Research

Vallely MP, Stern HS

Eur J Cardiothorac Surg 2011 May;39(5):793

PMID: 20932771

Abstract

Yan TD, Padang R, Poh C, Cao C, Wilson MK, Bannon PG, Vallely MP

J. Thorac. Cardiovasc. Surg. 2011 May;141(5):1134-44

PMID: 21167508

Abstract

BACKGROUND: We performed the present systematic review and meta-analysis of randomized and nonrandomized comparative studies in an attempt to compare the safety and efficacy of drug-eluting stents with coronary artery bypass grafting for patients with coronary artery disease.

METHODS: Twenty-five eligible comparative studies (1 randomized and 24 nonrandomized) were assessed. Two reviewers independently appraised each study. Meta-analysis was performed by combining the results of reported incidence of morbidity, mortality, and repeat revascularization. The relative risk was used as a summary statistic.

RESULTS: In these 25 studies 34,278 patients were compared, of whom 18,538 received drug-eluting stents and 15,740 underwent coronary artery bypass grafting. It must be acknowledged that this comparison represented a selected group of patients who received drug-eluting stents or underwent coronary artery bypass grafting. The accumulative incidences of all-cause mortality at 12 months (4.5% vs 4.0%, P = .92) and 24 months (6.2% vs 8.4%, P = .27) and 30-day myocardial infarction (1.4% vs 2.0%, P = .60) were similar, respectively, between the drug-eluting stent and coronary artery bypass grafting groups. Drug-eluting stents were associated with lower rates of all-cause mortality at 30 days (0.9% vs 2.3%, P < .001), stroke (0.4% vs 1.7%, P < .001), and 30-day major adverse cardiac and cerebrovascular events (3.6% vs 5.5%, P < .04). However, the coronary artery bypass grafting group had a lower incidence of postprocedural myocardial infarction (5.5% vs 4.7%, P = .03), repeat revascularization (22.2% vs 4.1%, P < .001), and 12-month major adverse cardiac and cerebrovascular events (16.7% vs 10.5%, P < .001). Subgroup analysis of patients with multivessel coronary artery disease showed similar results.

CONCLUSIONS: Drug-eluting stents are associated with less periprocedural risks but a higher incidence of postprocedural myocardial infarction, repeat revascularization, and 12-month major adverse cardiac and cerebrovascular events compared with coronary artery bypass grafting.

Cao C, Yan TD, Kennedy C, Hendel N, Bannon PG, McCaughan BC

Ann. Thorac. Surg. 2011 Feb;91(2):339-43

PMID: 21256263

Abstract

BACKGROUND: Bronchopulmonary carcinoid tumors are considered as a relatively uncommon and less malignant group of lung cancers. However, patients with histologically atypical disease are known to have a worse prognosis. The present study aims to evaluate the long-term outcomes after resection of bronchopulmonary carcinoid tumors according to the new tumor, nodes, metastasis (TNM) staging system.

METHODS: Patients with histologically proven bronchopulmonary carcinoid tumors who underwent surgery in our thoracic unit over the last 25 years were identified from a prospectively collected database.

RESULTS: One hundred and eighty-six patients were identified from our electronic database. Of these, 164 were known to have typical disease, while 22 had atypical disease. Median overall survival was 20.0 years. The mean follow-up was 8.0 years (median 7.0 years). Univariate analysis found age over 60, atypical disease, TNM staging, N status, and M status to have a statistically significant influence on overall survival. Multivariate analysis found age over 60 and atypical histopathology to have a detrimental impact on overall survival. Patients in the atypical subgroup were found to be significantly older, and presented with higher stage disease.

CONCLUSIONS: It is clear from the current study and previous reports that patients with atypical histopathology have different baseline characteristics, disease behavior, and prognosis compared with patients with typical disease. The proposed TNM staging system appears to be applicable to patients in our surgical experience, and may offer more accurate prognostic information and assist in the management plans for individuals.

Spina R, Forrest AP, Adams MR, Wilson MK, Ng MK, Vallely MP

Heart Lung Circ 2010 Dec;19(12):736-41

PMID: 20869915

Abstract

Extracorporeal membrane oxygenation (ECMO) provides circulatory or respiratory support, or both, to patients with severe but potentially reversible cardiac or respiratory failure refractory to standard therapy. The use of ECMO in the paediatric cardiac surgical population is established. Likewise, the use of ECMO for severe adult respiratory failure has recently been established and has been the subject of recent clinical trials. However, its use as a means of cardiac support in the adult population is not routine in clinical practice. We herein review the indications, technical procedure, complications and outcomes of extracorporeal membrane oxygenation as pertinent to cardiac disease in general, and specifically, to catheter-based interventions. We describe two cases of high-risk cardiac catheterisation laboratory procedures performed with veno-arterial ECMO support in adult patients who were deemed to be at unacceptably high risk for conventional open-heart surgery and cardiopulmonary bypass.

Chow V, Ranasinghe I, Lau J, Stowe H, Bannon P, Hendel N, Kritharides L

Heart Lung Circ 2010 Dec;19(12):706-12

PMID: 20851678

Abstract

BACKGROUND: Haematoma formation is a recognised complication after permanent pacemaker (PPM) implantation. The contribution of peri-procedural anticoagulation to the risk of haematoma formation is unclear.

METHOD: The records of 518 consecutive patients, mean age 76.9±9.8 years, receiving their first PPM (2004-2007) in a single tertiary referral centre were reviewed. Follow-up was complete for 506 patients (97.7%) up to six weeks. Haematomas were diagnosed clinically, and further subdivided according to the need for evacuation.

RESULTS: There were 27 instances of haematoma formation in 25 patients (4.9%) with 19 requiring drainage or evacuation. Twenty-one of the 25 patients who developed a haematoma had stopped warfarin and received bridging therapeutic anticoagulation pre- and post-PPM. The incidence of haematoma was significantly greater in those receiving peri-operative therapeutic anticoagulation (26.9% vs 0.9%, p<0.001), but was unaffected by the use of anti-platelet therapy. Most haematomas developed in patients whose heparin was recommenced within 24 hours of implantation. The development of haematoma post-PPM increased median hospital stay significantly (p<0.001). The main indication for anticoagulation in these patients was atrial fibrillation (79.5%) and most of these patients had a low to intermediate risk of peri-procedural thromboembolic events.

CONCLUSION: Peri-operative therapeutic anticoagulation is associated with more than 25-fold increase in haematoma formation post-pacemaker implantation. The risk-benefit ratio of therapeutic anticoagulation should be carefully considered, particularly in patients with a low risk of thromboembolic events.

Wise SG, Byrom MJ, Waterhouse A, Bannon PG, Weiss AS, Ng MK

Acta Biomater 2011 Jan;7(1):295-303

PMID: 20656079

Abstract

Small-diameter synthetic vascular graft materials fail to match the patency of human tissue conduits used in vascular bypass surgery. The foreign surface retards endothelialization and is highly thrombogenic, while the mismatch in mechanical properties induces intimal hyperplasia. Using recombinant human tropoelastin, we have developed a synthetic vascular conduit for small-diameter applications. We show that tropoelastin enhances endothelial cell attachment (threefold vs. control) and proliferation by 54.7 ± 1.1% (3 days vs. control). Tropoelastin, when presented as a monomer and when cross-linked into synthetic elastin for biomaterials applications, had low thrombogenicity. Activation of the intrinsic pathway of coagulation, measured by plasma clotting time, was reduced for tropoelastin (60.4 ± 8.2% vs. control). Platelet attachment was also reduced compared to collagen. Reductions in platelet interactions were mirrored on cross-linked synthetic elastin scaffolds. Tropoelastin was subsequently incorporated into a synthetic elastin/polycaprolactone conduit with mechanical properties optimized to mimic the human internal mammary artery, including permeability, compliance, elastic modulus and burst pressure. Further, this multilayered conduit presented a synthetic elastin internal lamina to circulating blood and demonstrated suturability and mechanical durability in a small scale rabbit carotid interposition model.

Edelman JJ, Yan TD, Padang R, Bannon PG, Vallely MP

Ann. Thorac. Surg. 2010 Oct;90(4):1384-90

PMID: 20868861

Abstract

We performed a meta-analysis of all studies comparing off-pump coronary artery bypass graft surgery (OPCABG) and percutaneous coronary intervention (PCI) for patients with coronary artery disease. Ten studies were included in the meta-analysis and 4,821 patients were compared, of whom 3,450 patients underwent PCI and 1,371 patients underwent OPCABG. The rates of stroke, myocardial infarction, cardiac mortality, and all-cause mortality were similar. The 12-month rate of major adverse cardiac or cerebrovascular events and need for repeat revascularization was significantly lower in the OPCABG group when compared with the PCI group.

Yan TD, Vallely MP

Ann. Thorac. Surg. 2010 Oct;90(4):1392-3; author reply 1393-4

PMID: 20868864

Abstract

Cao CQ, Yan TD, Bannon PG, McCaughan BC

J Thorac Oncol 2010 Oct;5(10):1692-703

PMID: 20802345

Abstract

INTRODUCTION: The primary objective of the present systematic review was to evaluate the safety and efficacy of extrapleural pneumonectomy (EPP) for patients with malignant pleural mesothelioma.

METHODS: A systematic review of relevant studies identified through five online search databases was performed. Two reviewers independently appraised each study.

RESULTS: Thirty-four of 58 relevant studies from 26 institutions containing the most updated data were evaluated for survival and perioperative outcomes after EPP. The median overall survival varied from 9.4 to 27.5 months, and 1-, 2-, and 5-year survival rates ranged from 36 to 83%, 5 to 59%, and 0 to 24%, respectively. Overall perioperative mortality rates ranged from 0 to 11.8%, and the perioperative morbidity rates ranged from 22 to 82%. Quality of life assessments from three studies reported improvements in nearly all domains at 3 months postoperatively. Patients who underwent trimodality therapy involving EPP and adjuvant chemoradiotherapy had a median overall survival of 13 to 23.9 months.

DISCUSSIONS: The current evidence suggests that selected patients with malignant pleural mesothelioma may benefit from EPP, especially when combined with neoadjuvant or adjuvant chemotherapy and adjuvant radiotherapy.

Roberts P, Spina R, Vallely M, Wilson M, Bailey B, Celermajer DS

Circ Cardiovasc Interv 2010 Aug;3(4):e14-5

PMID: 20716752

Abstract