2024
Somatic Variants Acquired Later in Life Associated with Thoracic Aortic Aneurysms: JAK2 V617F
Waldron C, Zafar M, Ma D, Zhang H, Dykas D, Ziganshin B, Popa A, Jha A, Kwan J, Elefteriades J. Somatic Variants Acquired Later in Life Associated with Thoracic Aortic Aneurysms: JAK2 V617F. Genes 2024, 15: 883. PMID: 39062663, PMCID: PMC11276600, DOI: 10.3390/genes15070883.Peer-Reviewed Original ResearchThoracic aortic aneurysmDevelopment of thoracic aortic aneurysmAortic aneurysmJAK2 V617FMyeloproliferative neoplasmsSomatic variantsPrevalence of thoracic aortic aneurysmsDescending thoracic aortic aneurysmJAK2 V617F burdenAortic valve diseaseTarget of therapyDriver of myeloproliferative neoplasmsSurgical aortic replacementVariant allele fractionAscending thoracic aortic aneurysmAortic replacementAneurysm sizeAneurysm patientsValve diseaseVariant carriersIncreased riskJAK2 geneExome sequencing databaseAllele fractionAneurysm
2023
Evidence Accumulates: Patients with Ascending Aneurysms Are Strongly Protected from Atherosclerotic Disease
Waldron C, Zafar M, Ziganshin B, Weininger G, Grewal N, Elefteriades J. Evidence Accumulates: Patients with Ascending Aneurysms Are Strongly Protected from Atherosclerotic Disease. International Journal Of Molecular Sciences 2023, 24: 15640. PMID: 37958625, PMCID: PMC10650782, DOI: 10.3390/ijms242115640.Peer-Reviewed Original ResearchConceptsThoracic aortic aneurysmAortic aneurysmCarotid intima-media thicknessLow-density lipoprotein levelsIntima-media thicknessDevelopment of atherosclerosisMatrix metalloproteinase proteinsAscending aneurysmAortic calcificationAtherosclerotic diseaseLipoprotein levelsMyocardial infarctionLeading causeAneurysmsMetalloproteinase proteinsGrowth factorProtective relationshipDiseasePossible mechanismCurrent understandingMorbidityInfarctionAtherosclerosisPatientsPathophysiology“Big Data” Analyses Underlie Clinical Discoveries at the Aortic Institute
Zafar M, Ziganshin B, Li Y, Ostberg N, Rizzo J, Tranquilli M, Mukherjee S, Elefteriades J. “Big Data” Analyses Underlie Clinical Discoveries at the Aortic Institute. The Yale Journal Of Biology And Medicine 2023, 96: 427-440. PMID: 37780996, PMCID: PMC10524815, DOI: 10.59249/lndz2964.Peer-Reviewed Original ResearchConceptsBig dataArtificial intelligenceThoracic aortic aneurysmArtificial intelligence techniquesData setsAortic aneurysmLarge clinical data setsIntelligence techniquesAdvanced machineYale-New Haven HospitalClinical data setsAortic aneurysm patientsAortic root dilatationBicuspid aortic valveProspective clinical databaseNew Haven HospitalLarge genetic data setsIntelligenceSequencing filesThoracoabdominal aortaAortic dilatationMale patientsRisk prognosticationRoot dilatationSurgical treatmentSafety of cerebrospinal fluid drainage in descending and thoracoabdominal aortic replacement surgery
Nasir A, Zafar M, Abdelbaky M, Papanikolaou D, Ellauzi H, Shaikh M, Ziganshin B, Elefteriades J. Safety of cerebrospinal fluid drainage in descending and thoracoabdominal aortic replacement surgery. Annals Of Cardiothoracic Surgery 2023, 12: 47683-47483. PMID: 37817851, PMCID: PMC10561341, DOI: 10.21037/acs-2023-scp-0121.Peer-Reviewed Original ResearchCerebrospinal fluid drainageThoracoabdominal aortic aneurysmsSpinal cord injuryOpen surgical repairSurgical repairElectronic health recordsAortic aneurysmFluid drainagePersistent cerebrospinal fluid leakageAortic replacement surgeryMean hospital lengthSpinal cord protectionRetrospective chart reviewThoracic aortic aneurysmThoracoabdominal aortic diseaseCerebrospinal fluid leakageLong-term survivalHospital mortalityHospital lengthPermanent paraplegiaChart reviewMinor complicationsPatient agePostoperative courseCutaneous fistulaNatural History and Intervention Thresholds for Ascending Thoracic Aortic Aneurysm—Not an Easy Nut to Crack
Zafar M, Elefteriades J. Natural History and Intervention Thresholds for Ascending Thoracic Aortic Aneurysm—Not an Easy Nut to Crack. JAMA Cardiology 2023, 8: 512-512. PMID: 36920367, DOI: 10.1001/jamacardio.2023.0153.Peer-Reviewed Original ResearchConceptsThoracic aortic aneurysmAscending Thoracic Aortic AneurysmsAortic aneurysmNatural historyIntervention thresholdBicuspid aortopathy does not require earlier surgical intervention
Zafar M, Wu J, Vinholo T, Li Y, Papanikolaou D, Ellauzi H, Ostberg N, Kalyanasundaram A, Kalogerakos P, Mukherjee S, Ziganshin B, Rizzo J, Elefteriades J. Bicuspid aortopathy does not require earlier surgical intervention. Journal Of Thoracic And Cardiovascular Surgery 2023, 168: 760-769.e4. PMID: 37088130, DOI: 10.1016/j.jtcvs.2023.04.017.Peer-Reviewed Original ResearchBicuspid aortic valveAdverse aortic eventsEvent-free survivalAortic eventsAortic sizeAortic diameterAortic growth rateEarly surgical interventionLong-term complicationsRisk of complicationsThoracic aortic aneurysmAortic deathComplication rateSurgical repairOperative repairProphylactic surgerySurgical interventionAortic aneurysmAortic valveSurgical correctionBicuspid aortopathyRelative riskExpert centersTAV-ATAAPatientsAortic Size at the Time of Type A and Type B Dissections
Perez Z, Zafar M, Velasco J, Sonsino A, Ellauzi H, John C, Kalyanasundaram A, Ziganshin B, Elefteriades J. Aortic Size at the Time of Type A and Type B Dissections. The Annals Of Thoracic Surgery 2023, 116: 262-268. PMID: 37062339, DOI: 10.1016/j.athoracsur.2023.03.037.Peer-Reviewed Original ResearchConceptsType B dissectionTime of dissectionB dissectionAortic sizeAortic diameterBicuspid aortic valveThoracic aortic aneurysmAortic interventionAortic dissectionSurgical interventionAortic aneurysmFemale sexAortic valveThoracic aortaProphylactic repairUnadjusted regressionLeft shiftLogistic regressionDissectionNew guidelinesType ASize criteriaOddsInterventionTime of typesNonsize Criteria for Surgical Intervention on the Ascending Thoracic Aorta
Elefteriades J, Ziganshin B, Zafar M. Nonsize Criteria for Surgical Intervention on the Ascending Thoracic Aorta. Aorta 2023, 11: 071-086. PMID: 37172942, PMCID: PMC10232037, DOI: 10.1055/s-0043-1766114.Peer-Reviewed Original ResearchThoracic aortic aneurysmSurgical interventionAortic eventsAortic dissectionSubsternal chest painBlood pressure elevationBicuspid aortic valveAfferent neural pathwaysAscending thoracic aortaEmission Tomography ImagingPositron emission tomography (PET) imagingAortic stressAscending aneurysmAortic surgeryChest painEarly surgerySpecific genetic aberrationsHigh rupture riskMural thickeningRoot dilatationBicuspid valvePressure elevationAneurysm patientsAortic aneurysmAortic riskFate of the unoperated ascending thoracic aortic aneurysm: three-decade experience from the Aortic Institute at Yale University
Wu J, Zafar M, Liu Y, Chen J, Li Y, Ziganshin B, Ellauzi H, Mukherjee S, Rizzo J, Elefteriades J. Fate of the unoperated ascending thoracic aortic aneurysm: three-decade experience from the Aortic Institute at Yale University. European Heart Journal 2023, 44: 4579-4588. PMID: 36994934, DOI: 10.1093/eurheartj/ehad148.Peer-Reviewed Original ResearchConceptsAdverse aortic eventsThoracic aortic aneurysmAortic sizeAortic aneurysmCox regressionAortic growthRisk factorsSignificant independent risk factorsMultivariable Cox regressionIndependent risk factorCohort of patientsUnivariable Cox regressionSignificant protective factorAortic deathATAA patientsAortic eventsPrimary endpointSurgical interventionThree-decade experienceNatural historyYearly riskProtective factorsAneurysmsPatientsIntervention criteriaKIF6 Trp719Arg Genetic Variant Increases Risk for Thoracic Aortic Dissection
Velasco J, Li Y, Ziganshin B, Zafar M, Rizzo J, Ma D, Zang H, Kalyanasundaram A, Elefteriades J. KIF6 Trp719Arg Genetic Variant Increases Risk for Thoracic Aortic Dissection. Genes 2023, 14: 252. PMID: 36833179, PMCID: PMC9956195, DOI: 10.3390/genes14020252.Peer-Reviewed Original ResearchConceptsThoracic aortic aneurysmAortic dissectionOdds ratioVariant statusArg allele carriersThoracic aortic dissectionOccurrence of ADAortic sizeArg alleleMarked adverse impactTAA patientsAortic aneurysmClinical assessmentSurgical decisionAllele carriersIncrease riskVariant patientsArg carriersPilot studyDissectionImportant intracellular functionsConfirmatory findingsPatientsAneurysmsPresent study
2022
Rapid growth of thoracic aortic aneurysm: Reality or myth?
Sonsino A, Ellauzi H, Ziganshin BA, Zafar MA, Elefteriades JA. Rapid growth of thoracic aortic aneurysm: Reality or myth? Journal Of Thoracic And Cardiovascular Surgery 2022, 167: 1206-1213. PMID: 36028356, DOI: 10.1016/j.jtcvs.2022.06.021.Peer-Reviewed Original ResearchRapid aortic growthAortic growthAortic growth rateProphylactic surgical interventionThoracic aortic aneurysmPrompt surgeryInoperable patientsAortic diseaseSurgical interventionAortic measurementsAortic aneurysmPositivity ratePatientsAortaExperienced cliniciansGenetic findingsAortic imagesAneurysmsAmerican AssociationPotential sourceSurgeryAscendingCliniciansDiseaseSurvivorsClinical Experience with “Stand-Alone” Elephant Trunk Procedure for Descending Aortic Aneurysms
Kumbasar U, Zafar MA, Ziganshin BA, Elefteriades JA. Clinical Experience with “Stand-Alone” Elephant Trunk Procedure for Descending Aortic Aneurysms. Aorta 2022, 10: 52-56. PMID: 35933985, PMCID: PMC9357495, DOI: 10.1055/s-0042-1743535.Peer-Reviewed Original ResearchElephant trunk procedureAortic replacementElephant trunkAortic aneurysmLanding zoneDeep hypothermic circulatory arrestHypothermic circulatory arrestProximal landing zoneThoracic aortic aneurysmStage 1Subclavian levelCardiac causesCirculatory arrestEndovascular approachSubclavian arteryEndovascular treatmentLeft carotidSuitable landing zoneClinical experiencePatientsAneurysmsProximal foundationAortaStrokeMortalityBovine Aortic Arch: A Result of Chance or Mandate of Inheritance?
Shang M, Vinholo TF, Buntin J, Zafar MA, Ziganshin BA, Elefteriades JA. Bovine Aortic Arch: A Result of Chance or Mandate of Inheritance? The American Journal Of Cardiology 2022, 172: 115-120. PMID: 35321803, PMCID: PMC9978865, DOI: 10.1016/j.amjcard.2022.02.030.Peer-Reviewed Original ResearchConceptsBovine archThoracic aortic aneurysmAortic aneurysmThoracic aortic aneurysm diseaseAortic arch configurationAortic aneurysm diseaseSecond-degree relativesInstitutional databaseAneurysm diseaseChest imagingPatientsAneurysmsAvailable scansGenetic mutationsArch resultsArchArch configurationFamily membersSample populationProbandsScansMagnetic resonanceResult of chancePrevious studiesChestAortic gene dictionary in the precision medicine era—update from the Aortic Institute at Yale New Haven
Papanikolaou D, Zafar MA, Ziganshin BA, Elefteriades JA. Aortic gene dictionary in the precision medicine era—update from the Aortic Institute at Yale New Haven. Indian Journal Of Thoracic And Cardiovascular Surgery 2022, 38: 14-23. PMID: 35463698, PMCID: PMC8980985, DOI: 10.1007/s12055-021-01308-9.Peer-Reviewed Original ResearchPhenotyping Zebrafish Mutant Models to Assess Candidate Genes Associated with Aortic Aneurysm
Prendergast A, Ziganshin BA, Papanikolaou D, Zafar MA, Nicoli S, Mukherjee S, Elefteriades JA. Phenotyping Zebrafish Mutant Models to Assess Candidate Genes Associated with Aortic Aneurysm. Genes 2022, 13: 123. PMID: 35052463, PMCID: PMC8775119, DOI: 10.3390/genes13010123.Peer-Reviewed Original ResearchConceptsAortic aneurysmSkeletal abnormalitiesThoracic aortic aneurysmWhole-exome sequencingDirect microscopic assessmentSilico genetic analysisVisualized abnormalitiesTAA patientsClinical managementGeneral populationClinical practiceRoutine assessmentClinical testingCell countEvidence-based decisionsUnknown significanceUncertain significanceExperimental modelPilot studyExome sequencingAbnormalitiesMicroscopic assessmentPatientsPositive controlAneurysms
2021
Root Dilatation Is More Malignant Than Ascending Aortic Dilation
Kalogerakos PD, Zafar MA, Li Y, Mukherjee SK, Ziganshin BA, Rizzo JA, Elefteriades JA. Root Dilatation Is More Malignant Than Ascending Aortic Dilation. Journal Of The American Heart Association 2021, 10: e020645. PMID: 34238012, PMCID: PMC8483477, DOI: 10.1161/jaha.120.020645.Peer-Reviewed Original ResearchConceptsMid-ascending aortaAortic rootAdverse eventsRoot dilatationNatural historyAcute aortic dissectionLong-term complicationsAortic root dilatationSignificant higher riskThoracic aortic aneurysmSerious risk factorAortic interventionAortic dilatationAortic dilationAortic dissectionAortic aneurysmInternational registryRisk factorsAortic segmentsGuideline criteriaHigh riskExpert centersAortaShort statureResult diametersRisk reduction and pharmacological strategies to prevent progression of aortic aneurysms
Weininger G, Chan SM, Zafar M, Ziganshin BA, Elefteriades JA. Risk reduction and pharmacological strategies to prevent progression of aortic aneurysms. Expert Review Of Cardiovascular Therapy 2021, 19: 619-631. PMID: 34102944, DOI: 10.1080/14779072.2021.1940958.Peer-Reviewed Original ResearchConceptsAortic aneurysmAbdominal aortic aneurysmß-blockersAngiotensin II receptor blockersAngiotensin-converting enzyme inhibitorAnti-platelet medicationDifferent pharmacologic therapiesII receptor blockersAortic aneurysm patientsThoracic aortic aneurysmRisk reductionAortic aneurysm growthPharmacologic managementReceptor blockersPharmacologic therapyMedical therapySurgical interventionAneurysm patientsMiscellaneous drugsAneurysm diseasePharmacological strategiesSyndrome patientsMarfan syndromeEnzyme inhibitorsAneurysmsAccuracy of the “Thumb-Palm Test” for Detection of Ascending Aortic Aneurysm
Blumel R, Patel K, Rizzo JA, Mok S, Barrett A, Wu J, Zafar MA, Ziganshin BA, Elefteriades JA. Accuracy of the “Thumb-Palm Test” for Detection of Ascending Aortic Aneurysm. The American Journal Of Cardiology 2021, 150: 114-116. PMID: 34020772, DOI: 10.1016/j.amjcard.2021.03.041.Peer-Reviewed Original ResearchConceptsAscending aortic diameterAortic aneurysmTransesophageal echocardiographyPalm testAortic diameterIntra-operative transesophageal echocardiographyAscending Aortic AneurysmThoracic aortic aneurysmStandard physical examinationThousands of patientsVariety of disordersAscending aneurysmCardiac surgeryAneurysm patientsPhysical examinationPositive testPatientsNegative testAneurysmsHigher likelihoodNegative resultsAscAASubstantial likelihoodSignsEchocardiographyInterstage mortality in two‐stage elephant trunk surgery
Saeyeldin A, Gryaznov AA, Zafar MA, Wu J, Mukherjee S, Vallabhajosyula P, Ziganshin BA, Elefteriades JA. Interstage mortality in two‐stage elephant trunk surgery. Journal Of Cardiac Surgery 2021, 36: 1882-1891. PMID: 33634489, DOI: 10.1111/jocs.15441.Peer-Reviewed Original ResearchConceptsExtensive thoracic aortic aneurysmThoracic aortic aneurysmInterstage intervalStage IIET procedureStage II procedureHospital mortalityInterstage mortalityMega aortaTrunk surgeryAortic ruptureOverall mortalitySingle surgeonAortic diseasePatient groupAortic aneurysmPatientsStage IMortalityCumulative mortalityI procedureInterval periodRupturePrior studiesSafetySafety of perioperative cerebrospinal fluid drain as a protective strategy during descending and thoracoabdominal open aortic repair
Abdelbaky M, Papanikolaou D, Zafar MA, Ellauzi H, Shaikh M, Ziganshin BA, Elefteriades JA. Safety of perioperative cerebrospinal fluid drain as a protective strategy during descending and thoracoabdominal open aortic repair. JTCVS Techniques 2021, 6: 1-8. PMID: 34318127, PMCID: PMC8300913, DOI: 10.1016/j.xjtc.2020.12.039.Peer-Reviewed Original ResearchCerebrospinal fluid drainsThoracoabdominal aortic aneurysmsOpen aortic repairAortic repairAortic aneurysmFluid drainsPersistent CSF leakageMean hospital lengthMean patient ageLate clinical resultsThoracic aortic aneurysmLong-term survivalHospital mortalityPostoperative paraplegiaHospital lengthPermanent paraplegiaPatient ageCutaneous fistulaOpen repairTransient paresisSurgical managementIntracranial hemorrhageClinical resultsLumbar pressureIntracranial pressure