodicals, Inc.)
- Published
- 2011
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26. Initial experience of mitral valve repair using the Carpentier-Edwards Physio II annuloplasty ring.
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Vohra HA, Whistance RN, Bezuska L, and Livesey SA
- Subjects
- Aged, Aged, 80 and over, Echocardiography, Transesophageal, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve Annuloplasty adverse effects, Mitral Valve Annuloplasty methods, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency etiology, Retrospective Studies, Treatment Outcome, Mitral Valve surgery, Mitral Valve Annuloplasty instrumentation, Mitral Valve Insufficiency surgery, Prostheses and Implants adverse effects
- Abstract
Objective: The Carpentier-Edwards (CE) Physio II ring is a new prosthetic ring designed to accommodate the changing pathology seen in the spectrum of degenerative valve disease, particularly the larger anterior leaflet in repair of the Barlow valve. The aim of our study was to assess the safety and efficacy of mitral valve (MV) repair with the CE Physio II ring., Methods: Between April 2009 and March 2010, 100 patients underwent MV repair using the Physio II ring. Median age of patients was 70 years (54-85 years). The left ventricle (LV) was moderately (30-50%; n=21) or severely (<30%; n=6) impaired in 27 patients preoperatively. Mitral regurgitation (MR) was due to degenerative disease in 87 patients (bileaflet prolapse: 34 patients). Mean logistic EuroSCORE was 10.07 ± 8.9 and mean follow-up was 6.3 ± 2.4 months., Results: Seventeen patients were non-elective (eight emergencies), five were re-do operations and 23 Maze ± pulmonary vein isolations, and 14 tricuspid annuloplasties were performed. Neo-chordae were inserted in 50 patients (50%), whereas sliding annuloplasty was performed only in three patients. The median ring size was 32 mm (range 26-40 mm). On-table trans-oesophageal echocardiography (TOE) showed trivial/no MR in 87 patients, and mild in 13 patients, and there were no cases of systolic anterior motion (SAM). There were two re-explorations for bleeding and two patients required haemofiltration. There were no strokes or deep sternal wound infections (DSWIs). There was one hospital death (1%). At discharge, mean left ventricular end-diastolic (LVEDD) was 4.8 ± 0.7 cm compared with 5.5 ± 0.8 cm preoperatively (p=0.03) and mean left ventricular end-systolic (LVESD) was 3.3 ± 0.5 cm as compared with 3.6 ± 0.8 preoperatively (p=0.4). There was no MR in 87 patients and mild MR in 13 patients. The mean mitral valve area (MVA) was 2.8 ± 0.7 cm(2). The mean systolic pulmonary artery pressure (SPAP) was 26.6 ± 7.3 mmHg as compared with 50.9 ± 17.2 mmHg preoperatively (p=0.02). During follow-up, there were no thrombo-embolic complications, re-operation, endocarditis or deaths., Conclusions: MV repair with the Physio II ring has excellent short-term results, including subgroups with large anterior mitral valve leaflet (AMVL). Moreover, the dimensional ratios of the ring may allow it to be used for MV repair for degenerative MV disease, irrespective of anterior leaflet size., (Crown Copyright © 2010. Published by Elsevier B.V. All rights reserved.)
- Published
- 2011
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27. A case of Tropheryma whipplei infective endocarditis of the aortic and mitral valves in association with psoriatic arthritis and lumbar discitis.
- Author
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Whistance RN, Elfarouki GW, Vohra HA, and Livesey SA
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Aortic Valve surgery, Discitis complications, Endocarditis, Bacterial therapy, Heart Valve Prosthesis Implantation, Humans, Lumbar Vertebrae, Male, Mitral Valve surgery, Treatment Outcome, Tropheryma isolation & purification, Whipple Disease drug therapy, Aortic Valve microbiology, Arthritis, Psoriatic complications, Endocarditis, Bacterial microbiology, Mitral Valve microbiology, Tropheryma pathogenicity, Whipple Disease microbiology
- Abstract
Whipple's disease is a chronic condition that is characterized by diarrhea, weight loss and arthropathy, and caused by infection with the fastidious bacterium Tropheryma whipplei. Although once rare, Whipple's disease is being increasingly described owing mainly to advances in molecular genetics and an improved isolation of the organism. Whilst cardiac Whipple's disease occurs less commonly, especially in the absence of gastrointestinal symptoms, it has become apparent that some cases of culture-negative endocarditis may well be attributable to T. whipplei. The case is reported of a patient with Whipple's disease endocarditis in association with psoriatic arthritis and lumbar discitis.
- Published
- 2011
28. Early and late clinical outcomes of pulmonary embolectomy for acute massive pulmonary embolism.
- Author
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Vohra HA, Whistance RN, Mattam K, Kaarne M, Haw MP, Barlow CW, Tsang GM, Livesey SA, and Ohri SK
- Subjects
- Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Adult, Aged, Angiography, Echocardiography, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Incidence, Male, Middle Aged, Pulmonary Embolism diagnosis, Pulmonary Embolism mortality, Respiratory Tract Infections epidemiology, Respiratory Tract Infections etiology, Retrospective Studies, Risk Factors, Severity of Illness Index, Stroke epidemiology, Stroke etiology, Tachycardia, Ventricular epidemiology, Tachycardia, Ventricular etiology, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, United Kingdom epidemiology, Young Adult, Embolectomy methods, Postoperative Complications, Pulmonary Embolism surgery
- Abstract
Background: The aim of this study was to investigate the early and late outcomes of patients undergoing pulmonary embolectomy for acute massive pulmonary embolus., Methods: Twenty-one patients (15 male, 6 female) underwent pulmonary embolectomy at our institution between March 2001 and July 2010. The median age was 55 years (range, 24 to 70 years). Of these, 9 patients presented with out-of-hospital cardiac arrest and 8 presented with New York Heart Association class III or IV. Sixteen patients underwent preoperative transthoracic echocardiography, which showed evidence of right ventricular dilatation in all, whereas in 14 patients (66.6%) pulmonary artery pressures were significantly elevated with moderate to severe tricuspid regurgitation. The median preoperative Euroscore was 9 (range, 3 to 16), and 11 patients (52.1%) received systemic thrombolysis preoperatively. There were 6 salvage (28.5%), 10 emergency (47.6%), and 5 urgent (23.8%) procedures. Concomitant procedures were performed in 3 patients (14.2%), and surgery was performed without the use of cardiopulmonary bypass in 3 patients (14.2%). The median follow-up was 38 months (range, 0 to 114 months)., Results: The in-hospital mortality was 19% (n = 4). Postoperative complications included stroke (n = 3, 14.2%), lower respiratory tract infection (n = 6, 28.5%), wound infection (n = 3, 14.2%), acute renal failure requiring hemofiltration (n = 4, 19%), and supraventricular tachyarrhythmias (n = 4, 19%). At discharge, transthoracic echocardiography showed mild to moderate right ventricular dysfunction and dilatation in 11 survivors (64.7%). Two patients died during follow-up, and actuarial survival at 5 years was 76.9% ± 10.1% and at 8 years was 51.2% ± 22.0%. At final follow-up, 11 of the 15 survivors (73.3%) were New York Heart Association class I, and no patients required further intervention., Conclusions: Patients who undergo surgery for massive pulmonary embolism have an acceptable outcome despite being high-risk., (Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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29. Surgical management of valve disease in the early 21st century.
- Author
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Sheikh AM and Livesey SA
- Subjects
- Bioprosthesis, Cardiac Surgical Procedures adverse effects, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Humans, Postoperative Complications epidemiology, Prosthesis Design, Heart Valve Diseases surgery
- Abstract
Surgery offers good results for patients with significant valvular heart disease. Valve replacement and repair are the main surgical options. Older patients and redo procedures are increasingly frequent.
- Published
- 2010
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30. Iatrogenic pseudoaneurysm of internal mammary artery: case report and literature review.
- Author
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Nasir A, Viola N, and Livesey SA
- Subjects
- Aged, Aneurysm, False diagnosis, Aneurysm, False therapy, Angiography, Diagnosis, Differential, Embolization, Therapeutic methods, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation methods, Humans, Iatrogenic Disease, Mitral Valve Stenosis complications, Mitral Valve Stenosis surgery, Thoracotomy adverse effects, Tomography, X-Ray Computed, Tricuspid Valve Insufficiency complications, Tricuspid Valve Insufficiency surgery, Ultrasonography, Doppler, Aneurysm, False etiology, Heart Valve Prosthesis Implantation adverse effects, Mammary Arteries
- Abstract
Pseudoaneurysms of the internal mammary artery (IMA) following median sternotomy are very uncommon and were first reported in 1973. Presentation and treatment of such a complication has been variable. We are presenting a case of a patient with pseudoaneurysm of IMA after mitral valve replacement. Selective embolization of the branches of right IMA was performed. Hematoma was evacuated after a week without any complication. Patient was reviewed in the clinic after 6 weeks and she was doing very well.
- Published
- 2009
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31. Impact of surgeon-specific data reporting on surgical training.
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Khan OA, Iyengar S, Pontefract DE, Rogers V, Ohri SK, and Livesey SA
- Subjects
- Adult, Aortic Valve surgery, Cardiac Surgical Procedures education, Cardiac Surgical Procedures mortality, Consultants, Coronary Artery Bypass statistics & numerical data, England, Humans, Medical Staff, Hospital statistics & numerical data, Mitral Valve surgery, Retrospective Studies, Cardiac Surgical Procedures statistics & numerical data, Education, Medical, Continuing standards, Medical Staff, Hospital education
- Abstract
Introduction: Since April 2002, collection and publication of surgeon-specific data in adult cardiac surgery has become mandatory in the UK. It has been suggested that this may discourage consultants from allowing trainees to perform cases. The aim of this study was to attempt to analyse the effect of the introduction of surgeon-specific data (SSD) on surgical training in a large cardiac surgical centre., Patients and Methods: A retrospective analysis was performed on 2111 consecutive patients undergoing elective coronary artery bypass surgery, aortic and mitral valve surgery at Southampton General Hospital between April 2000 and April 2004. Results were analysed and compared over a 2-year period prior to and a 2-year period following the introduction of SSD., Results: There were no changes in the overall mortality rate following the introduction of SSD. SSD was associated with a reduction in the overall proportion of cases performed by trainees (49% versus 42.8%; P = 0.004) and, in particular, a reduction in the proportion of aortic and mitral valve procedures performed by trainees. In addition, the proportion of cases performed by the trainees without consultant supervision declined significantly following SSD (18.7% versus 10.4%; P < 0.001)., Conclusions: Publication of surgeon-specific data has coincided with a decrease in both the proportion and variety of cases performed by trainees.
- Published
- 2007
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32. Subcoronary allograft aortic valve replacement: parametric risk-hazard outcome analysis to a minimum of 20 years.
- Author
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Hickey E, Langley SM, Allemby-Smith O, Livesey SA, and Monro JL
- Subjects
- Adolescent, Adult, Antibiotic Prophylaxis, Cell Survival, Child, Endocarditis prevention & control, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation mortality, Humans, Male, Middle Aged, Reoperation, Transplantation, Homologous, Treatment Outcome, Aortic Valve transplantation, Heart Valve Prosthesis Implantation adverse effects
- Abstract
Background: Differences in sterilization, preservation, and implantation have been implicated in aortic allograft longevity. We report follow-up to 30 years of patients from a single unit who underwent aortic valve replacement with aortic allografts sterilized in antibiotics and refrigerated at 4 degrees C., Methods: Two hundred consecutive patients underwent subcoronary allograft aortic valve replacement and have been followed up to a minimum of 20 and maximum of 30 years. Follow-up was 96% complete. Parametric hazard phase modeling was used to identify incremental predictors of time-related risk., Results: Early mortality was 1.5%. Kaplan-Meier actuarial survival, including early death, was 81.2% +/- 2.8% (mean +/- standard error of the mean), 58.0% +/- 3.7%, and 52% +/- 5.1% at 10, 20, and 25 years, respectively. Freedom from reoperation for any reason was 86.4% +/- 2.6%, 39.6% +/- 5.2%, and 35.0% +/- 5.4% at 10, 20, and 25 years, respectively. Larger implanted valve, reexploration for bleeding, previous cardiac surgery, and operative rank were independent risks for reoperation. Early mortality in reoperations was 5.1%. Allograft endocarditis has occurred in 6 patients, giving an overall freedom of 94% at 25 years. Seven patients of the original cohort are known to be alive with their original allograft valve in situ, and of these the longest follow-up period is 29.8 years., Conclusions: The use of antibiotic-sterilized allografts for subcoronary aortic valve replacement confers low operative mortality and excellent long-term survival with durability matching any other nonmechanical device. Significantly reduced time-related risk of reoperation and excellent internal to external diameter ratio renders allograft aortic valve replacement especially ideal for smaller roots.
- Published
- 2007
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33. The evaluation of real-time 3-dimensional transthoracic echocardiography for the preoperative functional assessment of patients with mitral valve prolapse: a comparison with 2-dimensional transesophageal echocardiography.
- Author
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Sharma R, Mann J, Drummond L, Livesey SA, and Simpson IA
- Subjects
- Computer Systems, Feasibility Studies, Female, Humans, Image Enhancement methods, Male, Middle Aged, Prognosis, Reproducibility of Results, Sensitivity and Specificity, Echocardiography, Three-Dimensional methods, Echocardiography, Transesophageal methods, Image Interpretation, Computer-Assisted methods, Mitral Valve Prolapse diagnostic imaging, Mitral Valve Prolapse surgery, Preoperative Care methods
- Abstract
Objective: We sought to compare the feasibility and accuracy of transthoracic real-time 3-dimensional echocardiography (RT-3DE) with transesophageal echocardiography (TEE) for the preoperative functional assessment of patients with mitral valve prolapse., Methods: In 44 patients with severe mitral regurgitation caused by type 2 valve dysfunction, TEE and RT-3DE were performed 24 hours before surgery and analyzed by two separate observers. TEE and RT-3DE images were acquired digitally and stored for offline analysis. The echocardiographic results were validated intraoperatively., Results: Five patients did not have image quality suitable for analysis with RT-3DE and were excluded from analysis, leaving a sample size of 39. In total, 54 of 334 analyzed mitral valve segments were diseased. Prolapse of a single mitral valve segment was present in 25 patients and 14 patients had complex disease involving two or more segments. Sensitivity, specificity, and accuracy for TEE in identification of diseased segments were 94%, 100%, and 96%, respectively. The same values for RT-3DE were 91%, 100%, and 94%, respectively. The differences were not statistically significant. Accuracies were not significantly different according to segment location. Interobserver agreement was 92% for TEE and 88% for RT-3DE (P = nonsignificant)., Conclusions: RT-3DE is feasible with comparative accuracy to TEE for precise anatomic localization of prolapsing mitral valve segments. However, the technique is limited by poor image quality in 11% of patients.
- Published
- 2007
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34. Post mortem examinations after cardiac surgery.
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Hickling MF, Pontefract DE, Gallagher PJ, and Livesey SA
- Subjects
- Cause of Death, Humans, Myocardium pathology, United Kingdom, Autopsy statistics & numerical data, Cardiac Surgical Procedures
- Published
- 2007
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- View/download PDF
35. Papillary fibroelastoma in the left ventricular outflow tract.
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Efthymiou CA, Moorjani N, and Livesey SA
- Subjects
- Aged, Echocardiography, Fibroma diagnostic imaging, Heart Neoplasms diagnostic imaging, Humans, Male, Ventricular Outflow Obstruction diagnostic imaging, Fibroma complications, Heart Neoplasms complications, Ventricular Outflow Obstruction etiology
- Published
- 2007
- Full Text
- View/download PDF
36. The effect of leucodepletion on leucocyte activation, pulmonary inflammation and respiratory index in surgery for coronary revascularisation: a prospective randomised study.
- Author
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Alexiou C, Tang AA, Sheppard SV, Smith DC, Gibbs R, Livesey SA, Monro JL, and Haw MP
- Subjects
- Aged, Analysis of Variance, Biomarkers analysis, Female, Humans, Inflammation immunology, Inflammation physiopathology, Leukocyte Count methods, Lung Diseases metabolism, Male, Middle Aged, Myocardial Revascularization methods, Nitric Oxide analysis, Oxygen physiology, Postoperative Complications etiology, Prospective Studies, Pulmonary Alveoli physiopathology, Time Factors, Cardiopulmonary Bypass, Leukocytes physiology, Lung Diseases immunology, Pulmonary Alveoli immunology
- Abstract
Objective: Leucocyte activation is central to end-organ damage that occurs during cardiac surgery under cardiopulmonary bypass (CPB). Exhaled nitric oxide (NO) increases in inflammatory lung conditions and has been proposed as a marker of pulmonary inflammation during CPB. This study examined the effect of leucodepletion on leucocyte activation, pulmonary inflammation and oxygenation in patients undergoing coronary revascularisation., Methods: Fifty low-risk patients undergoing first time coronary artery bypass graft (CABG) were randomised to two groups. Twenty-five patients had an arterial line leucocyte-depleting filter and 25 controls had a standard filter. Arterial blood samples were taken before CPB, 5 and 30 min on CPB, 5 min after aortic clamp removal and 6 h post-operatively. Activated leucocytes were identified with Nitroblue Tetrazolium staining. NO was sampled via an endotracheal teflon tube 15 min after median sternotomy before CPB and 30 min after discontinuation of CPB using a real-time chemiluminescense analyser. Respiratory index (alveolar-arterial oxygenation index, AaOI) was calculated before CPB, 1, 2, 4, 8 and 18 h post-operatively. Clinical outcome end-points were also recorded., Results: Total and activated leucocyte counts were significantly lower following leucodepletion during CPB (P < 0.0001). Exhaled NO rose significantly after CPB in the control group (3.8+/-1 ppb/s before CPB vs 5.6+/-2 ppb/s after CPB (P = 0.003) but not in the leucodepleted group (3.7+/-1 ppb/s before CPB vs 3.9+/-1 ppb/s after CPB (P = 0.051). AaOIs were consistently lower after leucodepletion (anova, P = 0.001). The duration of mechanical ventilation, the intensive care and hospital stay and the frequency of cardiac and respiratory complications were similar in the two groups., Conclusions: Leucodepletion reduces the numbers of circulating activated leucocytes and the pulmonary inflammation during CPB. This appears to limit lung injury and improve oxygenation in low-risk patients undergoing CABG surgery. Larger numbers of patients are required to evaluate the effect of continuous arterial line leucodepletion on the clinical outcome.
- Published
- 2004
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37. Explant pathology study of decellularized carotid artery vascular grafts.
- Author
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Hilbert SL, Boerboom LE, Livesey SA, and Ferrans VJ
- Subjects
- Animals, Carotid Arteries anatomy & histology, Carotid Arteries pathology, Carotid Arteries ultrastructure, Goats surgery, Head blood supply, Male, Microscopy, Electron, Veins anatomy & histology, Carotid Arteries transplantation
- Abstract
The purpose of this study was to evaluate the morphologic findings in small-diameter freeze-dried decellularized carotid artery grafts implanted in goats as carotid artery interposition grafts for 6-7 months. Unimplanted decellularized carotid artery grafts did not contain intact cells; however, remnants of smooth muscle cells were present in the media. The extracellular matrix was well preserved. All decellularized grafts were patent at explant, without significant dimensional changes or aneurysm formation. Their luminal surfaces were lined by a thin neointima, consisting of myofibroblasts, collagen, and a discontinuous layer of endothelial cells. Histologic evidence of calcification within the explants was not observed; however, electron microscopy showed calcification of minute remnants of cell membranes. Inflammatory cells were not present in the graft wall. Host cell migration was greatest in the adventitia along the length of the graft. Migration of host cells into the media was more apparent close to the anastomoses, forming cellular nests rich in extracellular proteoglycans, whereas cell migration into areas subjacent to the lumen was minimal. Ingrowth of host blood vessels was not observed. These results demonstrate satisfactory structural and morphologic features of a decellularized carotid artery small-diameter graft implanted for up to 7 months., (Copyright 2004 Wiley Periodicals, Inc. J Biomed Mater Res 69A: 197-204, 2004)
- Published
- 2004
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38. Biochemical stabilization enhances red blood cell recovery and stability following cryopreservation.
- Author
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Wagner CT, Martowicz ML, Livesey SA, and Connor J
- Subjects
- Cryoprotective Agents, Dextrans, Erythrocyte Membrane metabolism, Flurbiprofen, Glycerol, Humans, Hydroxyethyl Starch Derivatives, In Vitro Techniques, Niacinamide, Nifedipine, Osmotic Fragility, Thermodynamics, Blood Preservation methods, Cryopreservation methods, Erythrocytes cytology, Erythrocytes metabolism
- Abstract
Glycerolized red blood cells (RBC) are approved for long-term cryopreservation. However, the need to remove the glycerol cryoprotectant prior to transfusion has limited the usefulness of this cryopreservation method. This report describes using non-cryoprotectant biochemical stabilization techniques to substitute for the standard glycerol cryoprotectant. The glycerolized RBC method was compared to a newly developed LC-V method that combines transfusable cryoprotectants (hydroxyethyl starch and dextran) and specific non-cryoprotectant biochemical stabilizers (nicotinamide, nifedipine, and flurbiprofen). Results demonstrate that the biochemical stabilizers significantly reduce cryopreservation-induced hemolysis compared to cryopreservation in their absence and that thaw hemolysis levels approach those of standard 40% (w/v) glycerolized RBC (3.1+/-0.2% for 40% glycerol compared to 8.7+/-0.9% for the LC-V protocol). Furthermore, LC-V cryopreserved RBC exhibit a significantly enhanced post-thaw stability compared to glycerolized RBC as determined by osmotic fragility index (0.557+/-0.034 for 40% glycerol compared to 0.478+/-0.016 for the LC-V protocol). Analysis of biochemically stabilized RBC proteins revealed a transient translocation of carbonic anhydrase to the membrane fraction. However, the enhanced RBC recovery and stability could not be attributed to this event. Finally, DSC analysis demonstrated that the biochemical stabilizers of the LC-V process were not functioning as surrogate cryoprotectants in that they did not affect the quantity or quality of ice formed. Overall, this work demonstrates that cryopreservation-induced RBC damage may be corrected or prevented through specific biochemical stabilization and represents a significant step toward a directly transfusable cryopreserved RBC product.
- Published
- 2002
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39. Risk of reoperation for structural failure of aortic and mitral tissue valves.
- Author
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Dalrymple-Hay MJ, Crook T, Bannon PG, Ohri SK, Haw MP, Bayfield MS, Hendel NP, Livesey SA, Hughes CF, and Monro JL
- Subjects
- Adult, Aged, Australia epidemiology, Blood Vessel Prosthesis Implantation, Coronary Artery Bypass, Female, Heart Valve Diseases epidemiology, Heart Valve Diseases surgery, Heart Valve Prosthesis, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Morbidity, Retrospective Studies, Risk Factors, Stents, Survival Analysis, Treatment Failure, United Kingdom epidemiology, Aortic Valve surgery, Mitral Valve surgery, Reoperation mortality
- Abstract
Background and Aim of the Study: The study aim was to assess the risk of reoperation for patients with a failing stented tissue valve., Methods: Between 1980 and 1999, 259 patients (118 males, 141 females; mean age 60.1+/-15.4 years) underwent redo valve replacement to replace a failing stented tissue valve. Of these patients, 94 (36.3%) underwent redo aortic valve replacement (AVR), 105 (40.5%) redo mitral valve replacement (MVR), and 60 (23.2%) redo aortic and mitral valve replacement (DVR). Twenty patients (7.7%) had previous coronary artery bypass grafting (CABG); further CABG were performed in 32 cases (12.4%). Preoperatively, 216 patients (83.3%) were in NYHA functional class III or IV., Results: The early mortality was (6.5%; n = 17), including three patients who had AVR, five DVR, and nine MVR. A higher preoperative NHYA status (p <0.0004) and emergency surgery (p <0.0001) were significantly associated with an increased risk of operative death (univariate analysis). Age at surgery (p = 0.45), previous CABG (p = 0.45), position of the valve replaced (p = 0.2), type of implant (p = 0.06) and presence of coronary artery disease (p = 0.51) were not associated with a significant risk of operative mortality. Including those patients who died, 88 (34.0%) experienced a peri- or postoperative complication, seven of which (2.7%) were permanent., Conclusion: A failing tissue valve can be replaced, with acceptable operative mortality and morbidity. The choice of valve is a balance of its advantages and disadvantages, and these must be discussed with the patient. It appears, however, that the trend towards reducing the age at which tissue valve implantation is performed may be justified.
- Published
- 2002
40. Mitral valve surgery for acute papillary muscle rupture following myocardial infarction.
- Author
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Chen Q, Darlymple-Hay MJ, Alexiou C, Ohri SK, Haw MP, Livesey SA, and Monro JL
- Subjects
- Aged, Aged, 80 and over, Cardiomyopathies surgery, Coronary Artery Bypass, Emergencies, Female, Heart Rupture, Post-Infarction mortality, Heart Rupture, Post-Infarction surgery, Humans, Length of Stay, Male, Middle Aged, Mitral Valve Insufficiency etiology, Reoperation, Cardiomyopathies complications, Heart Rupture, Post-Infarction complications, Mitral Valve Insufficiency surgery, Papillary Muscles
- Abstract
Background and Aim of the Study: Acute papillary muscle rupture (PMR) is a rare but fatal complication of myocardial infarction (MI). Surgery represents the best treatment option, but carries a high risk. Our experience of emergency mitral valve surgery in patients with acute PMR following MI during the past 22 years is reviewed., Methods: Between 1978 and 2000, 33 patients (20 males, 13 females; mean age 64 years; range: 46-80) underwent emergency surgery for acute post-infarct PMR in our institution. The site of MI was anterior in three patients and inferior in 30. Preoperatively, 17 patients had an intra-aortic balloon pump (IABP) inserted, 26 were on inotropic support, and 17 were ventilated. Twenty patients (61%) underwent concomitant coronary bypass grafting (CABG). The valve was replaced in 31 patients and repaired in two. Mean (+/- SD) duration of follow up was 63+/-54 months (range: 0-183 months)., Results: Early mortality (in-hospital) was 21% (n = 7). Factors associated with significant risk of early mortality included raised preoperative serum creatinine (p = 0.02), need for preoperative inotropic support (p = 0.03) and preoperative ventilation (p = 0.03). Raised preoperative serum creatinine remained significant on multiple logistic regression (p = 0.04). Postoperatively, 21 patients required an IABP. Mean duration of intensive care unit stay was 4+/-2.5 days (range: 0-10 days). Survival, including in-hospital mortality, at one, five and 10 years was 75+/-7.4, 65+/-8.6 and 32+/-9.7%, respectively. Four patients required valve-related reoperation (three for a paraprosthetic leak, one for failed repair)., Conclusion: Patients with acute post-infarct PMR present in a severely compromised state. Early mortality is high, but the intermediate outcome is encouraging for operative survivors.
- Published
- 2002
41. Aortic root replacement in patients with Marfan's syndrome: the Southampton experience.
- Author
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Alexiou C, Langley SM, Charlesworth P, Haw MP, Livesey SA, and Monro JL
- Subjects
- Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Postoperative Complications epidemiology, Survival Rate, Time Factors, Aorta surgery, Aortic Valve surgery, Marfan Syndrome surgery
- Abstract
Background: The purpose of this study was to evaluate the early and late clinical outcome after aortic root replacement (ARR) in patients with Marfan's syndrome., Methods: A total of 65 consecutive patients with Marfan's syndrome (mean age 41.7 +/- 10.7 years, range 15 to 76 years) undergoing ARR between 1972 and 1998 in Southampton were studied. Of the patients, 45 had a chronic aneurysm of the ascending aorta and 20 had a type A dissection (16 acute and 4 chronic). The operations were elective in 38 and nonelective in 27 cases (emergency in 22 and urgent in 5). Mean size of the ascending aorta was 6.3 +/- 1.4 cm (3.8 to 12 cm). A Bentall procedure was performed in 62 and a homograft root replacement in 3 patients. Mean follow-up was 8 +/- 4.1 years (0 to 22.9 years)., Results: Operative mortality was 6.1% (4 deaths) (for the elective vs nonelective procedures it was 2.6% vs 11%, p = 0.2). The 10-year freedom from thromboembolism, hemorrhage, and endocarditis was 88%, 89.8%, and 98.4% (0.9%, 0.9%, and 0.2% per patient-year) and from late aortic events it was 86.3% (1.3% per patient-year). Aortic root replacement for dissection was an independent predictor of occurrence of late aortic events (p = 0.01). Five patients had a reoperation with one early death. The 10-year freedom from reoperation was 89.2% (1.1% per patient year) (for elective and nonelective procedures, 90.8% vs 84.6%, p = 0.6). The 10-year survival, including operative mortality, was 72.7% (for elective and nonelective procedures, 78% vs 66.5%, p = 0.6). Late aortic events was an independent adverse predictor of survival (p = 0.02)., Conclusions: In patients with Marfan's syndrome, elective ARR, usually for chronic aneurysm, is associated with a low mortality, low rate of aortic complications, and good late survival. Nonelective ARR, mostly for dissection, has a greater operative risk and a significantly higher incidence of late catastrophic aortic events. Early prophylactic surgery in these patients is therefore recommended. Long-term clinical and radiologic follow-up to prevent or to treat late aortic events is highly desirable.
- Published
- 2001
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42. Notice on use of AlloDerm.
- Author
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Livesey SA
- Subjects
- Humans, United States, Biocompatible Materials administration & dosage, Collagen administration & dosage, Dura Mater, United States Food and Drug Administration
- Published
- 2001
- Full Text
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43. Autotransfusion decreases blood usage following cardiac surgery -- a prospective randomized trial.
- Author
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Dalrymple-Hay MJ, Dawkins S, Pack L, Deakin CD, Sheppard S, Ohri SK, Haw MP, Livesey SA, and Monro JL
- Subjects
- Adult, Aged, Coronary Artery Bypass, Female, Heart Valve Diseases surgery, Humans, Male, Postoperative Period, Prospective Studies, Blood Transfusion, Autologous, Cardiac Surgical Procedures
- Abstract
Introduction: 10% of blood issued by the National Blood Service (220,000) is utilised in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We tested the efficacy of autotransfusion of washed postoperative mediastinal fluid in a prospective randomized trial., Patients and Methods: 166 patients undergoing coronary artery bypass grafting (CABG), valve or CABG + valve procedures were randomized into three groups. The indication for transfusion was a postoperative haemoglobin (Hb) < 10 g/l or a packed cell volume (PCV) < 30. When applicable, group A patients received washed post-operative drainage fluid. Group B all received blood processed from the cardiopulmonary bypass (CPB) circuit following separation from CPB and if appropriate washed post-operative drainage fluid. Group C were controls. Groups were compared using analysis of variance., Results: There was no significant difference in age, sex, type of operation, CPB time and preoperative Hb and PCV between the groups. Blood requirements were as shown. [table - see text] Twelve patients in group A and 10 in group B did not require a homologous transfusion following processing of the mediastinal drainage fluid., Conclusion: Autotransfusion of washed postoperative mediastinal fluid can decrease the amount of homologous blood transfused following cardiac surgery. There was no demonstrable benefit in processing blood from the CPB circuit as well as mediastinal drainage fluid.
- Published
- 2001
- Full Text
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44. Sex differences in investigation results and treatment in subjects referred for investigation of chest pain.
- Author
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Wong Y, Rodwell A, Dawkins S, Livesey SA, and Simpson IA
- Subjects
- Aged, Cardiology Service, Hospital, Cohort Studies, Coronary Angiography, Coronary Disease therapy, England, Exercise Test, Female, Humans, Male, Middle Aged, Myocardial Revascularization, Pain Clinics, Predictive Value of Tests, Sex Factors, Chest Pain etiology, Coronary Disease diagnosis, Health Services Accessibility, Outcome and Process Assessment, Health Care, Prejudice, Referral and Consultation statistics & numerical data
- Abstract
Objective: To evaluate differences in investigation results and treatment between men and women referred for diagnostic treadmill exercise testing and coronary arteriography., Design: Cohort study., Setting: Tertiary cardiology centre., Subjects: 1522 subjects referred by primary care physicians to an open access chest pain clinic for initial investigation of chest pain, of whom 485 were subsequently referred for coronary arteriography; and a similar cohort of 107 subjects referred directly by secondary care physicians for diagnostic coronary arteriography., Main Outcome Measures: Rates of positive exercise tests and rates for referral for arteriography and revascularisation according to sex., Results: Overall, women were less likely to be referred for arteriography and revascularisation than men. However, men were more likely to have positive exercise tests, and for various exercise test diagnostic end points men were also more likely to have significant coronary artery disease. After taking this into account, there was no sex difference in referral rates for arteriography or revascularisation., Conclusions: There was no evidence of a sex bias resulting in inappropriate underinvestigation or undertreatment of women. However, the positive predictive value of treadmill exercise testing is low for women and further research is needed into how best to investigate women with chest pain.
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- 2001
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45. Red blood cell stabilization reduces the effect of cell density on recovery following cryopreservation.
- Author
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Wagner CT, Burnett MB, Livesey SA, and Connor J
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- Hematocrit, Hemolysis, Humans, Osmotic Fragility, Cryopreservation, Erythrocytes cytology
- Abstract
The relationship between red blood cell hematocrit and hemolysis during cryopreservation has been examined. Cells were frozen with glycerol, thawed, and deglycerolized in a model system based on the protocols used in transfusion medicine. Analysis included determination of hemolysis following thaw (Thaw) and deglycerolization (Overall) and osmotic fragility of the final cell suspensions. Results demonstrate that thaw hemolysis decreased with increasing hematocrit at all glycerol levels tested. Overall hemolysis increased with increasing hematocrit at low (15% w/v) glycerol and decreased with increasing hematocrit at high (40% w/v) glycerol levels. These results were paralleled by changes in the fragility index. Furthermore, these results indicate a distinction between freeze/thaw lysis and damage which leads to lysis during postthaw processing. To examine this further, a biochemical stabilizing solution, having no cryoprotective effects itself, was added to suboptimal glycerol concentrations. This addition resulted in hemolysis levels and fragility indices comparable to those using high (40% w/v) glycerol levels. Thus, the damage observed with increasing hematocrit is not necessarily a function of the packing on the volume of the ice-free zone, but rather an expression of cell damage. Furthermore, this damage is, in part, biochemical in nature and may be protected against through specific cellular stabilization prior to cryopreservation., (Copyright 2000 Academic Press.)
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- 2000
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46. Aortic valve replacement for endocarditis: determinants of early and late outcome.
- Author
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Langley SM, Alexiou C, Stafford HM, Dalrymple-Hay MJ, Haw MP, Livesey SA, and Monro JL
- Subjects
- Adolescent, Adult, Aged, Bioprosthesis, Child, Endocarditis, Bacterial mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Care, Recurrence, Reoperation, Staphylococcal Infections surgery, Survival Rate, Treatment Outcome, Aortic Valve surgery, Endocarditis, Bacterial surgery, Heart Valve Prosthesis Implantation mortality
- Abstract
Background and Aim of the Study: The study aim was to determine risk factors for operative mortality, recurrent infection, reoperation and long-term survival following aortic valve replacement (AVR) for infective endocarditis., Methods: Between 1973 and 1997, 109 patients (91 male, 18 female, mean age 52.6 years) underwent isolated AVR for infective endocarditis in our unit. Native valve endocarditis was present in 89 (81.6%) and prosthetic valve endocarditis in 20 (18.4%). Active culture-positive endocarditis was present in 53 (48.6%). Preoperatively, 99 patients (90.8%) were in NYHA classes III and IV. Indications for surgery included cardiac failure in 41 patients, valvular dysfunction in 38, vegetations in 18, sepsis in seven, abscess in six and embolism in four. Mechanical valves were implanted in 69 patients (63.3%) and bioprostheses in 40 (36.7%), including a homograft in 19 (17.4%). Follow up was complete (mean 5.8 years; range: 0-23.8 years; total 633.5 patient-years)., Results: The operative mortality was 10.1% (11 deaths). At ten years, freedom from recurrent infection was 94.2%, and freedom from reoperation 83.6%. Biological valve and younger age were significant adverse parameters for freedom from reoperation (p = 0.01 and p = 0.01). There have been 21 late deaths, 15 due to cardiac causes. Kaplan-Meier survival, including operative mortality, at five and ten years was 77.4% and 68.0%, respectively. On Cox proportional hazards regression, Staphylococcus aureus infection (p = 0.008) and older age (p = 0.04) were independent adverse predictors of survival., Conclusion: AVR for endocarditis carries a relatively high operative mortality, but can result in a satisfactory freedom from recurrent infection, reoperation and long-term survival. Analysis of our series demonstrates that implantation of a biological valve limits the freedom from reoperation and that infection by Staph. aureus reduces the probability of long-term survival.
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- 2000
47. Mid-term results with 1,503 CarboMedics mechanical valve implants.
- Author
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Dalrymple-Hay MJ, Pearce RK, Dawkins S, Alexiou C, Haw MP, Livesey SA, and Monro JL
- Subjects
- Aged, Aortic Valve surgery, Endocarditis epidemiology, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation, Hospital Mortality, Humans, Incidence, Male, Middle Aged, Mitral Valve surgery, Morbidity, Postoperative Complications epidemiology, Prosthesis Design, Reoperation statistics & numerical data, Thromboembolism epidemiology, Time Factors, Heart Valve Prosthesis adverse effects
- Abstract
Background and Aim of the Study: The CarboMedics bileaflet prosthetic heart valve was introduced in 1986, and first implanted by the authors in March 1991. The aim of this study was to analyze the authors' clinical experience with this valve., Methods: Between March 1991 and October 1998, 1,503 valves were implanted in 1,350 patients (758 males, 592 female; mean age 62 +/- 13 years). Follow up was 99% complete and totaled 4,342 patient-years (pt-yr)., Results: The hospital mortality rate was 4.3% (59/1,350). Preoperative NYHA class (p = 0.012), emergency surgery (p = 0.03) and cardiopulmonary bypass time (p = 0.01) were significantly associated with increased risk of operative death (multiple logistic regression). Mean (+/- SEM) survival rates at one and five years were 92.0 +/- 0.7% (n = 1,109) and 80.0 +/- 1.3% (n = 335). Freedom from valve-related complications (linearized rate 5.6%/pt-yr) at one and five years was 89.5 +/- 0.8% (n = 1,031) and 76.3 +/- 1.4% (n = 284). Linearized rates for bleeding events were 2.19%/pt-yr, thromboembolic events 2%/pt-yr, operated valvular endocarditis 0.18%/pt-yr, valve thrombosis 0.14%/pt-yr and non-structural dysfunction 1.22%/pt-yr. Freedom from reoperation at one and five years was 98.5 +/- 0.3% (n = 1,107) and 97.3 +/- 0.5% (n = 334)., Conclusion: Mid-term results demonstrate that the CarboMedics prosthetic heart valve exhibits a low incidence of valve-related complications.
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- 2000
48. Surgery for active culture-positive endocarditis: determinants of early and late outcome.
- Author
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Alexiou C, Langley SM, Stafford H, Lowes JA, Livesey SA, and Monro JL
- Subjects
- Adolescent, Adult, Aged, Aortic Valve microbiology, Endocarditis, Bacterial microbiology, Endocarditis, Bacterial mortality, Female, Follow-Up Studies, Heart Valves pathology, Humans, Male, Middle Aged, Mitral Valve microbiology, Prosthesis-Related Infections, Recurrence, Reoperation, Risk Factors, Staphylococcus isolation & purification, Streptococcus isolation & purification, Survival Rate, Treatment Outcome, Endocarditis, Bacterial surgery
- Abstract
Background: The purpose of this study was to describe a single unit experience in the surgical treatment of active culture-positive endocarditis and identify determinants of early and late outcome., Patients and Methods: One hundred eighteen consecutive patients with positive blood culture up to 3 weeks before operation (or positive valve culture) and macroscopic evidence of lesions typical for endocarditis, undergoing operation between January 1973 and December 1996 in Southampton, were evaluated. The aortic valve was infected in 53 (48.9%), the mitral in 46 (39%), both aortic and mitral in 12 (10.1%), the tricuspid in 4 (3.9%), and the pulmonary valve in 3 (2.5%). Native valve endocarditis was present in 83 (70.3%) and prosthetic valve endocarditis in 35 (29.7%). Streptococci and staphylococci were the most common pathogens. Mean follow-up was 5.6 years (range, 0 to 25 years)., Results: Operative mortality was 7.6% (9 patients). Endocarditis recurred in 8 (6.7%). A reoperation was required in 12 (10.2%). There was 24 late deaths, 17 of them cardiac. Actuarial freedom from recurrent endocarditis, reoperation, late cardiac death, and long-term survival at 10 years were 85.9%, 87.2%, 85.2%, and 73.1%, respectively. On multiple regression analysis the following were independent adverse predictors: pulmonary edema (p = 0.007) and impaired left ventricular function (p = 0.02) for operative mortality; prosthetic valve endocarditis (p = 0.01) for recurrent infection; myocardial invasion by the infection (p = 0.01) and reoperation (p = 0.04) for late cardiac death; and coagulase-negative staphylococcus (p = 0.02), annular abscess (p = 0.02), and longer intensive care unit stay (p = 0.02) for long-term survival., Conclusions: Operation for active culture-positive endocarditis carries an acceptable mortality. Freedom from recurrent infection, reoperation, and long-term survival are satisfactory. In our data, patients' hemodynamic status at operation was the major determinant of operative mortality. Prosthetic valve endocarditis, coagulase-negative staphylococcus, and annular or myocardial infectious invasion were the critical adverse determinants of late outcome.
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- 2000
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49. Surgical treatment of infective mitral valve endocarditis: predictors of early and late outcome.
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Alexiou C, Langley SM, Stafford H, Haw MP, Livesey SA, and Monro JL
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- Actuarial Analysis, Female, Follow-Up Studies, Heart Valve Prosthesis adverse effects, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Prosthesis-Related Infections surgery, Recurrence, Reoperation statistics & numerical data, Risk Factors, Survival Rate, Time Factors, Endocarditis, Bacterial mortality, Endocarditis, Bacterial surgery, Mitral Valve
- Abstract
Background and Aims of the Study: The study aim was to review our experience in surgical treatment of infective mitral valve endocarditis, and to identify predictors of early and late outcome., Methods: Ninety-one consecutive patients (52 males, 39 females, mean age 55.6 years) underwent surgery between 1973 and 1997 for endocarditis of isolated mitral (n = 65, 71%), mitral and aortic (n = 25, 28%) and mitral, aortic and tricuspid valves (n = 1, 1%). Native valve endocarditis (NVE) was present in 60 patients (66%) and prosthetic valve endocarditis (PVE) in 31 (34%). The main indications for surgery were heart failure in 32 patients, valve dysfunction in 23, vegetations in 21, and persistent sepsis in 11. Eighty-six patients (95%) were in NYHA classes III-IV, and 58 (64%) had active culture-positive endocarditis at surgery. Mechanical valves were implanted in 73 patients and bioprosthetic valves in 13; valves were repaired in five patients. The impact of 46 parameters on early and late outcome was defined by means of univariate and multivariate statistical analysis. Follow up was complete (mean 5.5 years; range: 0-23.1 years; total 507.3 patient-years)., Results: Operative mortality rate was 11% (n = 10). Recurrent infection was recorded in five patients (6%), and reoperation was required in eight (9%). Freedom from recurrent infection and reoperation at 10 years was 89.1% and 87.8% respectively. There were 22 late deaths, 15 from cardiac causes. Actuarial survival rates for all patients at 5, 10 and 15 years were 73.0%, 62.7% and 58.7% (for hospital survivors, the corresponding rates were 81.9%, 69.7% and 66.0%). On multiple logistic regression and Cox proportional hazards models, the following were independent predictors: preoperative pulmonary edema (p = 0.01) for operative mortality; PVE (p = 0.02) for recurrence; younger age (p = 0.02) and PVE (p = 0.02) for reoperation; male gender (p = 0.004) and longer ITU stay for survival (if all patients were included); male gender (p = 0.01) and myocardial invasion by infection (p = 0.02) for survival (if only the hospital survivors were analyzed)., Conclusion: Surgery for infective mitral valve endocarditis carries a relatively high, though acceptable, risk but provides satisfactory freedom from recurrent infection, reoperation and improved long-term survival. Analysis of these data demonstrated that the preoperative hemodynamic status was the major predictor of in-hospital outcome, PVE increased the risk for recurrent infection and reoperation, whereas male gender and myocardial invasion by the infective process critically reduced the probability of long-term survival. The type of offending pathogen, the activity of infection and the involvement of more than one valve did not appear to influence early and/or late outcome.
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- 2000
50. A single-center experience with 1,378 CarboMedics mechanical valve implants.
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Dalrymple-Hay MJ, Pearce R, Dawkins S, Haw MP, Lamb RK, Livesey SA, and Monro JL
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- Adolescent, Adult, Aged, Aged, 80 and over, Evaluation Studies as Topic, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Humans, Male, Middle Aged, Prospective Studies, Prosthesis Design, Reoperation, Heart Valve Prosthesis
- Abstract
Background: The CarboMedics bileaflet prosthetic heart valve was introduced in 1986. We first implanted it in March 1991. The purpose of this study was to analyze our clinical experience with this valve., Methods: Between March 1991 and December 1997, 1,378 valves were implanted in 1,247 patients, 705 men (56.5%) and 542 (43.5%) women with a mean age of 62 +/- 11.9 years (+/- the standard deviation). Follow-up is 99% complete and totals 3,978 patient-years., Results: The early mortality rate was 4.4% (55/1,247). The survival rates at 1 year and 5 years were 91.8% +/- 0.8% (+/- the standard error of mean) (n = 1,062) and 79.2% +/- 1.4% (n = 281), respectively. Freedom from valve-related complications (linearized rate, 4.9% per patient-year) at 1 year and 5 years was 90.6% +/- 0.8% (+/- the standard error of the mean) (n = 996) and 80.6% +/- 1.4% (n = 243), respectively. Linearized rates for various complications were as follows: bleeding events, 1.73% per patient-year; embolic events, 1.76% per patient-year; operated valvular endocarditis, 0.18% per patient-year; valve thrombosis, 0.10% per patient year; and nonstructural dysfunction, 1.21% per patient-year. Freedom from reoperation at 1 year and 5 years was 98.6% +/- 0.3% (+/- the standard error of the mean) (n = 1,070) and 97.7% +/- 0.5% (n = 285), respectively., Conclusions: Midterm results demonstrate that the CarboMedics prosthetic heart valve exhibits a low incidence of valve-related complications.
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- 2000
- Full Text
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