Sayar Kumar Munshi

All Publications

• A Novel Ex Vivo Model of Unbalanced Common Atrioventricular Valve: Insights into Biomechanics and Hemodynamics During Single Ventricle Palliation. The Journal of thoracic and cardiovascular surgery Munshi, S. K., Huber, J. A., Sharir, A., Ono, Y., Choi, P. S., Reed, A. K., Kaiser, A. D., Ma, M. R. 2026

  Abstract

  To investigate biomechanics and failure mechanisms of unbalanced right-dominant common atrioventricular valves (CAVVs) across stages of single ventricle palliation (SVP).A patient-specific adjustable valve testing mount was developed and size-matched porcine tricuspid and mitral valves were combined to construct CAVVs (n=5). Valves were tested in a heart simulator under hemodynamic conditions replicating Norwood, Glenn and Fontan physiologies. Papillary muscles were displaced vertically and horizontally to simulate chordal prolapse, shortening, and ventricular dilatation. Strain sensors configured as neochordae quantified leaflet force profiles.Bridging leaflets experienced higher peak and mean forces than mural leaflets (p<0.05), correlating with larger leaflet surface area. Regurgitant fraction (RF) increased with all geometric perturbations (p<0.001), with greater rate of increase during chordal prolapse than shortening. Forces were higher in 5mm chordal prolapse compared to baseline. Forces decreased in 5mm chordal shortening and ventricular dilatations as RF increased. Peak leaflet forces and average yank were highest under Norwood conditions (p<0.05), whereas mean forces were greatest during Fontan physiology (p<0.01). Although RF increased with geometric changes at all SVP stages, the relative increase over baseline was greatest during Norwood (p<0.05).Stage-dependent loading conditions and ventricular geometry critically determine CAVV biomechanics and failure during SVP. Glenn offloading reduces peak leaflet forces and improves valve performance, whereas Fontan afterload increases mean leaflet stress, potentially accelerating long-term failure. Ventricular geometric perturbations exert the greatest adverse effect during Norwood, conferring the highest risk of valve dysfunction.

  View details for DOI 10.1016/j.jtcvs.2026.08.007

  View details for PubMedID 42624397

• Extracorporeal membrane oxygenation in congenital cardiac surgery: a 10-year single-centre experience CARDIOLOGY IN THE YOUNG Munshi, S., Narwaley, M., Generali, T., Kutty, R., Lotto, A., Guerrero, R., Horan, M., Brady, A., Simpson, L., Dhannapuneni, R. 2026: 1-8

  Abstract

  Extracorporeal Membrane Oxygenation (ECMO) has evolved as an effective mechanical support for cardiorespiratory failure in patients undergoing congenital cardiac surgery, and the threshold of using it has substantially reduced. This study presents a 10-year single-centre experience evaluating outcomes, survival, and risk factors associated with perioperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in paediatric congenital cardiac surgery.A retrospective review was undertaken for all patients younger than 16 years old who required ECMO during the perioperative period between January 2013 and December 2022. Patients were categorised according to the timing of ECMO initiation into pre-operative, intra-operative, immediate post-operative (<24 hours), and early post-operative (>24 hours) groups, while extracorporeal cardiopulmonary resuscitation (ECPR ECMO) cases were analysed separately using standard statistical methods.A total of 150 patients required ECMO support, with overall survival to discharge of 54%. Survival was higher in patients requiring ECMO within 24 hours after surgery (57.4%) compared with those requiring ECMO later (35.1%), while ECPR ECMO patients showed 46.0% survival. Prolonged cardiopulmonary bypass time (p = 0.017), aortic cross-clamp time (p = 0.002), and longer ECMO duration (p < 0.001) were significantly associated with mortality. Intracranial haemorrhage, ischaemia, sepsis, acute kidney injury, gastrointestinal complications, and mediastinal bleeding were major complications linked to increased mortality. Survival at 1 and 5 years was 50.3% and 41.6%, respectively.VA-ECMO remains a life-saving strategy after congenital cardiac surgery with survival exceeding 50%. Early initiation and shorter ECMO duration may improve outcomes, while prevention of major complications and careful patient selection are essential to optimise survival in paediatric cardiac centres.

  View details for DOI 10.1017/S1047951126123658

  View details for Web of Science ID 001837419700001

  View details for PubMedID 42533627