Research & Publications
New
Article
Full-text available
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
·
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
·
Yusuf Shieba
·
Rashad Zayat
·
Ajay Moza
·
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.
