Dhiren Shah - Academia.edu (original) (raw)

Papers by Dhiren Shah

British journal of anaesthesia, 2018

The surgical safety checklist is widely used to improve the quality of perioperative care. Howeve... more The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (1...

This a preprint and has not been peer reviewed. Data may be preliminary.

Percutaneous Coronary Intervention (PCI) with drug eluting stent placement is a well-established ... more Percutaneous Coronary Intervention (PCI) with drug eluting stent placement is a well-established treatment modality for coronary stenotic lesions. Although infection involving implanted stent is rare, it can occur at any point of time, leading to high morbidity and mortality. We describe a rare case of infected coronary stents complicated with recurrent stent thrombosis, sepsis and myocardial abscess formation after 2 years of PCI. Using multi-modality imaging final diagnoses to evaluate the precise location, extent and morphology of Myocardial Abscess (MA) was done. “On pump” Coronary Artery Bypass Graft (CABG) was performed, Left Anterior Descending (LAD) artery intramyocardially was opened up, about 7 ml to10 ml of pus was evacuated and 2 Drug Eluting Stents (DES) were removed. The isolated identified organism was Pseudomonas aeruginosa which had remained dormant and restricted to the stent area for almost 2 years thinning the myocardium; an unusual trait of a very virulent bacte...

Journal of Cardiac Surgery, 2021

Primary cardiac synovial sarcoma is an exceedingly rare soft tissue malignant tumor, involving ei... more Primary cardiac synovial sarcoma is an exceedingly rare soft tissue malignant tumor, involving either the pericardium or chambers, with a striking male predominance, prevalently seen in the fourth decade. These tumours most commonly present as breathlessness on exertion. These patients readily exhibit gastrointestinal and systemic symptoms but sometimes the presentation can be fallacious.

Asian Cardiovascular and Thoracic Annals, 2020

A 67-year-old man who had undergone a percutaneous coronary intervention, presented with cardiac ... more A 67-year-old man who had undergone a percutaneous coronary intervention, presented with cardiac symptoms. He was managed for acute coronary syndrome and left ventricular dysfunction. After stabilization, he underwent coronary artery bypass grafting but developed dengue hemorrhagic fever postoperatively. He was monitored for hematocrit, platelet count, liver enzymes, and daily fluid balance. His platelet count fell below 40,000/µL, and due to the increased risk of bleeding, warfarin was discontinued and single antiplatelet therapy (aspirin) was continued. After 2 weeks, parameters had normalized. Regular monitoring of hematocrit, platelet count, liver enzymes, and fluid balance played a vital role in the patient’s successful recovery.

Journal of Cardiothoracic Surgery, 2018

Background: Indian patients undergoing surgical aortic valve replacement (SAVR) differ from weste... more Background: Indian patients undergoing surgical aortic valve replacement (SAVR) differ from western populations with respect to aortic annulus size and valve disease morphology. The purpose of this post-market, non-randomized observational study was to evaluate the early hemodynamic performance of the Trifecta™ bioprosthesis (Abbott, previously St. Jude Medical, Minneapolis, US) in an Indian patient population. Methods: From January 2014 to September 2015, 100 patients (mean age 64.4 ± 7.1 years, 62% male) undergoing SAVR for valve disease (68% stenosis, 7% insufficiency, 25% mixed pathology) were enrolled across 10 centers in India. Patients implanted with a 19-27 mm Trifecta™ valve were eligible to participate and were prospectively followed for 12-months post-implantation. Echocardiographic hemodynamic performance was evaluated at pre-implant, pre-discharge and at 12-months by an independent core laboratory. Adverse events were adjudicated by the study sponsor. Functional status at 12-months was assessed according to NYHA classification. Continuous data was summarized using descriptive statistics (mean &standard deviation,) and categorical data was summarized using frequencies and percentages. Result: Ninety patients (mean age 64.5, 62.2% male) completed the 12-month follow up. Significant improvements in hemodynamic valve performance were reported in 81 patients with available echocardiographic data at 12 months. Compared to baseline at 12-month follow up visit, mean effective orifice area increased from 0.75cm 2 to 1.61cm 2 (p < 0.0001), mean pressure gradient reduced to 10.42 mmHg from 51.47 mmHg (p < 0.0001), cardiac output increased from 4.46 l/min to 4.85 l/min (P 0.9254). Compared to baseline, functional status improved by ≥1 NYHA class in 75% of patients at 12 months (95% Clopper-Pearson (Exact) confidence limit [64.6%, 83.6%]). No instances of early mortality (< 30 days from index procedure) or structural valve dysfunction were reported. Conclusion: In an Indian patient population, implantation of the Trifecta™ bioprosthesis is shown to be safe and associated with favorable early hemodynamic performance and improved functional status at 12 months.

British Journal of Surgery, 2019

BackgroundThe Clavien–Dindo classification is perhaps the most widely used approach for reporting... more BackgroundThe Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs).MethodsThis was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparin...

Journal of the American College of Cardiology, 2014

Background: Post-Operative Inappropriate Sinus Tachycardia (IST) is common After Coronary Artery ... more Background: Post-Operative Inappropriate Sinus Tachycardia (IST) is common After Coronary Artery Bypass Graft (CABG) surgery requiring treatment to reduce heart rate (HR). If untreated, increases incidence of complications including post-operative stroke. methods: A total of 151 patients undergoing CABG surgery at a tertiary care center in Western India from 10/2012-3/2013, who developed post-CABG IST, were divided as per cardiac surgeons discretion into 5 treatment groups for IST: Metoprolol 12.5 mg bid (n=47); Metoprolol 25 mg bid (n=24); Ivabradine 5 mg + Metoprolol 12.5 mg (bid,n=34); Ivabradine 5 mg + Metoprolol 25 mg (bid,n=23); and Ivabradine 5 mg bid (n=23). Safety and Efficacy were compared. results:Of the 151 patients (Mean age 59 ± 8 years, Male 87%), 41% had diabetes, 45% had hypertension and 67% had triple vessel disease. Mean pre-operative vitals were: HR 80, BP 125/78 mm Hg; respiratory rate 21/min and temperature 98.4 °F. "Off pump" CABG was done in 98% patients. During surgery, nor adrenaline was used in 87% patients, dobutamine in 2% patients and both in 11% patients. Mean intra-operative fluid balance was 988 ml. Average ICU and total hospital stay were 3.7 and 7.3 days respectively. IST developed post-CABG, averaging a 32% increase from baseline HR. HR was reduced similarly(p>0.05) in all treatment groups. conclusions: Metoprolol, Ivabradine and its combination equally and effectively controlled IST in CABG patients without inducing hypotension or arrhythmia.

Indian Journal of Thoracic and Cardiovascular Surgery, 2018

Percutaneous transluminal coronary angioplasty (PTCA) with drug-eluting stent placement is a well... more Percutaneous transluminal coronary angioplasty (PTCA) with drug-eluting stent placement is a well-established treatment modality for coronary stenotic lesions. Although infection involving implanted stent is rare, it can occur at any point of time, leading to high morbidity and mortality. We describe a rare case of infected coronary stents complicated with recurrent stent thrombosis, sepsis, and myocardial abscess formation after 2 years of percutaneous cornary intervention (PCI). Using multi-modality imaging final diagnoses to evaluate the precise location, extent and morphology of myocardial abscess (MA) was done. BOn pump^coronary artery bypass graft (CABG) was performed, left anterior descending (LAD) artery intramyocardially was opened up, about 7-10 ml of pus was evacuated, and two drug-eluting stents (DES) were removed. The isolated identified organism was Pseudomonas aeruginosa which had remained dormant and restricted to the stent area for almost 2 years thinning the myocardium; an unusual trait of a very virulent bacterium which otherwise spreads fast to cause septicemia. The present case exemplifies the high index of clinical sensitivity with early multi-modality diagnosis, aggressive medical therapy, multidisciplinary care, and timely surgical intervention saving the patient's life in otherwise fatal condition.