Author(s) Meharban N. (Drmobashir@outlook.com); Munir W.; Idhrees M.; Bashir A.; Bashir M.
Source Asian Cardiovascular and Thoracic Annals; 2021
AbstractPenetrating atherosclerotic ulcers present with an insidious onset with a reported mortality of 9%, varying across populations. With vast arrays of risk factors and potentially ominous complications, it is vital to efficiently provide optimum strategies for management. There exists controversy in the literature regarding management, especially for Type B penetrating atherosclerotic ulcers; the decision-making framework encompasses numerous factors in considerations for medical management versus invasive intervention and choice of endovascular versus open repair in the latter. The concomitant presence of intramural haematoma adds further complexity to the already intricate decision-making for management. We performed searches through PubMed and SCOPUS analysing studies reporting outcomes for management strategies for penetrating atherosclerotic ulcers treatment, focusing on Type B, further seeking to analyse studies reporting their experiences of PAU patients with concomitant intramural haematoma. Our review highlights the ambiguity and controversy existing in the literature, comprising studies burdened by their inherent hindering limitations of their single-centre retrospective experiences. Endovascular therapy has come to the forefront of penetrating atherosclerotic ulcers management, often considered first line therapy. In the case of penetrating atherosclerotic ulcers alongside intramural haematoma, there have been reports of potential hybrid surgical approaches to management. Studies further show misdiagnosis of penetrating atherosclerotic ulcers in earlier data sets further complicates management. However, it is clear we must progress on the journey towards precision medicine, allowing delivery of optimum care to our patients.Copyright © The Author(s) 2021.
Author(s) Yap Z.J.; Sharif M.; Bashir M. (email@example.com)
Source Journal of Cardiac Surgery; Apr 2021; vol. 36 (no. 4); p. 1520-1530
AbstractBackground and Aim: Aortic aneurysms most commonly occur in the infra-renal and proximal thoracic regions. While generally asymptomatic, progressive aneurysmal dilation can become rapidly lethal when dissection or ruptures occurs, highlighting the need for more robust screening. Abdominal aortic aneurysm (AAA) is more prevalent compared to thoracic aortic aneurysm (TAA). The true incidence of TAA is underreported due to the absence of population screening and the silent nature of TAA. To achieve the optimum survival rate in aortic aneurysms, knowledge of natural course, genetic association, and surgical results are needed to be applied with adequate medical treatment and careful selection of patients for operation. The purpose of this paper is to provide a comprehensive review of the literature on natural history, immunology, and genetic differences between thoracic and AAAs. Method(s): The literature was collected from OVID, SCOPUS, and PubMed. Result(s): (1) AAA expands faster than TAA. AAA expands at approximately 0.3-0.45 cm annually, depending on various factors (advancing age, diameter of aorta, smoking etc.). TAA expands up to 0.3 cm annually in a non-bicuspid aortic valve patient. (2) An increase in Matrix metallopeptidase 1, 2, 9, 12, 14 led to degrading extracellular matrix of the aortic vessel wall. This significantly contributed to the pathogenesis in AAA, whereas overactive Transforming growth factor-beta played a major role in the pathogenesis of TAA. Conclusion(s): In the future, genetic testing may be the gold standard for tackling the geneticheterogeneity of aneurysms, therefore, identifying at-risk individuals developing TAA andAAA earlier.Copyright © 2021 Wiley Periodicals LLC
Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease
Author(s) Wang R.; Gao C.; Tao L.; Kawashima H.; Ono M.; Hara H.; Wijns W.; Onuma Y.; Serruys P.W. (firstname.lastname@example.org); van Geuns R.-J.; Garg S.; Morice M.-C.; Davierwala P.M.; Kappetein A.P.; Holmes D.R.
AbstractAims: To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Method(s): The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Result(s): Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08-1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83-1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in >= 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11-4.23, p < 0.001) compared to those without CVD. Conclusion(s): The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.]Copyright © 2021, The Author(s).
When is extra-anatomical bypass for the left subclavian artery required to prevent ischaemia after thoracic endovascular stent grafting?
Author(s) Moore K.; Gordon A.; Thomas R.; Wood A.; White R.D.; Bailey D.M.; Lewis M.H.; Bashir M.; Williams I.M. (Ian.Williams5@wales.nhs.uk)
AbstractIntroduction: Thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for thoracic aortic disease. However, the principal complications relate to coverage of the thoracic aortic wall and deliberate occlusion of aortic branches over a potentially long segment. Complications include risk of stroke, spinal cord ischaemia (SCI) and arterial insufficiency to the left arm (left arm ischaemia (LAI)). This study specifically scrutinised the development of SCI and LAI after TEVAR for interventions for thoracic aortic disease from 1999 to 2020. In particular, those who underwent extra-anatomical bypass (both immediate and late) were compared to the length of thoracic aortic coverage by the stent graft.
Author(s) Lopuszko; Patrick Tan, Sven Zhen Cian; Munir, Wahaj; Bashir, Mohamad
Source Journal of Cardiac Surgery; Jul 2021; vol. 36 (no. 7); p. 2496-2501
Publication Date Jul 2021
AbstractBackground: Aortic aneurysm (AA) is a common atherosclerotic condition, accounting for nearly 6000 deaths in England and up to 175,000 deaths globally each year. The pathological outward bulging of the aorta typically results from atherosclerosis or hereditary connective tissue disorders. AAs are usually asymptomatic until spontaneous rupture or detected on incidental screening. Eight in 10 patients do not survive the rupture and die either before reaching hospital or from complications following surgery. Similar to other cardiovascular pathologies, AA is thought to be subject to chronobiological patterns of varying incidence.Methods: We performed a literature review of the current literature to evaluate the association between circadian rhythms, seasonal variations, and genetic factors and the pathogenesis of AA, reviewing the impact of chronobiology.Results: The incidence of AA is found to peak in the early morning (6-11 a.m.) and colder months, and conversely troughs towards the evening and warmer months, exhibiting a similar pattern of chronobiological rhythm as other cerebrovascular pathologies, such as myocardial infarcts, or cerebrovascular strokes.Conclusion: Literature suggests there exists a clear relationship between chronobiology and the incidence and pathogenesis of ruptured AA; incidence increases in the morning (6-11 a.m.), and during colder months (December-January). This is more pronounced in patients with Marfan syndrome, or vitamin D deficiency. The underlying pathophysiology and implications this has for chronotherapeutics, are also discussed. Our review shows a clear need for further research into the chronotherapeutic approach to preventing ruptured AA in the journey towards precision medicine.
Neurological complications following frozen elephant trunk for aortic dissection: What's truly to blame?
Author(s) Tan ; El Santawy, Hazem; Abdelhaliem, Amr
Source Journal of Cardiac Surgery; Sep 2021; vol. 36 (no. 9); p. 3352-3353
Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta-analysis
Author(s) Mousavizadeh; Daliri, Mahdi; Aljadayel, Hadi Abo; Mohammed, Idhrees; Rezaei, Yousef; Bashir, Mohamad; Hosseini, Saeid
Source Journal of Cardiac Surgery; Sep 2021; vol. 36 (no. 9); p. 3337-3351
Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review
Author(s) Serruys; Hara, Hironori; Garg, Scot; Kawashima, Hideyuki; Nørgaard, Bjarne L.; Dweck, Marc R.; Bax, Jeroen J.; Knuuti, Juhani; Nieman, Koen; Leipsic, Jonathon A.; Mushtaq, Saima; Andreini, Daniele; Onuma, Yoshinobu
Source Journal of the American College of Cardiology (JACC); Aug 2021; vol. 78 (no. 7); p. 713-736
Author(s) Idhrees; Hosseini, Saeid; Rezaei, Yousef; Mousavizadeh, Mostafa; Daliri, Mahdi; Aljadayel, Hadi Abo; Bashir, Mohamad
Source Journal of Cardiac Surgery; Aug 2021; vol. 36 (no. 8); p. 3011-3012
Publication Date Aug 2021
Author(s) Bashir M. (email@example.com); Mohammed I.; Mousavizadeh M.; Rezaei Y.; Hosseini S.
Source Journal of Cardiac Surgery; 2021
Author(s) Serruys; Ono, Masafumi; Garg, Scot; Hara, Hironori; Kawashima, Hideyuki; Pompilio, Giulio; Andreini, Daniele; Holmes, David R.; Onuma, Yoshinobu; King III, Spencer B.
Source Journal of the American College of Cardiology (JACC); Jul 2021; vol. 78 (no. 4); p. 384-407
Publication Date Jul 2021
Author(s) Division of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea.; Liew Houng Bang; Eun Jung Jun; Ae-Young Her; Ju-Hyun Chung; Garg, Scot; Joo Myung Lee; Joon-Hyung Doh; Chang-Wook Nam; Bon-Kwon Koo; Qiang Tang
Source Cardiology Journal; Jul 2021; vol. 28 (no. 4); p. 615-622
AbstractAlthough drug-eluting stents (DES) have become the mainstay of percutaneous coronary intervention, late and very late stent thrombosis remains a concern. Drug-coated balloons (DCB) have the advantage of preserving the anti-restenotic benefits of DES while minimizing potential long-term safety concerns. Currently the two methods to ensure successful DCB treatment of a stenotic lesion are angiography or physiology-guided DCB application. This review will evaluate these two methods based on previous evidence and make suggestions on how to perform DCB treatment more efficiently and safely.
Coronary artery bypass grafting versus percutaneous coronary intervention in ischaemic heart failure. Can reliable treatment decisions in high-risk patients be based on non-randomized data?
Author(s) Ono M.; Onuma Y.; Serruys P.W. (firstname.lastname@example.org); Garg S.
Source European Heart Journal; Jul 2021; vol. 42 (no. 27); p. 2665-2669
Author(s) Rimmer L.; Bashir M. (email@example.com); Mellor S.; Harky A.; Gouda M.
Source Journal of Cardiac Surgery; Apr 2021; vol. 36 (no. 4); p. 1232-1240
AbstractBackground: Type B aortic dissection (TBAD) occurs seldomly, particularly in pregnancy, but has disastrous consequences for both mother and fetus. The focus of immediate surgical repair of type A aortic dissection due to higher mortality of patients is less clear in its counterpart, TBAD, in which management is controversial and debated. This article collates knowledge so far on this rare event during pregnancy. Method(s): A comprehensive literature search was performed in PubMed, Scopus, Google Scholar, Embase, and Medline. Key search terms included "type B aortic dissection,""pregnancy," and corresponding synonyms. Non-English papers were excluded. Result(s): Risk factors for TBAD include aortic wall stress due to hypertension, previous cardiac surgery, structural abnormalities (bicuspid aortic valve, aortic coarctation), and connective tissue disorders. In pregnancy, pre-eclampsia is a cause of increased aortic wall stress. Management of this condition is often conservative, but this is dependent on a number of factors, including gestation, cardiovascular stability of the patient, and symptomology. In most cases, a cesarean section before intervention is carried out unless certain indications are present. Conclusion(s): Due to a scarce number of cases across the decades, it is difficult to determine which management is optimal. The gold-standard management of TBAD has traditionally been the medical treatment for uncomplicated cases and open surgery for those needing urgent intervention, but with the advent of techniques, such as thoracic endovascular aortic repair, the management of these group of patients continues to develop.Copyright © 2021 Wiley Periodicals LLC
Invasive versus medically managed acute coronary syndromes with prior bypass (CABG-ACS): Insights into the registry versus randomised trial populations
Author(s) Lee M.M.Y.; Petrie M.C.; Simpson J.; Jackson C.E.; Corcoran D.S. et al.
Source Open Heart; Feb 2021; vol. 8 (no. 1)
Background Coronary artery bypass graft (CABG) patients are under-represented in acute coronary syndrome (ACS) trials. We compared characteristics and outcomes for patients who did and did not participate in a randomised trial of invasive versus non-invasive management (CABG-ACS). Methods ACS patients with prior CABG in four hospitals were randomised to invasive or non-invasive management. Non-randomised patients entered a registry. Primary efficacy (composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction (MI), heart failure) and safety outcomes (composite of bleeding, stroke, procedure-related MI, worsening renal function) were independently adjudicated.
Author(s) Garg S.; Chichareon P.; Kogame N.; Takahashi K.; Modolo R. et al.
Source Catheterization and Cardiovascular Interventions; Dec 2020; vol. 96 (no. 7); p. 1369-1378
Publication Date Dec 2020
Objective: To investigate the impact of different anti-platelet strategies on outcomes after percutaneous coronary intervention (PCI) in patients with established cardiovascular disease (CVD).
Impact of dissection after drug-coated balloon treatment of de novo coronary lesions: Angiographic and clinical outcomes
Author(s) Hui L.; Shin E.-S.; Jun E.J.; Kim T.-H.; Sohn C.-B.; Choi B.J.; Yuan S.L.; Kun L.; Zhi W.; Hao J.; Zhentao S.; Qiang T.; Bhak Y.; Garg S.
Source Yonsei Medical Journal; Dec 2020; vol. 61 (no. 12); p. 1004-1012
Publication Date Dec 2020
Purpose: Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions.
Efficacy and safety of one-month DAPT followed by 23-month ticagrelor monotherapy in patients undergoing proximal LAD stenting: Insights from the GLOBAL LEADERS trial
Author(s) Takahashi K.; Kawashima H.; Ono M.; Hara H.; Wykrzykowska J.J. et al.
Source International Journal of Cardiology; Dec 2020; vol. 320 ; p. 27-34
Publication Date Dec 2020
Backgrounds: Data on optimal antiplatelet therapy in patients undergoing stenting of the proximal left anterior descending artery (LAD) are limited. Method(s): This is a post-hoc analysis of the GLOBAL LEADERS trial, a prospective, multi-center, randomized controlled trial, comparing the experimental strategy (1-month dual anti-platelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) with the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in relation to stenting of the proximal LAD. The primary endpoint was the composite of all-cause death or new Q-wave myocardial infarction (MI) and key secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at two years. Result(s): Among 15,845 patients included in the analysis, 3823 (23.9%) patients underwent stenting of the proximal LAD, while 12,022 (75.2%) did not. In the proximal LAD stenting group, there was no significant difference in the risk of the primary endpoint between the two antiplatelet strategies (3.38% vs. 3.93%; hazard ratio [HR]:0.86; 95% CI:0.62-1.20; Pinteraction = 0.951). However, the risk of any MI (2.63% vs. 3.88%; HR:0.68; 95% CI:0.47-0.97; Pinteraction = 0.015) and any revascularization (7.84% vs. 9.94%; HR:0.78; 95% CI:0.63-0.97; Pinteraction = 0.058) was significantly lower in the experimental strategy group, while demonstrating a similar risk of BARC type 3 or 5 bleeding between the two antiplatelet strategies (1.93% vs. 1.99%; HR:0.98; 95% CI:0.62-1.54; Pinteraction = 0.981). Conclusion(s): The present study showed patients having stenting to the proximal LAD could potentially benefit from the experimental strategy with lower ischaemic events without a trade-off in major bleeding at two years.Copyright © 2020 Elsevier B.V.
Ticagrelor monotherapy in patients with concomitant diabetes mellitus and chronic kidney disease: a post hoc analysis of the GLOBAL LEADERS trial
Author(s) Gao C.; Wang R.; van Geuns R.-J.; Tomaniak M.; Takahashi K. et al.
Source Cardiovascular Diabetology; Dec 2020; vol. 19 (no. 1)
Publication Date Dec 2020
Background: Patients with both diabetes mellitus (DM) and chronic kidney disease (CKD) are a subpopulation characterized by ultrahigh ischemic and bleeding risk after percutaneous coronary intervention. There are limited data on the impact of ticagrelor monotherapy among these patients.
Serial optical coherence tomography findings after drug-coated balloon treatment in de novo coronary bifurcation lesion
Author(s) Jun E.J.; Yuan S.L.; Shin E.-S.; Garg S.
Source Cardiology Journal; 2020; vol. 27 (no. 4); p. 429-430
Author(s) Rimmer L.; Heyward-Chaplin J.; South M.; Bashir M.; Gouda M.
Source Journal of Cardiac Surgery; 2020
Background: Type A acute aortic dissection (TAAD) during pregnancy is a life-threatening event for both the mother and the unborn baby. Pregnancy has been recognized as an independent risk factor for TAAD, postulated to be due to physiological changes that cause hyperdynamic circulation. This review seeks to outline the current controversies around this unique group.
Factors influencing the uptake of cardiac rehabilitation by cardiac patients with a comorbidity of stroke
Author(s) Harrison A.S.; Doherty P.; Gaskins N.J.; Connell L.A.
Source IJC Heart and Vasculature; Apr 2020; vol. 27
Author(s) Chichareon P.; Modolo R.; Kawashima H.; Takahashi K.; Kogame N. et al.
Source JACC: Cardiovascular Interventions; Mar 2020; vol. 13 (no. 5); p. 634-646
Objectives: This study assessed the ability of the dual-antiplatelet therapy (DAPT) score in stratifying ischemic and bleeding risk in a contemporary percutaneous coronary intervention (PCI) population. Background(s): The DAPT score is recommended by guidelines as a tool to stratify ischemic and bleeding risk. Its utility in contemporary PCI is unknown.
Author(s) Bashir M.; Harky A.
Source The Journal of cardiovascular surgery; Jan 2020
Type A dissection is a clinical emergency and the extent of repairing the damaged tissue is variable and depends on several factors including the expanse of dissection, entry tear, surgeon's experience, and unit resource availability and performance. The conservative surgeon prefers to perform aortic root up-to hemi arch replacement while the patient recovers planning onward for the second stage approach, however, the aggressive school prefers to replace the entire aortic arch with the deployment of a frozen elephant trunk and control intimal tear and alter false lumen natural history. Data to date remains debatable in terms of short- and long-term outcomes with equivocal results between both approaches. Through our manuscript, we aim to highlight the indifferences, challenges, resultant optimum outcomes from the surgeon and patients' perspectives, plus we will mull over the evidence best practice in limited versus extended type A aortic dissection repair.
Association of Sex with Outcomes in Patients Undergoing Percutaneous Coronary Intervention: A Subgroup Analysis of the GLOBAL LEADERS Randomized Clinical Trial
Author(s) Chichareon P.; Modolo R.; Kerkmeijer L.; Kogame N.; Takahashi K. et al.
Source JAMA Cardiology; Jan 2020; vol. 5 (no. 1); p. 21-29
Importance: Women experience worse ischemic and bleeding outcomes after percutaneous coronary intervention (PCI). Objective(s): To assess the association of sex with patient outcomes at 2 years after contemporary PCI and with the efficacy and safety of 2 antiplatelet strategies.
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