69 results on '"Norman Briffa"'
Search Results
2. A Systematic Review of 4D-Flow MRI Derived Mitral Regurgitation Quantification Methods
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Benjamin Fidock, Natasha Barker, Nithin Balasubramanian, Gareth Archer, Graham Fent, Abdullah Al-Mohammad, James Richardson, Laurence O'Toole, Norman Briffa, Alexander Rothman, Rob van der Geest, Rod Hose, James M. Wild, Andrew J. Swift, and Pankaj Garg
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mitral regurgitation ,4D flow CMR ,4D flow MRI ,phase contrast ,echocardiography ,retrospective-valve-tracking ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Four-dimensional flow cardiac magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology that can be used to quantify mitral regurgitation (MR) volume. Current methods of quantification have demonstrated limitations in accurate analysis, particularly in difficult cases such as complex congenital heart disease. 4D flow CMR methods aim to circumvent these limitations and allow accurate quantification of MR volume even in complex cases. This systematic review aims to summarize the available literature on 4D flow CMR MR quantification methods and examine their ability to accurately classify MR severity.Methods: Structured searches were carried out on Medline and EMBASE in December 2018 to identify suitable research outcome studies. The titles and abstracts were screened for relevance, with a third adjudicator utilized when study suitability was uncertain.Results: Seven studies met the eligibility criteria and were included in the systematic review. The most widely used 4D flow MRI method was retrospective valve tracking (RVT) which was examined in five papers. The key finding of these papers was that RVT is a reliable and accurate method of regurgitant volume quantification.Conclusions: MR quantification through 4D flow MRI is both feasible and accurate. The evidence gathered suggests that for MR assessment, 4D flow MRI is potentially as accurate and reliable to echocardiography and may be complementary to this technique. Further work on MR quantification 4D flow image analysis is needed to determine the most accurate analysis technique and to demonstrate 4D flow MRI as a predictor of clinical outcome.PROSPERO Registration Number: CRD42019122837, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019122837
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- 2019
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3. Indications for echocardiography of replacement heart valves: a joint statement from the British Heart Valve Society and British Society of Echocardiography
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John B Chambers, Madalina Garbi, Norman Briffa, Vishal Sharma, and Richard P Steeds
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valve replacement ,echocardiography ,valve clinic ,structural valve deterioration ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Echocardiography plays a vital role in the follow-up of patients with replacement heart valves. However, there is considerable variation in international guidelines regarding the recommended time points after implantation at which routine echocardiography should be performed. The purpose of routine echocardiography is to detect early structural valve deterioration in biological valves to improve the timing of redo interventions. However, the risk of valve deterioration depends on many valve-related factors (valve design and patient prosthesis mismatch) and patient-related factors (age, diabetes, systemic hypertension, renal dysfunction and smoking). In this statement, the British Heart Valve Society and the British Society of Echocardiography suggest practical guidance. A plan should be made soon after implantation, but this may need to be modified for individual patients and as circumstances change. It is important that patients are managed in a multidisciplinary valve clinic.
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- 2019
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4. Commentary: Surgical aortic valve replacement for the younger patient, but which one?
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Norman Briffa
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Text mining ,Aortic valve replacement ,business.industry ,MEDLINE ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2023
5. Negative pressure wound therapy in patients with diabetes undergoing left internal thoracic artery harvest: A randomized control trial
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Sam, Jenkins, Mohamed, Komber, Kavitha, Mattam, and Norman, Briffa
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Patients with diabetes undergoing CABG are at risk of wound infection. Incisional negative pressure wound therapy has been shown to be effective in decreasing incidence of infection in high-risk wounds. Near infrared spectroscopy (NIRS) can be used to assess wound oxygenation and low values can predict infection.To evaluate utility of NIRS to assess wound oxygenation, to assess effect of sternotomy, left internal thoracic artery harvest, and wound dressing type on wound edge oxygenation.In this blinded randomized control trial, patients with diabetes undergoing isolated coronary artery bypass grafting with a left internal thoracic artery were randomized to receive either incisional negative pressure wound therapy dressing or a standard dressing. NIRS measurements were made on the left upper arm (control), and left and right parasternal regions on day -1 (preoperative), day 5, and week 6 after surgery. Results were analyzed using repeated measures parametric methods.Eighty patients with diabetes were recruited, 40 to the incisional negative pressure wound therapy group and 40 to the standard dressing group. Adjusted NIRS readings dropped significantly in all patients by day 5 and partially recovered by week 6. In both groups, there was no difference between readings on the left and right. At all time points and on both sides, there was no difference in readings between patients in the 2 groups.NIRS can be used to assess oxygenation adjacent to a sternotomy wound. Adjusted tissue oxygen levels change with time after sternotomy and left internal thoracic artery harvest in patients with diabetes. Wound dressing type does not influence day 5 wound edge oxygenation.
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- 2022
6. Indirect effects of the first two years of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries
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F Lucy Wright, Kate Cheema, Raph Goldacre, Nick Hall, Naomi Herz, Nazrul Islam, Zainab Karim, David Moreno-Martos, Daniel R Morales, Daniel O’Connell, Enti Spata, Ashley Akbari, Mark Ashworth, Mark Barber, Norman Briffa, Dexter Canoy, Spiros Denaxas, Kamlesh Khunti, Amanj Kurdi, Mamas Mamas, Rouven Priedon, Cathie Sudlow, Eva JA Morris, Ben Lacey, and Amitava Banerjee
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BackgroundAlthough morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.MethodsAnalyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care.ResultsIn 2020, there were 31,064 (−6%) fewer hospital admissions (14,506 [-4%] fewer emergencies, 16,560 [-23%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (−10,996 [-15%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25,878 [+6%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions.ConclusionThis study highlights increasing emergency cardiovascular admissions as a result of the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.Key QuestionWhat is the impact in 2020 and 2021 of the COVID-19 pandemic on hospital admissions and procedures for six major cardiovascular diseases in England, Scotland and Wales?Key FindingIn 2020, there were 6% fewer hospital admissions (emergency: -4%, elective: -23%) compared to 2016-2019 for six major cardiovascular diseases, across three UK countries. Overall, admissions returned to pre-pandemic levels in 2021, but elective admissions remained below expected levels.Take-home MessageThere was increasing emergency cardiovascular admissions as a result of the pandemic, with substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.
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- 2022
7. Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries
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F Lucy Wright, Kate Cheema, Raph Goldacre, Nick Hall, Naomi Herz, Nazrul Islam, Zainab Karim, David Moreno-Martos, Daniel R Morales, Daniel O'Connell, Enti Spata, Ashley Akbari, Mark Ashworth, Mark Barber, Norman Briffa, Dexter Canoy, Spiros Denaxas, Kamlesh Khunti, Amanj Kurdi, Mamas Mamas, Rouven Priedon, Cathie Sudlow, Eva J A Morris, Ben Lacey, Amitava Banerjee, and Consortium, CVD-COVID-UK
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Health Policy ,Cardiology and Cardiovascular Medicine - Abstract
Background Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described. Methods and results Analyses used national administrative electronic hospital records in England, Scotland, and Wales for 2016–21. Admissions and procedures during the pandemic (2020–21) related to six major cardiovascular conditions [acute coronary syndrome (ACS), heart failure (HF), stroke/transient ischaemic attack (TIA), peripheral arterial disease (PAD), aortic aneurysm (AA), and venous thromboembolism(VTE)] were compared with the annual average in the pre-pandemic period (2016–19). Differences were assessed by time period and urgency of care. In 2020, there were 31 064 (−6%) fewer hospital admissions [14 506 (−4%) fewer emergencies, 16 560 (−23%) fewer elective admissions] compared with 2016–19 for the six major cardiovascular diseases (CVDs) combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries [−10 996 (−15%) fewer admissions]. However, these reductions were offset by higher than expected total emergency admissions [+25 878 (+6%) higher admissions], notably for HF and stroke in England, and for VTE in all three countries. Analyses for procedures showed similar temporal variations to admissions. Conclusion The present study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.
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- 2022
8. Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care
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Hannah Zelie Ruth McConkey, Laura Elizabeth Dobson, Christopher Allen, Patricia Khan, Andrew Marshall, Dominik Schlosshan, John B. Chambers, Neil Cartwright, Peter John Savill, Benoy N. Shah, Brian Campbell, Norman Briffa, and Mamta Buch
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Heart Valve Diseases ,Disease ,Betacoronavirus ,Intervention (counseling) ,Outpatients ,Pandemic ,Ambulatory Care ,medicine ,Humans ,Heart valve ,Intensive care medicine ,Pandemics ,SARS-CoV-2 ,business.industry ,valvular heart disease ,COVID-19 ,medicine.disease ,Triage ,Organizational Innovation ,medicine.anatomical_structure ,Models, Organizational ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business ,Outpatient management - Abstract
The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict ‘normal’ practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic—such as increased use of virtual clinics—should be further developed and evaluated.
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- 2020
9. Offset of ticagrelor prior to coronary artery bypass graft surgery for acute coronary syndromes: effects on platelet function and cellular adenosine uptake
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Mark R Thomas, Kok Weng Ow, Heather M Judge, Jessica Hanson, Robert F. Storey, Norman Briffa, Mark M Porter, and William A E Parker
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Male ,0301 basic medicine ,Ticagrelor ,Acute coronary syndrome ,medicine.medical_specialty ,Adenosine ,Platelet Function Tests ,Arbitrary unit ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,P2Y12 ,Internal medicine ,Humans ,Medicine ,Platelet ,Acute Coronary Syndrome ,Coronary Artery Bypass ,Aged ,business.industry ,Antagonist ,Hematology ,General Medicine ,medicine.disease ,Adenosine diphosphate ,030104 developmental biology ,chemistry ,Cardiology ,Female ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Ticagrelor is an antagonist of both platelet adenosine diphosphate (ADP) receptor P2Y12 and equilibrative nucleoside transporter-1. Optimal timing of ticagrelor cessation prior to coronary artery bypass grafting (CABG) remains unclear. We characterized the offset of ticagrelor's effects on platelets and cellular adenosine uptake in ticagrelor-treated patients (n = 13) awaiting CABG. Blood was drawn prior to CABG at multiple timepoints 2 to 120 (h) after the last dose of ticagrelor. Platelet function (n = 13) was assessed with multiple electrode aggregometry (MEA), expressed as arbitrary units (U) derived from area-under-the-curve (AUC) in response to ADP, and inhibition of adenosine uptake by high-performance liquid chromatography (n = 7). Mean±SD AUC was 20.3 ± 8.2 U (2 h post-ticagrelor), 33.0 ± 18.3U (24 h), 56.6 ± 30.6U (48 h), 61.4 ± 20.2U (72 h), 82.8 ± 24.2U (96 h) and 96.0 ± 15.3U (120 h). There was a significant difference between 72 h and 120 h (p = .007), but not between 96 h and 120 h (p > .99). By 96 h, all patients had AUC >31U, an accepted cutoff below which surgical bleeding risk is increased. Adenosine uptake showed no significant differences between the timepoints. These data suggest it takes 4 days for platelet reactivity to recover sufficiently after cessation of ticagrelor to avoid the excess risk of CABG-related bleeding. Discontinuing ticagrelor had no measurable effect on cellular adenosine uptake.
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- 2020
10. COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records
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Johan H Thygesen, Christopher Tomlinson, Sam Hollings, Mehrdad A Mizani, Alex Handy, Ashley Akbari, Amitava Banerjee, Jennifer Cooper, Alvina G Lai, Kezhi Li, Bilal A Mateen, Naveed Sattar, Reecha Sofat, Ana Torralbo, Honghan Wu, Angela Wood, Jonathan A C Sterne, Christina Pagel, William N Whiteley, Cathie Sudlow, Harry Hemingway, Spiros Denaxas, Hoda Abbasizanjani, Nida Ahmed, Badar Ahmed, Abdul Qadr Akinoso-Imran, Elias Allara, Freya Allery, Emanuele Di Angelantonio, Mark Ashworth, Vandana Ayyar-Gupta, Sonya Babu-Narayan, Seb Bacon, Steve Ball, Ami Banerjee, Mark Barber, Jessica Barrett, Marion Bennie, Colin Berry, Jennifer Beveridge, Ewan Birney, Lana Bojanić, Thomas Bolton, Anna Bone, Jon Boyle, Tasanee Braithwaite, Ben Bray, Norman Briffa, David Brind, Katherine Brown, Maya Buch, Dexter Canoy, Massimo Caputo, Raymond Carragher, Alan Carson, Genevieve Cezard, Jen-Yu Amy Chang, Kate Cheema, Richard Chin, Yogini Chudasama, Emma Copland, Rebecca Crallan, Rachel Cripps, David Cromwell, Vasa Curcin, Gwenetta Curry, Caroline Dale, John Danesh, Jayati Das-Munshi, Ashkan Dashtban, Alun Davies, Joanna Davies, Gareth Davies, Neil Davies, Joshua Day, Antonella Delmestri, Rachel Denholm, John Dennis, Alastair Denniston, Salil Deo, Baljean Dhillon, Annemarie Docherty, Tim Dong, Abdel Douiri, Johnny Downs, Alexandru Dregan, Elizabeth A Ellins, Martha Elwenspoek, Fabian Falck, Florian Falter, Yat Yi Fan, Joseph Firth, Lorna Fraser, Rocco Friebel, Amir Gavrieli, Moritz Gerstung, Ruth Gilbert, Clare Gillies, Myer Glickman, Ben Goldacre, Raph Goldacre, Felix Greaves, Mark Green, Luca Grieco, Rowena Griffiths, Deepti Gurdasani, Julian Halcox, Nick Hall, Tuankasfee Hama, Anna Hansell, Pia Hardelid, Flavien Hardy, Daniel Harris, Camille Harrison, Katie Harron, Abdelaali Hassaine, Lamiece Hassan, Russell Healey, Angela Henderson, Naomi Herz, Johannes Heyl, Mira Hidajat, Irene Higginson, Rosie Hinchliffe, Julia Hippisley-Cox, Frederick Ho, Mevhibe Hocaoglu, Elsie Horne, David Hughes, Ben Humberstone, Mike Inouye, Samantha Ip, Nazrul Islam, Caroline Jackson, David Jenkins, Xiyun Jiang, Shane Johnson, Umesh Kadam, Costas Kallis, Zainab Karim, Jake Kasan, Michalis Katsoulis, Kim Kavanagh, Frank Kee, Spencer Keene, Seamus Kent, Sara Khalid, Anthony Khawaja, Kamlesh Khunti, Richard Killick, Deborah Kinnear, Rochelle Knight, Ruwanthi Kolamunnage-Dona, Evan Kontopantelis, Amanj Kurdi, Ben Lacey, Alvina Lai, Andrew Lambarth, Milad Nazarzadeh Larzjan, Deborah Lawler, Thomas Lawrence, Claire Lawson, Qiuju Li, Ken Li, Miguel Bernabeu Llinares, Paula Lorgelly, Deborah Lowe, Jane Lyons, Ronan Lyons, Pedro Machado, Mary Joan Macleod, John Macleod, Evaleen Malgapo, Mamas Mamas, Mohammad Mamouei, Sinduja Manohar, Rutendo Mapeta, Javiera Leniz Martelli, David Moreno Martos, Bilal Mateen, Aoife McCarthy, Craig Melville, Rebecca Milton, Mehrdad Mizani, Marta Pineda Moncusi, Daniel Morales, Ify Mordi, Lynn Morrice, Carole Morris, Eva Morris, Yi Mu, Tanja Mueller, Lars Murdock, Vahé Nafilyan, George Nicholson, Elena Nikiphorou, John Nolan, Tom Norris, Ruth Norris, Laura North, Teri-Louise North, Dan O'Connell, Dominic Oliver, Adejoke Oluyase, Abraham Olvera-Barrios, Efosa Omigie, Sarah Onida, Sandosh Padmanabhan, Tom Palmer, Laura Pasea, Riyaz Patel, Rupert Payne, Jill Pell, Carmen Petitjean, Arun Pherwani, Owen Pickrell, Livia Pierotti, Munir Pirmohamed, Rouven Priedon, Dani Prieto-Alhambra, Alastair Proudfoot, Terry Quinn, Jennifer Quint, Elena Raffetti, Kazem Rahimi, Shishir Rao, Cameron Razieh, Brian Roberts, Caroline Rogers, Jennifer Rossdale, Safa Salim, Nilesh Samani, Christian Schnier, Roy Schwartz, David Selby, Olena Seminog, Sharmin Shabnam, Ajay Shah, Jon Shelton, James Sheppard, Shubhra Sinha, Mirek Skrypak, Martina Slapkova, Katherine Sleeman, Craig Smith, Filip Sosenko, Matthew Sperrin, Sarah Steeg, Jonathan Sterne, Serban Stoica, Maria Sudell, Luanluan Sun, Arun Karthikeyan Suseeladevi, Michael Sweeting, Matt Sydes, Rohan Takhar, Howard Tang, Johan Thygesen, George Tilston, Claire Tochel, Clea du Toit, Renin Toms, Fatemeh Torabi, Julia Townson, Adnan Tufail, Tapiwa Tungamirai, Susheel Varma, Sebastian Vollmer, Venexia Walker, Tianxiao Wang, Huan Wang, Alasdair Warwick, Ruth Watkinson, Harry Watson, William Whiteley, Hannah Whittaker, Harry Wilde, Tim Wilkinson, Gareth Williams, Michelle Williams, Richard Williams, Eloise Withnell, Charles Wolfe, Lucy Wright, Jinge Wu, Jianhua Wu, Tom Yates, Francesco Zaccardi, Haoting Zhang, Huayu Zhang, Luisa Zuccolo, Apollo - University of Cambridge Repository, Consortium, Longitudinal Health and Wellbeing COVID-19 National Core Study and the CVD-COVID-UK/COVID-IMPACT, and Khalid, S
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SARS-CoV-2 ,Medicine (miscellaneous) ,COVID-19 ,Health Informatics ,State Medicine ,Cohort Studies ,COVID-19 Testing ,Health Information Management ,England ,Longitudinal Health and Wellbeing COVID-19 National Core Study and the CVD-COVID-UK/COVID-IMPACT Consortium ,Electronic Health Records ,Humans ,Decision Sciences (miscellaneous) ,England/epidemiology ,COVID-19/epidemiology - Abstract
Background Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. Methods In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. Findings Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. Interpretation Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. Funding British Heart Foundation Data Science Centre, led by Health Data Research UK.
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- 2021
11. Standard and emerging CMR methods for mitral regurgitation quantification
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Ever D Grech, Norman Briffa, Pankaj Garg, Alexander M.K. Rothman, Andrew J. Swift, Chiara Bucciarelli-Ducci, Gareth Archer, Rod Hose, Rob J. van der Geest, Alaa Elhawaz, Jun-Mei Zhang, Ian Hall, Natasha Barker, Jeroen J. Bax, Liang Zhong, Nigel Lewis, Abdallah Al-Mohammad, Benjamin Fidock, Jim M. Wild, Saul G. Myerson, Sven Plein, and Estefania De Garate
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CMR, Cardiac Magnetic Resonance ,Reproducibility of results ,VENC, Velocity Encoding ,medicine.medical_treatment ,RVSV, ight Ventricular Stroke Volume ,SV, Stroke Volume ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,STJ, Sino-Tubular Junction ,Severity of Illness Index ,Article ,MVR, Mitral Valve Replacement ,AoPC, Aortic Phase-Contrast Forward Volume ,03 medical and health sciences ,0302 clinical medicine ,Magnetic resonance imaging ,Predictive Value of Tests ,medicine ,Left ventricular Stroke volume ,Humans ,030212 general & internal medicine ,Mitral valve insufficiency ,Observer Variation ,MR, Mitral Regurgitation ,Reproducibility ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,Mitral valve replacement ,4D, 4 Dimensional ,Stroke volume ,LVSV, Left Ventricular Stroke Volume ,Aortic forward flow ,Concordance correlation coefficient ,CCC, Concordance Correlation Coefficient ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,FOV, Field of View - Abstract
Background There are several methods to quantify mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR). The interoperability of these methods and their reproducibility remains undetermined. Objective To determine the agreement and reproducibility of different MR quantification methods by CMR across all aetiologies. Methods Thirty-five patients with MR were recruited (primary MR = 12, secondary MR = 10 and MVR = 13). Patients underwent CMR, including cines and four-dimensional flow (4D flow). Four methods were evaluated: MRStandard (left ventricular stroke volume - aortic forward flow by phase contrast), MRLVRV (left ventricular stroke volume - right ventricular stroke volume), MRJet (direct jet quantification by 4D flow) and MRMVAV (mitral forward flow by 4D flow - aortic forward flow by 4D flow). For all cases and MR types, 520 MR volumes were recorded by these 4 methods for intra−/inter-observer tests. Results In primary MR, MRMVAV and MRLVRV were comparable to MRStandard (P > 0.05). MRJet resulted in significantly higher MR volumes when compared to MRStandard (P, Highlights • In primary mitral regurgitation, direct quantification has significant limitations • MRMVAV method is the most consistent method quantification across all groups. • All CMR methods are agreeable in secondary and valvular intervention groups
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- 2021
12. Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis
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Alexander M.K. Rothman, Andrew J. Swift, Natasha Barker, Rachel Jones, Rob J. van der Geest, Hamza Zafar, Ever D Grech, Rod Hose, Alaa Elhawaz, Peter C. Braidley, Abdallah Al-Mohammad, Norman Briffa, Jim M. Wild, Julian Gunn, Benjamin Fidock, Gareth Archer, Pankaj Garg, Steven Hunter, and Ian Hall
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medicine.medical_specialty ,SIX MINUTE WALK ,4D flow ,Diastole ,Aortic valve stenosis ,030204 cardiovascular system & hematology ,ventricular remodeling ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,echocardiography ,magnetic resonance imaging ,Radiology, Nuclear Medicine and imaging ,Ventricular remodeling ,medicine.diagnostic_test ,business.industry ,walk test ,Doppler ,Magnetic resonance imaging ,Blood flow ,medicine.disease ,Stenosis ,Walk test ,Cardiology ,exercise tolerance ,Original Article ,business - Abstract
Background: Left ventricular (LV) kinetic energy (KE) assessment by four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) may offer incremental value over routine assessment in aortic stenosis (AS). The main objective of this study is to investigate the LV KE in patients with AS before and after the valve intervention. In addition, this study aimed to investigate if LV KE offers incremental value for its association to the six-minute walk test (6MWT) or LV remodelling post-intervention.Methods: We recruited 18 patients with severe AS. All patients underwent transthoracic echocardiography for mean pressure gradient (mPG), CMR including 4D flow and 6MWT. Patients were invited for post-valve intervention follow-up CMR at 3 months and twelve patients returned for follow-up CMR. KE assessment of LV blood flow and the components (direct, delayed, retained and residual) were carried out for all cases. LV KE parameters were normalised to LV end-diastolic volume (LVEDV).Results: For LV blood flow KE assessment, the metrics including time delay (TD) for peak E-wave from base to mid-ventricle (14 +/- 48 vs. 2.5 +/- 9.75 ms, P=0.04), direct (4.91 +/- 5.07 vs. 1.86 +/- 1.72 mu J, P=0.01) and delayed (2.46 +/- 3.13 vs. 1.38 +/- 1.15 mu J, P=0.03) components of LV blood flow demonstrated a significant change between preand post-valve intervention. Only LV KEi(EDV) (r=-0.53, P
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- 2021
13. Sutureless aortic valve prostheses
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Marjan Jahangiri, Rajdeep Bilkhu, Norman Briffa, and Michael A. Borger
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Aortic valve ,medicine.medical_specialty ,Calcified aortic valve ,medicine.medical_treatment ,Heart Valve Diseases ,Hemodynamics ,030204 cardiovascular system & hematology ,Prosthesis Design ,Prosthesis ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,medicine ,Humans ,030212 general & internal medicine ,business.industry ,Gold standard (test) ,medicine.disease ,Sutureless Surgical Procedures ,Surgery ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Concomitant ,Aortic valve stenosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Conventional surgical aortic valve replacement (AVR) is the ‘gold standard’ for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.
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- 2019
14. Results of mechanical versus tissue AVR: caution in young patients with tissue AVR
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Norman Briffa
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Bioprosthesis ,Heart Valve Prosthesis Implantation ,medicine.medical_specialty ,Aortic valve prosthesis ,business.industry ,medicine.medical_treatment ,Patient choice ,Heart Valve Diseases ,Atrial fibrillation ,Retrospective cohort study ,medicine.disease ,Prosthesis ,Surgery ,Mechanical heart-valve ,medicine.anatomical_structure ,Aortic valve replacement ,Aortic Valve ,Heart Valve Prosthesis ,medicine ,Humans ,Heart valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
The first aortic valve prosthesis, implanted more than 50 years ago, was a mechanical prosthesis (ball-and-cage design). Over the ensuing decades, tissue prostheses and new mechanical designs were introduced to mitigate the need for anticoagulation with its associated side effects. Tissue and mechanical heart valve prostheses were compared in two head-to-head randomised control trials. Both of these confirmed that mechanical prostheses were durable but patients suffered anticoagulant-related bleeds. Patients who received a tissue prosthesis were more likely to suffer prosthetic dysfunction and require reoperation. This trend was stronger in younger patients. Since the publication of those two trials, several large retrospective studies using data from meta-analyses of published papers or registries have failed to show a survival advantage of either prostheses when implanted in the aortic position in younger patients. This equipoise has been reflected in the heart valve disease guidelines published by European and US societies. In recent years, the primacy of patient choice, the rapid increase in life expectancy of populations, the increased incidence of atrial fibrillation with requirement for anticoagulation, the advent of transcatheter techniques to treat degenerating tissue valves as well as advances in anticoagulant therapy and in new tissue and to a lesser extent mechanical prosthetic design continue to influence choice of aortic valve prosthesis in younger patients undergoing aortic valve replacement.
- Published
- 2019
15. Indications for echocardiography of replacement heart valves: a joint statement from the British Heart Valve Society and British Society of Echocardiography
- Author
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Norman Briffa, John C. Chambers, Madalina Garbi, Vishal Sharma, and Richard P. Steeds
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Radiological and Ultrasound Technology ,business.industry ,medicine.medical_treatment ,Guidelines and Recommendations ,030204 cardiovascular system & hematology ,Prosthesis ,structural valve deterioration ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Valve replacement ,lcsh:RC666-701 ,valve clinic ,Medicine ,echocardiography ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Heart valve ,valve replacement ,business ,Intensive care medicine - Abstract
Echocardiography plays a vital role in the follow-up of patients with replacement heart valves. However, there is considerable variation in international guidelines regarding the recommended time points after implantation at which routine echocardiography should be performed. The purpose of routine echocardiography is to detect early structural valve deterioration in biological valves to improve the timing of redo interventions. However, the risk of valve deterioration depends on many valve-related factors (valve design and patient prosthesis mismatch) and patient-related factors (age, diabetes, systemic hypertension, renal dysfunction and smoking). In this statement, the British Heart Valve Society and the British Society of Echocardiography suggest practical guidance. A plan should be made soon after implantation, but this may need to be modified for individual patients and as circumstances change. It is important that patients are managed in a multidisciplinary valve clinic.
- Published
- 2019
16. THROMBOINFLAMMATORY RESPONSE TO ON-PUMP CORONARY ARTERY BYPASS GRAFT SURGERY LEADS TO IMPAIRED PLATELET REACTIVITY IN PATIENTS WITH ACUTE CORONARY SYNDROME
- Author
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Nadir Elamin, Thomas Nelson, William Parker, Frances Varian, Georgia Williamson, Hannah McMellon, Jessica Hanson, Janet Middle, Claire Bridge, Heather M. Judge, Norman Briffa, Steven Hunter, and Robert F. Storey
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
17. Commentary: A novel cross-species model of Barlow's disease to biomechanically analyze repair techniques in an ex vivo left heart simulator
- Author
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Norman Briffa
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Barlow's disease ,Medicine ,Surgery ,Anatomy ,Cardiology and Cardiovascular Medicine ,business ,Ex vivo - Published
- 2021
18. Validation of four-dimensional flow cardiovascular magnetic resonance for aortic stenosis assessment
- Author
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R.J. van der Geest, Benjamin Fidock, Alaa Elhawaz, Jim M. Wild, Malenka M. Bissell, Rod Hose, Ever D Grech, Alexander M.K. Rothman, Andrew J. Swift, Gareth Archer, Natasha Barker, Abdallah Al-Mohammad, Norman Briffa, Ian Hall, Thomas A. Treibel, and Pankaj Garg
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Medicine ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,Aortic diseases ,Cardiovascular System ,Article ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,Left ventricular mass ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Predictive Value of Tests ,Internal medicine ,Medicine ,Humans ,Prospective Studies ,Four-Dimensional Computed Tomography ,lcsh:Science ,Prospective cohort study ,Pressure gradient ,Aged ,Alternative methods ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Multidisciplinary ,medicine.diagnostic_test ,business.industry ,lcsh:R ,Magnetic resonance imaging ,Stroke Volume ,Aortic Valve Stenosis ,medicine.disease ,Magnetic Resonance Imaging ,Echocardiography, Doppler ,Stenosis ,Treatment Outcome ,Echocardiography ,Predictive value of tests ,Aortic Valve ,Cardiology ,lcsh:Q ,Female ,business - Abstract
The management of patients with aortic stenosis (AS) crucially depends on accurate diagnosis. The main aim of this study were to validate the four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) methods for AS assessment. Eighteen patients with clinically severe AS were recruited. All patients had pre-valve intervention 6MWT, echocardiography and CMR with 4D flow. Of these, ten patients had a surgical valve replacement, and eight patients had successful transcatheter aortic valve implantation (TAVI). TAVI patients had invasive pressure gradient assessments. A repeat assessment was performed at 3–4 months to assess the remodelling response. The peak pressure gradient by 4D flow was comparable to an invasive pressure gradient (54 ± 26 mmHG vs 50 ± 34 mmHg, P = 0.67). However, Doppler yielded significantly higher pressure gradient compared to invasive assessment (61 ± 32 mmHG vs 50 ± 34 mmHg, P = 0.0002). 6MWT was associated with 4D flow CMR derived pressure gradient (r = −0.45, P = 0.01) and EOA (r = 0.54, P
- Published
- 2020
19. Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database
- Author
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Nick Freemantle, Vassilios Avlonitis, Alex Cale, Rajdeep Bilkhu, Martin Amadee Jarvis, Jorge Mascaro, Seyed Hossein Javadpour, Simon Kendall, Amal K. Bose, Manoj Kuduvalli, Dheeraj Mehta, Marjan Jahangiri, Narain Moorjani, Reubendra Jeganathan, Krishna Mani, Karen Booth, Kulvinder Lall, Serban Stoica, Rajamiyer Venkateswaran, Sunil K Bhudia, Jon Anderson, Hakim-Moulay Dehbi, Inderpaul Birdi, Indu Deglurkar, Norman Briffa, Christopher Satur, Keith Buchan, Afzal Zaidi, Leonidas Hadjinikolaou, Sunil K. Ohri, Shakil Farid, Paul D. Ridley, Max Baghai, Andrew Embleton-Thirsk, Uday Trivedi, Prakash P Punjabi, and Patrick Yiu
- Subjects
medicine.medical_specialty ,cardiothoracic surgery ,Cardiovascular Medicine ,Risk Assessment ,law.invention ,Transcatheter Aortic Valve Replacement ,Postoperative Complications ,Aortic valve replacement ,Risk Factors ,law ,Cardiopulmonary bypass ,medicine ,Humans ,Stroke ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,EuroSCORE ,Aortic Valve Stenosis ,General Medicine ,Middle Aged ,medicine.disease ,United Kingdom ,Cardiac surgery ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Cardiothoracic surgery ,Aortic Valve ,cardiology ,Concomitant ,Medicine ,business ,cardiac surgery ,Artery - Abstract
ObjectivesTo date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice.DesignRetrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed.Setting27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis.Participants31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG.ResultsIn-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: 75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes.ConclusionsSurgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.
- Published
- 2021
20. Commentary: The ability to see is key to 21st-century heart valve interventions
- Author
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Norman Briffa
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Commentary ,medicine ,Psychological intervention ,Key (cryptography) ,Surgery ,Heart valve ,business ,Intensive care medicine - Published
- 2020
21. Multicentre, propensity-matched study to evaluate long-term impact of implantation technique in isolated aortic valve replacement on mortality and incidence of redo surgery
- Author
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Mubarak Chaudhry, Norman Briffa, Mahmoud Loubani, Yama Haqzad, and Priyadharshanan Ariyaratnam
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Valve surgery ,Objective (goal) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Aortic valve replacement ,Suture (anatomy) ,Humans ,Medicine ,Propensity Score ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Sutures ,business.industry ,Incidence ,Incidence (epidemiology) ,Suture Techniques ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,United Kingdom ,Surgery ,Survival Rate ,Treatment Outcome ,030228 respiratory system ,Aortic Valve ,Redo surgery ,Baseline characteristics ,Multivariate Analysis ,Aortic valve surgery ,Female ,ORIGINAL ARTICLES ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
OBJECTIVES Studies suggest that the use of semicontinuous suture (SC) technique increases the risk of redo valve surgery after aortic valve replacement (AVR). The objective of this study was to identify 30-day mortality, rate of redo operation and long-term outcomes after AVR using either a semicontinuous suture or interrupted suture (IS) technique. METHODS A total of 1617 patients from 2 cardiothoracic centres, undergoing isolated AVR between April 2005 and August 2013 were included. AVR was performed using SC technique in 765 patients and IS technique in 852 patients. Data were collected prospectively and follow-up was obtained to date for all patients. We compared 30-day mortality, rate of redo operation and long-term mortality in SC and IS groups. One-to-one propensity-matching analysis was performed using IBM SPSS version 22 to evaluate outcomes. RESULTS Four hundred and eleven patients in the SC group were matched to 411 patients in the IS group (total of 822 patients) using propensity-score matching. The baseline characteristics were similar between SC and IS groups after matching. There were no statistically significant differences in 30-day mortality (3.9 vs 2.7%; P = 0.328), long-term mortality at 9-year follow-up (14.4 vs 15.3%; log-rank = 0.524) or rate of redo surgery (2.9 vs 2.0%; P = 0.320) between SC and IS, respectively. However, shorter cross-clamp time (51.9 ± 15.2 vs 60.9 ± 17.6 min; P < 0.001), bypass time (71.3 ± 23.0 vs 81.3 ± 37.8 min; P < 0.001) and the use of larger valve sizes (23.4 ± 2.1 vs 21.9 ± 2.2 mm; P < 0.001) were observed in SC patients compared with IS patients. Multivariate analysis did not show the suture technique as a significant determinant of redo valve surgery. CONCLUSIONS This multicentre study demonstrates that neither mortality nor the risk of redo surgery was influenced by the choice of implantation technique using semicontinuous vs interrupted suture techniques. The SC technique allowed shorter operations and larger size valves to be utilized.
- Published
- 2016
22. NOVEL METHODS IN THE ASSESSMENT OF AORTIC STENOSIS
- Author
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Gareth Archer, Ever D Grech, Ian P. Hall, Norman Briffa, Jim M. Wild, and Pankaj Garg
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medicine.medical_specialty ,Stenosis ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2020
23. Biological Valves in Younger Patients Undergoing Aortic Valve Replacement: A Word of Caution
- Author
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Norman Briffa and John C. Chambers
- Subjects
Aortic valve ,Male ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,medicine.medical_treatment ,Administration, Oral ,Degeneration (medical) ,030204 cardiovascular system & hematology ,Prosthesis Design ,Risk Assessment ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve replacement ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Age of Onset ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,business.industry ,Anticoagulants ,Aortic Valve Stenosis ,Vitamin K antagonist ,Middle Aged ,medicine.disease ,Surgery ,Prosthesis Failure ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,Aortic valve stenosis ,Heart Valve Prosthesis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aortic stenosis is becoming more prevalent as populations age, and surgically implanting a replacement valve can restore a patient’s expected life span. There is much discussion about the relative merits of a mechanical or biological valve design. A mechanical valve is expected to outlast the patient but requires anticoagulation with a vitamin K antagonist, whereas a biological valve does not require anticoagulation but is subject to structural valve degeneration after 10 years. After taking patient preferences into consideration, the 2014 American Heart Association/American College of Cardiology guidelines1 recommend that a mechanical valve should be implanted in patients 65 years of age. However, biological valves are increasingly being used in patients
- Published
- 2017
24. Medical associates: junior doctors should pick their battles
- Author
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Norman Briffa
- Subjects
Medical education ,medicine.medical_specialty ,Attitude of Health Personnel ,business.industry ,Surgical care ,education ,Counterintuitive ,Allied Health Personnel ,General Medicine ,030204 cardiovascular system & hematology ,United Kingdom ,humanities ,03 medical and health sciences ,0302 clinical medicine ,Cardiothoracic surgery ,Medical Staff, Hospital ,medicine ,Humans ,030212 general & internal medicine ,business ,health care economics and organizations - Abstract
The BMA junior doctors’ vote against professional equivalency for medical associate professionals is counterintuitive and shortsighted.1 What is professional equivalency? Doctors are doctors, with their own terms and conditions, pay, regulator, and undergraduate and postgraduate courses and exams, and physician associates and surgical care practitioners are what they are. In cardiothoracic surgery, surgical care practitioners have performed surgical tasks such as conduit harvest since the early 1990s. Senior house officers …
- Published
- 2019
25. Foreward to TAVI/SAVR supplement
- Author
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Norman Briffa and Marjan Jahangiri
- Subjects
Male ,medicine.medical_specialty ,Population ageing ,medicine.medical_treatment ,Heart valve disorder ,Prosthesis ,Transcatheter Aortic Valve Replacement ,Aortic valve replacement ,medicine ,Humans ,Heart valve ,Aged ,business.industry ,General surgery ,Incidence (epidemiology) ,Aortic Valve Stenosis ,medicine.disease ,Systolic murmur ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Female ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
At the recent annual meeting of the British Heart Valve Society, an invited speaker asked: Why has Aortic Stenosis become so complicated? This rhetorical question was posted on Twitter and liked and retweeted several hundred times. Until recently, aortic stenosis was perceived as a relatively simple heart valve disorder. The diagnosis was straightforward—hear a systolic murmur, demonstrate a withdrawal gradient on cardiac catheterisation or an increased velocity on echocardiography and the diagnosis was complete. If the patient was symptomatic, they were referred for the only available treatment—surgical aortic valve replacement. The surgeon saw them in the clinic and they were listed for surgery. If aged ≥70, then they received a tissue prosthesis, if aged
- Published
- 2019
26. Left ventricular free wall rupture complicating acute STEMI
- Author
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Graham Fent, Ever D Grech, Norman Briffa, and Yasir Parviz
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Ventricular Free Wall Rupture ,medicine.medical_treatment ,Heart Rupture ,Percutaneous coronary intervention ,Electrocardiography ,Percutaneous Coronary Intervention ,St elevation myocardial infarction ,Internal medicine ,Emergency Medicine ,Cardiology ,medicine ,Humans ,ST Elevation Myocardial Infarction ,Radiology, Nuclear Medicine and imaging ,Female ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,Acute STEMI ,Aged - Published
- 2016
27. Improving Medical Students' Application of Knowledge and Clinical Decision-Making Through a Porcine-Based Integrated Cardiac Basic Science Program
- Author
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M Stott, Michael R. Gooseman, and Norman Briffa
- Subjects
0301 basic medicine ,Educational measurement ,Models, Educational ,020205 medical informatics ,Basic science ,Swine ,media_common.quotation_subject ,education ,Clinical Decision-Making ,Cardiology ,02 engineering and technology ,Education ,03 medical and health sciences ,Intervention (counseling) ,ComputingMilieux_COMPUTERSANDEDUCATION ,0202 electrical engineering, electronic engineering, information engineering ,Medicine ,Animals ,Humans ,Action research ,Curriculum ,media_common ,Medical education ,business.industry ,United Kingdom ,Test (assessment) ,Disease Models, Animal ,Needs assessment ,Surgery ,030101 anatomy & morphology ,Educational Measurement ,Worry ,Anatomy ,business ,Needs Assessment ,Education, Medical, Undergraduate - Abstract
Objective Despite the concerted effort of modern undergraduate curriculum designers, the ability to integrate basic sciences in clinical rotations is an ongoing problem in medical education. Students and newly qualified doctors themselves report worry about the effect this has on their clinical performance. There are examples in the literature to support development of attempts at integrating such aspects, but this "vertical integration" has proven to be difficult. We designed an expert-led integrated program using dissection of porcine hearts to improve the use of cardiac basic sciences in clinical medical students' decision-making processes. To our knowledge, this is the first time in the United Kingdom that an animal model has been used to teach undergraduate clinical anatomy to medical students to direct wider application of knowledge. Methods Action research methodology was used to evaluate the local curriculum and assess learners needs, and the agreed teaching outcomes, methods, and delivery outline were established. A total of 18 students in the clinical years of their degree program attended, completing precourse and postcourse multichoice questions examinations and questionnaires to assess learners' development. Results Student's knowledge scores improved by 17.5% (p = 0.01; students t -test). Students also felt more confident at applying underlying knowledge to decision-making and diagnosis in clinical medicine. An expert teacher (consultant surgeon) was seen as beneficial to students' understanding and appreciation. Conclusions This study outlines how the development of a teaching intervention using porcine-based methods successfully improved both student's knowledge and application of cardiac basic sciences. We recommend that clinicians fully engage with integrating previously learnt underlying sciences to aid students in developing decision-making and diagnostic skills as well as a deeper approach to learning.
- Published
- 2016
28. Giant Vein Graft Aneurysm
- Author
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Anupama, Barua, Pradeep, Kaul, and Norman, Briffa
- Subjects
Male ,Imaging, Three-Dimensional ,Treatment Outcome ,Coronary Aneurysm ,Humans ,Saphenous Vein ,Coronary Artery Bypass ,Mammary Arteries ,Coronary Angiography ,Tomography, X-Ray Computed ,Coronary Vessels ,Aged - Published
- 2015
29. Detection and prevention of post-operative delirium–are we forgetting the guidelines within cardiothoracic surgery?
- Author
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M. Anderson, A. Watts, Norman Briffa, H. Patel, and O. Yaghi
- Subjects
medicine.medical_specialty ,Post operative delirium ,Forgetting ,business.industry ,Cardiothoracic surgery ,General surgery ,medicine ,Surgery ,General Medicine ,Intensive care medicine ,business - Published
- 2015
- Full Text
- View/download PDF
30. Atrial Myxomas: A Single Unit's Experience in the Modern Era
- Author
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Norman Briffa, D. Hopkinson, Pradip K. Sarkar, Corinne E. Owers, Paul Vaughan, Graham Cooper, Glen A. L. Wilkinson, Timothy J. Locke, and Peter C. Braidley
- Subjects
medicine.medical_specialty ,business.industry ,Mortality rate ,medicine.medical_treatment ,Mitral valve replacement ,Atrial fibrillation ,Chest pain ,medicine.disease ,Surgery ,Aortic cross-clamp ,Papillary fibroelastoma ,medicine ,Palpitations ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Background: Although an atrial myxoma is the commonest cardiac tumor, it is still relatively rare, with an annual incidence of approximately 0.5 per million. In our unit, which performs 1000 major cardiac procedures per year, this equates to approximately 3 patients annually. We therefore sought to evaluate our experience of managing this type of tumor over the last 5 years. Methods: A retrospective review was performed of prospectively collected data from the departmental database. We analyzed consecutive patients who were operated upon between 2002 and 2007. Three patients with a papillary fibroelastoma on histological examination were excluded from this study. Results: We have performed excision of atrial myxoma in 18 patients. Twelve patients (66%) were female; the median age was 64 years (range, 35-80 years), and the median logistic euroSCORE was 5.22% (range, 1.51-27.82%). Fifteen patients (83%) were deemed urgent, 2 elective, and 1 emergency. Sixteen tumors (89%) were left sided. Symptoms attributable to the tumor were found in 16 of the 18 patients (embolic, n = 9; chest pain, n = 3; palpitations, n = 2; incidental finding, n = 2, others n = 4), and the mean time from diagnosis to operation was 3 days (range, 0-22 months). The median cardiopulmonary bypass time was 87 minutes (range, 28-228 minutes), with the median aortic cross clamp time being 61 minutes (16-175 minutes). The approaches used were transeptal via right atriotomy (n = 8), biatrial/Dubost (n = 4), left atrial (n = 4), and right atrial (n = 2); the interatrial septum was involved in 14 patients. The resultant defect was closed using a pericardial (n = 8) or prosthetic patch (n = 5) or directly sutured (n = 5). Concomitant procedures were performed in 8 patients (coronary artery bypass graft [CABG], n = 4; mitral valve replacement [MVR], n = 2; valve + grafts, n = 2). All tumors were completely excised. Postoperatively there were no deaths within 30 days of the procedure. Indeed, only 2 patients have died at 4 and 25 months postoperatively, respectively, both of unrelated causes. Median intensive therapy unit (ITU) stay was 2 days (range, 1-9 days), and median hospital stay was 10 days (range, 5-20 days). A permanent pacemaker was required in only 1 patient, and median blood loss was 340 mL (range, 140-1760 mL). Atrial fibrillation was the commonest complication affecting 6/18 patients (33%). Conclusions: Excision of atrial myxoma can be performed using a variety of intraoperative approaches and closure techniques, all with acceptable postoperative morbidity and low mortality rates. To date, no recurrences have been found at median 2-year follow-up.
- Published
- 2011
31. Paul Vincent Briffa
- Author
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Norman Briffa
- Subjects
History ,World War II ,Copper wire ,Art history ,General Medicine ,Commission ,Colonialism - Abstract
Paul Vincent Briffa grew up in Malta during the second world war. He was a hardworking and ambitious student who went to extraordinary lengths at university to ensure he acquired as comprehensive a knowledge as possible in all subjects. While studying anatomy, he managed to obtain a human skeleton, which he articulated himself by using copper wire, and he painted by hand the origins and insertions of every muscle in the body. As was the custom at the time in colonial Malta he moved to the UK after qualifying. He joined the British Army and obtained his commission as captain …
- Published
- 2018
32. Patient-Reported Outcome Measures (PROMS) in patients undergoing heart valve surgery: why should we measure them and which instruments should we use?
- Author
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Charlotte Holmes and Norman Briffa
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Population ,QUALITY OF CARE AND OUTCOMES ,Cardiac surgery ,CARDIAC SURGERY ,Quality of life ,Floor effect ,Valvular Heart Disease ,Physical therapy ,Medicine ,Ceiling effect ,Observational study ,Patient-reported outcome ,Cardiology and Cardiovascular Medicine ,business ,education - Abstract
Objective As the population ages, the incidence of heart valve disease (HVD) is increasing. The aim of treatment is to improve prognosis and quality of life. Standard surgical treatment is being superseded by new catheter-based treatments, many of which are as yet unproven. The need for appropriate instruments to measure quality of life in patients receiving treatment for HVD has therefore never been greater. Methods In this prospective observational study, a generic instrument, Euroqol, and a disease-specific one (Minnesota Living with Heart Failure Questionnaire—MLHFQ) were, for the first time, formally tested before and after surgery in 84 patients with HVD who completed their treatment. Patients were interviewed on the night before surgery and 6–12 weeks after being discharged. Instruments were tested for validity, reliability, responsiveness, sensitivity and interpretability. Results Both Euroqol and MLHFQ registered significant improvements in patients9 health. Tests for validity were significantly positive for both Euroqol and MLHFQ. Tests for reliability and responsiveness were very positive for MLHFQ, less so for EQ-5D. There was a moderate ceiling effect in the postoperative Index scores of Euroqol and a moderate floor effect in MLHFQ. Conclusions Both instruments together performed very well in assessing the health of patients undergoing surgical treatment of HVD. As the incidence of HVD increases and therapeutic options increase, measurement of PROMS using these two instruments should become a matter of routine.
- Published
- 2015
33. IMA Harvesting
- Author
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Norman Briffa
- Published
- 2015
34. Valvular heart disease: a call for global collaborative research initiatives
- Author
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Benoy N. Shah, Norman Briffa, John C. Chambers, Guy Lloyd, David Shanson, Roger Hall, Bernard D. Prendergast, Simon Ray, David E. Newby, Patricia V. Lawford, and Gerry P McCann
- Subjects
Heart Valve Prosthesis Implantation ,medicine.medical_specialty ,Heart disease ,business.industry ,valvular heart disease ,Endomyocardial fibrosis ,Heart Valve Diseases ,Cardiovascular Agents ,Endocarditis, Bacterial ,Disease ,Global Health ,medicine.disease ,Natural history ,Internal medicine ,Cardiovascular agent ,Epidemiology ,Global health ,medicine ,Cardiology ,Humans ,Morbidity ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
The burden of valvular heart disease (VHD) is rising rapidly as life expectancy increases. The prevalence in the USA alone is 13% in those aged over 75 years,1 while the global prevalence of rheumatic heart disease is estimated at 15.6–19.6 million.2 Despite this, the treatment of VHD still lacks an adequate research base. None of the 64 recommendations in the 2012 European Society of Cardiology (ESC) VHD guidelines3 had Level A evidence and only 14% had Level B evidence. This compares with 28% at Level A and 42% at Level B among the 270 recommendations in the 2010 ESC myocardial revascularisation guidelines.4 Therefore, there is an urgent need to stimulate the investigation. In this article, we identify deficits in our knowledge which may be amenable to research and make a call for national and international collaborative efforts to address this evidence gap. The prevalence of VHD in industrialised countries has been extrapolated from studies predominantly conducted in the USA,1 while the prevalence of rheumatic disease in sub-Saharan Africa is extrapolated from studies in North Africa. True figures need to be established nationally, while for rare causes of VHD (eg, carcinoid or antiphospholipid syndrome), this might be better done using international registries with standardised protocols. Serial echocardiography within these projects will improve our understanding of the contemporary natural history of VHD, which was previously determined in small cohorts of patients and generally with fewer comorbidities compared with the present. The genetics and developmental biology of VHD are poorly understood. Collation of genetic analyses from established bio-banks and twin studies may identify new determinants of disease or its progression. Such techniques may also provide clues towards the development of treatments for challenging conditions such as endomyocardial fibrosis. Lipid-lowering therapy has not been successful in modifying the progression …
- Published
- 2013
35. A rare case of giant coronary artery aneurysm in the context of multiple arterial aneurysms
- Author
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Govind Chetty, Andriy Solodkyy, Norman Briffa, and Joseph Shalhoub
- Subjects
Surgical repair ,Coronary artery aneurysm ,medicine.medical_specialty ,Aortic aneurysm ,business.industry ,nutritional and metabolic diseases ,Coronary aneurysm ,Context (language use) ,medicine.disease ,Article ,Abdominal aortic aneurysm ,Surgery ,Iliac aneurysm ,mental disorders ,Rare case ,cardiovascular system ,medicine ,Etiology ,cardiovascular diseases ,Iliac Aneurysm ,business - Abstract
INTRODUCTION Whilst the incidence of CAA has been reported as up to 5%, giant CAA (>2 cm) is rare. PRESENTATION OF CASE We present a rare case of 3 cm × 4 cm giant coronary artery aneurysm (CAA) in the context of aorto-iliac aneurysmal disease, treated by staged open surgical repair. DISCUSSION Abdominal aortic aneurysm (AAA) and CAA share risk factors and aetiological mechanisms, therefore should be considered, particularly when CAA is diagnosed in the first instance. CONCLUSIONS Surgical intervention for diagnosed giant CAA appears to be the treatment of choice in the reported literature, with the order of intervention when AAA co-exists remaining a point for debate.
- Published
- 2012
36. Putting a stop to preventable deaths
- Author
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Norman, Briffa
- Subjects
Hospitals, Public ,Mortality, Premature ,Hospital Mortality ,Cooperative Behavior ,Organizational Culture ,State Medicine ,United Kingdom ,Quality of Health Care - Published
- 2013
37. MULTIDIMENSIONAL ASSESSMENT OF GRAFT VASCULAR DISEASE (GVD) IN AORTIC GRAFTS BY SERIAL INTRAVASCULAR ULTRASOUND IN RHESUS MONKEYS1
- Author
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Bernard Hausen, Jan Gummert, Paul G. Yock, Yasuhiro Honda, Margaret E. Billingham, Robert C. Robbins, Motoya Hayase, Tuija Ikonen, Randall E. Morris, and Norman Briffa
- Subjects
Transplantation ,Aorta ,Pathology ,medicine.medical_specialty ,Intimal hyperplasia ,medicine.diagnostic_test ,business.industry ,Vascular disease ,Lumen (anatomy) ,Hyperplasia ,medicine.disease ,surgical procedures, operative ,medicine.anatomical_structure ,medicine.artery ,Intravascular ultrasound ,medicine ,business ,Mesenteric arteries - Abstract
Background. Graft vascular disease (GVD) is an incompletely understood process and the primary cause of late allograft failure. A nonhuman primate model was established to study the progression of GVD by using serial intravascular ultrasound (IVUS). Methods. Aortic allografts were transplanted below the inferior mesenteric arteries (IMA) into 6 rhesus monkeys. Removed and re-implanted aortic segments between renal arteries, and the inferior mesenteric arteries served as autografts. IVUS was performed at days 0, 24, 52, 80, and 98 after transplantation. Vessel area (VA) and lumen area (LA) were measured from each cross-section at 0.5 mm intervals. Intimal index (II=100x (VA-LA/VA)) and corresponding vessel volumes were calculated for the whole grafts. Histologic features were assessed from autopsy samples using computerized morphometric method and a score from 0 to 3 for GVD (0=none, 3=severe). Results. In allografts, vessel volume and luminal volume decreased significantly (P
- Published
- 2000
38. The histology of subcutaneously implanted donor bronchial rings correlates with rejection scores of lung allografts in a primate lung transplant model11This study was funded by Novartis Pharmaceuticals, Inc., Basle, Switzerland; the Hedco Foundation; and the Falk Medical Trust. B. Hausen and U. Christians funded by the German Research Society. T. Ikonen funded by the ISHLT/Roche Laboratories Transplantation Fellowship
- Author
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Tuija Ikonen, Bernard Hausen, Randall E. Morris, Norman Briffa, Gerald J. Berry, L. Hook, Uwe Christians, and Paul Dagum
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Pathology ,medicine.medical_specialty ,Bronchus ,Lung ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,respiratory system ,medicine.disease ,respiratory tract diseases ,medicine.anatomical_structure ,Pneumothorax ,Fibrosis ,Biopsy ,medicine ,Lung transplantation ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Subcutaneous tissue - Abstract
Background: The diagnosis of acute rejection in lung transplantation generally relies on transbronchial biopsies. This invasive procedure may be associated with bronchial bleeding or pneumothorax and may not be feasible in patients with severely compromised lung function. The hypothesis of the current study was that histopathological findings of donor bronchial segments implanted into the subcutaneous tissue of lung allograft recipients would predict lung tissue rejection scores, thus providing the clinician with an alternate source of information. Methods Unilateral left lung transplantation was performed in 34 cynomolgus monkeys as part of a drug efficacy study. After completion of the transplant procedure, 4 bronchial ring segments of the explanted recipient left lung and 4 bronchial ring segments of the non-transplanted right donor lung were implanted subcutaneously in the abdominal region. Lung allograft rejection was evaluated by open lung biopsies of the allograft performed on postoperative (PO) Day 14 and during sacrifice on PO Day 28. At the time of each biopsy, 2 donor and 2 recipient subcutaneous bronchial rings were explanted. Histologic evaluation of the lung tissue samples was performed according to the working formulation of the International Society for Heart and Lung Transplantation. Bronchial rings were independently evaluated by assessing the degree of airway narrowing; percentage of intact epithelial coverage as well as its specific histology (respiratory ciliated, flattened cuboidal, squamous); presence of lymphocytes, macrophages or spindle cells; and presence of peribronchial inflammation, luminal fibrosis, lymphocytic bronchitis or luminal mucous. Statistical analysis was performed by logistic regression. Results In the recipient bronchial rings, there was no evidence of airway narrowing. There was 98% epithelial coverage, 71% that were respiratory ciliated cells, and there was no inflammation. Donor bronchial rings showed no airway narrowing for monkeys with grade A0 to A2 rejection in tissue biopsies and a maximum narrowing (41.2%) with A4 rejection. Epithelial cell coverage was ∼100% with grade A0–A2 and 44 ± 11% with A4 rejection. Lymphocytic bronchitis was most severe in A4 rejection and minimal in A0 to A2 rejection. By logistic regression analysis, independent predictors of a likelihood of rejection were the degree of airway obliteration, the percentage of epithelial cell coverage, the degree of lymphocytic bronchitis and the product of respiratory and flattened cuboidal cell coverage. Conclusions The current data show that histologic alterations of subcutaneously implanted donor bronchial rings correlate with lung tissue biopsy scores based on the ISHLT working formulation. Because subcutaneous bronchial rings can be explanted under local anesthesia, they may provide useful information for the diagnosis of acute allograft rejection in patients with impaired lung function, patients that obtaining lung tissue samples may not be feasible.
- Published
- 1999
39. New immunosuppressive regimens in lung transplantation
- Author
-
Norman Briffa and Randall E. Morris
- Subjects
Graft Rejection ,Immunosuppression Therapy ,Pulmonary and Respiratory Medicine ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Bronchiolitis obliterans ,medicine.disease ,Kidney Transplantation ,Tacrolimus ,Transplantation ,surgical procedures, operative ,Sirolimus ,Monoclonal ,Immunology ,Humans ,Medicine ,Lung transplantation ,Drug Therapy, Combination ,business ,Bronchiolitis Obliterans ,Immunosuppressive Agents ,Kidney transplantation ,Lung Transplantation ,medicine.drug - Abstract
Survival after lung transplantation is less than 50% after 5 yrs and is limited by infection and obliterative bronchiolitis. There is, therefore, a need for new immunosuppressive regimens if we are to attempt to improve long-term survival. Several trials in lung transplantation of new immunosuppressive agents are in the planning stages. In this article, we review the experience with a new monoclonal agent (interleukin 2 (IL2) receptor antagonist) in kidney transplantation, together with the pharmacokinetic (PK) and pharmacodynamic properties and experience in transplantation in general, of the more promising of the new xenobiotic compounds (cyclosporine microemulsion, mycophenolate mofetil, tacrolimus and sirolimus). Recent novel approaches to the vexing problem of resistant lung rejection and obliterative bronchiolitis, such as the use of aerosolized cyclosporine, methotrexate, total lymphoid irradiation and phototherapy, are discussed. Finally an immunosuppressive regimen, using these new drugs in lung transplantation is suggested.
- Published
- 1997
40. Giant Vein Graft Aneurysm
- Author
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Pradeep Kaul, Norman Briffa, and Anupama Barua
- Subjects
Pulmonary and Respiratory Medicine ,Coronary angiography ,medicine.medical_specialty ,business.industry ,Treatment outcome ,Vein graft ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Tomography x ray computed ,030228 respiratory system ,Mammary artery ,medicine ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2015
41. Expert-led cardiac basic science teaching in an integrated clinical learning environment: Improving global educational outcomes for undergraduates
- Author
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J. Mickleburgh, Norman Briffa, M Stott, and Michael R. Gooseman
- Subjects
Medical education ,business.industry ,Basic science ,Medicine ,Surgery ,General Medicine ,business ,Clinical learning - Published
- 2015
42. Off pump coronary artery bypass: a passing fad or ready for prime time?
- Author
-
Norman Briffa
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Bypass, Off-Pump ,Coronary Disease ,Risk Assessment ,law.invention ,Coronary artery bypass surgery ,Randomized controlled trial ,law ,Internal medicine ,medicine.artery ,medicine ,Cardiopulmonary bypass ,Humans ,Derivation ,Coronary Artery Bypass ,Off-pump coronary artery bypass ,Randomized Controlled Trials as Topic ,Retrospective Studies ,Aorta ,business.industry ,Surgery ,medicine.anatomical_structure ,Circulatory system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Off pump coronary artery bypass (OPCAB) allows multivessel coronary disease to be bypassed surgically without the need for cardiopulmonary bypass, myocardial ischaemia, and in many cases ascending aortic manipulation. Many randomized controlled studies of OPCAB vs. on pump CABG (coronary artery bypass grafting) have been completed and published. Although non-inferior, OPCAB does not, in these trials, offer any clear benefits. As a consequence, surgeons and industry are losing interest in this undeniably harder technique. As the risk profile of patients being referred for coronary surgery is increasing, is it time for OPCAB to prove itself? A large, appropriately powered randomized controlled trial of OPCAB vs. on pump CABG in high-risk patients will determine whether it is now or never for OPCAB.
- Published
- 2008
43. Evaluation of the effect of treatment in patients undergoing heart valve surgery in Sheffield using patient reported outcome measures
- Author
-
Charlotte Holmes and Norman Briffa
- Subjects
medicine.medical_specialty ,Valve surgery ,business.industry ,medicine ,Surgery ,Patient-reported outcome ,In patient ,General Medicine ,business - Published
- 2015
44. Routine preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting
- Author
-
Norman Briffa and Hunaid A. Vohra
- Subjects
medicine.medical_specialty ,Bypass grafting ,medicine.medical_treatment ,Grafting (decision trees) ,Coronary Artery Bypass, Off-Pump ,Intra-Aortic Balloon Pumping ,Preoperative care ,law.invention ,Ventricular Dysfunction, Left ,Intraaortic balloon pump ,law ,Risk Factors ,Internal medicine ,Preoperative Care ,medicine ,Cardiopulmonary bypass ,Humans ,Angina, Unstable ,Off-pump coronary artery bypass ,Aged ,business.industry ,Coronary Stenosis ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
The beneficial effects of intraaortic balloon pump (IABP) in coronary artery bypass graft surgery with cardiopulmonary bypass have been reported. However, whether preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting (OPCAB) has any beneficial effects remains to be established. We report our experience of preoperative insertion of IABP in OPCAB.
- Published
- 2005
45. Surgical angioplasty of the left main coronary artery: Follow-up with magnetic resonance imaging
- Author
-
G. Kugan, Stephen Clarke, John Wallwork, Richard Coulden, Samer A.M. Nashef, and Norman Briffa
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,Bypass grafting ,Gauche effect ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,medicine.disease ,Posterior approach ,Angina ,medicine.anatomical_structure ,Internal medicine ,Angioplasty ,medicine ,Cardiology ,Vascular Patency ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background. Ostial stenosis of the left main coronary artery is a serious condition with a dismal prognosis. The treatment is surgical, with the two viable options being coronary artery bypass grafting and surgical angioplasty of the left main coronary artery. Methods. We describe the use of surgical angioplasty to treat 3 patients (2 women and 1 man) with left main ostial stenosis using the posterior approach. Patency of the angioplasty was demonstrated subsequently with magnetic resonance imaging. Results. All 3 patients were free of angina 12, 18, and 24 months after operation. Magnetic resonance imaging scans in all 3 patients demonstrated the widely patent left main coronary artery. Conclusions. Surgical angioplasty is an effective alternative to coronary artery bypass grafting in patients with left main ostial stenosis. Magnetic resonance imaging is an excellent noninvasive method for monitoring the patency of the left main coronary artery.
- Published
- 1996
46. The predictors and outcome of recidivism in cardiac ICUs
- Author
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Ira Goldsmith, Michael D Rosin, Hunaid A. Vohra, Norman Briffa, and Ramesh L. Patel
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Cardiac output ,medicine.medical_treatment ,Patient Readmission ,law.invention ,Postoperative Complications ,Valve replacement ,law ,Risk Factors ,Cardiac tamponade ,medicine ,Humans ,Hospital Mortality ,Coronary Artery Bypass ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Postoperative Care ,Recidivism ,business.industry ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Prognosis ,Intensive care unit ,Cardiac surgery ,Surgery ,Intensive Care Units ,Respiratory failure ,England ,Heart failure ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: Reinstitution of step-up care (recidivism) following cardiac surgery may be associated with increased mortality. This has, however, not been widely reported. Methods: We, therefore, studied 8113 consecutive patients who underwent coronary artery bypass grafting (CABG), valve replacement/repair or combined valveCCABG surgery between January 1996 and December 2003 to determine the reasons for readmission to the intensive care unit (ICU) and their outcomes in terms of length of stay in (i) the ICU (ii) hospital and (iii) the in-hospital mortality following recidivism. Results: Of the 7717 patients discharged out of the ICU, 2.3% (182) of patients [mean age 70.4G8.35 years (range 30–90 years); 65.4% (119) males] required step-up care. Recidivism was 1.8% (101 of 5633) following coronary artery by-pass grafting (CABG) and 3.9% (81 of 2084) following valve replacement/repairGCABG (P!0.05). The mean interval from ICU discharge to ICU recidivism was 6.6G8.4 days (range 6 h to 28 days). The principal reasons for recidivism were (i) respiratory failure requiring reintubation and ventilation in 54.9% (nZ100) of patients (ii) cardiovascular instability (including that secondary to dysrhythmias) and heart failure in 23.1% (nZ42) (iii) renal failure requiring haemofiltration in 6.6% (nZ12) (iv) sepsis in 1.1% (nZ2) (v) cardiac tamponade/bleeding requiring re-exploration in 7.7% (nZ14) and (vi) gastro-intestinal complications requiring laparotomy in 6.0% (nZ11) patients. Multivariate analysis showed that, during primary ICU stay, respiratory complications, low cardiac output state, dysrhythmias, renal failure requiring haemofiltration and re-exploration for bleeding were independent predictors of recidivism. Following recidivism (i) the mean length of stay in the ICU was 6.65G6.2 days (range 4 h to 51 days), (ii) mean hospital stay was 19.2G17.3 days (10–60 days) and (iii) the 30-day in-hospital mortality was 32.4%. Conclusions: Patients are more likely to require recidivism following valve surgeryGCABG than CABG alone. Whilst respiratory complications were the most common reasons for recidivism in our study, patients who required mechanical supports to maintain vital functions following surgery were most prone to recidivism. Hence, efforts should be made to treat cardio-respiratory problems early in this group of patients to reduce ICU recidivism. q 2004 Elsevier B.V. All rights reserved.
- Published
- 2004
47. Histological and immunological characteristics of, and the effect of immunosuppressive treatment on, xenograft vasculopathy
- Author
-
Norman Briffa, H. T. Silva, Timothy R. Brazelton, Margaret E. Billingham, Jason R. Chan, Randall E. Morris, and R. Shorthouse
- Subjects
Neointima ,Pathology ,medicine.medical_specialty ,Xenotransplantation ,medicine.medical_treatment ,Immunology ,Transplantation, Heterologous ,Hamster ,Antibodies, Heterophile ,Immunofluorescence ,Rats, Nude ,Cricetinae ,medicine ,Animals ,Aorta ,Leflunomide ,Transplantation ,biology ,medicine.diagnostic_test ,Mesocricetus ,business.industry ,Isoxazoles ,Rats ,Immunoglobulin M ,Rats, Inbred Lew ,biology.protein ,Cyclosporine ,Tissue and Organ Harvesting ,Immunohistochemistry ,Drug Therapy, Combination ,Antibody ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Like allografts, vascularized xenografts are susceptible to a process of chronic rejection. We have used the hamster-to-rat aortic transplant model to study characteristics of this phenomenon and to determine whether it could be controlled or prevented by immunosuppressive therapy. Golden Syrian hamster aortas were transplanted into untreated Lewis rats, athymic rats, and Lewis rats receiving cyclosporin (10 mg/kg), leflunomide (5, 10 or 15 mg/kg), or 10 mg/kg of both drugs. Grafts were harvested on days 2, 7, 14, 28 and 56. Grafts and recipient spleens were analysed using computerized morphometry, immunohistochemistry and immunofluorescence. Blood was taken on various days for the measurement of anti-hamster antibodies (flow cytometry) and of the leflunomide metabolite A77 127. In untreated rats, by day 56, transplanted aortas developed a cell-free media with a mature neointimal lesion consisting of actin-positive cells, CD4 T cells, and macrophages. There were large increases in anti-hamster immunoglobulin M (IgM) and IgG, collections of proliferating cell nuclear antigen (PCNA)-positive cells in splenic germinal centres, and IgM, C3 and C5a deposition in aortas. In athymic recipients, the media architecture was preserved, and the changes in the neointima and in anti-hamster IgM and IgG were markedly abrogated, but not prevented. In Lewis rats receiving leflunomide, absence of circulating or deposited IgM did not prevent neointimal formation by day 14. Combination treatment was the most effective at preventing neointimal formation and humoral changes. Leflunomide monotherapy was the least effective. There were no changes in peak concentrations of the main metabolite of leflunomide over 8 weeks. The hamster-to-rat aortic transplant model is suitable for the study of xenograft vasculopathy, the histological and serological changes of which are predominantly T-cell dependant. Combination treatment with 10 mg/kg of cyclosporin and 10 mg/kg of leflunomide was most effective in preventing xenograft vasculopathy.
- Published
- 2004
48. Single lung transplantation for end stage emphysema
- Author
-
F. C. Wells, C. Dennis, John Wallwork, Samer A.M. Nashef, T. W. Higenbottam, Norman Briffa, and S.R. Large
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Air trapping ,FEV1/FVC ratio ,Forced Expiratory Volume ,Pulmonary fibrosis ,medicine ,Humans ,Lung transplantation ,Lung ,Survival rate ,business.industry ,Respiratory disease ,Middle Aged ,respiratory system ,medicine.disease ,respiratory tract diseases ,Surgery ,Survival Rate ,Transplantation ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary Emphysema ,Female ,medicine.symptom ,business ,Research Article ,Lung Transplantation - Abstract
BACKGROUND-- The first successful single lung transplantation was carried out in 1983 for pulmonary fibrosis. Because of the inherent advantages of single lung transplantation, a transplantation programme has been started for patients with end stage lung disease due to emphysema. METHODS-- Between October 1990 and August 1993 25 patients with severe emphysema (15 men, mean age 51 years) received a single lung transplant at our institution. All patients were severely disabled with a mean (SD) 12 minute walking distance of 281 (165) metres. There were five deaths in the series, four in the first 20 days and one on day 503. Two patients suffered graft compression by air trapping in the native lung. Bronchial narrowing requiring insertion of endobronchial stenting occurred in four patients. RESULTS-- Mean (SD) FEV1 improved from a preoperative value of 17.8(13%) predicted to a six month value of 53.6(13)%, and FEV1/FVC from 23.8(12)% to 68.6(15)%. After the transplant 12 patients are in New York Heart Association (NYHA) class I and the rest of the survivors are in NYHA II. Actuarial survival was 82% at one year and 74% at three years. CONCLUSIONS-- Single lung transplantation is an effective treatment for end stage lung disease due to emphysema and carries an acceptable mortality and morbidity.
- Published
- 1995
49. Role of frailty assessment in patients undergoing cardiac interventions
- Author
-
Rebecca Rowe, Ayyaz Sultan, Martin A. Denvir, Javaid Iqbal, Rachel Orme, Julian Gunn, Norman Briffa, and Rachel Murali-Krishnan
- Subjects
Gerontology ,education.field_of_study ,business.industry ,Population ,Psychological intervention ,MEDLINE ,Review ,Disease ,Quality of life (healthcare) ,Cardiac interventions ,Life expectancy ,Medicine ,Cardiology and Cardiovascular Medicine ,education ,business ,Risk assessment - Abstract
Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications. Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality. Frailty assessment has emerged as a measure of biological age that correlates well with quality of life, hospital admissions and mortality. Potentially, the incorporation of frailty into current risk assessment models will cause a shift towards more appropriate care. The need for a more accurate method of risk stratification incorporating frailty, particularly for elderly patients is pressing. This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice.
- Published
- 2014
50. The natural history of small abdominal aortic aneurysms: An ultrasound study
- Author
-
Norman Briffa, J.R. Nash, K.G. Callum, and A.K.M. Walsh
- Subjects
Male ,medicine.medical_specialty ,Text mining ,medicine ,Humans ,Aorta, Abdominal ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,Ultrasound study ,business.industry ,Ultrasound ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Abdominal aortic aneurysm ,Aortic Aneurysm ,Surgery ,Natural history ,cardiovascular system ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
A retrospective study was undertaken to assess whether, using serial ultrasound examinations, the behaviour of small abdominal aortic aneurysms could be predicted. The average increase in size was found to be 0.3 cm/year. The pattern of increase in size was not affected by age, sex or the presence of hypertension. A proposed course of management of patients with small aneurysms is suggested, particularly if they have other significant medical problems.
- Published
- 1990
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