Video-assisted thoracoscopic surgery (VATS) was recently described as an approach to clip the pat... more Video-assisted thoracoscopic surgery (VATS) was recently described as an approach to clip the patent ductus arteriosus (PDA). Between May 1994 and May 1996, we performed this procedure on 34 children below 12 years of age (mean 7 years). Thirty-two had an isolated PDA and two had associated small perimembranous ventricular septal defect (VSD), diagnosed on echocardiography and colour flow mapping. None had pulmonary arterial hypertension. The procedure was successful in 33 (97%) children confirmed by absence of residual shunt on serial echocardiography. Complications in the form of pneumothorax (1) and vocal card paralysis (2) were encountered in three children. The overall hospital stay was reduced to five days. In conclusion, the technique of PDA clipping using VATS is easy to learn and highly successful with acceptable risk of complications.
Background Patients with poor ejection fraction undergoing coronary artery bypass grafting carry ... more Background Patients with poor ejection fraction undergoing coronary artery bypass grafting carry higher operative risk and have poor long-term survival. Cardiac magnetic resonance is a useful modality to assess viability which can identify patients likely to benefit most from revascularization. In this study, we aimed to assess the outcome in patients selected for surgical revascularization by cardiac magnetic resonance imaging and identify predictors associated with poor outcomes. Methods The study included patients with severely impaired left ventricular function but with at least six viable segments. Patients requiring emergency surgery, undergoing combined procedures, or where cardiopulmonary bypass was required were excluded. Cardiac magnetic resonance was carried out both preoperatively and at six months postoperatively by the same radiologist in all cases. Late gadolinium enhancement was used for the evaluation of myocardial viability. Results Amongst a total of 493 segments ...
A 58-year-old female presented with exertional dyspnea (New York Heart Association functional cla... more A 58-year-old female presented with exertional dyspnea (New York Heart Association functional class II to III) of 8 months duration. Two years earlier, she had undergone mastectomy followed by radiotherapy for infiltrative duct carcinoma of the left breast. A total of 4500 rads was ...
An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocard... more An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocardial left anterior descending coronary artery (LAD), during off-pump coronary artery bypass grafting (OPCAB), led to pulmonary artery air embolism and hemodynamic instability, requiring conversion to cardiopulmonary bypass (CPB) prior to repair. This required a special maneuver in positioning the patient to identify the RV injury and prevent the pulmonary air embolism.
An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocard... more An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocardial left anterior descending coronary artery (LAD), during off-pump coronary artery bypass grafting (OPCAB), led to pulmonary artery air embolism and hemodynamic instability, requiring conversion to cardiopulmonary bypass (CPB) prior to repair. This required a special maneuver in positioning the patient to identify the RV injury and prevent the pulmonary air embolism.
Sacubitril-valsartan has been used selectively in patients undergoing coronary artery bypass graf... more Sacubitril-valsartan has been used selectively in patients undergoing coronary artery bypass grafting (CABG) and ischemic cardiomyopathy due to safety concerns. The aim of this prospective observational study was to assess the safety profile of sacubitril-valsartan in patients with reduced ejection fraction (EF <40%) undergoing CABG. Primary outcome was tolerability and safety profile. Thirty consecutive patients undergoing CABG with EF <40% were included. No mortality or readmissions occurred during 6 months follow-up. One (3.3%) patient experienced hypotension requiring discontinuation. Mild (8.9%) elevation in blood urea nitrogen, p = 0.35; along with a significant increase in serum creatinine (0.12mg/DL), p = 0.02; and potassium (0.23 mmol/L), p 0.003 was seen during follow-up. Sacubitril-valsartan is well tolerated in patients with reduced EF undergoing CABG.
Kardiochirurgia i Torakochirurgia Polska = Polish Journal of Cardio-Thoracic Surgery, 2020
Kawasaki disease is more common in children but can occasionally present in late adulthood as obs... more Kawasaki disease is more common in children but can occasionally present in late adulthood as obstructive coronary artery disease, which is a chronic sequela of the condition. Revascularization is often required in these patients. The decision making can be difficult because of presence of concomitant aneurysms. Attempted percutaneous coronary intervention (PCI) of coronary artery lesions in Kawasaki disease in adults can be challenging and fraught with complications and coronary artery bypass grafting (CABG) should be preferred. We report a case of a 44-year-old patient presenting with obstructive coronary artery lesions where an attempted PCI was associated with complications and a salvage CABG needed to be carried out. A 44-year-old man presented with acute ST elevation myocardial infarction. He was non-diabetic, non-hypertensive and a nonsmoker but had a clinical diagnosis of Kawasaki disease made in his childhood. Coronary angiography showed an aneurysm involving the left main ...
Ankylosing spondylitis (AS) a seronegative inflammatory disease that often presents with co-exist... more Ankylosing spondylitis (AS) a seronegative inflammatory disease that often presents with co-existing issues like bilateral hip replacements, nephrolithiasis, skin lesions, peripheral vascular disease and coronary artery disease.. We describe a patient with ankylosing spondylitis with bilateral hip replacements in the past who was waiting for an elective coronary artery bypass grafting (CABG) but needed urgent admission with renal colic and unstable angina. In the current COVID pandemic in order to reduce hospital stay and risk of hospital acquired COVID infection we decided to perform simultaneous CABG and removal of ureteric stone. In this case report we discuss the issues in relation to management of patients with coronary artery disease and ankylosing spondylitis.
Indian Journal of Thoracic and Cardiovascular Surgery, 2021
On-pump beating heart (OP-BH) coronary artery bypass grafting (CABG) is often undertaken as an al... more On-pump beating heart (OP-BH) coronary artery bypass grafting (CABG) is often undertaken as an alternative between off-pump coronary artery bypass (OPCAB) and conventional on-pump coronary artery bypass grafting (On-pump CABG), especially in India. However, outcome data following OP-BH surgery is sparse. The aim of this study was to compare the outcomes of OP-BH CABG with OPCAB. From our institutional database, all patients undergoing OP-BH CABG (n = 531) were identified. A propensity-matched cohort undergoing OPCAB (n = 531) was identified from the database. Nearest neighbor matching technique was used and the groups were matched for variables including age, gender, body mass index, EuroSCORE, history of recent myocardial infarction or unstable angina, hypertension, peripheral vascular disease, chronic obstructive airway disease, diabetes, pre-op renal impairment, pre-op neurological events, and left ventricular function. The propensity-matched groups were well matched in terms of baseline characteristics. The mean EuroSCORE was 3.17 and 3.20 in the OP-BH and the OPCAB groups. The unadjusted 30-day mortality in the propensity-matched OPCAB group was 2.07% (11/531) while mortality in the on-pump beating heart group was significantly higher at 6.9% (37/531). Multivariate analysis showed that OP-BH CABG was an independent risk factor for 30-day mortality as well as major adverse post-operative outcomes including renal, neurological, and respiratory outcomes and post-operative atrial fibrillation. OP-BH CABG is associated with worse clinical outcomes compared to patients undergoing OPCAB.
Indian Journal of Thoracic and Cardiovascular Surgery, 2021
The Trifecta valve has been reported to have excellent hemodynamics. Controversy exists on occurr... more The Trifecta valve has been reported to have excellent hemodynamics. Controversy exists on occurrence of patient-prosthesis mismatch (PPM) and data on mid-term outcome is sparse. Health-related quality of life (HRQoL) assessment for the Trifecta valve has not been reported before. The aim of this study was to report the mid-term clinical and HRQoL outcomes in patients undergoing Trifecta valve implantation at our institution. In this prospective, observational study, patients undergoing an aortic valve replacement (AVR) using the Trifecta valve were included. Data collection was retrospective from prospectively collected institutional database. Clinical and echocardiographic data were collected prospectively during follow-up. Quality of life was assessed using the Short Form-36 (SF-36) questionnaire. Forty-seven patients were included in the study of which 9 (19%) were women. Isolated AVR was carried out in 33 (70%) patients. In-hospital mortality and 30-day mortality were 1 (2.1%) and 2 (4.2%), respectively. With a mean indexed effective orifice area (iEOA) 0.96 ± 0.1, none of the patients had severe PPM. Moderate PPM was seen in 19%. The mean follow-up was 3 ± 1.7 years. The 5-year survival estimate was 83.2% in the overall cohort, 81.4% in the isolated and 87.5% in the concomitant procedure group. Freedom from re-operation and structural valve degeneration at 5 years was 95.7% and 97.8%. The mean physical health composite was 69.24 ± 2 and the mean mental health composite was 69.7 ± 25, indicating excellent mental and physical well-being among patients. The Trifecta valve provides satisfactory hemodynamics, survival and freedom from re-operation and excellent HRQoL at mid-term follow-up.
Video-assisted thoracoscopic surgery (VATS) was recently described as an approach to clip the pat... more Video-assisted thoracoscopic surgery (VATS) was recently described as an approach to clip the patent ductus arteriosus (PDA). Between May 1994 and May 1996, we performed this procedure on 34 children below 12 years of age (mean 7 years). Thirty-two had an isolated PDA and two had associated small perimembranous ventricular septal defect (VSD), diagnosed on echocardiography and colour flow mapping. None had pulmonary arterial hypertension. The procedure was successful in 33 (97%) children confirmed by absence of residual shunt on serial echocardiography. Complications in the form of pneumothorax (1) and vocal card paralysis (2) were encountered in three children. The overall hospital stay was reduced to five days. In conclusion, the technique of PDA clipping using VATS is easy to learn and highly successful with acceptable risk of complications.
Background Patients with poor ejection fraction undergoing coronary artery bypass grafting carry ... more Background Patients with poor ejection fraction undergoing coronary artery bypass grafting carry higher operative risk and have poor long-term survival. Cardiac magnetic resonance is a useful modality to assess viability which can identify patients likely to benefit most from revascularization. In this study, we aimed to assess the outcome in patients selected for surgical revascularization by cardiac magnetic resonance imaging and identify predictors associated with poor outcomes. Methods The study included patients with severely impaired left ventricular function but with at least six viable segments. Patients requiring emergency surgery, undergoing combined procedures, or where cardiopulmonary bypass was required were excluded. Cardiac magnetic resonance was carried out both preoperatively and at six months postoperatively by the same radiologist in all cases. Late gadolinium enhancement was used for the evaluation of myocardial viability. Results Amongst a total of 493 segments ...
A 58-year-old female presented with exertional dyspnea (New York Heart Association functional cla... more A 58-year-old female presented with exertional dyspnea (New York Heart Association functional class II to III) of 8 months duration. Two years earlier, she had undergone mastectomy followed by radiotherapy for infiltrative duct carcinoma of the left breast. A total of 4500 rads was ...
An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocard... more An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocardial left anterior descending coronary artery (LAD), during off-pump coronary artery bypass grafting (OPCAB), led to pulmonary artery air embolism and hemodynamic instability, requiring conversion to cardiopulmonary bypass (CPB) prior to repair. This required a special maneuver in positioning the patient to identify the RV injury and prevent the pulmonary air embolism.
An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocard... more An inadvertent vent in the right ventricle (RV) resulted during dissection of a deep intramyocardial left anterior descending coronary artery (LAD), during off-pump coronary artery bypass grafting (OPCAB), led to pulmonary artery air embolism and hemodynamic instability, requiring conversion to cardiopulmonary bypass (CPB) prior to repair. This required a special maneuver in positioning the patient to identify the RV injury and prevent the pulmonary air embolism.
Sacubitril-valsartan has been used selectively in patients undergoing coronary artery bypass graf... more Sacubitril-valsartan has been used selectively in patients undergoing coronary artery bypass grafting (CABG) and ischemic cardiomyopathy due to safety concerns. The aim of this prospective observational study was to assess the safety profile of sacubitril-valsartan in patients with reduced ejection fraction (EF <40%) undergoing CABG. Primary outcome was tolerability and safety profile. Thirty consecutive patients undergoing CABG with EF <40% were included. No mortality or readmissions occurred during 6 months follow-up. One (3.3%) patient experienced hypotension requiring discontinuation. Mild (8.9%) elevation in blood urea nitrogen, p = 0.35; along with a significant increase in serum creatinine (0.12mg/DL), p = 0.02; and potassium (0.23 mmol/L), p 0.003 was seen during follow-up. Sacubitril-valsartan is well tolerated in patients with reduced EF undergoing CABG.
Kardiochirurgia i Torakochirurgia Polska = Polish Journal of Cardio-Thoracic Surgery, 2020
Kawasaki disease is more common in children but can occasionally present in late adulthood as obs... more Kawasaki disease is more common in children but can occasionally present in late adulthood as obstructive coronary artery disease, which is a chronic sequela of the condition. Revascularization is often required in these patients. The decision making can be difficult because of presence of concomitant aneurysms. Attempted percutaneous coronary intervention (PCI) of coronary artery lesions in Kawasaki disease in adults can be challenging and fraught with complications and coronary artery bypass grafting (CABG) should be preferred. We report a case of a 44-year-old patient presenting with obstructive coronary artery lesions where an attempted PCI was associated with complications and a salvage CABG needed to be carried out. A 44-year-old man presented with acute ST elevation myocardial infarction. He was non-diabetic, non-hypertensive and a nonsmoker but had a clinical diagnosis of Kawasaki disease made in his childhood. Coronary angiography showed an aneurysm involving the left main ...
Ankylosing spondylitis (AS) a seronegative inflammatory disease that often presents with co-exist... more Ankylosing spondylitis (AS) a seronegative inflammatory disease that often presents with co-existing issues like bilateral hip replacements, nephrolithiasis, skin lesions, peripheral vascular disease and coronary artery disease.. We describe a patient with ankylosing spondylitis with bilateral hip replacements in the past who was waiting for an elective coronary artery bypass grafting (CABG) but needed urgent admission with renal colic and unstable angina. In the current COVID pandemic in order to reduce hospital stay and risk of hospital acquired COVID infection we decided to perform simultaneous CABG and removal of ureteric stone. In this case report we discuss the issues in relation to management of patients with coronary artery disease and ankylosing spondylitis.
Indian Journal of Thoracic and Cardiovascular Surgery, 2021
On-pump beating heart (OP-BH) coronary artery bypass grafting (CABG) is often undertaken as an al... more On-pump beating heart (OP-BH) coronary artery bypass grafting (CABG) is often undertaken as an alternative between off-pump coronary artery bypass (OPCAB) and conventional on-pump coronary artery bypass grafting (On-pump CABG), especially in India. However, outcome data following OP-BH surgery is sparse. The aim of this study was to compare the outcomes of OP-BH CABG with OPCAB. From our institutional database, all patients undergoing OP-BH CABG (n = 531) were identified. A propensity-matched cohort undergoing OPCAB (n = 531) was identified from the database. Nearest neighbor matching technique was used and the groups were matched for variables including age, gender, body mass index, EuroSCORE, history of recent myocardial infarction or unstable angina, hypertension, peripheral vascular disease, chronic obstructive airway disease, diabetes, pre-op renal impairment, pre-op neurological events, and left ventricular function. The propensity-matched groups were well matched in terms of baseline characteristics. The mean EuroSCORE was 3.17 and 3.20 in the OP-BH and the OPCAB groups. The unadjusted 30-day mortality in the propensity-matched OPCAB group was 2.07% (11/531) while mortality in the on-pump beating heart group was significantly higher at 6.9% (37/531). Multivariate analysis showed that OP-BH CABG was an independent risk factor for 30-day mortality as well as major adverse post-operative outcomes including renal, neurological, and respiratory outcomes and post-operative atrial fibrillation. OP-BH CABG is associated with worse clinical outcomes compared to patients undergoing OPCAB.
Indian Journal of Thoracic and Cardiovascular Surgery, 2021
The Trifecta valve has been reported to have excellent hemodynamics. Controversy exists on occurr... more The Trifecta valve has been reported to have excellent hemodynamics. Controversy exists on occurrence of patient-prosthesis mismatch (PPM) and data on mid-term outcome is sparse. Health-related quality of life (HRQoL) assessment for the Trifecta valve has not been reported before. The aim of this study was to report the mid-term clinical and HRQoL outcomes in patients undergoing Trifecta valve implantation at our institution. In this prospective, observational study, patients undergoing an aortic valve replacement (AVR) using the Trifecta valve were included. Data collection was retrospective from prospectively collected institutional database. Clinical and echocardiographic data were collected prospectively during follow-up. Quality of life was assessed using the Short Form-36 (SF-36) questionnaire. Forty-seven patients were included in the study of which 9 (19%) were women. Isolated AVR was carried out in 33 (70%) patients. In-hospital mortality and 30-day mortality were 1 (2.1%) and 2 (4.2%), respectively. With a mean indexed effective orifice area (iEOA) 0.96 ± 0.1, none of the patients had severe PPM. Moderate PPM was seen in 19%. The mean follow-up was 3 ± 1.7 years. The 5-year survival estimate was 83.2% in the overall cohort, 81.4% in the isolated and 87.5% in the concomitant procedure group. Freedom from re-operation and structural valve degeneration at 5 years was 95.7% and 97.8%. The mean physical health composite was 69.24 ± 2 and the mean mental health composite was 69.7 ± 25, indicating excellent mental and physical well-being among patients. The Trifecta valve provides satisfactory hemodynamics, survival and freedom from re-operation and excellent HRQoL at mid-term follow-up.
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Papers by Lalit Kapoor