Supravalvular aortic stenosis is a rare cause of secondary aortic root distension and/or aortic v... more Supravalvular aortic stenosis is a rare cause of secondary aortic root distension and/or aortic valve regurgitation. Non-syndromic aortic aneurysms may also occur in young adults and can develop silently, representing an asymptomatic, life-threatening condition. Clinicians should, therefore, be alert to the possibility of this uncommon, but potentially serious disease, often first revealed by an imaging modality requested for other indications, even in case of an established, more benign diagnosis.
Myxomatous degeneration of mitral valve apparatus affects 2–3% of the general population and it i... more Myxomatous degeneration of mitral valve apparatus affects 2–3% of the general population and it is the most common cause of severe mitral regurgitation in western countries. More than 90% of degenerative mitral valves are suitable for valve repair rather than replacement, with short and long term clinical outcomes being superior after repair. In addition to the clinical benefits, mitral valve repair is associated with an economic benefit in the form of reduced short and long term medical expenses. Patients who have undergone mitral valve repair have mitral function restored, have avoided the added expense of a prosthetic valve and are free from lifelong anti-coagulation requirement. A variety of surgical approaches (sternotomy, anterolateral thoracotomy, and robotic assisted procedures) and repair techniques have been developed over the last four decades to treat mitral valve regurgitation. In this chapter, we delineate different aspects of mitral valve repair techniques.
A serious complication after cardiac surgery is sternal wound infection. Although incidence rates... more A serious complication after cardiac surgery is sternal wound infection. Although incidence rates vary worldwide, this complication raises significant concern in a certain patient demographic. This article uses risk assessment strategies to identify a high-risk patient profile and draws parallels with positive predictors in the preoperative, intraoperative and postoperative setting. It describes the complexity of sternal wound infections and highlights guidelines on detection and treatment. The optimal goal of this article is to help minimise the incidence of sternal wound complications after sternotomy by discussing recommendations for preoperative, intraoperative and postoperative preventive measures.
Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 created a challengi... more Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, we investigated the impact of the COVID-19 pandemic on our urgent aortic program. Methods 36 individuals presenting with TAAD in a single centre were analysed from the pre-pandemic period (2019, n=16) and the pandemic era (2020, n=20). Retrospective data review was conducted on patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes and length of stay. A comparison was made between both eras applying appropriate testing methods, and a p-value <0.05 was considered statistically significant. Results A 25% increase in TAAD referrals occurred during the pandemic era. Patients were ...
We report a 62-year-old female who required surgery for severe mitral regurgitation. Under roboti... more We report a 62-year-old female who required surgery for severe mitral regurgitation. Under robotic assistance, the valve was repaired by transection of the fibrous bridge, implantation of four neo-chordaes to the anterior leaflet, commissuroplasty of the posterolateral commissure, and annuloplasty.
A serious complication after cardiac surgery is sternal wound infection. Although incidence rates... more A serious complication after cardiac surgery is sternal wound infection. Although incidence rates vary worldwide, this complication raises significant concern in a certain patient demographic. This article uses risk assessment strategies to identify a high-risk patient profile and draws parallels with positive predictors in the preoperative, intraoperative and postoperative setting. It describes the complexity of sternal wound infections and highlights guidelines on detection and treatment. The optimal goal of this article is to help minimise the incidence of sternal wound complications after sternotomy by discussing recommendations for preoperative, intraoperative and postoperative preventive measures.
The Journal of Heart and Lung Transplantation, 2021
Purpose Veno-arterial (VA) ECMO plays a central role in patients with refractory cardiogenic shoc... more Purpose Veno-arterial (VA) ECMO plays a central role in patients with refractory cardiogenic shock. Whether involvement of a multidisciplinary heart failure team (HF-MDT) at time of VA-ECMO initiation would be associated with differences in downstream management and outcomes is unknown. Methods Patients who received VA-ECMO (12/16 to 09/20) at a quaternary care center in the Middle East were retrospectively identified. Patients were grouped according to HF- MDT involvement—defined as providing input on VA-ECMO initiation/ weaning in addition to active management of vasoactive medications. Baseline characteristics, subsequent management and clinical outcomes were compared between patient who received VA-ECMO with and without HF-MDT involvement. Results A total of 47 unique patients (median age 49 years, 78.7% males) were identified. Most common indications for ECMO initiation was post-cardiotomy (34%), followed by cardiogenic shock secondary to advanced heart failure (25.5%). HF-MDT was involved in ECMO initiation in 48.9% (23/47) patients. Patients where HF-MDT was involved were younger (41.1 ± 13.9 vs 57.9 ± 14.6; P Conclusion HF-MDT involvement in VA-ECMO initiation provides unique input on decision-making, including selection for advanced therapies and hemodynamics-directed use of vasoactive medications. Establishing multidisciplinary teams for cardiogenic shock management helps standardize treatment of this subset of complex patients. The impact of such teams on resource use and clinical outcomes needs to be evaluated in larger studies.
Supravalvular aortic stenosis is a rare cause of secondary aortic root distension and/or aortic v... more Supravalvular aortic stenosis is a rare cause of secondary aortic root distension and/or aortic valve regurgitation. Non-syndromic aortic aneurysms may also occur in young adults and can develop silently, representing an asymptomatic, life-threatening condition. Clinicians should, therefore, be alert to the possibility of this uncommon, but potentially serious disease, often first revealed by an imaging modality requested for other indications, even in case of an established, more benign diagnosis.
Myxomatous degeneration of mitral valve apparatus affects 2–3% of the general population and it i... more Myxomatous degeneration of mitral valve apparatus affects 2–3% of the general population and it is the most common cause of severe mitral regurgitation in western countries. More than 90% of degenerative mitral valves are suitable for valve repair rather than replacement, with short and long term clinical outcomes being superior after repair. In addition to the clinical benefits, mitral valve repair is associated with an economic benefit in the form of reduced short and long term medical expenses. Patients who have undergone mitral valve repair have mitral function restored, have avoided the added expense of a prosthetic valve and are free from lifelong anti-coagulation requirement. A variety of surgical approaches (sternotomy, anterolateral thoracotomy, and robotic assisted procedures) and repair techniques have been developed over the last four decades to treat mitral valve regurgitation. In this chapter, we delineate different aspects of mitral valve repair techniques.
A serious complication after cardiac surgery is sternal wound infection. Although incidence rates... more A serious complication after cardiac surgery is sternal wound infection. Although incidence rates vary worldwide, this complication raises significant concern in a certain patient demographic. This article uses risk assessment strategies to identify a high-risk patient profile and draws parallels with positive predictors in the preoperative, intraoperative and postoperative setting. It describes the complexity of sternal wound infections and highlights guidelines on detection and treatment. The optimal goal of this article is to help minimise the incidence of sternal wound complications after sternotomy by discussing recommendations for preoperative, intraoperative and postoperative preventive measures.
Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 created a challengi... more Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, we investigated the impact of the COVID-19 pandemic on our urgent aortic program. Methods 36 individuals presenting with TAAD in a single centre were analysed from the pre-pandemic period (2019, n=16) and the pandemic era (2020, n=20). Retrospective data review was conducted on patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes and length of stay. A comparison was made between both eras applying appropriate testing methods, and a p-value <0.05 was considered statistically significant. Results A 25% increase in TAAD referrals occurred during the pandemic era. Patients were ...
We report a 62-year-old female who required surgery for severe mitral regurgitation. Under roboti... more We report a 62-year-old female who required surgery for severe mitral regurgitation. Under robotic assistance, the valve was repaired by transection of the fibrous bridge, implantation of four neo-chordaes to the anterior leaflet, commissuroplasty of the posterolateral commissure, and annuloplasty.
A serious complication after cardiac surgery is sternal wound infection. Although incidence rates... more A serious complication after cardiac surgery is sternal wound infection. Although incidence rates vary worldwide, this complication raises significant concern in a certain patient demographic. This article uses risk assessment strategies to identify a high-risk patient profile and draws parallels with positive predictors in the preoperative, intraoperative and postoperative setting. It describes the complexity of sternal wound infections and highlights guidelines on detection and treatment. The optimal goal of this article is to help minimise the incidence of sternal wound complications after sternotomy by discussing recommendations for preoperative, intraoperative and postoperative preventive measures.
The Journal of Heart and Lung Transplantation, 2021
Purpose Veno-arterial (VA) ECMO plays a central role in patients with refractory cardiogenic shoc... more Purpose Veno-arterial (VA) ECMO plays a central role in patients with refractory cardiogenic shock. Whether involvement of a multidisciplinary heart failure team (HF-MDT) at time of VA-ECMO initiation would be associated with differences in downstream management and outcomes is unknown. Methods Patients who received VA-ECMO (12/16 to 09/20) at a quaternary care center in the Middle East were retrospectively identified. Patients were grouped according to HF- MDT involvement—defined as providing input on VA-ECMO initiation/ weaning in addition to active management of vasoactive medications. Baseline characteristics, subsequent management and clinical outcomes were compared between patient who received VA-ECMO with and without HF-MDT involvement. Results A total of 47 unique patients (median age 49 years, 78.7% males) were identified. Most common indications for ECMO initiation was post-cardiotomy (34%), followed by cardiogenic shock secondary to advanced heart failure (25.5%). HF-MDT was involved in ECMO initiation in 48.9% (23/47) patients. Patients where HF-MDT was involved were younger (41.1 ± 13.9 vs 57.9 ± 14.6; P Conclusion HF-MDT involvement in VA-ECMO initiation provides unique input on decision-making, including selection for advanced therapies and hemodynamics-directed use of vasoactive medications. Establishing multidisciplinary teams for cardiogenic shock management helps standardize treatment of this subset of complex patients. The impact of such teams on resource use and clinical outcomes needs to be evaluated in larger studies.
Uploads
Papers by Gurjyot Bajwa