Asif Mohammed

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Chapters

• Mohammed, A. N., & Potchileev, I. (2023).

  Percutaneous Valve Repair/Replacement

  . In Advanced Anesthesia Review. doi:10.1093/med/9780197584521.003.0137
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  Abstract Percutaneous valve replacement and repair have become a rapidly emerging treatment modality in the field of cardiology and cardiothoracic surgery due to the less invasive nature and the ability to prolong the lives of patients with significant comorbidities. When percutaneous techniques were introduced, most patients were treated under general anesthesia. However, studies and experience demonstrated over time that moderate sedation led to improved outcomes in the majority of patients. Methods to repair the valve include balloon valvuloplasty, edge-to-edge repair, annuloplasty, or complete valve replacement. Physical approaches can be performed via transfemoral, subclavian, axillary, radial, transcarotid, or, less commonly, transapical routes. Hemodynamic goals vary according to the type of valvular lesion being repaired, but the anesthesiologist should strive to maintain sinus rhythm, preload and afterload, and contractility of the heart through inotropic support.
• Potchileev, I., Дорошенко, М. В., & Mohammed, A. N. (2015).

  Positive Pressure Ventilation

  . In Stat Pearls Publishing. doi:10.1007/978-3-642-29613-0_101183

Journals/Publications

• Aljure, O., Fischer, C., Jain, P., & Mohammed, A. N. (2022).

  Current and Investigational Transcatheter Mitral Valve Replacement Systems: A Narrative Review for the Cardiac Anesthesiologist

  . Journal of Cardiothoracic and Vascular Anesthesia. doi:10.1053/j.jvca.2022.05.019
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  TRANSCATHETER MITRAL VALVE REPLACEMENT (TMVR) systems with bioprosthetic transcatheter heart valves (THV), originally designed for the implantation in the aortic position, have gained widespread acceptance in recent years despite the absence of discrete society recommendations. Numerous dedicated TMVR systems are also currently under investigation. Cardiac anesthesiologists working alongside interventional cardiologists will be expected to provide intraprocedural care, and, potentially, echocardiographic guidance for the current and future TMVR systems.
• Ghodsizad, A., Grant, A. A., Mohammed, A. N., Navas-Blanco, J. R., Ruhparwar, A., Mirsaeidi, M., Hare, J. M., DeMarchena, E., & Loebe, M. (2022).

  Bilateral pneumonectomy and lung transplant for COVID-19–induced respiratory failure

  . JYCVS. doi:10.1016/j.xjtc.2022.01.019
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  Central MessageBilateral pneumonectomy with a novel cannulation strategy followed by lung transplantation can be a rescue measure for those patients with severe, irreversible lung damage caused by SARS-CoV-2.See Commentary on page 288. Bilateral pneumonectomy with a novel cannulation strategy followed by lung transplantation can be a rescue measure for those patients with severe, irreversible lung damage caused by SARS-CoV-2. See Commentary on page 288. There are few published descriptions of lung transplant for COVID-19 (Table E1). Here, we describe a COVID-19 polymerase chain reaction (PCR) test-positive patient who underwent bilateral pneumonectomy before lung transplant using a novel cannulation strategy. Institutional review board approval was not required for this case study and the patient provided consent. A 37 year-old woman was admitted with COVID-19 infection required intubation on day 6, and venovenous (VV) extracorporeal membrane oxygenation (ECMO) on day 8. She was treated for Stenotrophomonas superinfection. On day 20, she was enrolled in a trial for application of stem cells via the ECMO circuit, which occurred without complication. For the next several weeks, she required full ECMO with an inability to wean. On day 37, due to persistent positivity (based on PCR test), a cycle threshold (Ct) was obtained and resulted at 30, indicating she may still have a high viral load,1Prasad A. Ghodsizad A. Brehm C. Kozak M. Koerner M. El Banayosy A. et al.Refractory pulmonary edema and upper body hypoxemia during veno-arterial extracorporeal membrane oxygenation—a case for atrial septostomy.Artif Organs. 2018; 41: 664-669Crossref Scopus (17) Google Scholar which could complicate transplantation. We elected to perform pneumonectomy before transplant to reduce or eliminate the viral reservoir. She was listed for transplant on day 39, and 3 days later underwent bilateral pneumonectomy at which time her VV ECMO was converted to central venoarterial ECMO using a novel cannulation strategy taking advantage of the patient's known patent foramen ovale (PFO). Venous drainage occurred with 3 cannulas: 1 via the right internal jugular vein and 1 from the left femoral vein. The third cannula was placed in the right pulmonary artery (PA). All blood was returned to a single ECMO device using Y-connectors. The blood was then returned to the patient via an arterial cannula into the ascending aorta. Filling of the left heart occurred primarily from the Thebesian veins (Figure 1). Postoperative echocardiogram demonstrated a decompressed right and left ventricle. There was no evidence of mitral regurgitation and even with the left to right shunt induced by ECMO and the PFO, the left ventricle did fill and was able to expel blood into the aorta with inotropic support. Her chest was closed on postoperative day 2. On day 48, donor lungs were found. The left lung was not appropriate for transplantation but fortunately the right lung was oversized. Based on the length of time she had been on ECMO and now 5 days after bilateral pneumonectomy, the multidisciplinary team believed it was prudent to proceed with single lung transplant. She was converted to VV ECMO and her PA cannula was removed. She tolerated routine postoperative immunosuppression and no additional antiviral therapy was added. Her posttransplant PCR test result converted to negative and remained so (Table 1). She was decannulated from ECMO approximately 8 weeks after transplant. Six months posttransplant, she was alert and oriented, off mechanical ventilation, and debilitated but participating in rehabilitation.Table 1Reverse transcription polymerase chain reaction (PCR) results over timeHospital dayPCR test resultEventDay 21PositiveDay 34PositiveDay 39Bilateral pneumonectomyDay 42Positive∗The patient turned negative immediately following her single lung transplant. We do not believe this is a result of receiving her single lung transplant, but rather the result of her bilateral pneumonectomy 5 days prior. She did have 1 PCR performed after pneumonectomy that was positive, but we do not have cycle threshold data on this specimen and cannot determine its significance.Day 45Single lung transplantDay 46NegativeDay 49NegativeDay 51NegativeDay 54NegativeDay 56NegativeDay 59NegativeDay 61NegativeDay 62Negative∗ The patient turned negative immediately following her single lung transplant. We do not believe this is a result of receiving her single lung transplant, but rather the result of her bilateral pneumonectomy 5 days prior. She did have 1 PCR performed after pneumonectomy that was positive, but we do not have cycle threshold data on this specimen and cannot determine its significance. Open table in a new tab Substituting the lungs with mechanical support requires a thoughtful strategy that prevents stasis and distention of the heart. Ligation of the PA removes the right heart outlet, and ligation of the pulmonary veins compromises left heart preload. We maintained flow across the right heart by inserting a cannula into the right PA to allow for right ventricle ejection and reduce afterload. For the left heart, we relied on the Thebesian veins for preload. After months of critical illness and refractory hypoxia, our patient's left heart function was reduced with an ejection fraction single lung100PCR, Polymerase chain reaction; ECMO, extracorporeal membrane oxygenation. Open table in a new tab PCR, Polymerase chain reaction; ECMO, extracorporeal membrane oxygenation.
• Yu, S., Peffley, S., Fabbro, M., & Mohammed, A. N. (2022).

  A Narrative Review of the 2020 Guidelines for Use of Transesophageal Echocardiography to Assist with Surgical Decision- Making by the Cardiac Anesthesiologist in the Operating Room

  . JCVA. doi:10.1053/j.jvca.2021.02.011
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  Transesophageal echocardiography (TEE) has become an integral part in helping to diagnose, manage, and assess interventions in the cardiac operating room. Multiple guidelines have been created by the American Society of Echocardiography for performing a TEE examination for different cardiac pathologies. The operating room can provide unique challenges when performing a TEE examination, which include hemodynamic instability, time constraints, and use of general anesthesia. The Guideline for the use of TEE to assist in surgical decision- making in the operating room recently was published to provide a starting protocol for conducting a TEE examination for different cardiac surgeries and for using the information obtained to interpret and to communicate findings to the surgical team. This present narrative review focuses and expands upon the relevant portions for the cardiac anesthesiologist.
• Aljure, O. D., Gonzalez, V. H., Miranda, J., Mohammed, A. N., & Navas-Blanco, J. R. (2021).

  Supra-systemic pulmonary hypertension after complicated percutaneous mitral balloon valvuloplasty: a case report and review of literature

  . BMC Anesthesiology. doi:10.1186/s12871-021-01481-9
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  The World Symposium of Pulmonary Hypertension in 2018, updated the definition of pulmonary hypertension (PH) as mean pulmonary artery pressures (PAP) > 20 mmHg. Pulmonary venous hypertension secondary to left-heart disease, constitutes the most common cause of PH, and the determination of a co-existent pre-capillary (primary) PH becomes paramount, particularly at the moment of evaluating and managing patients with heart failure. Pulmonary artery pressures above the systemic pressures define supra-systemic PH and generally leads to frank right ventricular failure and high mortality.We present the perioperative management of a patient with rheumatic mitral valve disease, initially found to have severe PH due to pulmonary venous hypertension, who underwent percutaneous mitral balloon valvuloplasty complicated with mitral chordae rupture, severe mitral regurgitation and supra-systemic PH. Multiple medical therapies and an intra-aortic balloon pump were used as means of non-surgical management of this complication.This case report illustrates the perioperative implications of combined pre- and post-capillary PH and supra-systemic PH, as this has not been widely discussed in previous literature. A thorough literature review of the clinical characteristics of PH, methods to determine co-existent pre- and post-capillary PH components, as well as concomitant right ventricular failure is presented. Severe PH has known detrimental effects on the hemodynamic status of patients, which can ultimately lead to a decrease in effective cardiac output and poor tissue perfusion.
• Clifford, H., Eden, C., Mohammed, A. N., Wang, A. Y., & Yim, P. J. (2021).

  Carotid approach to anterior circulation thromboembolectomy in an adult with failing fontan physiology: a case report

  . BMC Anesthesiology. doi:10.1186/s12871-021-01364-z
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  Anesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion.We describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. She was admitted to the hospital almost 29 years after her initial surgeries to undergo workup for a dual heart and liver transplant in the context of a failing Fontan with elevated end diastolic pressures, NYHA III heart failure symptoms, and liver cirrhosis from congestive hepatopathy. During the workup in the context of holding anticoagulation for invasive procedures, she developed a middle cerebral artery (MCA) stroke requiring a thromboembolectomy via left carotid artery approach. DISCUSSION AND CONCLUSIONS: This case posed many challenges to the anesthesiologist including airway control, hemodynamic and cardiopulmonary monitoring, evaluation of perfusion, vascular access, and management of anticoagulation in an adult patient in heart and liver failure with Fontan physiology undergoing thromboembolectomy for MCA embolic stroke.
• Mohammed, A. N., Lifgren, S. A., Fabbro, M., & Jain, P. (2021).

  A Narrative Review for Cardiac Anesthesiologists of the 2019 Expert Consensus on Operator and Institutional Recommendations for Transcatheter Mitral Valve Intervention

  . JCVA. doi:10.1053/j.jvca.2020.11.023
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  US Food and Drug Administration approval of the edge-to-edge clip repair device (MitraClip; Abbott Laboratories, Abbott Park, IL) in 2013 led to wide adoption of the device for treatment of severe primary mitral regurgitation in patients unsuitable for surgery. Demonstration of favorable outcomes in the setting of secondary mitral regurgitation by the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial in 2019 provided an additional impetus to the transcatheter mitral interventional program. The role of the cardiac anesthesia service also is expanding to echocardiography services for these patients outside of the procedure room. Moreover, cardiac anesthesiologists serve on the multidisciplinary team that is involved in clinical decision-making pertaining to patient selection, optimization, and intervention. This document has direct implications for the cardiac anesthesiologist involved in the care of these patients because a broader understanding of pertinent issues is essential to function as an effective clinical member within the multidisciplinary team. As such, this narrative review serves to highlight the salient features of the “2019 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Mitral Valve Intervention: A Joint Report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons,” focuses on issues pertinent to the cardiac anesthesiologist, and provides an outline for the clinical context and evolution of transcatheter mitral valve interventions. US Food and Drug Administration approval of the edge-to-edge clip repair device (MitraClip; Abbott Laboratories, Abbott Park, IL) in 2013 led to wide adoption of the device for treatment of severe primary mitral regurgitation in patients unsuitable for surgery. Demonstration of favorable outcomes in the setting of secondary mitral regurgitation by the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial in 2019 provided an additional impetus to the transcatheter mitral interventional program. The role of the cardiac anesthesia service also is expanding to echocardiography services for these patients outside of the procedure room. Moreover, cardiac anesthesiologists serve on the multidisciplinary team that is involved in clinical decision-making pertaining to patient selection, optimization, and intervention. This document has direct implications for the cardiac anesthesiologist involved in the care of these patients because a broader understanding of pertinent issues is essential to function as an effective clinical member within the multidisciplinary team. As such, this narrative review serves to highlight the salient features of the “2019 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Mitral Valve Intervention: A Joint Report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons,” focuses on issues pertinent to the cardiac anesthesiologist, and provides an outline for the clinical context and evolution of transcatheter mitral valve interventions.