Thanos Athanasiou

Imperial College London | Imperial · Imperial College Healthcare NHS Trust

Objective. The aim of the present series was first to present our experience in the management of 37 patients with spontaneous pneumomediastinum (SPM), and further to indicate the necessity of identifying true SPM cases as they are currently inadequately defined. Methods. This is a single-center, retrospective study, conducted in a university hospi...

The neurohormonal model of heart failure (HF) pathogenesis states that a reduction in cardiac output caused by cardiac injury results in sympathetic nervous system (SNS) activation, that is adaptive in the short-term and maladaptive in the long-term. This model has proved extremely valid and has been applied in HF with a reduced left ventricular (L...

Several attempts have been made, by the scientific community, to develop a unifying hypothesis that explains the clinical syndrome of heart failure (HF). The currently widely accepted neurohormonal model has substituted the cardiorenal and the cardiocirculatory models, which focused on salt-water retention and low cardiac output/peripheral vasocons...

Arguably, Georg Wilhelm Friedrich Hegel has been one of the most influential philosophers of the 19th century [...]

Automated computed tomography (CT) scan segmentation (labelling of pixels according to tissue type) is now possible. This technique is being adapted to achieve three‐dimensional (3D) segmentation of CT scans, opposed to single L3‐slice alone. This systematic review evaluates feasibility and accuracy of automated segmentation of 3D CT scans for volu...

Despite overwhelming epidemiological evidence, the contribution of hypertension (HTN) to heart failure (HF) development has been undermined in current clinical practice. This is because approximately half of HF patients have been labeled as suffering from HF with preserved left ventricular (LV) ejection fraction (EF) (HFpEF), with HTN, obesity, and...

Objective: Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly pa...

We conducted a thorough literature review on the emerging role of failure to rescue (FTR) as a quality metric for cardiovascular surgery and critical care. For this purpose, we identified all original research studies assessing the implementation of FTR in cardiovascular surgery and critical care from 1992 to 2023. All included studies were evaluat...

Background: Simulation is playing an increasingly important role in surgical training but is not yet a mandatory part of most surgical curricula. A simulator must undergo rigorous validation to verify it as a reliable tool. The aim of this study was to review the literature to identify simulators that are currently available to augment thoracic su...

The aim of this review is to describe the different statistical methods used in estimating the minimal clinically important difference (MCID) for the assessment of quality of life (QOL)-related and clinical improvement interventions, along with their implementation in cardiothoracic surgery. A thorough literature search was performed in three datab...

Background and objective: Numerical simulations of blood flow are a valuable tool to investigate the pathophysiology of ascending thoratic aortic aneurysms (ATAA). To accurately reproduce in vivo hemodynamics, computational fluid dynamics (CFD) models must employ realistic inflow boundary conditions (BCs). However, the limited availability of in v...

Objective: We conducted a thorough literature search on patients with central non-small cell lung cancer (NSCLC) undergoing either extended sleeve lobectomy (ESL) or pneumonectomy (PN). Methods: We identified all original research studies that compared the long-term survival of ESL versus PN from 1990 to 2022. The primary endpoints were the medi...

Background: Left ventricular assist devices (LVAD) represent an important therapeutic option for patients progressing to end-stage heart failure. Women have been historically underrepresented in LVAD studies, and have been reported to have worse outcomes despite technological optimisation. We aimed to systematically explore the evidence on sex dis...

Objective We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG). Methods Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median ove...

Numerical simulations of blood flow are a valuable tool to investigate the pathophysiology of ascending thoracic aortic aneurysms (ATAA). To accurately reproduce hemodynamics, computational fluid dynamics (CFD) models must employ realistic inflow boundary conditions (BCs). However, the limited availability of in vivo velocity measurements still mak...

Introduction/Background Educating and equipping students and trainees into clinicians capable of meeting healthcare demands and service provision needs is essential. Unprecedented events like COVID-19 pandemic, highlight urgent need for reformation of training to ensure high quality education is maintained. To this end, we describe an innovative an...

With the rise of non-surgical treatment methods for coronary artery disease (CAD), especially percutaneous techniques, outcomes demonstrating efficacy of coronary artery bypass graft surgery (CABG) should focus on more than only survival and cardiac related morbidity. There are several studies reporting on patient functionality and health related q...

Objectives: The aim of this review is to describe the different statistical methods used in estimating the Minimal Clinically Important Difference (MCID) for the assessment of quality of life (QOL)-related and clinical improvement interventions, along with its implementation in cardiac surgery. Methods: A thorough literature search was performed in...

Operating on the thoracic aorta is a challenging task, with historically high morbidity and mortality. While outcomes are improving in recent times, there is increased focus on patient-reported outcome measures, principle of which is health-related quality of life (HRQoL), a development beyond isolated markers of operative morbidity or mortality. T...

With the rise of newer technologies such as transcatheter aortic and mitral valve replacements as treatment methods for valvular diseases, outcomes demonstrating efficacy of valve surgery should focus on more than only survival and cardiac related morbidity. There are several studies reporting on patient functionality and health related quality of...

Background: Despite the improvement in left ventricular assist device (LVAD) technology and the advent of third-generation LVADs, hemocompatibility-related events remain a significant issue. Therefore, new pharmacological treatments are necessary to optimize patient management and to further reduce hemocompatibility-related events. The purpose of...

The expansion in the repertoire of genes linked to thoracic aortic aneurysms (TAA) has revolutionised our understanding of the disease process. The clinical benefits of such progress are numerous, particularly helping our understanding of non-syndromic hereditary causes of TAA (HTAAD), and further refinement in the subclassification of disease. Fur...

Objective We reviewed the available literature on patients with MPM undergoing either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D).Methods Original research studies that evaluated long-term outcomes of P/D versus EPP were identified, from January 1980 to February 2022. The 30-days and 90-day mortality, along with the 1-, 2-,...

Introduction Cardiac surgery involving cardiopulmonary bypass (CPB) activates an inflammatory response releasing cytokines that are associated with less favourable outcomes. This study aims to compare i) CPB during cardiac surgery (control) versus ii) CPB with haemoadsorption therapy; and assess the effect of adding this therapy in reducing the inf...

Introduction Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve‐in‐valve aortic valve replacement (ViV‐TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population under...

Background Outcomes of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients with aortic stenosis and bicuspid aortic valve (BAV) must be better investigated. Methods A meta‐analysis including studies published by January 2022 reporting immediate outcomes (in‐hospital death, stroke, acute kidney...

We aim to review the available literature on patients with esophageal cancer treated with robot-assisted (RAME) or video-assisted McKeown's esophagectomy (VAME), to compare the efficacy and safety of the two approaches. Original research studies that evaluated perioperative and oncologic outcomes of RAME versus VAME were identified, from January 19...

Objective This study aims to characterise the material properties of ascending thoracic aortic aneurysmal tissue, using regional biomechanical assessment of both tensile and dissection propagation peel strength. Methods Thirty-four aneurysm specimens (proximal thoracic aorta) were harvested en-bloc from patients undergoing surgery for aneurysm rep...

Objectives This study aims to identify the clinical utility of targeted-genetic sequencing in a cohort of patients with TAA and establish a new method for regional histological characterisation of TAA disease. Methods Fifty-four patients undergoing surgery for proximal TAA were recruited. Exclusions: connective tissue disease, bicuspid aortic valv...

Background This review aims to systematically evaluate the currently available evidence investigating the use of artificial intelligence (AI) and machine learning (ML) in the field of cardiac transplantation. Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the...

The UK government had intended to introduce a comprehensive EHRs system in England by 2020. These EHRs would run across primary, secondary, and social care linking data in a single digital platform. This systematic review's objectives were to identify studies that compare EHRs in terms of direct comparison between systems and evaluate them using Sy...

Objectives: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). Methods: A systematic review of the MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7th, 2021) was...

Objectives: To compare biological versus mechanical aortic valve replacement. Methods: We searched MEDLINE, Scopus, and Cochrane Library databases for randomized clinical trials and propensity-score matched studies published by October 14th, 2021 according to PRISMA statement. Individual patient data on overall survival were extracted. One- and two...

Background: Recent studies suggest that blood flow in main arteries is intrinsically disturbed, even under healthy conditions. Despite this, many computational fluid dynamics (CFD) analyses of aortic haemodynamics make the assumption of laminar flow, and best practices surrounding appropriate modelling choices are lacking. This study aims to addres...

Objectives: Our aim was to compare the safety and efficacy of proximal repair (PR) versus extensive repair (ER) for acute type A aortic dissection (ATAAD). Methods: A literature search in three databases was performed according to the PRISMA statement. Studies comparing PR versus ER for ATAAD were included. Random-effects meta-analyses were perf...

Background This study aimed to evaluate the outcomes of high-intensity focused ultrasound (HIFU) on patients with advanced pancreatic cancer.MethodsA literature search was performed in PubMed, Scopus and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Difference, and 95% Confidence Interval were evaluated...

Background Sutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS). Methods A retrospective analysis of prospectively collec...

Background: Blood flow patterns can alter material properties of ascending thoracic aortic aneurysms (ATAA) via vascular wall remodeling. This study examines the relationship between wall shear stress (WSS) obtained from image-based computational modelling with tissue-derived mechanical and microstructural properties of the ATAA wall using segmenta...

Background Colorectal cancer is associated with secondary sarcopenia (muscle loss) and myosteatosis (fatty infiltration of muscle) and patients who exhibit these host characteristics have poorer outcomes following surgery. Furthermore, patients, who undergo curative advanced rectal cancer surgery such as pelvic exenteration, are at risk of skeletal...

Background This study aimed to assess the outcomes of contrast-enhanced intraoperative ultrasound (CE-IOUS) for patients with colorectal liver metastases (CRLMs) undergoing surgery.MethodA thorough literature search was performed in PubMed, Scopus, and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Diffe...

Background Ethnicity is not incorporated into standardized pre-operative risk-stratification tools for cardiac surgery. This study compared short-term outcomes following coronary artery bypass graft (CABG) surgery in South Asian and non-Asian patients. Methods Consecutive patients undergoing isolated CABG surgery via sternotomy between the years 2...

OBJECTIVES The aim of this study was to systematically review the simulators that are currently available for coronary artery bypass graft and valve surgery and, in addition, to review the validation evidence supporting them and to recommend several simulators for training based on the analysis of results. METHODS A systematic literature search of...

Objectives: Thoracic aortic aneurysm (TAA) is characterized by the dilation of the aorta and is associated with poor prognosis if not diagnosed and treated early. In this context, the identification of biomarkers regarding the TAA diagnosis, monitoring and prognosis is crucial. The purpose of the current study was to investigate the differential g...

Background Bariatric surgery, used to achieve effective weight loss in individuals with severe obesity, modifies the gut microbiota and systemic metabolism in both humans and animal models. The aim of the current study was to understand better the metabolic functions of the altered gut microbiome by conducting deep phenotyping of bariatric surgery...

Background Multiple industries and organisations are afflicted by and respond to institutional crises daily. As surgeons, we respond to crisis frequently and individually such as with critically unwell patients or in mass casualty scenarios; but rarely, do we encounter institutional or multi-institutional crisis with multiple actors as we have seen...

Background The geometrical characterisation of ascending thoracic aortic aneurysms (ATAA) in clinical practice is limited to diameter measurements. Despite growing interest in haemodynamic assessment, its relationship with ATAA pathogenesis is poorly understood. This study examines the relationship between geometry of the ventriculo-aortic junction...

Chemotherapy dosing is traditionally based on body surface area calculations; however, these calculations ignore separate tissue compartments, such as the lean body mass (LBM), which is considered a big pool of drug distribution. In our era, colorectal cancer patients undergo a plethora of computed tomography scans as part of their diagnosis, stagi...

OBJECTIVES We performed a literature meta-analysis to estimate the rate of pacemaker implantation after Perceval sutureless aortic valve replacement. METHODS Pertinent articles were identified from the PubMed, Google Scholar, Ovid MEDLINE and Ovid EMBASE databases. Eligible studies reported the de novo incidence of postoperative pacemaker implanta...

Background: We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. Methods: This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dil...

OBJECTIVES: Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS: A systematic database search with pooled analysis was conducted of o...

Type A aortic dissection after percutaneous coronary intervention is a rare and life-threatening situation. The reported incidence ranges from 0,02% to 0,6% of all diagnostic and interventional percutaneous procedures. We describe a case of aortic dissection after percutaneous coronary intervention in a patient with acute myocardial infarction from...

Pseudoaneurysms of the aorta are rare complications of cardiac surgery, and sternal re-entry to address the pathology is particularly challenging. In this case, we describe a rare presentation of thoracic aortic pseudoaneurysm due to chronic erosion from a sternal wire, 10 years following the index operation. The patient was treated in two-stages,...

Blood flow in the aorta is often assumed laminar, however aortic valve pathologies may induce transition to turbulence and our understanding of turbulence effects is incomplete. The aim of the study was to provide a detailed analysis of turbulence effects in aortic valve stenosis (AVS). Methods Large-eddy simulation (LES) of flow through a patient...

At a time where delivering the best quality of care is the raison d’être of the health service, outliers can pose a serious challenge to both clinicians and policy makers. Methods of outlier detection are highly variable. The collection and assimilation of outcome variables can also be very challenging. Despite this, the publication of surgeon spec...

Background Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes...

Strain measurement during tissue deformation is crucial to elucidate relationships between mechanical loading and functional changes in biological tissues. When combined with specified loading conditions, assessment of strain fields can be used to craft models that accurately represent the mechanical behavior of soft tissue. Inhomogeneities in stra...

Background The subclavian artery is an alternative access route for transcatheter aortic valve implantation (TAVI), with a potential advantage in patients unsuitable for traditional access routes such as the femoral artery. This study aimed to determine the safety and efficacy of the trans-subclavian (TSc) compared to the trans-femoral (TF) approac...

Aim The aim of this study was to compare minimally invasive surgery (MI) and median sternotomy (MS) in terms of post-procedure health-related quality of life (HRQoL) and functional outcome. Method We conducted a multicentre prospective cohort study that enrolled patients from January 2015 until February 2017. Combined cardiac procedures were perfo...

BACKGROUND Electronic health records are digital records of a patient’s health and care. At present in the UK, patients may have several paper and electronic records stored in various settings. The UK government, via NHS England, intends to introduce a comprehensive system of electronic health records in England by 2020. These electronic records wi...

Objectives This is the first systematic review to look at all published data on EHRs to determine which systems are advantageous. Design A systematic review was performed by searching EMBASE and Ovid MEDLINE between 1974 and November 2019. Participants All original studies that appraised EHR systems were included. Main outcome measures EHR syste...

Background: Inflammatory Bowel Disease(IBD) is a risk factor for colorectal cancer(CRC). The aim of this study is to determine whether stage at diagnosis and survival differ between sporadic, ulcerative colitis (UC) and Crohn’s disease(CD) related CRC. Method: The English National Cancer Registry (NCIN), Hospital Episode Statistics(HES) and Office...

Background Educating and equipping students and trainees into clinicians capable of meeting healthcare demands and service provision needs is essential. Unprecedented events like COVID-19 pandemic, highlight urgent need for reformation of training to ensure high quality education is maintained. To this end, we describe an innovative and globally ad...

Background Assessing patient fitness prior to high-risk operations is becoming increasingly vital in cardiothoracic surgery. Physical activity (PA) and frailty measures are powerful perioperative tools, albeit underused in clinical practice. This study aimed to assess the influence of patient frailty on PA post-surgery and other short-term outcomes...

Background Colorectal cancer is associated with secondary sarcopenia (muscle loss) and myosteatosis (fatty infiltration of muscle) and patients who exhibit these host characteristics have poorer outcomes following surgery. Furthermore, patients who undergo curative advanced rectal cancer surgery such as pelvic exenteration, are at risk of skeletal...

Background Porcine aortic roots (PAR) have been reported in the literature with acceptable short‐ and long‐term outcomes for the treatment of aortic root aneurysms. However, their efficacy in type A aortic dissection (TAAD) is yet to be defined. Methods Using data from a locally collated aortic dissection registry, we compared the outcomes in pati...