الأبحاث والمنشورات
New
Article
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Sex Differences in Postoperative Recovery and Mortality After High‐Risk Cardiac Surgery: A Propensity Score–Matched Post Hoc Analysis of the SUSTAIN‐CSX Trial
2026
Journal of the American Heart Association
Rashad Zayat
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Alish Kolashov
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Christian Stoppe
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Quirin Notz
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Yusuf Shieba
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Ajay Moza
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Daniel Catena
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Ghaith Mohsen
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Jan Beer
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Georg Daniel Duerr
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Ahmed F.A. Mohammed
Abstract
Whether women do worse than men after cardiac surgery is contested, largely because women tend to present with higher baseline risk, making raw comparisons unreliable. This analysis addressed that by matching rather than comparing crude groups.
Using data from the SUSTAIN-CSX trial (1,386 patients with complete data), women were matched 1:1 to men by age and EuroSCORE II, with exact matching on surgical category, producing 327 matched pairs.
Survival at 180 days did not differ significantly between women and men. Women had numerically longer intensive care and hospital stays, and after adjustment for residual imbalance — frailty, haemoglobin, renal disease, ejection fraction, previous infarction, preoperative medication and creatinine — female sex remained associated with longer intensive care stay (adjusted IRR 1.8) and hospital stay (adjusted IRR 1.4). Major complications were similar.
The paper is careful about what it does not show: the mortality estimates changed depending on the statistical model used, so they are reported as inconclusive rather than positive. The defensible finding is a longer recovery trajectory in women, not a difference in death.
Using data from the SUSTAIN-CSX trial (1,386 patients with complete data), women were matched 1:1 to men by age and EuroSCORE II, with exact matching on surgical category, producing 327 matched pairs.
Survival at 180 days did not differ significantly between women and men. Women had numerically longer intensive care and hospital stays, and after adjustment for residual imbalance — frailty, haemoglobin, renal disease, ejection fraction, previous infarction, preoperative medication and creatinine — female sex remained associated with longer intensive care stay (adjusted IRR 1.8) and hospital stay (adjusted IRR 1.4). Major complications were similar.
The paper is careful about what it does not show: the mortality estimates changed depending on the statistical model used, so they are reported as inconclusive rather than positive. The defensible finding is a longer recovery trajectory in women, not a difference in death.
New
Article
Full-text available
Sex-Related Differences in Prosthesis-Patient Mismatch Following Aortic Valve Replacement with Perceval Sutureless Valve
2026
Journal of Cardiovascular Development and Disease
Ali Aljalloud
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Yusuf Shieba
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Rashad Zayat
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Ajay Moza
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Ahmed Farghal Ahmed Mohammed
Abstract
Women have smaller aortic roots than men, so a valve that performs adequately in a man may be functionally too small in a woman — prosthesis–patient mismatch, which impairs recovery of the left ventricle. Sutureless valves offer a larger effective orifice for a given annulus, and this study asked whether that closes the gap.
We retrospectively analysed 139 patients (68 men, 71 women) undergoing Perceval sutureless aortic valve replacement between 2016 and 2020, grading mismatch by indexed effective orifice area under VARC-3 criteria and stratifying by body mass index.
Mismatch occurred in 74.6% of women against 22.1% of men, and the gap persisted among non-obese patients (47.9% versus 16.2%). Women received smaller valves and had lower indexed orifice areas despite comparable gradients; postoperatively they had lower indexed orifice area but higher ejection fraction. Early clinical outcomes were similar, and most mismatch was moderate.
The conclusion is that favourable sutureless haemodynamics do not overcome anatomical sex differences. Tailored strategies — aortic root enlargement, and sex-specific orifice-area thresholds — may improve valve selection for women.
We retrospectively analysed 139 patients (68 men, 71 women) undergoing Perceval sutureless aortic valve replacement between 2016 and 2020, grading mismatch by indexed effective orifice area under VARC-3 criteria and stratifying by body mass index.
Mismatch occurred in 74.6% of women against 22.1% of men, and the gap persisted among non-obese patients (47.9% versus 16.2%). Women received smaller valves and had lower indexed orifice areas despite comparable gradients; postoperatively they had lower indexed orifice area but higher ejection fraction. Early clinical outcomes were similar, and most mismatch was moderate.
The conclusion is that favourable sutureless haemodynamics do not overcome anatomical sex differences. Tailored strategies — aortic root enlargement, and sex-specific orifice-area thresholds — may improve valve selection for women.
New
Article
Full-text available
Hemocompatibility and Long-Term Outcomes in HeartWare Versus HeartMate II Versus HeartMate 3: Multicenter Real-World Cohort
2026
Artificial Organs
Hamza H. H. Ben Nasir
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Ahmed F. A. Mohammed
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Omar Allham
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Alish Kolashov
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Yusuf Shieba
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Lachmandath Tewarie
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Bernd Panholzer
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Ajay Moza
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Assad Haneya
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Rashad Zayat
Abstract
Left ventricular assist devices keep patients alive in advanced heart failure, but their long-term problems are dominated by how the pump interacts with blood — pump thrombosis, ischaemic stroke and major bleeding. This multicentre study compared three generations of device in ordinary clinical practice rather than trial conditions.
We followed 327 adult recipients: 112 HeartWare (HVAD), 142 HeartMate II, and 73 HeartMate 3. Survival was analysed by Kaplan–Meier and Cox models, and blood-compatibility events were assessed with competing-risk methods that treat death as a competing event rather than ignoring it.
The third-generation centrifugal HeartMate 3 showed better long-term survival than both the axial-flow HeartMate II and the centrifugal HVAD, together with a lower burden of haemocompatibility-related adverse events across follow-up.
The finding supports the shift toward fully magnetically levitated pump design, and illustrates why competing-risk analysis matters in this population: patients who die cannot go on to have a stroke, and conventional methods overstate event rates if that is not accounted for.
We followed 327 adult recipients: 112 HeartWare (HVAD), 142 HeartMate II, and 73 HeartMate 3. Survival was analysed by Kaplan–Meier and Cox models, and blood-compatibility events were assessed with competing-risk methods that treat death as a competing event rather than ignoring it.
The third-generation centrifugal HeartMate 3 showed better long-term survival than both the axial-flow HeartMate II and the centrifugal HVAD, together with a lower burden of haemocompatibility-related adverse events across follow-up.
The finding supports the shift toward fully magnetically levitated pump design, and illustrates why competing-risk analysis matters in this population: patients who die cannot go on to have a stroke, and conventional methods overstate event rates if that is not accounted for.
New
Article
Full-text available
Sex-Related Differences in Prosthesis-Patient Mismatch Following Aortic Valve Replacement with Perceval Sutureless Valve
2026
Journal of Cardiovascular Development and Disease
Ali Aljalloud
·
Yusuf Shieba
·
Rashad Zayat
·
Ajay Moza
·
Ahmed Farghal Ahmed Mohammed
Abstract
Women have smaller aortic roots than men, so a replacement valve that performs well in a man can still be functionally too small in a woman — a problem called prosthesis–patient mismatch, which holds back recovery of the left ventricle. Sutureless valves give a larger opening area for a given annulus size, and this study asked whether that advantage is enough to close the gap between the sexes.
We reviewed 139 patients (68 men, 71 women) who received a Perceval sutureless aortic valve between 2016 and 2020, grading mismatch by indexed effective orifice area under VARC-3 criteria.
Mismatch was far more common in women than men (74.6% versus 22.1%). The difference persisted in non-obese patients, where body size cannot explain it away (47.9% versus 16.2%). Women received smaller valves and had consistently lower indexed orifice areas despite similar pressure gradients. Early clinical outcomes were nonetheless comparable between the sexes, and most mismatch was moderate rather than severe.
The practical message is that a sutureless valve does not by itself solve the anatomical problem. Planning for women may need to include root enlargement, and the thresholds used to define mismatch may themselves need to be sex-specific.
We reviewed 139 patients (68 men, 71 women) who received a Perceval sutureless aortic valve between 2016 and 2020, grading mismatch by indexed effective orifice area under VARC-3 criteria.
Mismatch was far more common in women than men (74.6% versus 22.1%). The difference persisted in non-obese patients, where body size cannot explain it away (47.9% versus 16.2%). Women received smaller valves and had consistently lower indexed orifice areas despite similar pressure gradients. Early clinical outcomes were nonetheless comparable between the sexes, and most mismatch was moderate rather than severe.
The practical message is that a sutureless valve does not by itself solve the anatomical problem. Planning for women may need to include root enlargement, and the thresholds used to define mismatch may themselves need to be sex-specific.
New
Article
Full-text available
Comparative Analysis of Short-Term Outcomes in Thoracoscopic Minimally Invasive Versus Traditional Mitral Valve Replacement: Randomized Clinical Trial Study
2025
AL-Kindy College Medical Journal
Yusuf Shieba
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Abd Elhalim Shalaby
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Tamer Elbanna
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Mohamed-Adel Elgamal
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Ahmed El-minshawy
Abstract
Mitral valve replacement has traditionally required splitting the breastbone. This randomised trial tested whether a thoracoscopic approach through a small right-sided incision gives comparable results.
One hundred patients with isolated mitral valve disease were randomly allocated to either video-assisted right anterolateral mini-thoracotomy or conventional median sternotomy.
The minimally invasive operation took significantly longer (291 versus 228 minutes). Every recovery measure, however, favoured it: intensive care stay fell from 3.8 to 2.1 days, time to extubation from 8.5 to 4.2 hours, postoperative blood loss from 449 to 272 mL, and hospital stay from 11.2 to 7.2 days. Pain scores were markedly lower, at 3.8 versus 7.6 on a visual analogue scale.
The trade-off is explicit: longer time in theatre buys a shorter, less painful recovery. For suitable patients, the thoracoscopic approach is a safe and effective alternative to sternotomy.
One hundred patients with isolated mitral valve disease were randomly allocated to either video-assisted right anterolateral mini-thoracotomy or conventional median sternotomy.
The minimally invasive operation took significantly longer (291 versus 228 minutes). Every recovery measure, however, favoured it: intensive care stay fell from 3.8 to 2.1 days, time to extubation from 8.5 to 4.2 hours, postoperative blood loss from 449 to 272 mL, and hospital stay from 11.2 to 7.2 days. Pain scores were markedly lower, at 3.8 versus 7.6 on a visual analogue scale.
The trade-off is explicit: longer time in theatre buys a shorter, less painful recovery. For suitable patients, the thoracoscopic approach is a safe and effective alternative to sternotomy.
New
Article
Full-text available
Sex-related differences in prosthesis-patient mismatch following aortic valve replacement with the edwards intuity valve system
2025
Frontiers in Cardiovascular Medicine
Muhammad Jawoosh
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Rashad Zayat
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Leyla Dogan
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Yusuf Shieba
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Ajay Moza
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Lachmandath Tewarie
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Shahram Lotfi
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Mohammad Amen Khattab
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Ahmad Abugameh
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Ahmed F. A. Mohammed
Abstract
This study repeated the question of sex and prosthesis–patient mismatch using a different valve — the Edwards Intuity rapid-deployment prosthesis — to see whether the pattern held.
We included 256 patients (196 men, 60 women) who received isolated or combined rapid-deployment aortic valve replacement between 2018 and 2023, defining mismatch by indexed effective orifice area under VARC-3 criteria.
Mismatch was again substantially more common in women. Among patients with a body mass index below 30, it occurred in 55% of women compared with 13.3% of men; above that threshold, in 11.7% versus 2.0%. Severe mismatch occurred in 16.7% of non-obese women and in no men in that group. In-hospital mortality did not differ between the sexes, and multivariate regression identified no independent predictor of mismatch.
Taken with the sutureless valve findings, the pattern looks like anatomy rather than a property of any one prosthesis. The paper argues that because left ventricular geometry and function differ in women, the orifice-area thresholds used to define mismatch may need to be different for men and women rather than shared.
We included 256 patients (196 men, 60 women) who received isolated or combined rapid-deployment aortic valve replacement between 2018 and 2023, defining mismatch by indexed effective orifice area under VARC-3 criteria.
Mismatch was again substantially more common in women. Among patients with a body mass index below 30, it occurred in 55% of women compared with 13.3% of men; above that threshold, in 11.7% versus 2.0%. Severe mismatch occurred in 16.7% of non-obese women and in no men in that group. In-hospital mortality did not differ between the sexes, and multivariate regression identified no independent predictor of mismatch.
Taken with the sutureless valve findings, the pattern looks like anatomy rather than a property of any one prosthesis. The paper argues that because left ventricular geometry and function differ in women, the orifice-area thresholds used to define mismatch may need to be different for men and women rather than shared.
New
Article
Full-text available
Pericardial Closure Preserves Early Right Ventricular Function After Cardiac Surgery: A Retrospective Cohort Study
2025
Journal of Cardiovascular Development and Disease (JCDD)
Hannah Breuer
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Marjolijn C. Sales
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Natasja W. M. Ramnath
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Yusuf Shieba
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Alish Kolashov
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Ajay Moza
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Lachmandath Tewarie
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Rashad Zayat
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Nima Hatam
Abstract
Right ventricular dysfunction is common after cardiac surgery and predicts poor outcomes. One suggested cause is simple and mechanical: the pericardium normally supports the thin-walled right ventricle, and it is routinely left open at the end of an operation. This study asked whether closing it again protects early right ventricular function.
We compared patients whose pericardium was closed against those left open, measuring right ventricular longitudinal function early after surgery by TAPSE and tricuspid annular systolic velocity. Because the two groups differed at baseline, comparisons were adjusted for baseline function, left ventricular strain, ejection fraction, ventricular volume, sex, procedure, and bypass and cross-clamp times, with correction for testing two primary endpoints.
Pericardial closure was independently associated with better early right ventricular function — TAPSE higher by 1.53 mm and tricuspid annular systolic velocity by 1.69 cm/s. Mixed-effects sensitivity analyses agreed.
This is a retrospective, adjusted finding rather than proof of cause, but it supports considering closure as a low-cost step to protect right ventricular performance, and it makes the case for a prospective trial.
We compared patients whose pericardium was closed against those left open, measuring right ventricular longitudinal function early after surgery by TAPSE and tricuspid annular systolic velocity. Because the two groups differed at baseline, comparisons were adjusted for baseline function, left ventricular strain, ejection fraction, ventricular volume, sex, procedure, and bypass and cross-clamp times, with correction for testing two primary endpoints.
Pericardial closure was independently associated with better early right ventricular function — TAPSE higher by 1.53 mm and tricuspid annular systolic velocity by 1.69 cm/s. Mixed-effects sensitivity analyses agreed.
This is a retrospective, adjusted finding rather than proof of cause, but it supports considering closure as a low-cost step to protect right ventricular performance, and it makes the case for a prospective trial.
New
Article
Full-text available
Empyema necessitans in a pediatric patient
2023
International Journal of Surgery Case Reports
Yusuf Shieba
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Alaa Ramadan
Abstract
Empyema necessitans is an uncommon and serious complication of pleural infection, in which pus tracks out of the pleural cavity through the chest wall and collects under the skin. It is rare in children, which is exactly why it is missed.
We report a one-year-old boy who presented with the condition, with Escherichia coli identified as the causative organism — an unusual pathogen in this setting. Treatment combined targeted antibiotics with drainage of the pleural collection, and the outcome was successful.
The clinical lesson is a simple one worth remembering: in a young child with an enlarging chest wall swelling, empyema necessitans belongs in the differential diagnosis. Early recognition and drainage, with paediatricians, thoracic surgeons, infectious disease specialists and interventional radiologists working together, is what determines the outcome.
We report a one-year-old boy who presented with the condition, with Escherichia coli identified as the causative organism — an unusual pathogen in this setting. Treatment combined targeted antibiotics with drainage of the pleural collection, and the outcome was successful.
The clinical lesson is a simple one worth remembering: in a young child with an enlarging chest wall swelling, empyema necessitans belongs in the differential diagnosis. Early recognition and drainage, with paediatricians, thoracic surgeons, infectious disease specialists and interventional radiologists working together, is what determines the outcome.
New
Article
Full-text available
Lifethreatening tracheal obstruction in a child caused by nodular fasciitis: case presentation
2022
The Egyptian Journal of Bronchology
Yusuf Shieba
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Mahmoud Khairy
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Mohamed Elzouk
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Albaraa Ali Mansour
Abstract
Nodular fasciitis is a benign, rapidly growing inflammatory soft-tissue lesion, most often found in the head and neck. In the trachea it is very rare — and dangerous, because a fast-growing mass in the airway can obstruct it before anyone suspects a tumour.
We report a 5-year-old child with nodular fasciitis of the trachea causing near-complete obstruction. Bronchoscopy with biopsy established the diagnosis, and the lesion was excised bronchoscopically.
The case matters because the presentation imitates pneumonia. A child with persistent respiratory symptoms that do not behave as infection should is worth imaging and, where doubt remains, examining bronchoscopically. Early detection is what prevents a benign lesion from becoming a fatal airway obstruction.
We report a 5-year-old child with nodular fasciitis of the trachea causing near-complete obstruction. Bronchoscopy with biopsy established the diagnosis, and the lesion was excised bronchoscopically.
The case matters because the presentation imitates pneumonia. A child with persistent respiratory symptoms that do not behave as infection should is worth imaging and, where doubt remains, examining bronchoscopically. Early detection is what prevents a benign lesion from becoming a fatal airway obstruction.
New
Article
Full-text available
Postoperative Outcomes of Minimally Invasive versus Conventional Mitral Valve Repair; A Randomized Study
2021
The Egyptian Cardiothoracic Surgeon
Ehab Nourelden
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Ahmed EL-Minshawy
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Ahmed Ghoneim
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Mohammed Alaa
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Yusuf Shieba
Abstract
This randomised study asked a narrower question than operative safety: what does a minimally invasive approach do to pain, recovery and — importantly — lung function after mitral valve repair?
Fifty patients with non-ischaemic mitral valve disease undergoing repair between 2017 and 2019 were randomly allocated to video-assisted anterolateral mini-thoracotomy or median sternotomy.
Operative time was longer in the minimally invasive group (207 versus 174 minutes), while cross-clamp and bypass times were only nonsignificantly longer. Intensive care stay was shorter (2.6 versus 3.8 days) and hospital stay much shorter (7.9 versus 14.5 days). The clearest difference was respiratory: postoperative FEV1 was 2.06 L after mini-thoracotomy against 1.39 L after sternotomy. Ejection fraction was unchanged between groups.
That respiratory difference is the mechanism behind the shorter stay. Leaving the sternum intact preserves the mechanics of breathing, which is what allows earlier mobilisation and fewer chest complications.
Fifty patients with non-ischaemic mitral valve disease undergoing repair between 2017 and 2019 were randomly allocated to video-assisted anterolateral mini-thoracotomy or median sternotomy.
Operative time was longer in the minimally invasive group (207 versus 174 minutes), while cross-clamp and bypass times were only nonsignificantly longer. Intensive care stay was shorter (2.6 versus 3.8 days) and hospital stay much shorter (7.9 versus 14.5 days). The clearest difference was respiratory: postoperative FEV1 was 2.06 L after mini-thoracotomy against 1.39 L after sternotomy. Ejection fraction was unchanged between groups.
That respiratory difference is the mechanism behind the shorter stay. Leaving the sternum intact preserves the mechanics of breathing, which is what allows earlier mobilisation and fewer chest complications.
New
Article
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Short term outcome of coronary artery bypass graft surgery: Evaluation of recently established cardiac center
2018
Journal of the Egyptian Society of Cardio-Thoracic Surgery
Yusuf S.E. Khalifa
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Karam M. Eisa
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Mohamed Abdel Bary
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Hossam Eldin M.M. Ismail
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Abdallah M. Taha
Abstract
New cardiac surgery units need to know whether their results match international benchmarks. This study audited the first 100 coronary artery bypass operations performed in the cardiothoracic surgery department at Qena University Hospital.
The cohort reflected a high-risk population: 95 of 100 patients had multi-vessel disease, with diabetes in 55%, hypertension in 69%, dyslipidaemia in 55% and smoking in 58%. The left internal mammary artery was grafted to the left anterior descending artery in the majority of cases, with saphenous vein to the remaining targets. An intra-aortic balloon pump was needed in only 2%. Septicaemia was the significant complication encountered. At six months, 97% of patients were alive.
Publishing institutional results rather than relying on international figures is the point of the paper. It establishes a local baseline against which the unit can be measured, and lets surgeons and interventional cardiologists judge whether published international data actually applies to their own patients.
The cohort reflected a high-risk population: 95 of 100 patients had multi-vessel disease, with diabetes in 55%, hypertension in 69%, dyslipidaemia in 55% and smoking in 58%. The left internal mammary artery was grafted to the left anterior descending artery in the majority of cases, with saphenous vein to the remaining targets. An intra-aortic balloon pump was needed in only 2%. Septicaemia was the significant complication encountered. At six months, 97% of patients were alive.
Publishing institutional results rather than relying on international figures is the point of the paper. It establishes a local baseline against which the unit can be measured, and lets surgeons and interventional cardiologists judge whether published international data actually applies to their own patients.
New
Article
Full-text available
Traumatic diaphragmatic hernia challenging diagnosis and early management
2018
Journal of the Egyptian Society of Cardio-Thoracic Surgery
Mohamed Abdelshafy
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Yusuf S.E. Khalifa
Abstract
Traumatic diaphragmatic hernia is easy to miss. The injury is usually part of major trauma, and the noisier injuries alongside it draw attention away — yet a missed diaphragmatic tear can later strangulate stomach or bowel in the chest.
We retrospectively reviewed 50 patients diagnosed with acute traumatic diaphragmatic hernia between September 2014 and September 2017.
Blunt trauma accounted for 80% of cases and the left side was involved in 72%. Critically, the diagnosis was made before surgery in only 40% of patients — the majority were found at operation. Repair was abdominal in 74% and thoracic in 26%. Complications occurred in 60%, most often pneumonia (32%), and 16% died, with delayed referral or severe head injury accounting for most deaths.
The conclusion is about index of suspicion rather than technique: in any patient assessed for abdominal or respiratory symptoms after trauma — recent or long past — the diaphragm should be actively considered rather than assumed intact.
We retrospectively reviewed 50 patients diagnosed with acute traumatic diaphragmatic hernia between September 2014 and September 2017.
Blunt trauma accounted for 80% of cases and the left side was involved in 72%. Critically, the diagnosis was made before surgery in only 40% of patients — the majority were found at operation. Repair was abdominal in 74% and thoracic in 26%. Complications occurred in 60%, most often pneumonia (32%), and 16% died, with delayed referral or severe head injury accounting for most deaths.
The conclusion is about index of suspicion rather than technique: in any patient assessed for abdominal or respiratory symptoms after trauma — recent or long past — the diaphragm should be actively considered rather than assumed intact.
