Research

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.

Yan TD, Vallely MP

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

PMID: 20868864

Abstract

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.

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

Vallely MP, Yan TD, Edelman JJ, Hayman M, Brereton RJ, Ross DE

Heart Lung Circ 2010 Sep;19(9):555-60

PMID: 20447865

Abstract

Several large series have demonstrated that performing off-pump coronary artery bypass surgery without manipulating the ascending aorta (anaortic) utilising all-arterial grafts provides superior protection against neurological injury. Recent series comparing percutaneous coronary intervention (PCI) with surgical revascularisation have demonstrated superior results for surgery over PCI. However, a significant criticism of coronary artery surgery remains the higher incidence of neurological injury when compared to PCI. We present a simple and reproducible technique for anaortic, total-arterial off-pump coronary artery revascularisation.

Cao CQ, Munkholm-Larsen S, Yan TD

Zhongguo Fei Ai Za Zhi 2010 Mar;13(3):242-6

PMID: 20681068

Abstract

Vallely MP, Ross DE

Ann. Thorac. Surg. 2010 Aug;90(2):700-1; author reply 701

PMID: 20667399

Abstract