Publications by authors named "Ibrahim Sultan"
Objectives: We sought to assess the effect of postoperative renal failure (RF) on outcomes and identify predictors of chronic kidney disease (CKD) post-ATAAD.
Methods: This retrospective single-center analysis included all adults with ATAAD from 2011-2023. Patients were stratified into renal failure (RF) and no RF groups.
Objectives: To evaluate the effect of intraoperative intravenous methadone within a standardized enhanced recovery after cardiac surgery pathway on the perioperative corrected QT interval (QTc).
Design: Retrospective cohort study.
Setting: Cardiac surgical patients from a tertiary academic medical institution.
Feasibility, safety and quality of complex mitral valve repair in the early phase of a robotic surgery programme.
Interdiscip Cardiovasc Thorac Surg
November 2024
Article Synopsis
- The study aimed to assess the feasibility, safety, and quality of robotic-assisted mitral valve repair in complex and non-complex cases from September 2021 to February 2024, involving 100 patients.
- Among the participants, 21 had complex repairs, which showed a higher prevalence of bileaflet prolapse and required additional procedures like neochord placement and commissuroplasty, along with longer surgical times compared to non-complex cases.
- Despite the increased complexity leading to longer operation times and less immediate extubation, both groups had similar hospital stays and low rates of postoperative complications, indicating that complex repairs can be safely done using robotic assistance early in the program.
Over a decade of randomized controlled trial data demonstrate excellent outcomes with transcatheter aortic valve replacement or surgical aortic valve replacement for patients with symptomatic severe aortic stenosis regardless of surgical risk. The 2020 American College of Cardiology/American Heart Association guidelines recommend both options for low-risk AS patients aged 65 to 80 years. However, the fastest growing population of patients receiving transcatheter aortic valve replacement in the United States is <65 years old, with little data to support the practice.
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- The study investigates spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR), focusing on whether extended aortic coverage increases the risk of SCI, which affects about 10% of patients.
- A review of 277 patients revealed that those with ≥205 mm of aorta coverage had specific risk factors like smoking and previous strokes, but there was no significant increase in SCI rates (4.7% vs. 4.2%) compared to standard coverage.
- The findings suggest that the lack of increased SCI risk with extended coverage may be due to a higher use of preventive lumbar drainage in that patient group, even though they experienced more type II endoleaks.
Article Synopsis
- The study aimed to evaluate the impact of hospital teaching status on outcomes for patients with type B aortic dissection (TBAD) using data from the National Readmissions Database over four years.
- A total of 44,981 TBAD patients were analyzed, revealing no significant differences in in-hospital mortality or 30-day readmission rates between those treated at teaching hospitals versus non-teaching hospitals.
- At teaching hospitals, the use of thoracic endovascular aortic repair (TEVAR) showed higher risks of in-hospital mortality, while higher hospital patient volumes were linked to increased chances of 30-day readmissions.
Article Synopsis
- The study aimed to assess how intraoperative neuromonitoring (IONM) affects the risk of stroke and mortality during coronary and valvular heart operations over a period of 11 years.
- Out of 19,299 patients, 589 (3.1%) received IONM, and those patients had higher pre-existing cerebrovascular diseases, resulting in increased rates of operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%).
- However, after adjusting for patient characteristics, there was no significant difference in stroke or mortality rates between IONM users and non-users, suggesting that IONM may indicate risks rather than directly influence outcomes.
Article Synopsis
- The study investigates the occurrence of subcutaneous emphysema (SE) after robotic cardiac surgery, analyzing data from 116 patients who underwent various procedures.
- SE was found in 45.7% of patients, with most cases being mild; however, severe cases required additional medical intervention like CT scans and chest tubes.
- Factors such as low body weight, low BMI, small body surface area, and older age are linked to a higher incidence of SE, particularly in those undergoing robotic mitral valve repair compared to other robotic surgeries.
Impact of epiaortic ultrasound utilization in patients undergoing coronary artery bypass grafting.
J Thorac Cardiovasc Surg
October 2024
Article Synopsis
- The study aimed to determine if using epiaortic ultrasound to assess aortic calcification would lower the rate of postoperative strokes in patients undergoing coronary artery bypass grafting (CABG).
- A total of 10,049 patients were analyzed, with 1,572 receiving epiaortic ultrasound. The results showed no significant difference in stroke rates between the groups, with 0.8% in the ultrasound group and 1.4% in the non-ultrasound group.
- Overall, the study concluded that epiaortic ultrasound did not significantly reduce the odds of postoperative stroke or hazards of mortality in CABG patients.
Article Synopsis
- This study evaluated how mitral regurgitation (MR) affects patient outcomes after undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS), finding significant survival differences based on MR severity.
- Out of 2250 TAVI patients, those with moderate or greater MR had lower survival rates and a higher chance of heart failure readmissions compared to those with less severe MR.
- The findings suggest the importance of monitoring MR progression after TAVI, as various clinical factors, but not procedural aspects, were linked to the persistence of significant MR, indicating a need for more research on managing combined AS and MR.
Article Synopsis
- Self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THVs) are being studied for their performance in valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), with a focus on clinical outcomes from 315 patients over a decade.
- Results showed that patients with SE THVs experienced lower aortic valve gradients both at 30 days and 1 year post-procedure compared to those with BE THVs, indicating better valve performance.
- Both types of valves showed similar survival rates and mortality, but BE THVs had a higher incidence of severe prosthesis-patient mismatch, suggesting potential differences in long-term outcomes that need further research.
Risk factors and operative risk of large vessel occlusion and stroke during cardiac surgery.
J Stroke Cerebrovasc Dis
November 2024
Objective: Perioperative Large Vessel Occlusions (LVOs) occurring during and following surgery are of immense clinical importance. As such, we aim to present risk factors and test if the Society of Thoracic Surgery (STS) mortality and stroke risk scores can be used to assess operative risk.
Methods: Using data containing 7 index cardiac operations at a single tertiary referral center from 2010 to 2022, logistic and multivariate regression analysis was performed to identify factors that correlate to higher operative LVO and stroke rate.
Background: Outcomes after hemiarch repair for acute DeBakey type I aortic dissection (ADTI) remain unfavorable, with high rates of major adverse events and negative aortic remodeling. The PERSEVERE study evaluates the safety and effectiveness of the AMDS Hybrid prosthesis, a novel bare metal stent, in patients presenting with preoperative malperfusion.
Methods: PERSEVERE is a prospective single-arm investigational study conducted at 26 sites in the United States.
Article Synopsis
- - The Navitor IDE study examines the safety and effectiveness of the Navitor valve for patients with severe aortic stenosis who are at high surgical risk, focusing on the connection between patient factors and the rate of new permanent pacemaker implantation (PPI) within 30 days post-surgery.
- - Researchers analyzed data from 260 patients, excluding those with prior pacemakers, and found that specific conduction abnormalities, like first-degree atrioventricular block and right bundle branch block, increased the likelihood of new PPI, while the depth of the valve implantation also played a significant role.
- - The study concludes that both existing conduction issues and the surgical technique (implant depth) are critical predictors of whether patients will need a new pacemaker
Article Synopsis
- Both Total Arch Replacement (TAR) and debranching plus Thoracic Endovascular Aortic Repair (TEVAR) are effective treatments for aortic arch pathologies, but it is still uncertain which is the better option.
- A meta-analysis of 11 studies involving 1142 patients revealed no significant difference in overall survival between the two treatments, though TAR showed a significantly lower risk of needing later aortic surgeries.
- Older patients may find debranching plus TEVAR more beneficial, while those with type A aortic dissections might have better outcomes with TAR.
Discovery of meningeal lymphatic vessels (LVs) in the dura mater, also known as dural LVs (dLVs) that depend on vascular endothelial growth factor C expression, has raised interest in their possible involvement in Alzheimer's disease (AD). Here we find that in the APdE9 and 5xFAD mouse models of AD, dural amyloid-β (Aβ) is confined to blood vessels and dLV morphology or function is not altered. The induction of sustained dLV atrophy or hyperplasia in the AD mice by blocking or overexpressing vascular endothelial growth factor C, impaired or improved, respectively, macromolecular cerebrospinal fluid (CSF) drainage to cervical lymph nodes.
View Article and Find Full Text PDFPatients with small aortic annuli (SAAs) are predominantly women. We sought to compare gender-based and propensity-matched outcomes of index transcatheter aortic valve replacement (TAVR) in patients with SAAs. In this retrospective institutional analysis (2012 to 2023), primary stratification was by gender.
View Article and Find Full Text PDFCommentary: Treating atrial fibrillation in women: Guidelines versus Reality.
J Thorac Cardiovasc Surg
July 2024
Objectives: Evaluate the effect of intravenous (IV) methadone versus intrathecal morphine (ITM) within an Enhanced Recovery After Cardiac Surgery (ERACS) pathway on postoperative pain and outcomes (length of hospital stay and postoperative complications) after cardiac surgery.
Design: Retrospective cohort study.
Setting: Two tertiary academic medical institutions within the same health system.