Ben Adams

• BSc (Hons) MBBS FRCS (C-Th)
• Consultant at Barts Health NHS Trust

The management of thoraco-abdominal aortic aneurysms (TAAA) remains challenging particularly in patients considered unsuitable for conventional endovascular due to unfavourable anatomy or unfit for traditional open surgical approaches due to comorbidities. In response to these limitations, a novel hybrid prosthesis has emerged as an alternative des...

Ischaemic spinal cord injury remains a significant challenge in thoracoabdominal aortic repairs. Modern techniques have reduced spinal cord injury rates yet managing patients during and after thoracoabdominal aortic repairs remains complex. This article outlines our comprehensive approach to the prevention of spinal cord injuries in open thoracoabd...

Objectives Surgical repair of Type A aortic dissection (TAAD) requires exclusion of the primary entry tear and reestablishment of flow into the distal true lumen. Provided that the majority of tears occur within the ascending aorta (AA), replacing only that segment seems a safe option; however, this strategy leaves the root susceptible to dilatatio...

Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade TAAD that impact of the management and prognosis Treatment is not standardised. We report our approach to spontaneous RTAAD in our institution between 2018-...

Aortic dissection during pregnancy is a life-threatening condition for both mother and fetus. We present the case of a 34-year old female with a rapidly expanding abdominal aorta, in the context of a chronic type B aortic dissection. She was incidentally diagnosed of 4-6 weeks viable pregnancy during the preoperative work-up. She underwent urgent E...

Acute type‐A aortic dissection is a rare but life‐threatening cardiac surgery emergency. Immediate operative management is important to give patients the best chance of survival. However, where an aortic dissection is complicated by a concurrent hemorrhagic stroke the risks of precipitating a catastrophic intracranial hemorrhage during surgery must...

Open surgical repair remains the gold standard for treatment of thoracoabdominal aortic aneurysms (TAAA), aiming to replace the whole length of the diseased distal aorta while protecting the spinal cord and visceral organs to limit ischemia-related complications. This surgery carries significant risks, including death, paraplegia, renal failure req...

Background and aims: The COVID-19 pandemic caused a dramatic shift in the provision of cardiac surgical services in the United Kingdom (UK) with all elective surgery suspended. We sought to explore referral patterns, changes in clinical decision making and resource allocation to adult cardiac surgical services in the UK during the first wave of the...

Background: Epicardial adipose tissue (EAT) directly overlies the myocardium with changes in its morphology and volume associated with myriad cardiovascular and metabolic diseases. However, EAT's immune structure and cellular characterization remain incompletely described. This study aimed to define the immune phenotype of EAT in humans, and compa...

Background The use of the Frozen Elephant Trunk (FET) device to manage complex surgical pathologies of the aorta (such as acute type A aortic dissection) has gained popularity since its introduction in the early 2000s. Though the distal anastomosis was traditionally performed at aortic Zone 3 (Z-3-FET), preference gradually shifted towards Zone 2 (...

Background Use of the Frozen Elephant Trunk (FET) device to manage complex surgical pathologies of the aorta (e.g. acute Type A aortic dissection) has gained popularity since its introduction in the early 2000s. Though the distal anastomosis was traditionally performed at Zone 3 (Z-3-FET), preference gradually shifted towards Zone 2 (Z-2-FET) in fa...

Acute type A aortic dissection is a surgical emergency with a high mortality rate if left untreated. Management of the aortic root in this setting constitutes an intricate decision- making framework, further complicated by the emergent nature of the dissection. There exists much controversy regarding pursuit of the aggressive aortic root replacemen...

Acute type A aortic dissection is a surgical emergency and management of such pathology can be complex with poor outcomes when there is organ malperfusion. Carotid artery involvement is present in 30% of patients diagnosed with acute type A aortic dissection, and given its emergency and complex nature, there is much controversy regarding the approa...

Endovascular graft infection is a rare but challenging complication that requires a tailored approach to remove the infected graft and restore the arterial circulation combined with long-term antibiotic therapy. We present a case surgically treated with explant of the graft and reconstruction of the thoracoabdominal aorta. Microbiological investiga...

The incidence of an aortic graft infection following the repair of thoracoabdominal aortic aneurysm, is a rare yet insidious complication which requires prompt recognition and management. The decision-making framework for management encompasses the choice or anti-microbial therapy alone versus pursuing surgical intervention, which can then also lea...

Objective In the United Kingdom, the coronavirus disease 2019 (COVID-19) pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol...

Background Acute type A aortic dissection (ATAAD), is a surgical emergency often requiring intervention on the aortic root. There is much controversy regarding root management; aggressively pursuing a root replacement, versus more conservative approaches to preserve native structures. Methods Electronic database search we performed through PubMed,...

Background: Acute type A aortic dissection (ATAAD), is a surgical emergency often requiring intervention on the aortic root. There is much controversy regarding root management; aggressively pursuing a root replacement, versus more conservative approaches to preserve native structures. Methods: Electronic database search we performed through PubMed...

Objectives Open surgical repair remains the gold standard for treatment of thoracoabdominal aortic aneurysms (TAAA). Surgery aims to replace the whole length of the diseased distal aorta while protecting the spinal cord and the visceral organs to limit ischemia-related complications. The substantial associated surgical risks, including death, parap...

Objectives: Recent guidelines have stated that age alone should not be a limiting factor for offering life‐saving surgery to patients with acute type A dissection (ATAD). The objective of this study was to review the outcomes of patients above the age of 70 undergoing surgery for type A aortic dissection (TAAD) in the UK. Methods: Prospectively co...

Background and aim of the study: Mitral valve surgery is the definitive treatment for acute infective endocarditis of the mitral valve. Depending on severity, both repair and replacement have been proposed. Based on a number of small studies, repair is recommended when technically feasible, but other studies have shown that many centers mainly per...

Mycotic aneurysms are infective aneurysms of native aorta. Pathogenesis is by septicaemic seeding of distant site infection to susceptible atherosclerotic aortic wall. Staphylococcus aureus is the most common causative organism in Western countries, whereas non-typhoid Salmonella species are more common in Asian countries. Mycotic aneurysms are usu...

Over the past few decades, the advents in monitoring, imaging, diagnostics, and implementation of multidisciplinary team approach in Type A aortic dissection surgery resulted in improved surgical outcomes. One other factor that needed to be targeted and carefully analyzed was the volume–outcome relationship on hospital and surgeon level in the sett...

Cardiovascular surgeons have long debated the safe duration of deep hypothermic circulatory arrest during thoracic aortic aneurysm surgery. The rationale for using adjunctive cerebral perfusion (or not) is to achieve the best technical aortic repair with the lowest risk of morbidity and death. In this literature review, we highlight the debates sur...

Background and aim of the study: The need for compatible biological prostheses in a rapidly aging population of cardiac patients with aortic valve disease requiring aortic valve replacement (AVR) is pushing biotechnologies towards a quest for the ideal prosthetic valve. The study aim was to comparatively evaluate the cumulative quality outcomes be...

Thoracic aortic aneurysm (TAA) represents a major cause of mortality and morbidity in Western countries. The natural history of TAA is indolent, with patients usually being asymptomatic until a catastrophic event such as rupture or dissection ensues. As such, early diagnosis is crucial and the search is ongoing for a biomarker that can indicate the...

Objective: Composite aortic root replacement is a standard procedure for various aortic root pathologies. This systematic review was set to identify the postoperative outcomes for composite mechanical root replacement (mCRR) compared to composite biological root replacement (bCRR). Methods: We systematically reviewed four major databases for all...

It is indisputable that open thoracoabdominal aortic aneurysm (TAAA) repair remains a highly complex and sophisticated surgical intervention. Despite advancements in the imaging modality, evolution of our understanding of the pathology afflicting the aorta, intraoperative brain and spinal cord monitoring, intraoperative organ protection, postoperat...

Management of aortic valve disease and, in particular, aortic valve stenosis has evolved through the course of time from medical management and balloon valvuloplasty to the presumed gold-standard surgical intervention. However, with the advent of surgical innovation, intra- and postoperative patients monitoring, understanding of hemodynamic dysfunc...

This paper forms the second of a two part series on the natural history and survival of Thoracic aortic aneurysms (TAA), in which this part focuses on patients following surgical operation( ). Surgical intervention on the thoracic aorta has historically been thwart with such high rates of morbidity and mortality that in the past surgeons have previ...

Pulmonary carcinosarcoma represents a category of extremely rare tumours accounting for 0.1% of all lung malignancies. It is defined as a poorly differentiated non-small-cell carcinoma that contains a component of sarcoma or sarcoma-like elements. These biphasic tumours typically have a poor prognosis due to late diagnosis and early metastases. Pre...

Coronary Sinus injury related to cardioplegia catheter insertion is a rare complication associated with significant morbidity and mortality risk. We describe a simple, safe and effective sutureless technique for the management of coronary sinus injury. This technique was developed in a porcine haemostatic workshop in Hamburg, Germany.

Background: Chest drain duration is one of the most important influencing aspects of hospital stay but the management is perhaps one of the most variable aspects of thoracic surgical care. The aim of our study is to report outcomes associated with increasing fluid and air leak criteria of protocol based management. Methods: A 6-year retrospectiv...

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: in high-risk patients undergoing sublobar resection for non-small-cell lung cancer, is brachytherapy effective in reducing local recurrence? Altogether, 60 papers were found using the reported search, of which 6 represented the best...

Despite extensive infection control measures against parasitic diseases, hydatid disease, caused by Echinococcus granulosus, still occurs in a minor group of our population. If the infection is not treated adequately, it goes on to developing life-threatening complications, one of which is hepatopulmonary fistula. These complications usually warran...

Objectives: Chest drain duration is one of the most important influencing aspects of hospital stay but the management is perhaps one of the most variable aspects of thoracic surgical care. The aim of our study is to report outcomes associated with increasing fluid and air leak criteria of protocol based management. Methods: A six-year retrospective...

Objectives To determine the level of the narrowest plane (neo-annulus) of a surgical heart valve (SHV), which could be used for sizing and securing a transcatheter heart valve (THV) during a valve-in-valve (VIV) procedure and define its relationship with the fluoroscopic markers of the SHV.Background In the native aortic valve, the aortic annulus i...

Guidelines advise that x-rays do not contribute to the clinical management of simple nasal fractures. However, in cases of simple nasal fracture secondary to assault, a facial x-ray may provide additional legal evidence should the victim wish to press charges, though there is no published guidance. We examine the ethical and medico-legal issues sur...

This report describes endovascular stenting of an acute mycotic ascending aortic aneurysm. An eighty-three year old lady presented nine weeks after aortic valve surgery and subsequent thyroidectomy with sternal pain secondary to a mycotic ascending aortic pseudoaneurysm. The pseudoaneurysm was visible through the unhealed sternum. Open repair was c...

Vascular regeneration occurs throughout life as a dynamic process. Millions of new endothelial cells are created with essentially the same number of cells undergoing programmed cell death or necrosis every day. As a result, the human vascular tree could be considered to essentially replace its entire endothelial population over a specified number o...

Endothelial dysfunction/loss is a key event in the development of vascular diseases, including native atherosclerosis, angioplasty-induced restenosis, transplant arteriosclerosis, and vein bypass graft atherosclerosis. In challenge to the traditional concept that lost endothelial cells were replaced by neighboring endothelial replication, recent st...

We applied a four stage model of human vision to the problem of similarity measurement of medical (liver) ultrasound images. The results showed that when comparing a given image to a set that contained images with similar features, the model was able to correctly identify the most similar image in the set. Additionally, the shape of the similarity...