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Nicholas Collins

Publications and source records attributed to Nicholas Collins.

9 recordsLinked to original sources
PubMed2026

Initial 4-Year Experience With Microaxial Flow Pumps Within a Tertiary Centre in Regional Australia.

BACKGROUND & AIM: The Microaxial Flow Pump (MFP) is a miniaturised rotary pump that aspirates blood from the left ventricle and expels it into the ascending aorta. It unloads the left ventricle and increases mean arterial pressure and cardiac output. MFP is most commonly utilised in cardiogenic shock, for protected percutaneous coronary intervention (PCI), and for ventricular offloading in veno-arterial extracorporeal membrane oxygenation (VA-ECMO). METHOD: We conducted a retrospective review of all patients who underwent MFP insertion at John Hunter Hospital, Australia. Categorical data are represented as counts and percentages, with continuous variables described as means with standard deviations. RESULTS: Twenty-three MFP devices were inserted between September 2020 and May 2024. Five (22%) were for protected PCI, three (13%) for venting with VA-ECMO (ECPELLA), and 15 (65%) for acute coronary syndrome (ACS) and cardiogenic shock. The median age for the overall cohort was 62 years, with a 74% male predominance. Eighty percent of the protected PCI cohort were elective outpatient procedures, and there were no deaths in this cohort. The mortality in the ECPELLA group was 67%. Thirteen (87%) of the patients with cardiogenic shock presented with an anterior infarct, and 53% had cardiac arrest on admission. The overall morality in the cardiogenic shock cohort was 40%. Complications in this cohort included limb ischaemia in four patients (17%) and site bleeding in seven patients (30%). Four patients (17%) required vascular surgery intervention. CONCLUSION: Our initial experience showed the use of MFP in a tertiary centre was safe and feasible, allowing progression from protected percutaneous intervention to acute cardiogenic shock.

Humans↗
PubMed2006

Abnormal pulmonary vascular responses in patients registered with a systemic autoimmunity database: Pulmonary Hypertension Assessment and Screening Evaluation using stress echocardiography (PHASE-I).

UNLABELLED: Patients with autoimmune disease, and in particular limited systemic sclerosis (CREST syndrome), are at risk of developing pulmonary artery hypertension (PAH) which is associated with a poor prognosis. With improvements in therapy offering improved survival and functional capacity, there has been an emphasis on screening to identify patients at risk. Assessment of patients during exercise may enable early identification of patients with this condition. AIMS AND METHODS: We aimed to assess the ability of exercise stress echocardiography to evaluate the change in pulmonary artery pressure in 51 patients with autoimmune disease (systemic lupus erythamatosus (SLE), limited systemic sclerosis (LSS or "CREST") and diffuse systemic sclerosis (DSS)). Systolic pulmonary artery pressure (sPAP) was estimated using interrogation of the tricuspid incompetence jet before and after exercise. PAH was classified as normal, mild, moderate or severe using echocardiographic assessment of sPAP. RESULTS: We were able to estimate pre-exercise and post-exercise sPAP in 92% and 90% of patients, respectively. Pulmonary pressures rose or remained unchanged in all screened individuals, with a mean rise during stress of 14.1mmHg (+/-1.1). Pulmonary artery pressure rose significantly in each of three subgroups (p<0.05). Stress echocardiography demonstrated PAH (using a cut-off of >35mmHg) in 59% of all individuals with systemic autoimmunity. CONCLUSION: Stress echocardiography is a useful tool in identifying individuals with autoimmune disease who may have underlying pulmonary arterial disease that may be amenable to therapy. We noted a consistent elevation in sPAP across all autoimmune subtypes, suggesting an abnormal pulmonary vascular response to exercise exists in these patients.

Aged↗
PubMed2006

A modified balloon crush approach improves side branch access and side branch stent apposition during crush stenting of coronary bifurcation lesions.

OBJECTIVES: Despite the advent of drug eluting stents and newer interventional techniques designed to treat the main vessel and side branch in bifurcation stenoses, optimal treatment of the side branch remains problematic. We aimed to assess the feasibility of a modified balloon crush technique for percutaneous treatment of coronary bifurcation stenoses. BACKGROUND: Use of the crush technique in bifurcation stenoses remains limited by access to the side branch after main vessel stent deployment, as well as limitations of side branch stent deployment. The modified balloon crush technique aims to improve side branch access and stent apposition. METHODS: The modified balloon crush is similar to the previously described balloon crush technique. Following side branch stent deployment, a balloon positioned in the main vessel is deployed to crush the proximal side branch stent. A guide wire is then placed into the side branch with a subsequent high-pressure balloon inflation at the side branch ostium. This opens the stent struts at the ostium of the side branch, facilitating future passage of the guide wire following main vessel stent deployment, prior to kissing balloon inflation. RESULTS: We performed this modification of the crush technique safely in 10 patients. We were successful in obtaining side branch access in nine of ten patients following initial main vessel stent deployment. In the only failure, there was a 90 degrees angle between the main vessel and side branch. CONCLUSIONS: The modified balloon crush technique can be safely performed, while optimizing side branch access and side branch stent apposition.

Aged↗
PubMed2006

Aortic rupture following a covered stent for coarctation: delayed recognition.

Primary stenting for aortic coarctation is frequently used in adult patients. Aortic rupture remains an infrequent complication. A number of strategies, including the use of covered stents, have been proposed to reduce the risk of this catastrophic complication. We describe a 51-year-old female who underwent stenting of aortic coarctation using a covered stent, which was complicated by aortic rupture. Treatment consisted of placement of an additional covered stent to seal the site of aortic disruption. The prevention and management of aortic rupture complicating aortic coarctation stenting are discussed.

Aorta, Thoracic↗
PubMed2004

Intrapericardial carcinoid metastasis.

Carcinoid tumors are malignancies of neuroendocrine tissue. Metastasis, most commonly to the liver, is associated with the carcinoid syndrome characterized by secretory symptoms and right-sided valvular heart disease. We report a case of previously unidentified pericardial metastasis, in the absence of any valvular disease, thus, reflecting an unusual cardiac complication of this tumor. A 50-year-old patient with histologically confirmed carcinoid syndrome underwent screening transthoracic echocardiography that demonstrated a large mass posterior to the interatrial septum. The location of this mass was confirmed by transesophageal echocardiography and magnetic resonance imaging to be entirely within the pericardial space without evidence of myocardial involvement. The mass was removed at thoracotomy and histology confirmed metastatic carcinoid disease. Although patients with carcinoid syndrome are at risk of cardiac valvular complications, and should be screened, this case demonstrates an unusual and previously unidentified site of metastatic disease.

Carcinoid Tumor↗