Nishith N Patel

University of Auckland · Department of Surgery

Background: Allogeneic erythrocyte transfusion in cardiac surgical patients is associated with a fourfold increase in pulmonary complications. Our understanding of the processes underlying these observations is poor and there is no experimental model of transfusion-related acute lung injury that shows homology to cardiac surgical patients. Our obj...

Post-cardiac surgery acute kidney injury (AKI) is common and is associated with a significant increase in morbidity and mortality. We aimed to systematically review randomised trials that assessed the renoprotective utility of pharmacological agents in patients undergoing cardiac surgery. We searched PubMed, Embase and the Cochrane Central Register...

The aim of this study was to determine whether administration of a specific endothelin A receptor antagonist, sitaxsentan sodium, would prevent the development of post-cardiopulmonary bypass acute kidney injury in swine. Experimental study. Cardiovascular Research Institute. Adult pigs (n = 8 per group) were randomized to undergo a sham procedure,...

Endoscopic harvesting of saphenous veins for use in CABG surgery has become standard practice worldwide. This strategy reduces postoperative infection and hospital stay, and increases patients' satisfaction when compared with open harvest. However, long-term follow-up data provided by Lopes et al. indicate that widespread use of this technique must...

Objectives Type A aortic dissection (ATAAD) is hypothesised as a progression of aneurysmal dilation, but 60% of patients in the International Registry of Acute Aortic Dissection (iRAD) registry had a maximum aortic diameter (MAD)<55 mm. We aim to demonstrate that size ratios and aortic wall stress, assessed using a simplified markers, are unique to...

Introduction: Type A aortic dissection is seen as a progression of aneurysmal dilation, but 60% of patients in the iRAD registry had a maximum aortic diameter (MAD) &lt 55mm. Hypothesis: We theorized that a simplified marker for vessel instability (aortic ratios) and shear stress may improve predictability of dissection compared to maximal aortic d...

Background: Simulation training is a useful adjunct to surgical training and education (SET) in Cardiothoracic Surgery yet training opportunities outside the Royal Australasian College of Surgery or industry-sponsored workshops are rare due to high cost and limited training faculty, time, assessment tools or structured curricula. We describe our e...

Objective Quantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI). Background CI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in...

Background: Acute Kidney Injury (AKI) is common complication of cardiac surgery however the phenotype of this condition is poorly defined. The aim of this study was to characterize changes in endothelial structure and function that underlie post cardiopulmonary bypass (CPB) AKI. Methods: Adult pigs (N=16) were randomised to undergo following pro...

Background: We evaluated the effects of two interventions that modify the red cell storage lesion on kidney and lung injury in experimental models of transfusion. Methods: White-landrace pigs (n = 32) were allocated to receive sham transfusion (crystalloid), 14-day stored allogeneic red cells, 14-day red cells washed using the red cells washing/...

Cardiac surgical patients are amongst the highest consumers of allogeneic red blood cells (RBC) due to the prevalence of anaemia and bleeding. Up until recently, there was a paucity of high quality evidence informing transfusion decisions in this patient group which led to wide-variability in transfusion decision making. The article reviews and cri...

Background: We sought to compare the incidence of incomplete revascularization (IR) and long-term survival (up to 20years) after off-pump (OPCAB) versus on-pump (ONCAB) coronary artery bypass in a high OPCAB volume centre where OPCAB was introduced in 1996 and has become the preferred strategy over the years. Methods and results: From 1996 to 20...

Good blood management emphasises the importance of utilising blood components as part of an overall treatment strategy that is focused on improving patient outcome. Acute haemorrhage and acute anaemia are common in surgical, obstetric and critical care patients. This chapter reviews the evidence to guide blood management strategies in patients with...

Objective: Surgical aortic valve replacement (AVR) remains the gold standard therapy for severe aortic stenosis. Long-term survival data following AVR is required. Our objective was to provide a detailed contemporary benchmark of long-term survival following AVR among elderly patients (≥65 years) in the UK. Methods: We conducted a retrospective...

Introduction: Allogeneic red blood cell (RBC) transfusion in cardiac surgery patients increases the risk of pulmonary and renal morbidity. These associations are attributable to the ‘storage lesion’ - accumulation of metabolites in the RBC supernatant that includes pro-inflammatory lipids, cell-free hemoglobin and energy depletion. Hypothesis: Stor...

Introduction: Randomised controlled trials demonstrate that Off-Pump Coronary Artery Bypass (OPCAB) is equivalent to On-Pump Coronary artery bypass graft (ONCAB) for in-hospital and short-term outcomes. Recent observational data, however, suggests that OPCAB may be associated with increased mid-term mortality although there are several conflicting...

Background: There is uncertainty regarding the safety of different volume replacement solutions. The aim of this study was systematically to review evidence of crystalloid versus colloid solutions, and to determine whether these results are influenced by trial design or clinical setting. Methods: PubMed, Embase and the Cochrane Central Register...

Background: Good blood management is an important determinant of outcome in cardiac surgery. Guidelines recommend restrictive red blood cell transfusion. Our objective was to systematically review the evidence from randomised controlled trials and observational studies that are used to inform transfusion decisions in adult cardiac surgery. Method...

Background Using porcine model of TRALI, we have previously demonstrated that red cell washing prior to transfusion fails to protect against organ injury after cardiac surgery. Red cell rejuvenation however, eliminated all metabolic, biochemical and histological features of TRALI. In current study we investigate the mechanisms that drive endothelia...

Bleeding is an important feature of cardiac surgery that may result in profound blood loss requiring large volume transfusion of red blood cells (RBC) and other blood components. However, transfusion of RBC may cause adverse effects and the degree of anaemia that should trigger their transfusion remains controversial. Coagulopathy that may arise fr...

In cardiac surgery, the principal aim of red blood cell transfusion is to maintain oxygen delivery and prevent tissue hypoxia in the setting of acute anaemia and severe bleeding. Both these clinical indications are common, and over 50% of all cardiac surgery patients receive red blood cell transfusion, utilising a significant proportion of blood se...

Acute kidney injury (AKI) is a common and serious complication of cardiac surgery using cardiopulmonary bypass (CPB). The pathogenesis is poorly understood and the study of AKI in rodent models has not led to improvements in clinical outcomes. We sought to determine the changes in renal medullary gene expression in a novel and clinically relevant p...

Context: Post cardiac surgery acute kidney injury (AKI) is common, poorly understood and associated with a significant increase in morbidity and mortality. Objectives: An overview of systematic reviews that have evaluated pharmacological agents for the prevention of AKI post cardiac surgery. Data Sources: We searched electronic databases (PubMed a...

Obesity confers a survival advantage in the critically ill and in patients undergoing cardiac surgery. We explored whether an obesogenic high fat diet could confer protection against post cardiopulmonary bypass (CPB) acute kidney injury (AKI) in a swine model. In this study, 28 anaesthetised adult female Landrace White swine (55 to 70kg) were alloc...

Objectives Single-port video-assisted thoracoscopic (VATS) lobectomy has recently been developed. Previously, 3-4 ports were typically used. A study was carried out to determine whether uniportal lobectomies resulted in less pain postoperatively compared to multiportal lobectomies. Methods Uniport VATS lobectomies were matched 1:1 to multiport VAT...

Good blood management is an important determinant of outcome in critically ill patients, trauma patients and those undergoing major surgery or treatment for postpartum or upper gastrointestinal (GI) haemorrhage. These patients have a high red cell requirement, a significant proportion of which is administered for the reversal of acute anaemia in no...

Off-pump coronary artery bypass grafting (OPCAB) has emerged as an important surgical technique with the potential to avoid the harmful effects of cardiopulmonary bypass (ONCAB). Its uptake worldwide, however, has been slow due to the poor understanding of the vast evidence surrounding this technique and this is reflected in the lack of clear guide...

Objective To determine if washing of old Red Blood Cell (RBC) units prior to transfusion will prevent transfusion mediated organ dysfunction in our large animal experimental model. Method Adult White-Landrace pigs (50-70kg, n=32) were randomized to either sham procedure or to receive an allogeneic transfusion of 1-, 14- or washed 14-day RBCs. Endpo...

Acute kidney injury after cardiac surgery is common, has no effective treatments, and is associated with adverse outcomes. The aim of this study was to determine whether administration of the phosphodiesterase-5 inhibitor sildenafil citrate (SDF) would prevent the development of post-cardiopulmonary bypass (CPB) acute kidney injury in swine. Adult...

Hypothermic cardiopulmonary bypass (CPB), although associated with a reduction in oxygen requirement, has a number of disadvantages including detrimental effects on enzymatic function, energy generation, and cellular integrity. Normothermic perfusion is potentially a more physiologic method to maintain the functional integrity of major organ system...

Patient choice is now a major facet of health-care policy within the National Health Service. Our objective was to determine whether the patient would like to choose if the 'beating heart' technique or the 'arrested heart' technique is employed for their coronary artery bypass graft (CABG) surgery. We undertook a cross-sectional, self-reported ques...

Optimal management of diffuse malignant pleural mesothelioma (DMPM) remains unclear. We report our 30-year surgical experience with DMPM with emphasis on surgical procedure and post-operative adjuvant therapy. During the period of the study, 217 patients with DMPM were referred for surgical opinion. Patients who only had pleural biopsies were exclu...

Vascular referrals include patients with conditions varying from varicose veins of cosmetic nuisance to patients with critical ischaemia, transient ischaemic attacks and abdominal aortic aneurysms. A large number of such referrals are received each week from general practitioners. It is important to prioritise patients with conditions that need to...

Patients with significant coronary artery disease (CAD) are now intensively treated by primary care physicians predominantly because of government pressure and remuneration to prescribe anti-platelet and anti-hyperlipidaemic drugs. Peripheral arterial disease (PAD) with the identical risk factors appeared to us to be less intensively investigated a...

Colorectal cancer is the third commonest cause of cancer death in UK. It commonly metastasises to the liver but rarely to small bones. We describe a case of a patient with adenocarcinoma of the descending colon who presented preoperatively with a right supraclavicular swelling. Subsequent imaging and cytology of the lesion revealed this to be a met...