Publications by authors named "Andrew Chukwuemeka"
Article Synopsis
- - The study examined the relationship between peak pre-operative troponin levels and survival rates for patients undergoing coronary artery bypass grafting (CABG) after non-ST elevation myocardial infarction (NSTEMI), involving a cohort of 1,746 patients from five UK centers.
- - Results indicated that elevated troponin levels were a strong predictor of early survival (up to 30 days post-surgery) and demonstrated a significant interaction with the time taken to perform surgery; longer waits improved survival for patients with higher troponin readings.
- - The findings suggest that while troponin levels can guide the timing of surgery for improving immediate outcomes, they do not affect long-term survival beyond 30 days, highlighting their potential use
Introduction: Bicuspid aortic valve (BAV) affects 1% of the general population. was the first gene associated with BAV. The proportion of familial and sporadic BAV disease attributed to mutations has not been estimated.
View Article and Find Full Text PDFObjectives: The clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK.
Methods: We retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020.
Article Synopsis
- Transcatheter aortic valve replacement (TAVR) is a recognized treatment for severe aortic stenosis and has recently been applied to treat failures of bioprosthetic surgical aortic valves (sAVR) through a technique known as valve-in-valve TAVR (ViV-TAVR).
- Though data on ViV-TAVR primarily come from observational studies, initial findings suggest it offers similar outcomes to re-do sAVR in high-risk patients.
- The case presented in this text highlights a rare situation of TAVR failure in a patient who had prior sAVR, necessitating an innovative procedure called valve-in-valve-in-valve TAVR (ViViV-TAVR).
Article Synopsis
- Patients with severe aortic stenosis (AS) often also suffer from coronary artery disease, which can affect blood flow and lead to symptoms during exertion; the study investigates how severe AS impacts coronary microcirculation, particularly in patients with and without coronary disease.
- The study involved two groups: 55 patients with severe AS undergoing transcatheter aortic valve implantation (TAVI) and 85 patients with coronary stenoses but no AS undergoing percutaneous coronary intervention; measurements of coronary pressure and flow were taken before and after their respective procedures.
- Results showed that TAVI significantly improved microvascular function regardless of existing coronary disease, equating the hemodynamic benefits of TAVI to those seen with stenting serious coronary lesions,
Trans-Axillary Transcatheter Aortic Valve Replacement (TAVR) has become established as the safest arterial approach when femoral arterial anatomy is unfavorable. Although a left sided axillary approach is generally preferred, patient specific factors may require use of the right axillary artery. In this case series we describe procedural modifications that are required to overcome the challenge of restricted space in the ascending aorta for in situ valve preparation of balloon-expandable valve systems when a right sided trans-Axillary approach is taken.
View Article and Find Full Text PDFArticle Synopsis
- A study investigated how severe aortic stenosis (AS) affects coronary flow and pressure in patients undergoing transcatheter aortic valve replacement (TAVR) with existing coronary artery disease.
- Results showed an increase in systolic and overall hyperemic coronary flow after TAVR, while diastolic flow remained unchanged.
- Notably, traditional measures for assessing coronary stenosis severity exhibited discrepancies post-TAVR, with the fractional flow reserve decreasing while the instantaneous wave-free ratio remained constant.
Aim: Severe aortic stenosis frequently involves the development of left ventricular hypertrophy (LVH) creating a dichotomous haemodynamic state within the coronary circulation. Whilst the increased force of ventricular contraction enhances its resultant relaxation and thus increases the distal diastolic coronary "suction" force, the presence of LVH has a potentially opposing effect on ventricular-coronary interplay. The aim of this study was to use non-invasive coronary wave intensity analysis (WIA) to separate and measure the sequential effects of outflow tract obstruction relief and then LVH regression following intervention for aortic stenosis.
View Article and Find Full Text PDFArticle Synopsis
- * In a study of 3758 patients, women who received TAVI had significantly lower mortality rates at 1 and 2 years post-procedure, whereas men showed no survival differences between TAVI and SAVR.
- * The results highlight a significant gender disparity in treatment outcomes, with women experiencing a 26-31% lower chance of mortality with TAVI compared to SAVR, while men had similar survival rates with both procedures.
Thrombosis of transcatheter aortic valve implantation (TAVI) is an uncommon complication that commonly occurs weeks to months following the procedure. Herein are described the details of a patient who presented with a recurrence of symptoms days after intervention with a bioprosthesis thrombosis that was successfully treated with direct oral anticoagulant (DOAC) therapy and resulted in hemodynamic improvement and resolution of symptoms. Whilst a previous trial of DOAC therapy with mechanical valves was stopped due to elevated events in comparison to warfarin, a TAVI valve may be different, and the rapid onset of action and reduced bleeding risk may be beneficial in this patient group.
View Article and Find Full Text PDFAim: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI).
Methods: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge).
A 90-year-old man presented with increasing exertional breathlessness. He had previous implantation of a Perimount bioprosthetic aortic valve (Edwards Lifesciences) and coronary artery bypass graft surgery. Due to severe transvalvular bioprosthetic regurgitation with preserved left ventricular dimensions and ejection fraction, the heart team decided on valve-in- valve transcatheter aortic valve implantation via the transfemoral route in view of the patient's prohibitively high surgical and anesthetic risk.
View Article and Find Full Text PDFNR2 antibody is associated with quality of life in aortic valve replacement.
Asian Cardiovasc Thorac Ann
July 2015
Article Synopsis
- The study investigates the link between N-methyl-D-aspartate receptor antibody levels and quality of life in patients undergoing aortic valve replacement.
- It involves measuring antibody levels preoperatively and assessing quality of life using standardized questionnaires before and after the surgery.
- Results show that patients with lower antibody levels had significantly better quality of life scores, indicating that higher antibody levels are associated with poorer outcomes both before and after the surgery.
Background. Aortic stiffness changes the flow pattern of circulating blood causing microvascular damage to different end-organ tissues, such as brain cells. The relationship between aortic stiffness measured by pulse wave velocity (PWV) and serum ischemic brain injury biomarker N-methyl-D-aspartate receptor antibody (NR2Ab) levels in aortic valve replacement has not been assessed.
View Article and Find Full Text PDFBackground: Accurate prediction, early detection and treatment of acute kidney injury (AKI) are essential for improving post-operative outcomes. This study aimed to examine the role of aortic stiffness and neutrophil gelatinase-associated lipocalin (NGAL) as predictors of AKI or need for early medical renal intervention following aortic valve replacement (AVR).
Methods: Aortic pulse wave velocity and plasma NGAL were measured pre-operatively in recruited patients undergoing AVR for aortic stenosis (AS).
Gender differences exist in outcomes after percutaneous coronary intervention and coronary artery bypass graft surgery but have yet to be fully explored after transcatheter aortic valve implantation. We aimed to investigate gender differences after transcatheter aortic valve implantation in the UK National Institute for Cardiovascular Outcomes Research registry. A retrospective analysis was performed of Medtronic CoreValve and Edwards SAPIEN implantation in 1,627 patients (756 women) from January 2007 to December 2010.
View Article and Find Full Text PDFCan lungs be taken for transplantation from donors with a significant smoking history?
Interact Cardiovasc Thorac Surg
July 2013
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Can lungs be taken for transplantation from donors with a significant smoking history?’. Five papers were found using the reported search that represented the best evidence to answer the clinical question.
View Article and Find Full Text PDFDo all patients with prosthetic valve endocarditis need surgery?
Interact Cardiovasc Thorac Surg
December 2012
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'do all patients with prosthetic valve endocarditis need surgery?' Seventeen papers were found using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.
View Article and Find Full Text PDFParaneoplastic neurological syndromes are conditions that manifest as the remote effects of cancer. These are very rare, occurring in 1/10000 patients with a malignancy, and include Lambert-Eaton myasthenic syndrome, limbic encephalitis, subacute cerebellar ataxia, opsoclonus-myoclonus, Stiff-Person Syndrome, retinopathies, chronic gastrointestinal pseudo-obstruction and sensory neuropathy. This report describes a case of 41-year-old man who presented with elements of multiple paraneoplastic syndromes, including chronic gastrointestinal pseudo-obstruction, myasthenia gravis-Lambert-Eaton overlap syndrome and polymyositis, and who was subsequently found to have a malignant thymoma.
View Article and Find Full Text PDFArticle Synopsis
- * New technologies, like percutaneous aortic valve replacement (PAVR) and coronary pulse wave analysis, allow for immediate assessment of blood flow changes after treating valvular stenosis.
- * The study found that before PAVR, the coronary suction wave decreased as heart rate increased, but post-PAVR, this wave normalized, indicating improved heart response and potentially relieving angina symptoms.
Article Synopsis
- Recent guidelines for managing the left subclavian artery (LSA) during thoracic aorta stenting do not clearly address dissection cases, prompting a systematic review of existing data.
- The review analyzed 46 studies involving 1,275 patients to compare various outcomes like left arm ischemia, stroke, and mortality in those with and without LSA coverage and revascularization.
- Results indicated that LSA coverage without revascularization significantly increases complications, and it's recommended that revascularization be considered pre-procedure to mitigate risks associated with aortic dissection.
Article Synopsis
- Right ventricular (RV) function declines significantly after cardiac surgery, particularly after the pericardium is opened, indicating a specific timing for this dysfunction.
- A study involving echocardiography in patients showed a drastic reduction in RV velocities, with a 43% drop occurring within three minutes of pericardial incision and more than a 60% reduction by the end of the surgery.
- The findings suggest that the observed RV dysfunction is primarily related to the surgical procedure itself (pericardial incision) rather than the effects of cardiopulmonary bypass.
Background And Aim Of The Study: The number of octogenarians is increasing in industrialized societies, and many patients aged over 80 years have heart valve disease which is amenable to surgical treatment. The perioperative outcomes and long-term results in very elderly patients undergoing valve surgery were evaluated.
Methods: A retrospective analysis was conducted of 2,791 patients with long-term follow up, who underwent valve surgery between 1990 and 2002.