Omar A Jarral

Imperial College London, Londinium, England, United Kingdom

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Publications (31)52.11 Total impact

  • Omar A Jarral, Thanos Athanasiou
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    ABSTRACT: On-pump coronary artery bypass surgery remains the gold standard for complex multivessel disease. Off-pump revascularization has matured as a technique over the last twenty years, but is used in less than 20% of cases worldwide. The poor uptake has been attributed to the significant learning curve in learning the procedure and conflicting evidence reports, together with concerns over mortality related conversion, graft patency and completeness of revascularization. Given these concerns, patient selection continues to be paramount and the subgroups that benefit most are hotly debated. Patients with left ventricular dysfunction constitute a high-risk subgroup which is enlarging in size. There is some evidence to suggest that avoidance of cardiopulmonary bypass in this group may lead to superior results in terms of early mortality, non-cardiac complications and organ dysfunction. Even with the theoretical risk of incomplete revascularization, the technique may be an attractive option in managing high-risk patients.
    Expert Review of Cardiovascular Therapy 01/2014;
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    ABSTRACT: Objective We have previously demonstrated that avoidance of cardiopulmonary bypass may reduce early mortality and cardiac related complications in patients with left ventricular dysfunction. This study examines the impact of cardiopulmonary bypass in the same subgroup in terms of organ dysfunction and non-cardiac related complications Methods A systematic literature review identified 24 studies including 7,976 patients. Data was extracted for the following outcomes of interest: stroke, renal failure, ventilation time, pulmonary complications and sternal wound infection. Random effects meta-analysis was used to aggregate the data. Sensitivity and heterogeneity were assessed. Results Meta-analysis through subgroup analysis of the highest quality studies revealed that the off-pump technique is associated with significantly lower incidence of stroke, renal failure, ventilation time and sternal wound infection. Conclusion These results highlight an important link between cardiopulmonary bypass and the incidence of multi-organ dysfunction in patients with left ventricular dysfunction. The results add to the growing body of evidence that off-pump surgery is more beneficial in high-risk patients. Even in the light of mixed reports on graft patency and completeness of revascularisation, the technique may be justified in selected patients in attempt to reduce organ dysfunction.
    Heart Lung &amp Circulation 01/2014; · 1.25 Impact Factor
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    ABSTRACT: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether vacuum-assisted closure therapy (VAC) is superior to conventional therapy for treating post-sternotomy mediastinitis. Altogether >261 papers were found using the reported search, of which 9 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. Several studies indicate that VAC therapy is associated with shorter lengths of intensive care and in-hospital stay as well as faster rates of wound healing and fewer dressing changes. It has also been shown that VAC therapy is correlated with a statistically significant reduction in reinfection rates, particularly those that occur in the early postoperative period (at the 1-week follow-up). Patients can be discharged with the dressing in situ and managed in the community with a view to delayed closure or reconstruction. However, the studies comparing VAC with conventional therapy are all retrospective in nature and reinforce the need for randomized controlled trials in order to more accurately establish differences in outcomes between VAC and conventional therapy. Additionally, owing tło the variability of treatment protocols within the non-VAC arm, it is more challenging to draw definitive conclusions regarding the superiority of VAC therapy to every modality that is considered conventional treatment. We conclude that VAC therapy is a portable and an increasingly economical option for the treatment of post sternotomy mediastinitis. Although reductions in mortality rates were not reproduced in all studies, evidence suggests that VAC should still be considered as a first-line therapy for post-sternotomy mediastinitis and as a bridge therapy to musculocutaneous reconstruction or primary closure.
    Interactive Cardiovascular and Thoracic Surgery 08/2013; · 1.11 Impact Factor
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    ABSTRACT: This best evidence topic was investigated according to a described protocol. The question posed was: should the irradiated perineal wound following abdominoperineal resection (APR) be closed with primary repair or a myocutaneous flap. Using the reported search 364 papers were found of which eight represented the best evidence to answer the clinical question. The conclusion drawn is that there is some limited evidence for recommending flap closure in abdominoperineal resection post radiotherapy. The best evidence available was from a systematic review of cohort studies and case series. Although no meta-analysis was performed, overall wound healing was improved using flap closure with a low frequency of flap necrosis. Other studies providing evidence were case-control series or cohort studies. Three papers prospectively compared vertical rectus abdominus muscle (VRAM) flap with primary closure; two of which demonstrated statistically significant improvement in complication rates with flap closure. Two retrospective case control series showed significant improvement in major wound complication rates in the flap group. Two studies retrospectively compared gracilis flap repair with primary closure and showed significantly lower incidence of major perineal complications. Most studies suffered from significant limitations, small sample sizes and no direct comparisons between matched groups with respect to type of anatomic flap, wound size, tumour recurrence or radiation dose. Whilst there is evidence that myocutaneous flap closure following APR in radiotherapy patients can reduce wound related complications, prospective randomized controlled trials are warranted.
    International Journal of Surgery (London, England) 05/2013; · 1.44 Impact Factor
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    Annals of The Royal College of Surgeons of England 01/2013; 95(1):73. · 1.33 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether there is a survival benefit from life-long follow-up after treatment for thyroid cancer. A total of 137 papers were identified using the reported searches of which 7 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The existing guidelines for follow-up in thyroid cancer recommend life-long follow-up as recurrence may present after 5 years. However, the strategy of life-long follow-up for everyone (as advised by the British, European and American Thyroid Association guidelines) is not evidence-based. The issue is that some of the recurrences may present after 5 years and low volume recurrence may be more effectively treated. However, as in many other malignancies, there is no study that reliably shows a survival benefit conferred from life-long follow-up, especially in stage 1 disease. Moreover, the risk of recurrence only parallels the risk of disease-specific mortality in the older thyroid cancer patient group (>45 years at diagnosis). The evidence from the present review supports a risk stratified approach to follow-up for thyroid cancer since low-risk thyroid cancer is associated with low recurrence rates and mortality compared to the other groups. For young patients (<45 years at diagnosis) with stage 1 disease, there is no proven survival benefit from life-long follow-up following primary treatment. These patients could be safely discharged to primary care after 5 years for follow-up with yearly thyroglobulin measurements.
    International Journal of Surgery (London, England) 12/2012; · 1.44 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether endoscopic mucosal resection (EMR) for early oesophageal cancer gives equivalent oncological outcomes as compared to oesophagectomy. A total of 340 papers were found using the reported searches of which 7 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Oesophagectomy with lymph node dissection for early oesophageal cancer is the standard to which every other treatment modality is compared to. However, the associated mortality and morbidity rates highlight the need for the development of effective, less invasive procedures. The evidence from the present review supports the use of EMR in this context as a first line treatment in T1a (mucosal) oesophageal cancer. The trade-off is a higher recurrence rate which can be dealt with successfully using a tight follow-up schedule and retreatment. The higher rates of lymph node involvement in T1b (submucosal) cancers preclude the use of endoscopic treatment in this setting except for patients unfit for surgery.
    International Journal of Surgery (London, England) 07/2012; · 1.44 Impact Factor
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    ABSTRACT: Despite advancements in surgical technique, intensive care methods and pharmaceutical prophylaxis atrial fibrillation (AF) after on-pump coronary artery bypass remains common. Transfusion, blood loss, and cardiopulmonary bypass (CPB) have been identified as risk factors for AF and adverse outcomes such as early mortality. This study examines outcomes in patients with left ventricular dysfunction after revascularization with and without CPB. A systematic literature review identified 22 studies including 7,454 patients. Meta-analysis through subgroup analysis of the highest-quality studies revealed that the off-pump coronary artery bypass (OPCAB) technique is associated with a significantly lower incidence of blood loss, transfusion requirement, reoperation for bleeding, and length of stay. There was also a reduction in the incidence of AF in the OPCAB group but this was not statistically significant (odds ratio = 0.77, 95% confidence interval 0.58-1.02, p = 0.07). The results strengthen research suggesting that CPB has a damaging effect on hemostasis and subsequent transfusion requirements in this patient group. More research is required to assess the association between OPCAB and AF in patients with ventricular dysfunction.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 06/2012; 58(4):311-9. · 1.39 Impact Factor
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    ABSTRACT: Isolated ostial stenosis of the left main coronary artery (LMCA) is rare, occurring in <1% of the patients undergoing coronary angiography. Surgical patch angioplasty (SPA) offers an alternative to conventional coronary artery bypass grafting (CABG) in such cases and is advantageous in restoring more physiological myocardial perfusion, maintaining ostial patency and preserving conduit material. However, a number of early technical failures and high perioperative mortality have limited the generalized uptake of this procedure, and only recently have advances in myocardial protection and novel surgical approaches to the LMCA resulted in a resurgence of the technique. A systematic literature search identified 45 studies incorporating 478 patients undergoing SPA. A variety of patch materials were used, including the pericardium, saphenous vein and internal mammary and pulmonary arteries. Patients were followed up for a mean of 54.4 months. The 30-day mortality was 1.7% and cardiac specific mortality 3.3% at last follow-up. Encouragingly, 92.4% of reported cases (n = 182) showed complete angiographic patency at last follow-up. Our results indicate that SPA may be a viable alternative to CABG in the surgical management of isolated ostial LMCA stenosis. However, no randomized trials have been performed, and it is clear that careful patient selection is essential in minimizing morbidity and mortality in the short- and long-term. Further research is required to allow a direct comparison of SPA to techniques with a more substantial evidence base such as CABG and percutaneous coronary intervention, and to define the optimal patch graft material, elucidating that any beneficial effects arterial patches may have on long-term patency.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2012; 42(4):719-27. · 2.40 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether early laparoscopic cholecystectomy (ELC) in patients presenting with a short history of acute cholecystitis provides better post-operative outcomes than a delayed laparoscopic cholecystectomy (DLC). A total of 92 papers were found using the reported searches of which 10 represented the best evidence; 3 meta-analyses, 4 randomized control trials, 1 prospective controlled study and 2 retrospective cohort studies were included. The authors, date, journal, study type, population, main outcome measures and results were tabulated. No significant difference in complication or conversion rates were shown between the ELC and the DLC group, in the meta-analyses of Gurusamy et al, Lau et al and Siddiqui et al. The ELC group had a decreased hospital stay whereas the DLC group presented a considerable risk for subsequent emergency surgery during the interval period, with a high rate of conversion to open cholecystectomy. All three meta-analyses were based on the randomized control trials of Lo et al, Lai et al, Kolla et al and Johansson et al; the results of each study are summarized. We conclude that there is strong evidence that early laparoscopic cholecystectomy for acute cholecystitis offers an advantage in the length of hospital stay without increasing the morbidity or mortality. The operating time in ELC can be longer, however the incidence of serious complications (i.e. common bile duct injury), is comparable to the DLC group. Larger randomized studies are required before solid conclusions are reached.
    International Journal of Surgery (London, England) 04/2012; 10(5):250-8. · 1.44 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was to identify which thoracotomy closure method lends itself to the least postoperative pain. Altogether 109 papers were found using the reported search; of which, seven 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. We conclude that the closure by intracostal sutures with intercostal nerve sparing offers a superior postoperative pain profile for thoracotomy patients when compared with conventional techniques. Up to 1-year follow-up has shown that this technique (avoiding strangulation of the intercostal nerve) leads to lower postoperative pain and analgesic use, better ambulation and a quicker return to daily activities. Three papers (including two randomized trials) found intracostal sutures with intercostal nerve sparing techniques to be superior to conventional methods such as pericostal suture closure. Rib approximation with intercostal nerve sparing was found to be superior to rib approximation without nerve sparing in one study. Two studies associated with the creation of an intercostal muscle flap prior to the insertion of a rib retractor to be associated with significantly reduced postoperative pain. One study described a novel 'edge-closure' technique, comparable to the closure with intracostal sutures without drilling, to be superior to conventional closure with pericostal sutures. Postoperative pain is a significant issue faced by thoracic surgeons both in-hospital and in the longer term where patients may complain of chronic thoracotomy pain. We would therefore recommend that some form of intercostal nerve protection be implemented during thoracotomy opening and closure.
    Interactive Cardiovascular and Thoracic Surgery 03/2012; 14(6):807-15. · 1.11 Impact Factor
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    Omar A Jarral, Srdjan Saso, Thanos Athanasiou
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass surgery (OPCAB) offered any beneficial effect on mortality when compared with on-pump coronary artery bypass surgery (ONCAB) in patients with left ventricular dysfunction (LVD). A total of 491 papers were found using the reported searches of which 17 represented the best evidence. The authors, date, journal, study type, outcome measures and results are tabulated. The 17 studies (only containing patients with LVD) comprised of one prospective randomized trial, one meta-analysis and 15 retrospective studies. The prospective trial associated the OPCAB technique with significantly lower in-hospital mortality. By comprising of seven studies and 1512 patients, the meta-analysis showed no significant difference in terms of operative mortality. Of the retrospective studies, all 15 compared short-term mortality (<30-day) of which four showed significantly lower mortality in the OPCAB group. Nine of the studies compared mid-term mortality (30 days to 5 years) with no significant difference detected and three of the studies compared long-term mortality (>5 years) with no significant difference detected. We conclude that there is limited evidence to associate the OPCAB technique with improved short-term mortality. The majority of the studies suffered from significant limitations such as containing data from operations carried out prior to the year 2000, a period when off-pump surgery was in its infancy. They frequently contained major differences in baseline characteristics with no specific inclusion/exclusion criteria, description of handling of patients converted from off-pump to bypass or reporting of myocardial viability and concomitant mitral regurgitation. Nine studies reported completeness of revascularization of which eight associated the OPCAB group with a poorer degree of revascularization making comparisons less valid. The lack of high-quality data indicates that prospective randomized trials are needed. The CRISP Trial ('Coronary artery grafting in high-risk patients randomized to off-pump or on-pump surgery') has recently been halted due to recruitment difficulties. The CORONARY ('Coronary artery bypass surgery off- or on-pump revascularization study') trial is a large international multicentre randomized study that is recruiting well and is likely to provide valuable information in the near future.
    Interactive Cardiovascular and Thoracic Surgery 03/2012; 14(6):856-64. · 1.11 Impact Factor
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    ABSTRACT: Minimally invasive esophageal surgery has arisen in an attempt to reduce the significant complications associated with esophagectomy. Despite proposed technical and physiological advantages, the prone position technique has not been widely adopted. This article reviews the current status of prone thoracoscopic esophagectomy. A systematic literature search was performed to identify all published clinical studies related to prone esophagectomy. Medline, EMBASE and Google Scholar were searched using the keywords "prone," "thoracoscopic," and "esophagectomy" to identify articles published between January 1994 and September 2010. A critical review of these studies is given, and where appropriate the technique is compared to the more traditional minimally invasive technique utilising the left lateral decubitus position. Twelve articles reporting the outcomes following prone thoracoscopic oesophagectomy were tabulated. These studies were all non-randomised single-centre prospective or retrospective studies of which four compared the technique to traditional minimally invasive surgery. Although prone esophagectomy is demonstrated as being both feasible and safe, there is no convincing evidence that it is superior to other forms of esophageal surgery. Most authors comment that the prone position is associated with superior surgical ergonomics and theoretically offers a number of physiological benefits. The ideal approach within minimally invasive esophageal surgery continues to be a subject of debate since no single method has produced outstanding results. Further clinical studies are required to see whether ergonomic advantages of the prone position can be translated into improved patient outcomes.
    Surgical Endoscopy 03/2012; 26(8):2095-103. · 3.43 Impact Factor
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    ABSTRACT: A best-evidence topic was written according to a structured protocol. The question addressed was whether the use of an intra-oesophageal bougie during Nissen fundoplication reduces post-operative dysphagia. A total of 34 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The popularity of bougie placement is likely to have been encouraged by an early study reported in this article in 1986 associating the use of a larger bougie with reduction of postoperative dysphagia. A more recent randomized study in 2000 also associated the use of bougie with significantly less long-term and severe dysphagia. Four retrospective studies showed no advantage from the use of a bougie, and the potential benefit are countered by the largest published series in the literature reporting the incidence of oesophageal perforation owing to bougie placement at 0.8%. Despite this risk, a survey of 393 German surgeons in 2005 revealed that 46% use a bougie. In summary, we conclude that there is some evidence to suggest that both the presence and size of bougie may have an impact on dysphagia. The evidence is not substantial enough to recommend change in clinical practice and its use must be weighed against the risk of oesophageal injury which patients should be consented for. These conclusions are in accordance with the 2010 Guidelines for Surgical Treatment of Gastroesophageal Reflux disease by the Society of American Gastrointestinal and Endoscopic Surgeons who give a Grade B recommendation for the placement of an oesophageal dilator. It is important that future studies are adequately powered and designed to measure longitudinal outcomes such as dysphagia severity with validated assessment tools at appropriate follow-up points. The measurement and usefulness of health-related quality of life needs to be investigated further in this patient population.
    Interactive Cardiovascular and Thoracic Surgery 03/2012; 14(6):828-33. · 1.11 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was: In [patients undergoing oesophagectomy for oesophageal cancer] is a [cervical anastomosis or intrathoracic anastomosis] superior in terms of [post-operative outcomes]. In total, 47 papers were found suitable using the reported search, and nine of these represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. We conclude that there is no convincing evidence that cervical anastomosis is superior to intrathoracic anastomosis with respect to post-operative outcomes. Only one prospective study showed significantly increased risk of anastomotic leak with cervical anastomosis, but this study was significantly limited due to patient selection and variations in surgical approach and technique. Cervical anastomosis was also shown to increase pharyngeal reflux on pH monitoring compared with intrathoracic anastomosis, but this did not influence symptoms or development of subsequent anastomotic complications. One randomized study showed intrathoracic anastomosis significantly increased risk of respiratory complications, but in this study patient treatment was variable and study design was limited. Intrathoracic anastomosis was also shown to correlate with anastomotic stricture formation and this was attributed to increased anastomotic stapling in this patient group compared with cervical anastomosis. Post-operative pain as measured by grouped symptom scales significantly increased with intrathoracic anastomosis compared with cervical anastomosis. This did not correlate with development of other cardiorespiratory complications and the difference between the two groups resolved within 24 months. Overall, there is currently insufficient evidence to show a significant difference between cervical and intrathoracic anastomosis with respect to post-operative complications and hospital mortality. The wide variety in methodology and outcomes reinforce the need for further randomized trials to more accurately establish significant differences in outcomes.
    Interactive Cardiovascular and Thoracic Surgery 02/2012; 14(6):821-6. · 1.11 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether Heller's myotomy provides superior results in comparison to botulinum toxin injection (BoTx) for treatment of achalasia. A total of 119 papers were retrieved using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results were tabulated. The highest level of evidence was one multicenter randomised controlled trial. We concluded that Heller's myotomy is superior to botulinum toxin injection for treatment of achalasia in terms of short and long term clinical outcome. Botulinum toxin injection may be considered in older patients and in patients for whom an operation or pneumatic dilation entails a higher risk, or as a bridge when these more effective modalities are not immediately available. It has an excellent safety profile and can be performed as a day case procedure.
    International Journal of Surgery (London, England) 02/2012; 10(3):120-3. · 1.44 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether video-assisted mediastinoscopy (VAM) has a better lymph node yield and safety profile than the conventional mediastinoscopy (CM). A total of 194 papers were found, using the reported searches, of which five 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. Two studies to date have directly compared CM and VAM with respect to lymph node yield, calculated diagnostics performance and complication rate. In both of these, lymph node yield is shown to be higher using VAM with better sensitivity, negative predictive value and accuracy rates. The favourable figures of lymph node sampling are found to be statistically significant in the single study providing such analysis. Complication rates using VAM are low, however, in the one instance where it is reported as higher than CM, the extensive lymph node dissection used in this technique may be a reasonable explanation for this finding. All studies described here exemplify VAM as a safe and useful tool in mediastinal staging, lymph node dissection and tissue diagnosis of mediastinal diseases given its superior visualization of surrounding structures and advantage of bimanual dissection. The future scope for diagnostic and therapeutic indications of cervical mediastinscopy is anticipated with recent advances and new techniques, such as video-assisted mediastinoscopic lymphadenectomy and virtual mediastinscopy.
    Interactive Cardiovascular and Thoracic Surgery 12/2011; 14(3):316-9. · 1.11 Impact Factor
  • Omar A Jarral, Srdjan Saso, Thanos Athanasiou
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    ABSTRACT: In symptomatic multivessel disease with left ventricular dysfunction, coronary artery bypass surgery (CAB) is the conventional approach. This study assesses outcomes in patients with left ventricular dysfunction undergoing coronary artery bypass with (on-pump; ONCAB) and without cardiopulmonary bypass (off-pump; OPCAB). A systematic literature search was performed and data were extracted for the following outcomes of interest: 30-day, midterm, and late-term mortality, myocardial infarction, and completeness of revascularization. Random effects meta-analysis was used to aggregate the data. Sensitivity, heterogeneity, and publication bias were assessed. Analysis of 23 nonrandomized studies revealed 7,759 patients, of whom 2,822 received OPCAB and 4,937 underwent ONCAB. Early mortality was significantly lower in the OPCAB group (odds ratio 0.64, 95% confidence interval 0.51 to 0.81) with no significant heterogeneity between the studies. This finding was supported by subgroup analysis that included assessment of studies only including patients with poor left ventricular function. Based on 13 studies, there was no difference in mortality at the midterm, and based on 4 studies there was no significant difference when comparing late-term mortality. Analysis of four studies revealed the OPCAB group was associated with significantly less complete revascularization. Off-pump CAB may be associated with lower incidence of early mortality in patients with impaired left ventricular function, although the method of handling the conversion-related mortality in each study is uncertain and may challenge these results. Incomplete revascularization provided by the OPCAB group occurred more often, although its impact was not reflected in the clinical outcomes but may explain why the early advantage in mortality was not continued to the late term.
    The Annals of thoracic surgery 09/2011; 92(5):1686-94. · 3.45 Impact Factor
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    ABSTRACT: A best evidence topic was written according to a structured protocol. The question addressed was whether harvesting the saphenous vein (SV) as a conduit for coronary artery bypass grafting (CABG) using a no-touch technique would result in better patency rates. This technique involves the harvest of the SV with a pedicle of peri-vascular tissue left intact and the avoidance of distension of the vein prior to anastomosis. A total of 405 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the ultrastructural and mechanical properties of the endothelium and vessel walls of the two harvesting techniques; the protein and enzymatic expression and activity observed; the early atherosclerotic changes detected; and the overall patency of the grafts during short- and long-term angiographical follow-up. Three small prospectively randomised studies compared the patency of grafts harvested using the two techniques and found significant improvements in graft patency using the no-touch harvesting technique in comparison to both the conventional technique and more importantly comparable to the left internal thoracic artery (LITA) patency. The most favourable difference was that of graft patency after 8.5 years of follow-up [90% vs. 76% (P = 0.01), LITA patency 90%], and incidence of graft stenosis [11% vs. 25% (P = 0.006)]. These findings were supported by the demonstrated improvements in the cellular integrity of the vessels and the reduction in the mechanisms leading to graft failure seen in the no-touch harvested SV grafts. These morphological and cellular analyses were carried by five small comparative studies, demonstrating improved endothelial integrity and reduced injury, decelerated atherosclerotic processes, intact adventitial collagen layers, increase in the total area of vasa vasorum, elevated endothelial nitric oxide synthase expression and activity, and increased peri-vascular leptin levels and activity. We conclude that there are clear enhancements in vessel wall properties at a cellular level and angiographical evidence of superior graft patency when the no-touch SV harvesting technique is employed.
    Interactive Cardiovascular and Thoracic Surgery 09/2011; 13(6):626-30. · 1.11 Impact Factor
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    Annals of The Royal College of Surgeons of England 07/2011; 93(5):415-6. · 1.33 Impact Factor

Publication Stats

74 Citations
52.11 Total Impact Points

Institutions

  • 2010–2014
    • Imperial College London
      • Section of Biosurgery and Surgical Technology
      Londinium, England, United Kingdom
    • Imperial College Healthcare NHS Trust
      • Division of Cardiology Cardiothoracic and Thoracic Surgery
      London, ENG, United Kingdom
  • 2013
    • University College London
      • Royal Free Hospital
      London, ENG, United Kingdom
  • 2012
    • King's College London
      Londinium, England, United Kingdom
  • 2011
    • Heart Research Institute (UK)
      Norwich, England, United Kingdom