Anthony P Salmon

Publications (25)60.78 Total impact

• Article: Esmolol-assisted balloon and stent angioplasty for aortic coarctation.

  Muthukumaran C Sivaprakasam, Gruschen R Veldtman, Anthony P Salmon, Richard Cope, Tom Pierce, Joseph J Vettukattil
  [show abstract] [hide abstract]
  ABSTRACT: The objective of this study was to evaluate the effectiveness and safety of esmolol-induced negative ino- and chronotropism during stent/balloon angioplasty for aortic coarctation. Balloon angioplasty and stent placement have become widely accepted therapies for native and recurrent coarctation of the aorta (CoA). Trauma to the vessel wall and stent migration related to forward displacement of the balloon and/or stent by cardiac output, are the most common complications. Controlling stroke volume and heart rate may assist in balloon stability and accurate deployment of stents. All methods currently used to achieve this have significant limitations. We describe our experience using esmolol to control stroke volume and heart rate during balloon/stent angioplasty of CoA. We performed a retrospective review of all patients who had intravenous esmolol during percutaneous treatment of CoA. Six interventions were performed in six patients: coarctation stent angioplasty in five patients (two native coarctation) and balloon angioplasty alone in one patient. The median systolic blood pressure achieved during the procedure was 65 mmHg (range, 57-75) representing a median reduction of 40 mmHg (range, 20-80; p = 0.008) from baseline. The median heart achieved was 50 beats/min (range, 20-80), representing a median reduction of 20 beats/min (range, 15-90, p = 0.048) from baseline. Optimal stent position was obtained in all patients. Intravenous esmolol controls periprocedural hemodynamics effectively and safely during percutaneous therapy for aortic coarctation, thereby aiding accurate stent placement. Further evaluation of its use during other percutaneous left heart interventions is required.
  Pediatric Cardiology 27(4):460-4. · 1.30 Impact Factor
• Article: Repair of truncus arteriosus in early infancy with antibiotic sterilized aortic homografts

  Christos Alexiou, Barry R Keeton, Anthony P Salmon, James L Monro
  [show abstract] [hide abstract]
  ABSTRACT: Background. To evaluate the fate of the truncal valve, the antibiotic sterilized aortic homografts, and the survival after repair of truncus arteriosus in the first 6 months of life.Methods. Between 1974 and 1994, 23 infants (mean age 1.7 months, range 5 days to 6 months) underwent primary repair of truncus arteriosus by one surgeon (J.L.M). Sixteen were neonates (age range 5 to 30 days). Continuity between the right ventricle and the pulmonary artery was established with an aortic antibiotic sterilized homograft (mean diameter 14.9 mm, range 11 to 17 mm). Follow-up was 100% complete.Results. Four neonates with severe truncal regurgitation died early (17.4%). Fourteen patients underwent reoperations. Five had a truncal valve replacement (mean time 7 years, range 6 months to 17 years). Ten-year freedom from truncal valve replacement was 78.2%. Eleven patients had homograft replacement (mean time 12.7 years, range 2 to 26.2 years). Ten-year freedom from homograft replacement for any cause was 77.1% (for homograft-related problems it was 86.7%). Seven patients retained the original homografts (mean time 14.3 years, range 6 to 18.7 years). There was one late death. Overall 10-year survival was 79% and for the hospital survivors it was 95%. All survivors are in New York Heart Association functional class I.Conclusions. Abnormal truncal valves pose serious early and late problems but the patients with normal truncal valves do well and seem unlikely to need replacement of these valves. The durability of the antibiotic sterilized aortic homograft even in sizes less than 14 mm is remarkably good. Late survival is excellent.
  The Annals of Thoracic Surgery.
• Article: Growth potential in the new aortic arch after non-end-to-end repair of aortic arch interruption in infancy

  James L. Monro, David J. Delany, Bruce C. Ogilvie, Anthony P. Salmon, Barry R. Keeton
  [show abstract] [hide abstract]
  ABSTRACT: Background.Complete repair of infants with interrupted arch and ventricular septal defect through a midline incision has been the preferred method for more than 20 years. End-to-end anastomosis can result in restenosis if there is excess tension. Two methods of reducing this tension have been described, and the subsequent growth of the new aortic arch is demonstrated.Methods.In 2 infants (5 and 9 months old) and duct was used to create a new aortic arch. In 3 other younger infants the left carotid artery was divided, turned down, and anastomosed to the descending aorta to form the new arch. These operations were performed through the midline at the same time as the ventricular septal defect was closed.Results.All 5 patients are well now 8 to 19 years postoperatively. One patient required reoperation for stenosis at the anastomotic site, but all have subsequently shown good growth on follow-up angiographic and magnetic resonance imaging studies.Conclusions.Although end-to-end repair is best, these alternative methods have shown very satisfactory aortic growth into adult life.
  The Annals of Thoracic Surgery.
• Article: Is there still a place for open surgical valvotomy in the management of aortic stenosis in children? The view from Southampton

  Christos Alexiou, Qiang Chen, Stephen M. Langley, Anthony P. Salmon, Barry R. Keeton, Marcus P. Haw, James L. Monro
  [show abstract] [hide abstract]
  ABSTRACT: Objective: The most appropriate management of aortic stenosis (AS) in children remains controversial. The purpose of this study was to determine the outcome following open valvotomy for AS in children. Methods: Ninety-seven consecutive, unselected, children (mean age 3.2±3.6 years, 1 day–15 years) underwent an open valvotomy for critical (n=36) or severe (n=61) AS between 1979 and 2000 in Southampton. Twenty-six were neonates (1–31 days), 27 were infants (1–12 months) and 44 were older children (1–15 years). Mean follow-up was 10±5.4 years, 1 month–21.9 years. Results: Two neonates died early giving an overall operative mortality of 2.1% (7.7% for the neonates and 0% for infants and older children). The mean aortic gradient was reduced from 76 to 24.5 mmHg (P<0.0001). Residual or recurrent AS occurred in 17 patients and severe aortic regurgitation in eight patients. Kaplan–Meier 10-year freedom from residual or recurrent AS was 83.1±4.7% and from severe aortic regurgitation was 95.3±2.7%. Twenty-five patients required an aortic re-operation or re-intervention, 18 of whom had an aortic valve replacement (AVR) (mean valve size 21.8±0.9 mm, range 21–25 mm). Ten-year freedom from any aortic re-operation or re-intervention was 78.4±5.2% and from AVR was 85.1±4.6%. There were ten late deaths. Overall 10-year survival, including hospital mortality, was 90.2±3.1% (69.7±9.7% for the neonates, 92±5.4% for the infants and 100% for older children, (P<0.0001). Ten-year survival for children with isolated AS (n=69) was 100% and for those with associated cardiovascular problems (n=28) was 67.3±8.9% (P<0.0001). All survivors are in New York Heart Association functional class I. Conclusions: Open valvotomy remains the gold standard in the management of AS in neonates, infants and older children. It is associated with low operative mortality and provides lengthy freedom from recurrent AS and regurgitation. Re-operations are common but if AVR is required, implantation of an adult-sized prosthesis is usually possible. There is a late death-hazard for those with severe associated lesions, but the survival prospects for the patients with isolated AS are excellent.
  European Journal of Cardio-Thoracic Surgery.
• Article: Mitral valve replacement with mechanical prostheses in children: improved operative risk and survival

  Christos Alexiou, Maria Galogavrou, Qiang Chen, Angus McDonald, Anthony P. Salmon, Barry K. Keeton, Marcus P. Haw, James L. Monro
  [show abstract] [hide abstract]
  ABSTRACT: Objective: The purpose of this study was to assess the early and late outcome following mitral valve replacement (MVR) with mechanical prostheses in children. Patients and methods: Between 1981 and 2000, 44 consecutive children (mean age 6.8±4.7 years, 2 months–16 years) underwent mechanical MVR in Southampton. Twenty-three children were less than 5-years-old and nine were infants. Disease aetiology was congenital in 37, rheumatic in four, infective in two and Marfan's syndrome in one. Mitral regurgitation was present in 36 and mitral stenosis in eight. Concomitant procedures were performed in 13, including aortic valve replacement (AVR) in seven. Follow-up was complete (mean 6.4±4.8 years, 1 month–18.1 years). Results: The overall operative mortality was 14% (six patients). Before and after 1990 operative mortality was 31 vs 3.6% (P=0.02). From 1990, operative mortality for infants was zero out of six, for children less than 5-years-old was one out of 16 (one death after emergency AVR and MVR) and for older children it was 0/12. Seven children experienced valve or anticoagulation treatment-related events and eight had a mitral valve re-operation. Ten-year freedom from thromboembolism, prosthetic valve infection, bleeding, paravalvular leak and a mitral valve re-operation was 92.8±5.2, 97.3±2.7, 97.7±2.3, 97.2±2.7 and 75±9.7%, respectively. Overall 10-year survival was 78±7% (four late deaths); for children under vs over 5 years it was 61±11 vs 95.2±4.6% (P=0.02), for atrio-ventricular septal defect (AVSD) vs other pathology 55±15 vs 89±6.1% (P=0.05) and for those operated before 1990 vs after 1990 it was 63±8.1 vs 86±8.2% (P=0.04). Conclusions: Mechanical MVR, in the current era, carries a low operative risk across the spectrum of paediatric age. Late survival is better for older children and those having no-AVSD pathology but it has improved substantially during the 1990s irrespective of age and disease aetiology.
  European Journal of Cardio-Thoracic Surgery.