
Nnamdi NwaejikeWythenshawe hospital (Manchester University NHS Foundation Trust) · Cardiac and Cardiothoracic Transplant Surgery
Nnamdi Nwaejike
MD, FRCS-CTh
About
52
Publications
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Introduction
Mr Nnamdi Nwaejike has a medical degree from Queen’s University Belfast; an MD from Queen Mary’s, University of London; and graduated from the accredited Advanced Cardiothoracic Fellowship Programme at Duke University Hospital, NC, USA.
Mr Nnamdi Nwaejike’s specializes in adult cardiac surgery, cardiothoracic transplantation and mechanical circulatory support.
Particular interests are OPCAB by total arterial revascularisation, Mitral valve repair and Concommitant Surgery for Atrial Fibrillation.
Publications
Publications (52)
The axillary intra-aortic balloon pump (ax-IABP) has been proposed as an alternative to the femoral IABP, particularly for patients with comorbidities rendering them unsuitable for fem-IABP insertion. Patient mobilisation with the ax-IABP in situ is deemed an additional potential benefit. We reviewed our experience with the ax-IABP. A single-centre...
Prosthetic valve endocarditis is a rare complication following surgical aortic valve replacement, accounting for a small fraction of all endocarditis cases. This complication is typically caused by bacterial pathogens and carries a high mortality rate. In rare cases, prosthetic valve endocarditis may be attributed to fungal organisms. We present th...
Introduction
The debate surrounding conduit selection in multi-vessel coronary artery bypass grafting (CABG) persists. Whilst combined arterial and venous conduits remains the gold standard approach, some studies report superior long-term outcomes with total arterial revascularisation (TAR).
Case Description
A 48-year-old male was admitted with ac...
A 38-year-old Caucasian male presented to a local hospital with breathlessness. After thorough investigation, transthoracic echocardiography demonstrated dilated cardiomyopathy. He continued to deteriorate and developed florid pulmonary oedema, necessitating transfer to our centre. Routine work-up for cardiac transplantation found him to be a carri...
A 38-year-old male with sickle cell trait and acute refractory heart failure received an axillary intra-aortic balloon pump and short-term biventricular assist device. He underwent orthotopic heart transplantation 45 days later, which was complicated by major bleeding necessitating significant intra-operative transfusion. Support with veno-arterial...
An 85‐year‐old male developed a hematoma over his radial artery harvest scar 6 weeks after coronary artery bypass grafting. This occurred immediately after his blood pressure was checked using a digital blood pressure monitor with the cuff applied to his left arm. The swelling resolved over the next 5 months. We recommend that patients who have und...
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether early extubation (EE) after cardiac surgery leads to a reduction in intensive care unit (ICU) length of stay (LOS)? A total of 564 papers were found using the reported search, of which 4 were randomized trials and hence repres...
Seroma formation is a common complication of any surgery producing a significant dead space or causing disruption of the lymphatic drainage. Although this is uncommonly reported in cardiac surgery. Such collections can cause localized pain, wound dehiscence, infection and can reoccur frequently, requiring multiple interventions. We present case of...
Severe COVID-19 disease is a multisystem inflammatory disorder and knowledge and experience with severe acute respiratory failure in infected patients has grown considerably since reports of the first few cases. Little is known about the effect of the SARS-CoV-2 virus on the heart, and there has been a suggestion from published literature that fulm...
There is growing evidence to support total arterial revascularization in coronary artery bypass grafting and the radial artery is being used with increasing frequency as the second conduit of choice. Open radial artery harvesting enables safe dissection and the procedure is both effective and easy to teach. In this video tutorial, we present our te...
Intra-aortic balloon pump (IABP) counterpulsation has been the most widely used circulatory assist device for nearly five decades. As a result of diastolic inflation and systolic deflation, coronary blood flow is increased and afterload decreased translating into augmentation of oxygen supply and lowering of oxygen demand. In routine clinical pract...
We evaluated the feasibility, tolerability, and efficacy of a strategy for transaxillary artery intra-aortic balloon pump placement for extended mechanical circulatory support of patients with postcardiotomy shock as a bridge to recovery. Patients requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure were identified...
We evaluated the feasibility, tolerability, and efficacy of a strategy for transaxillary artery intra-aortic balloon pump placement for extended mechanical circulatory support of patients with post-cardiotomy shock as a bridge to recovery. Patients requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure were identifie...
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is there a role for upper-extremity intra-aortic balloon pump counterpulsation (UE-IABP) in the treatment of end-stage heart failure? Altogether 230 papers were found using the reported search, of which 6 papers represented the best...
OBJECTIVES There is little information on the impact of a high-risk multidisciplinary team (HRMDT) for thoracic surgery. In our unit,
patients considered high risk for thoracic surgery have been discussed at this meeting since its inception in June 2013. The
aim of this study was to audit our selection of patients discussed at the HRMDT and its eff...
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with previous internal mammary artery/internal thoracic artery (ITA) grafts, can the internal mammary artery/ITA be reused/recycled in redo coronary artery bypass surgery? Fourteen papers were found using the reported sea...
Pulmonary vein deceleration injury is rare and patients can be deceptively stable for a period after injury. Quick diagnosis and transfer to the operating theatre is the only way to treat this potentially lethal injury successfully. Techniques of repair are a useful addition to the cardiovascular surgeon’s repertoire.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers represented the best evidence to answe...
The duplicated common femoral artery can be safely cannulated for femorofemoral bypass, but we recommend postoperative imaging to identify potential complications. We found no previous reports of duplicated common femoral artery.
A 29-year old woman at 26 weeks gestation (gravida 3 and para 0) presented with an acute left-sided pneumothorax. She had a 10 pack-year smoking history and no other relevant medical history. Over the next 3 weeks, she had three recurrences of her left-sided pneumothorax, each of which was managed by intercostal drain insertion. During the fourth e...
Pneumothorax during pregnancy is uncommon. Recently ambulatory chest drainage has been advised to treat the pneumothorax and to cover the delivery period. This imposes restrictions on the mother with associated co-morbidity. The authors present a case of recurrent chest-tube resistant pneumothorax during pregnancy which had persisted for 4-weeks. T...
The double orifice mitral valve is associated with a number of congenital abnormalities and comprises two mitral orifices separated by an accessory bridge of fibrous tissue and surrounded by a single fibrous annulus. We present our management of a case of a double orifice mitral valve associated with a papillary fibroelastoma.
We describe the successful management of a stent protruding from the right coronary ostium into the aortic root in the setting of aortic valve replacement for aortic stenosis. Due to advances in medical care more elderly patients present for aortic valve surgery after percutaneous coronary intervention. Therefore, with an aging population due to ad...
Pulmonary endarterectomy (PEA) is the definitive surgical treatment for chronic thromboembolic pulmonary hypertension, with
excellent short- and long-term results. PEA following previous coronary artery bypass graft surgery carries a risk of damage
to patent grafts, as well as the risk of inadequate myocardial protection, especially when a patent p...
We present a case of primitive neuroectodermal tumor of the left atrium with involvement of the coronary sinus. The initial presentation was of cardiac tamponade resulting from the size of the tumor. There was no evidence of tumor elsewhere, and after complete resection and without adjuvant chemotherapy the patient is well at 2-year follow-up. Ther...
Surgery for infective mitral valve endocarditis should include resection/debridement of all infected tissue, but this may leave behind insufficient-autologous mitral valve tissue for an adequate repair. Effective mitral valve repair using only bovine pericardium is feasible even in the presence of extensive endocarditis involving a large part of th...
Varicose vein surgery for recurrent disease can result from inadequate primary surgery. Redo open surgery is more difficult to perform than primary surgery and can be associated with a higher incidence of neurovascular injury and infection. In this study we evaluate EVLA, a percutaneous technique that uses intra-operative duplex ultrasound as an op...
Locally deranged joint anatomy can predispose to septic arthritis which can be managed by surgical debridement. We present a case of manubriosternal subluxation/dislocation caused by kyphoscoliosis leading to manubriosternal septic arthritis.
Aspiration of foreign bodies into the tracheobronchial tree is a common presentation in children, but less so in adults. Successful extraction depends on the type of foreign body aspirated, location of the foreign body in the tracheobronchial tree, the experience of the operator and the instrumentation available. We report on our management of a pa...
Chylopericardium is a rare disorder that can be secondary to thoracic duct injury. Consequences include nutritional, metabolic, and immunologic abnormalities, as well as cardiac complications, such as pericarditis and cardiac tamponade. We present a case of chylopericardium presenting as cardiac tamponade after a median sternotomy for mechanical ao...
Cardiac surgery for patients >80 years has seen a dramatic increase in the last decade. The aim was to assess the long term survival and quality of life in this patient population.
Patients who underwent cardiac surgery between 1995 and 2007 were identified and case notes reviewed. Follow-up was undertaken by personal interview with the patient or...
This prospective study evaluates the results of Endovenous laser ablation (EVLA) for the treatment of varicose veins.
Data were prospectively collected for all patients undergoing EVLA for varicose veins in our unit including clinical outcomes (CEAP classification) and post-operative duplex.
624 EVLA procedures were performed from April 2004 to Feb...
Recent evidence suggests that preemptive use of an intra-aortic balloon pump (IABP) is associated with better outcomes in high-risk patients undergoing cardiac surgery. This retrospective study compares preemptive (planned) use of the IABP to emergency (unplanned) use in a regional cardiothoracic center.
All patients who required an IABP from Febru...
La chirurgie conventionnelle pour l'incontinence de la veine petite saphène (VPS) a un taux élevé de récidive et est associée à des lésions neuro-vasculaires. Le but de cette étude était d'évaluer la sûreté et l'efficacité du traitement endoveineux par laser (TEVL) comme alternative à la chirurgie pour incontinence de la VPS. Les données ont été ra...
La cirugía convencional de la insuficiencia de la vena safena externa (VSE) tiene una elevada incidencia de recurrencia y está asociada a lesiones neurovasculares. El objetivo de este estudio fue evaluar la seguridad y la eficacia de la ablación mediante el tratamiento endovenoso con láser (TEVL) como alternativa a la cirugía abierta para tratar la...
The presence of superficial bruising, no abnormal signs on abdominal examination and a negative FAST scan of the abdomen may not be enough to rule out intra-abdominal pathology. We report on the usefulness of CT in diagnosing a post-traumatic abdominal wall hernia.
A 70yr old lady presented to accident and emergency with sudden onset pleuritic chest pain. A pulmonary embolus (PE) was diagnosed by CTPA. Ten days earlier she had bilateral EVLA for recurrent great saphenous vein disease. Confounding risk factors for pulmonary embolism included bilateral ligation and stripping of the great saphenous vein a year e...
Conventional surgery for short saphenous vein (SSV) incompetence has a high incidence of recurrence and is associated with neurovascular injury. The aim of this study was to evaluate the safety and efficacy of endovenous laser ablation (EVLA) as an alternative to open surgery for SSV incompetence. Data were prospectively collected for all patients...
The use of cardiopulmonary bypass (CPB) may contribute to post-operative complications and organ dysfunction. Off pump coronary artery bypass grafting (OPCABG) avoids the use of CPB and hence is proposed to reduce these complications. We present the results of OPCABG in Northern Ireland over ten years.
Data was collected retrospectively from 1995 t...
Enlargement of thymic lymph nodes may occur due to a benign or a malignant pathology. A high index of suspicion due to prior parathyroidectomy proved prudent to biopsy enlarged lymph nodes during mitral valve repair which turned out to be due to sarcoidosis. Cardiac surgeons need to be aware of the diseased thymic lymph nodes and a proper histologi...
Thoracoscopic sympathectomy has become an accepted therapeutic option for palmar hyperhidrosis. Objective assessment of sweat output after sympathectomy, however, has not been reported to date. We report for the first time sweat output measurements after sympathectomy during a 3-year postoperative period.
Thoracoscopic sympathectomy was performed b...
Reflex sympathetic dystrophy can result in severe disability with only one in five patients able to fully resume prior activities. Therefore, it is important to diagnose this condition early and begin appropriate treatment. Factitious lymphoedema can mimic reflex sympathetic dystrophy and is caused by self-inflicted tourniquets, blows to the arm or...
Cardiopulmonary bypass (CPB) allows operations on the heart in a motionless and bloodless field while reducing cardiac workload and sustaining systemic and coronary perfusion. Failure to wean from CPB remains a significant problem. Results from recent large registry data have shown dramatic improvement in the survival following ventricular assistan...
Some conditions, previously managed by general surgeons, may be treated more successfully by colorectal specialists. This argument is well established for rectal cancer but does it also apply to benign conditions? This study compares the treatment strategies and outcomes for fistulae-in-ano by general and colorectal surgeons in a district general h...
A frail, 79-year-old woman with small body habitus was admitted for elective coronary artery bypass surgery. She was known to have long-standing chronic stable angina with recent deterioration. Her only risk factor for coronary artery disease was that she was an ex-smoker of 6 years.