Mustafa Ahmed

Elective noncardiac surgery in patients with left ventricular assist devices.

Abstract  As the number of heart failure patients supported with left ventricular assist devices (LVAD) increases, the frequency of elective, noncardiac surgery in this patient population will similarly rise. We retrospectively analyzed our LVAD patient database and identified six patients who underwent elective, noncardiac surgery while on LVAD support. These cases are discussed, with an emphasis on the anesthetic and perioperative considerations. These patients have an acceptable risk profile for elective surgery and should be treated similarly to their age‐matched counterparts not on LVAD support. (J Card Surg 2012;27:639‐642)

Left Ventricular Assist Device and Bariatric Surgery: A Bridge to Heart Transplant by Weight and Waiting Time Reduction

Obesity poses significant challenges in advanced heart failure patients who otherwise meet criteria for listing for heart transplant. We present a patient who underwent bariatric surgery while on LVAD support that subsequently lost weight and was successfully bridged to heart transplantation. doi: 10.1111/jocs.12688 (J Card Surg 2016;31:120–122)

Effects of Perioperative Acetyl Salicylic Acid on Clinical Outcomes in Patients Undergoing Craniotomy for Brain Tumor.

OBJECTIVE To evaluate the safety of continuing acetyl salicylic acid (ASA) in patients undergoing brain tumor resection. Many patients are on antiplatelet agents that are withheld before elective neurosurgical procedures to reduce bleeding risk. Cessation of ASA in patients with cardiovascular disease is associated with a known increased risk of thrombotic events, especially in patients with coronary stents. METHODS The medical records of patients who underwent surgical resection of a brain tumor at the University of Florida from 2010 to 2014 were evaluated. The patients were separated into groups based on preoperative ASA use and whether or not it was stopped before surgery. Patients were evaluated for thrombotic complications, postoperative hemorrhage, estimated blood loss, length of hospital stay, and discharge disposition. RESULTS Of the 452 patients analyzed, 368 patients were not on chronic ASA therapy, 55 patients had their ASA discontinued before surgery, and 28 patients were continued on ASA perioperatively. The patients on preoperative ASA were comparable on all collected demographic variables. There were no statistical differences detected between the groups for outcomes including bleeding complications, need for reoperation, or thrombotic complications. CONCLUSIONS In this analysis, perioperative low dose ASA use was not associated with increased risk of perioperative complications.

A Rational Approach to Assess Volume Status in Patients with Decompensated Heart Failure

Although the past few decades have yielded significant improvements in the management of cardiomyopathy, heart failure remains a leading cause of hospitalization as well as readmissions, both in the United States and worldwide. Accurate assessment of volume status in these patients is of great importance because it guides initial therapies and aids in determining suitability for discharge. However, this assessment can prove to be challenging and, therefore, must be based on multiple data points and techniques. This review examines the various modalities of volume assessment in the patient with decompensated heart failure.

Constrictive pericarditis from an endocardial pacemaker lead

Constrictive pericarditis secondary to endocardial pacemaker inflammation, without associated pericardial effusion or infection, has yet to be described in the literature. We present a case of a 42-year-old man who developed recurrent ascites from regional constrictive pericarditis following pacemaker implant. Symptoms resolved after pericardiectomy.

The use of left ventricular assist devices in the treatment of class IV heart failure patients: what the non-heart failure specialist needs to know.

The New York Heart Association class IV heart failure patient represents a very sick patient population with a poor 6-month survival rate. With appropriate selection and timing, left ventricular assist devices can provide improved outcomes while these patients are supported for bridge to heart transplant or destination therapy. As the number of heart failure patients supported by left ventricular assist devices increases, physicians will need to be familiar with postoperative chronic issues (such as right ventricular failure, infection, hypertension, atrial fibrillation, bleeding, and thromboembolic events) that can affect the function of these devices.

Effects of Socioeconomic Status on Clinical Outcomes with Ventricular Assist Devices

Lower socioeconomic status (SES) is a known risk factor for worse outcomes after major cardiovascular interventions. Furthermore, individuals with lower SES face barriers to evaluation for advanced heart failure therapies, including ventricular assist device (VAD) implantation.

Muslims and Medical Ethics: Time to Move Forward by Going Back

The study of Islamic medical ethics represents the confluence of many domains, with an emphasis on anthropology, sociology, religious practice, Islamic law and morality. Navigating these waters in the context of an ever-changing medical environment, with advancements reminiscent of what was once considered ‘science fiction’, requires a multidisciplinary study. The University of Florida Center for Global Islamic Studies recently sponsored a 1-day symposium examining these issues. This was a multi-faith, multidisciplinary meeting which brought together experts from across the nation, supported by the University of Florida Office of Research, Center for the Humanities, Department of Religion, Center for Spirituality and Health, College of Medicine, and the Florida Bioethics Network as well as the Dr. and Mrs. Sayeed Ahmed Islamic Lecture Series. The following Special Section highlights the themes which were discussed and represents some of the ‘next steps’ required as we learn to tackle these complex issues. The need for open and honest dialogue about Islam, bioethics and modern healthcare is of growing importance as the number of American Muslim physicians and Muslims in American society continues to expand. Presently, Muslims make up 2 % of the US population, and 5–10 % of all US physicians. While these numbers can be described as ‘small and growing’, the religious and cultural heritage of Muslim physicians and patients has a significant impact on interpretations of sickness, wellness, healthcare delivery and acceptance. Moreover, the current sociopolitical issues surrounding Muslims both in the United States and abroad have the potential to create biases in the general population which may creep into the healthcare system, affecting how Muslims and others interface with one another, creating unnecessary barriers to the development of therapeutic relationships. Additionally, minority patient populations, such as Muslim patients, are known to receive lower quality of care and face significant barriers when attempting to interface

Predictors of Early and Late Heart Failure Post-orthotopic Liver Transplantation

Background: Amiodarone is associated with heart block in patients with atrial fibrillation and heart failure. The safety of amiodarone use in patients with amyloid is unknown. We sought to identify the prevalence of heart block in patients with amyloid and heart failure who received amiodarone and compare them to those without amyloid in elderly patients. Methods: We searched Explorys (Explorys Inc, Cleveland, Ohio), a database that aggregates electronic health records of 45 million patients from 23 integrated health systems in the United States. We included patients who are at least 55 years of age who have heart failure and atrial fibrillation and receive amiodarone therapy. We compared those to age adjusted controls with heart failure and atrial fibrillation without amyloidosis. Results: We identified 640 patients with amyloid and 87280 patients without amyloid. Prevalence of block was higher in patients with amyloid on amiodarone (43.8% vs 30.0%, p!0.0001). When adjusted for age, odds ratio of block was as follows: 55-59 (1.9 [1.4-2.5], p50.0017), 60-64 (1.8 [1.42.4], p50.0002), 65-69 (2.1 [1.7-2.5], p!0.0001), 70-74 (1.2 [0.9-1.6], p50.31), 7579 (1.5 [1.3-1.8], p50.0001), 80-84 (1.2 [1.0-1.5], p50.09), 85-89 (1.3 [1.0-1.8], p50.052), and 90+ (1.2 [0.9-1.7], p50.25), figure. Conclusion: Elderly patients

Coenzyme Q10 and Creatine in Heart Failure: Micronutrients, Macrobenefit?

Heart failure (HF) therapy over the last 3 decades has primarily focused on neurohormonal, hemodynamic, and electrophysiologic dimensions to reduce morbidity and mortality. Considerably less emphasis has been placed on energy substrate and micronutrient deficiencies in patients with HF. Micronutrient deficiencies have been identified in the failing human heart and have been associated with defective energy metabolism in cardiac myocytes.1 Plasma and myocardial levels of various micronutrients are known to be reduced in HF patients as compared to control populations. However, considerable debate continues as to whether low levels of micronutrients, such as coenzyme Q10 or creatine, are markers of or causes for systolic heart failure.2 Coenzyme Q10 (also known as ubiquinone) and creatine are both endogenously produced and acquired in a diet higher in red meat, poultry, and fish. Coenzyme Q10 is an important mediator of mitochondrial adenosine triphosphate production, is an antioxidant, and is thought to stabilize cell membranes. Creatine is an important mediator of energy metabolism in all muscle types. Dietary supplementation with either agent increases tissue concentrations and improves delivery to the myocardium. A host of small observational studies have shown benefit for coenzyme Q10 in regard to surrogate end points like ejection fraction, cardiac index, quality of life, and exercise capacity. However large, well-designed trials of coenzyme Q10 and creatine supplementation in HF are lacking, and hard end points (such as mortality and HF hospitalizations) have not been studied. The largest trial of coenzyme Q10 supplementation in HF patients to date was observational in nature.3 A recent meta-analysis of coenzyme Q10 supplementation in HF was undertaken in 2006.4 Eleven trials were included, all of which were double-blind, prospective, and placebo-controlled. The outcome measures studied in these trials included ejection fraction, cardiac output, cardiac index, stroke volume, and stroke index. Ten trials assessed ejection fraction, which improved by 3.7% (95% confidence interval [CI] 1.6–5.8). Two trials found a significant improvement in cardiac output (0.28 L/min [95% CI 0.03–0.53]) and stroke index (5.7 mL/m2 [95% CI 1.02–10.3]). Cardiac