A selection of published papers by the Aortic Team on a range of subjects relating to aortic conditions.

Perioperative management and outcomes of aortic surgery during pregnancy.

Yates M, Soppa G, Smelt J, Fletcher N, van Besouw JP, Thiaganathan B, Jahangiri M.

The Journal of Thoracic and Cardiovascular Surgery 2015; 149:607-10.

Pathology of the aortic valve and ascending thoracic aorta is an uncommon but life-threatening complication of pregnancy. Cardiac surgery during pregnancy is known to carry a high risk of mortality to both the mother and foetus. This paper presents our experience of performing aortic surgery during the patients’ pregnancy. 

Aortic Root Surgery: Does High Surgical Volume and a Consistent Perioperative Approach Improve Outcome?

Bilkhu R, Youssefi P, Soppa G, Sharma R, Child A, Edsell M, van Besouw J, Jahangiri M.

Seminars in Thoracic and Cardiovascular Surgery 2016;28: 302-09

There is evidence that high surgical volume and team consistency improve outcomes. Mortality of 4%-12% for aortic root surgery has been reported in the United States and UK. This paper assesses outcomes of patients undergoing aortic root surgery by a consistent, high-volume team.

Cut Well, Sew Well, Do Well… And Do It Often!

Giradi L. Editorial Comment re the above article

Quality of Life in relation to Length of Intensive Care Stay After Cardiac Surgery

Diab M, Bilkhu R, Soppa G, McGale N, HiraniS, Newman S, Jahangiri M.

Journal of Cardiothoracic and Vascular Anesthesia 2017;31: 1080-1090

Patient-specific computational fluid dynamics-assessment of aortic haemodynamics in a spectrum of aortic valve pathologies

Youssefi P, Gomez A, He T, Anderson L, Bunce N, Sharma R, Figueroa C, Jahangiri M.

The Journal of Thoracic and Cardiovascular Surgery 2017;153: 8-20

The complexity of aortic disease is not fully exposed by aortic dimensions alone, and morbidity or mortality can occur before intervention thresholds are met. This paper looks the use of patient-specific computational fluid dynamics (CFD) assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress (WSS), and oscillatory shear index (OSI) in the thoracic aorta.

Functional assessment of thoracic aortic aneurysms – the future of risk prediction?

Youssefi P, Sharma R, Figueroa C, Jahangiri M.

British Medical Bulletin 2017;61-71

Treatment guidelines for the thoracic aorta concentrate on size, yet acute aortic dissection or rupture can occur when aortic size is below intervention criteria. This paper looks at functional imaging and computational techniques as a means of assessing haemodynamic parameters involved in aortic pathology.

Removing the bicuspid source of aortopathy prevents further dilatation

Youssefi P, Jahangiri M.

European Journal of Cardiothoracic Surgery 2017;51:193

Proteomics of the epicardial fat secretome and its role in post-operative atrial fibrillation

Viviano A, Yin X, Zampetaki A, Fava M, Gallagher M, Mayr M, Jahangiri M.

Eurospace 2017; [Epub ahead of print]

Post-operative atrial fibrillation (POAF) is a predictor of morbidity and mortality after cardiac surgery. Latent predisposing factors may reside in the epicardial adipose tissue (EAT) due to its anatomical position and high protein production rate. In order to explore a possible mechanistic link, we characterized proteins secreted by the EAT preceding the onset of POAF. Understanding the role of EAT may offer novel insights into prevention and treatment of AF.

Impact of Patient-Specific Inflow Velocity Profile on Hemodynamics of the Thoracic Aorta.

Youssefi P, Gomez A, Arthurs C, Sharma R, Jahangiri M, Figueroa A.

Journal of Biomechanical Engineering Sep 2017; [Epub ahead of print]

Computational fluid dynamics (CFD) provides a non-invasive method to functionally assess aortic hemodynamics. The thoracic aorta has an anatomically complex inlet comprising of the aortic valve and root, which is highly prone to different morphologies and pathologies. This paper investigates the effect of using patient-specific (PS) inflow velocity profiles compared to idealized profiles based on the patient’s flow waveform.

Extracellular Matrix Proteomics Reveals Interplay of Aggrecan and Aggrecanases in Vascular Remodelling of Stented Coronary Arteries

Suna G, Wojakowski W, Lynch M, Barallobre-Barreiro J, Yin, Ursula Mayr, Ferheen Baig, Jahangiri M. et al.

Circulation Oct 2017; [Epub ahead of print]

Extracellular matrix (ECM) remodelling contributes to in-stent restenosis and thrombosis. Despite its important clinical implications little is known about ECM changes post-stent implantation. This study provides the first evidence implicating aggrecan and aggrecanases in the vascular injury response after stenting.

The impact of prolonged intensive care stay on quality of life, recovery and clinical outcomes following cardiac surgery: prospective cohort study

Diab M, Bilkhu R, Edsell M, Fletcher N, Heiberg J, Royse C, Jahangiri M.

The Journal of Thoracic and Cardiovascular Surgery 2017[Epub ahead of print]

Analysis of aortic area/height ratio in patients with thoracic aortic aneurysm and type A dissection

Acharya M, Youssefi, Soppa G, Valencia O, Nowell J, Kanagasabay R, Edsell, Morgan R, Tome M, Jahangiri M.

Presented EACTS 2017, Vienna

Reply: How Often Does Athlete Sudden Cardiac Death Occur Outside the Context of Exertion?

Gherardo Finocchiaro, Michael Papadakis, J.-L. Robertus, Harshil Dhutia, Alexandros Klavdios Steriotis, Maite Tome, Greg Mellor, Ahmed Merghani, Aneil Malhotra, Elijah Behr, Sanjay Sharma, Mary N. Sheppard

Journal of the American College of Cardiology 2016; 68:772-778.

A comment on a paper by Finocchiaro et al. regarding the causes of sudden cardiac death (SCD) in athletes and its precipitating factors (1).  We noted that this study was based on autopsy series, only including patients who did not survive, therefore creating a potential bias.  

Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK.

Nabeel Sheikh, Michael Papadakis, Vasileios F Panoulas, Keerthi Prakash, Lynne Millar, Paolo Adami, Abbas Zaidi, Sabiha Gati, Mathew Wilson, Gerald Carr-White, Maria Teresa Esteban Tomé, Elijah R Behr, Sanjay Sharma

Heart 2016;102:1797-1804.

This study investigated the influence of African/Afro-Caribbean (black) ethnicity on the clinical profile and outcomes in hypertrophic cardiomyopathy (HCM).  If found that black ethnicity is an important determinant of the phenotypic expression of HCM but does not adversely affect outcomes. Apical and concentric hypertrophy are common in black patients and may hinder the identification of HCM in this cohort. Hypertension has an adverse effect on outcome, irrespective of ethnicity.

Cost Implications of Using Different ECG Criteria for Screening Young Athletes in the United Kingdom.

Harshil Dhutia, Aneil Malhotra, Vincent Gabus, Ahmed Merghani, Gherardo Finocchiaro, Lynne Millar, Rajay Narain, Michael Papadakis, Huseyin Naci, Maite Tome, Sanjay Sharma

Journal of the American College of Cardiology 2016;68:76-80.

This study investigated the costs of ECG screening in athletes according to the 2010 European Society of Cardiology (ESC) recommendations and the Seattle refined interpretation criteria.  It found that contemporary ECG interpretation criteria decrease costs for de novo screening of athletes, which may be cost permissive for some sporting organizations.

The Prevalence and Significance of Anterior T wave Inversion in a Large White Population of Young Athletes and Non-athletes

Aneil Malhotra, Harshil Dhutia, Sabiha Gati, Helder Dores, Rachel Bastianen, Rajay Narain, Tee-Joo Yeo, Ahmed Merghani, Tracey Keteepe-Arachi, Lynne Millar, Gherardo Finnochario, Alexandros Steriotis, Andrew De Silva, Keerthi Prakash, Michael Papadakis, Elijah Behr, Maite Tome, Sanjay Sharma

Heart (British Cardiac Society) 06/2016; 102(Suppl 6)., DOI:10.1136/heartjnl-2016-309890.149

This study investigated the prevalence and significance of Anterior T wave inversion (ATWI) in a large cohort of young, white adults including athletes.  It found that ATWI confined to V1/ V2 may be a normal variant or physiological phenomenon in asymptomatic white individuals without a relevant family history. Conversely, ATWI beyond V2 is rare, particularly in males and may warrant investigation. The results of this study will have a significant impact on ECG interpretation in young white athletes and non-athletes.

The Cost Effectiveness of Screening Young Athletes with ECG in the UK.

Harshil Dhutia, Aneil Malhotra, Rajay Narain, Ahmed Merghani, Jon Senior, Saeed Azizi, Gherardo Finnochiaro, Michael Papadakis, Maite Tome, Sanjay Sharma

Heart (British Cardiac Society) 06/2016; 102(Suppl 6)., DOI:10.1136/heartjnl-2016-309890.148

High false positive rates and subsequent costs of additional investigations provide major obstacles to state-sponsored screening of young athletes for cardiac disease with ECG. However, the actual cost of ECG screening in large cohorts of athletes has never been assessed systematically. We investigated the financial implications of ECG screening in young athletes in the UK, and evaluated the impact of modification of ECG interpretation criteria on cost. 

Etiology of Sudden Death in Sports

Gherardo Finocchiaro, Michael Papadakis, Jan-Lukas Robertus, Harshil Dhutia, Alexandros Klavdios Steriotis, Maite Tome, Greg Mellor, Ahmed Merghani, Aneil Malhotra, Elijah Behr, Sanjay Sharma, Mary N. Sheppard

Journal of the American College of Cardiology 2016;67:62-68

This study investigated causes of sudden cardiac death (SCD) and their association with intensive physical activity in a large cohort of athletes to establish preventative strategies.  It found that conditions predisposing to SCD in sports demonstrate a significant age predilection. The strong association of ARVC and left ventricular fibrosis with exercise-induced SCD reinforces the need for early detection and abstinence from intense exercise. However, almost 40% of athletes die at rest, highlighting the need for complementary preventive strategies.

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