2024
Intimomedial tears of the aorta heal by smooth muscle cell-mediated fibrosis without atherosclerosis
Hassab A, Hur D, Vallabhajosyula P, Tellides G, Assi R. Intimomedial tears of the aorta heal by smooth muscle cell-mediated fibrosis without atherosclerosis. JCI Insight 2024, 9: e172437. PMID: 38592807, PMCID: PMC11141924, DOI: 10.1172/jci.insight.172437.Peer-Reviewed Original ResearchConceptsDepartment of SurgerySmooth muscle cellsCellular response to injuryResponse to injuryImmunofluorescence confocal microscopyVessel wall repairPrimary lesionAscending aortaConduit functionAneurysmal diseaseDense fibrosisRadiological signsMural hematomaTear progressionMuscle cellsNon-hemorrhagicErythrocyte extravasationWall repairAortaTear completionInduce atherosclerosisHealed lesionsScattered leukocytesMinimal injuryConclusionThese findings
2023
One-Year Results of a Low-Profile Endograft in Acute, Complicated Type B Aortic Dissection
Rossi P, Desai N, Malaisrie S, Lyden S, Nassiri N, Reece T, Adams J, Moanie S, Shults C, Investigators R, Vallabhajosyula P, Panneton J, Kumins N, Sharafuddin M, Toursavadkohi S, Ullery B, Duwayri Y, Han S, Rahimi S, Meisner R, Dryjski M, Starnes B, Fukuhara S, Cheema M. One-Year Results of a Low-Profile Endograft in Acute, Complicated Type B Aortic Dissection. The Annals Of Thoracic Surgery 2023, 117: 336-343. PMID: 37769702, DOI: 10.1016/j.athoracsur.2023.08.035.Peer-Reviewed Original ResearchConceptsType B aortic dissectionComplicated type B aortic dissectionMajor adverse eventsB aortic dissectionAdverse eventsCause mortalityAortic dissectionTechnical successEnd pointAortic diameter growthFalse lumen perfusionPrimary end pointSecondary end pointsKaplan-Meier analysisOne-year resultsParaplegia/paraparesisLong-term outcomesUnited States CentersMedian hospitalizationAortic expansionPatency lossRenal failurePivotal trialsRetrograde dissectionIliac artery
2018
Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection
Kreibich M, Bavaria JE, Branchetti E, Brown CR, Chen Z, Khurshan F, Siki M, Vallabhajosyula P, Szeto WY, Desai ND. Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection. The Annals Of Thoracic Surgery 2018, 107: 1174-1180. PMID: 30444990, DOI: 10.1016/j.athoracsur.2018.09.065.Peer-Reviewed Original ResearchMeSH KeywordsAgedAortic Aneurysm, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationCohort StudiesCoronary Artery BypassCoronary Artery DiseaseCoronary CirculationFemaleGermanyHeart Arrest, InducedHospital MortalityHospitals, UniversityHumansKaplan-Meier EstimateLength of StayMaleMiddle AgedPostoperative ComplicationsPrognosisRetrospective StudiesRisk AssessmentStatistics, NonparametricSurvival AnalysisTreatment OutcomeConceptsCoronary artery malperfusionType B patientsType C patientsAntegrade cardioplegiaC patientsB patientsAortic dissectionCoronary ostiumDissection flapCA diseaseA Aortic DissectionType C lesionsManagement of patientsType B lesionsLong-term survivalCA bypassBypass GraftingPerioperative mortalityC lesionsComplete avulsionB lesionsLandmark analysisMalperfusionSuture repairPatientsFunctional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring
Ko H, Bavaria JE, Habertheuer A, Augoustides JG, Siki MA, Freas M, Komlo C, Milewski K, Desai ND, Szeto WY, Vallabhajosyula P. Functional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring. The Annals Of Thoracic Surgery 2018, 107: 68-75. PMID: 30086284, DOI: 10.1016/j.athoracsur.2018.06.056.Peer-Reviewed Original ResearchConceptsSubcommissural annuloplastyAortic insufficiencyAortic valve repairTransvalvular gradientValve repairAortic ringsLeaflet prolapseAnnular stabilizationVentricular outflow tract diameterBicuspid aortic valve patientsBicuspid aortic valve repairOutflow tract diameterSevere aortic insufficiencyMean transvalvular gradientIntraoperative transesophageal echocardiographyAortic valve patientsLV outflow tractAortic root complexPostprocedure outcomesValve patientsTract diameterFunctional outcomeLV dimensionsTransesophageal echocardiographyOutflow tractPredictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair
Habertheuer A, Milewski RK, Bavaria JE, Siki M, Freas M, Desai N, Szeto W, Ram C, Hu R, Vallabhajosyula P. Predictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair. The Annals Of Thoracic Surgery 2018, 106: 1316-1324. PMID: 30055138, DOI: 10.1016/j.athoracsur.2018.06.026.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAdultAgedAortic ValveAortic Valve InsufficiencyBicuspid Aortic Valve DiseaseCardiac Valve AnnuloplastyDatabases, FactualFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHumansLogistic ModelsMaleMiddle AgedPredictive Value of TestsRecurrenceReoperationRetrospective StudiesRisk AssessmentSurvival RateTreatment OutcomeOutcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients
Kreibich M, Rylski B, Bavaria JE, Branchetti E, Dohle D, Moeller P, Vallabhajosyula P, Szeto WY, Desai ND. Outcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients. The Annals Of Thoracic Surgery 2018, 106: 491-497. PMID: 29673638, DOI: 10.1016/j.athoracsur.2018.03.035.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAortic AneurysmAortic DissectionBody Mass IndexBody WeightCohort StudiesComorbidityFemaleHospital MortalityHumansLogistic ModelsMaleMiddle AgedObesity, MorbidOdds RatioPostoperative ComplicationsPrognosisReference ValuesRetrospective StudiesRisk AssessmentSurvival AnalysisTreatment OutcomeConceptsAortic dissection type AMorbidly obese patientsNormal weight patientsObese patientsSurgical repairWeight patientsDistal aortic repairImmediate surgical approachMore obese patientsCalculated blood volumeBody mass indexIntensive care unitLength of stayType AHospital mortalityHospital stayPostoperative complicationsAortic repairPostoperative outcomesCare unitClinical featuresClinical presentationMass indexNormal weightAdverse outcomesTricuspid valve endocarditis in the era of the opioid epidemic
Wallen TJ, Szeto W, Williams M, Atluri P, Arnaoutakis G, Fults M, Sultan I, Desai N, Acker M, Vallabhajosyula P. Tricuspid valve endocarditis in the era of the opioid epidemic. Journal Of Cardiac Surgery 2018, 33: 260-264. PMID: 29663522, DOI: 10.1111/jocs.13600.Peer-Reviewed Original ResearchConceptsTricuspid valve endocarditisOpioid epidemicTricuspid endocarditisValve endocarditisRight heart endocarditisThirty-day mortalityTricuspid valve replacementCommon causative agentIndex hospitalizationRenal failureValve replacementSurgical volumeInstitutional experienceCommon isolatesExclusion criteriaEndocarditisAverage agePatientsStudy periodCausative agentStaphylococcus aureusEpidemicFivefold increaseReoperationHospitalizationHemodynamic Effects of Valve Asymmetry in Sapien 3 Transcatheter Aortic Valves.
Mangels DR, Siki M, Menon R, Bavaria J, Anwaruddin S, Giri J, Desai N, Szeto WY, Vallabhajosyula P, Herrmann HC. Hemodynamic Effects of Valve Asymmetry in Sapien 3 Transcatheter Aortic Valves. Journal Of Invasive Cardiology 2018, 30: 138-143. PMID: 29610444.Peer-Reviewed Original ResearchConceptsStructural valve deteriorationTranscatheter aortic valve replacementSAPIEN 3 valveParavalvular leakTransthoracic echocardiogramAortic insufficiencySAPIEN 3 transcatheter aortic valveAortic valve gradientSapien 3 prosthesisAortic valve replacementRetrospective cohort analysisTranscatheter aortic valveAI severityValve gradientAnnular calcificationHemodynamic effectsValve replacementValve deteriorationSmall prosthesisSingle institutionAortic valveAV gradientCohort analysisHigh incidenceSignificant differencesAssociation of Tricuspid Regurgitation With Transcatheter Aortic Valve Replacement Outcomes: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
McCarthy FH, Vemulapalli S, Li Z, Thourani V, Matsouaka RA, Desai ND, Kirtane A, Anwaruddin S, Williams ML, Giri J, Vallabhajosyula P, Li RH, Herrmann HC, Bavaria JE, Szeto WY. Association of Tricuspid Regurgitation With Transcatheter Aortic Valve Replacement Outcomes: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. The Annals Of Thoracic Surgery 2018, 105: 1121-1128. PMID: 29502934, DOI: 10.1016/j.athoracsur.2017.11.018.Peer-Reviewed Original ResearchConceptsTranscatheter aortic valve replacementHeart failure readmissionCardiology Transcatheter Valve Therapy RegistryThoracic Surgeons/American CollegeTranscatheter Valve Therapy RegistrySevere TRVentricular ejection fractionTricuspid regurgitationMild TRRisk patientsEjection fractionTR severityAmerican CollegeEffectiveness of TAVRInhospital major adverse cardiac eventsTranscatheter Aortic Valve Replacement OutcomesModerate TRMajor adverse cardiac eventsTricuspid regurgitation severityAdverse cardiac eventsAortic valve replacementHigh-risk patientsLow-risk patientsNumber of comorbiditiesIntensive care unitPredicting Distal Aortic Remodeling After Endovascular Repair for Chronic DeBakey III Aortic Dissection
Sultan I, Siki MA, Bavaria JE, Dibble TR, Savino DC, Kilic A, Szeto W, Vallabhajosyula P, Fairman RM, Jackson BM, Wang GJ, Desai ND. Predicting Distal Aortic Remodeling After Endovascular Repair for Chronic DeBakey III Aortic Dissection. The Annals Of Thoracic Surgery 2018, 105: 1691-1696. PMID: 29391144, DOI: 10.1016/j.athoracsur.2018.01.006.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAortic Aneurysm, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationChronic DiseaseCohort StudiesComputed Tomography AngiographyFemaleHospitals, UniversityHumansImaging, Three-DimensionalLogistic ModelsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsPrognosisRetrospective StudiesRisk AssessmentSeverity of Illness IndexSex FactorsSurvival RateTreatment OutcomeConceptsDeBakey III aortic dissectionAortic remodelingAortic dissectionVisceral vesselsTotal thrombosisGreater curveExact testDistal aortic remodelingOpen aortic reconstructionPositive aortic remodelingMultivariable logistic regressionNegative predictorFisher's exact testMultivariate logistic modelTomography angiography scansWilcoxon rank sumEndovascular aortic graftingAortic centersChronic dissectionAortic reconstructionCeliac axisAortic graftingEndovascular repairPrimary tearAortic size
2017
The role of extracorporeal membrane oxygenator therapy in the setting of Type A aortic dissection
Sultan I, Habertheuer A, Wallen T, Siki M, Szeto W, Bavaria JE, Williams M, Vallabhajosyula P. The role of extracorporeal membrane oxygenator therapy in the setting of Type A aortic dissection. Journal Of Cardiac Surgery 2017, 32: 822-825. PMID: 29216679, DOI: 10.1111/jocs.13245.Peer-Reviewed Original ResearchConceptsPost-operative dayAortic dissectionTAAD repairECMO supportPennsylvania Health Care Cost Containment Council databaseDiagnosis/procedure codesType A Aortic DissectionFirst post-operative dayAcute cardiopulmonary failurePost-cardiotomy shockSame hospital visitA Aortic DissectionAcute aortic dissectionSame dayWide clinical spectrumSalvage therapyTAAD surgeryECMO implantationCardiopulmonary failureHemodynamic stabilityCardiovascular collapseOpen repairOverall mortalityMedian timeClinical spectrumConscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement
Hyman MC, Vemulapalli S, Szeto WY, Stebbins A, Patel PA, Matsouaka RA, Herrmann HC, Anwaruddin S, Kobayashi T, Desai ND, Vallabhajosyula P, McCarthy FH, Li R, Bavaria JE, Giri J. Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement. Circulation 2017, 136: 2132-2140. PMID: 28864443, DOI: 10.1161/circulationaha.116.026656.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnesthesia, GeneralAortic Valve StenosisComparative Effectiveness ResearchConscious SedationFemaleHospital MortalityHumansIntention to Treat AnalysisLength of StayMalePatient DischargePractice Patterns, Physicians'RegistriesRisk AssessmentRisk FactorsTime FactorsTranscatheter Aortic Valve ReplacementTreatment OutcomeUnited StatesConceptsTranscatheter aortic valve replacementAortic valve replacementConscious sedationIntensive care unitGeneral anesthesiaHospital lengthValve replacementProcedural successCare unitEnd-point analysisPercutaneous transfemoral transcatheter aortic valve replacementConscious Sedation Versus General AnesthesiaTransfemoral transcatheter aortic valve replacementCardiology Transcatheter Valve Therapy RegistryThoracic Surgeons/American CollegeDeath/stroke ratePacemaker/defibrillator implantationTranscatheter Valve Therapy RegistryInverse probabilityConscious sedation groupDeath/strokeTreatment-weighted adjustmentTreatment-weighted analysisLower procedural successComparative effectiveness analysisConcomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling
Sultan I, Wallen TJ, Habertheuer A, Siki M, Arnaoutakis GJ, Bavaria J, Szeto WY, Milewski R, Vallabhajosyula P. Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. Journal Of Cardiac Surgery 2017, 32: 581-592. PMID: 28795434, DOI: 10.1111/jocs.13192.Peer-Reviewed Original ResearchConceptsTrue lumen diameterTEVAR groupTrue lumenThoracic aortaLumen diameterHemiarch reconstructionAortic remodelingStent graftingOpen repairAortic diameterAcute DeBakey I aortic dissectionDeBakey I aortic dissectionFalse lumen thrombosis rateThree-dimensional computed tomography scansAortic dissection repairDeBakey I dissectionsDistal aortic remodelingTotal aortic diameterFalse lumen thrombosisAbdominal aortic diameterEndovascular stent graftingEndovascular aortic repairComputed tomography scanArch tearDeBakey ICentral cannulation strategy for extent I thoracoabdominal aneurysm repair of chronic type B aortic dissection
Hobbs RD, Wallen TJ, Komlo CM, Moeller PJ, Pochettino A, Bavaria JE, Vallabhajosyula P. Central cannulation strategy for extent I thoracoabdominal aneurysm repair of chronic type B aortic dissection. Journal Of Cardiac Surgery 2017, 32: 494-499. PMID: 28691213, DOI: 10.1111/jocs.13171.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAorta, ThoracicAortic Aneurysm, ThoracicAortic DissectionCardiopulmonary BypassCatheterization, Central VenousChronic DiseaseCirculatory Arrest, Deep Hypothermia InducedEchocardiographyFemaleFemoral ArteryHumansMaleMiddle AgedSafetySurgery, Computer-AssistedThoracotomyTreatment OutcomeVascular Surgical ProceduresConceptsChronic type B dissectionThoracoabdominal aortic aneurysmsType B dissectionExtent I thoracoabdominal aortic aneurysmLeft thoracotomy incisionCannulation strategyB dissectionGroup IIGroup IThoracotomy incisionFemoral vesselsChronic type B aortic dissectionDeep hypothermic circulatory arrestType B aortic dissectionAlternative cannulation siteCentral aortic cannulationProximal aortic reconstructionThoracoabdominal aneurysm repairB aortic dissectionCirculatory arrest timeHypothermic circulatory arrestActuarial survivalCPB timeGroin incisionTAAA repairOutcomes of Elective Aortic Hemiarch Reconstruction for Aneurysmal Disease in the Elderly
Kilic A, Arnaoutakis GJ, Bavaria JE, Sultan I, Desai ND, Vallabhajosyula P, Williams ML, Milewski RK, Szeto WY. Outcomes of Elective Aortic Hemiarch Reconstruction for Aneurysmal Disease in the Elderly. The Annals Of Thoracic Surgery 2017, 104: 1522-1530. PMID: 28648536, DOI: 10.1016/j.athoracsur.2017.03.067.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overAorta, ThoracicAortic Aneurysm, ThoracicBlood Vessel Prosthesis ImplantationCirculatory Arrest, Deep Hypothermia InducedCohort StudiesElective Surgical ProceduresFemaleGeriatric AssessmentHospital MortalityHumansMaleMiddle AgedPlastic Surgery ProceduresPostoperative CarePostoperative ComplicationsPrognosisPropensity ScoreRegistriesRetrospective StudiesRisk AssessmentSex FactorsSurvival AnalysisTreatment OutcomeConceptsModerate hypothermic circulatory arrestAntegrade cerebral perfusionHypothermic circulatory arrestHemiarch reconstructionElderly patientsAneurysmal diseaseOperative mortalityCerebral perfusionCirculatory arrestConcomitant aortic valve replacementRisk-adjusted operative mortalityCoronary artery bypassOperative mortality rateAortic valve replacementGreater comorbidity burdenLow operative mortalityOverall stroke rateSafe strategyIntensive care unitComorbidity burdenArtery bypassHospital stayRoot replacementValve replacementCare unitFate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement
Milewski RK, Habertheuer A, Bavaria JE, Siki M, Szeto WY, Krause E, Korutla V, Desai ND, Vallabhajosyula P. Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement. Journal Of Thoracic And Cardiovascular Surgery 2017, 154: 421-432. PMID: 28599977, DOI: 10.1016/j.jtcvs.2017.03.150.Peer-Reviewed Original ResearchConceptsAortic valve replacementBicuspid aortic valveAorta replacementTricuspid aortic valveValve replacementAortic valveValsalva dimensionsPreoperative sinusSinus segmentValvular morphologyValvular pathologyElective aortic valve replacementMultivariable Cox regression modelsAortic arch replacementKaplan-Meier analysisAortic valve morphologyCox regression modelAortic valvulopathyArch replacementSurgical managementAortic aneurysmAortic rootLongitudinal sinusValsalva groupPatientsLong-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy
Liang JJ, Betensky BP, Muser D, Zado ES, Anter E, Desai ND, Callans DJ, Deo R, Frankel DS, Hutchinson MD, Lin D, Riley MP, Schaller RD, Supple GE, Santangeli P, Acker MA, Bavaria JE, Szeto WY, Vallabhajosyula P, Marchlinski FE, Dixit S. Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy. EP Europace 2017, 20: e30-e41. PMID: 28402404, DOI: 10.1093/europace/eux029.Peer-Reviewed Original ResearchConceptsNon-ischemic cardiomyopathyRadiofrequency catheter ablationLong-term outcomesSurgical ablationVT refractoryElectrophysiology labSocial Security Death IndexArrhythmia-related deathMapping/ablationPrimary surgical ablationRefractory ventricular tachycardiaVentricular tachycardia refractoryVT-free survivalLong-term survivalSurgical cryoablationICD interrogationConsecutive patientsEntire followCatheter ablationICD shocksTachycardia refractoryVT recurrenceOffice visitsTherapeutic optionsConsecutive pts
2016
Central Repair With Antegrade TEVAR for Malperfusion Syndromes in Acute Debakey I Aortic Dissection
Vallabhajosyula P, Gottret JP, Menon R, Sultan I, Abbas Z, Siki M, Kramer M, Pulsipher A, Naidu S, Pochettino A, Milewski K, Szeto WY, Bavaria JE. Central Repair With Antegrade TEVAR for Malperfusion Syndromes in Acute Debakey I Aortic Dissection. The Annals Of Thoracic Surgery 2016, 103: 748-755. PMID: 27666785, DOI: 10.1016/j.athoracsur.2016.06.097.Peer-Reviewed Original ResearchConceptsAcute DeBakey I aortic dissectionDeBakey I aortic dissectionTEVAR groupMalperfusion syndromeAortic dissectionStandard repairCirculatory arrestMortality rateHospital/30-day mortality ratePostoperative stroke rateRenal failure rateEnd-organ malperfusionStandard open repairEnd-organ systemDeBakey IParaplegia ratePreoperative comorbiditiesHemiarch replacementEmergent operationDistal repairOpen repairSurvival benefitThoracic aortaStroke rateCentral repairConcomitant aortic arch reconstruction using deep hypothermic circulatory arrest during heart transplantation.
Hobbs R, Gottret JP, Menon R, Komlo C, Pochettino A, Acker M, Vallabhajosyula P. Concomitant aortic arch reconstruction using deep hypothermic circulatory arrest during heart transplantation. The Journal Of Cardiovascular Surgery 2016, 57: 620-3. PMID: 27366883.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAorta, ThoracicAortic Aneurysm, ThoracicAortographyBlood Vessel Prosthesis ImplantationCirculatory Arrest, Deep Hypothermia InducedComputed Tomography AngiographyFemaleHeart FailureHeart TransplantationHumansMaleMiddle AgedPostoperative ComplicationsTreatment OutcomeYoung AdultNew Ventricular Septal Defects Following Balloon-Expandable Transcatheter Aortic Valve Replacement.
Rene AG, Jagasia D, Wickramasinghe SR, Desai N, Szeto W, Vallabhajosyula P, Li RH, Silvestry FE, Giri J, Jha S, Herrmann HC, Anwaruddin S. New Ventricular Septal Defects Following Balloon-Expandable Transcatheter Aortic Valve Replacement. Journal Of Invasive Cardiology 2016, 28: e59-65. PMID: 27342207.Peer-Reviewed Original ResearchMeSH KeywordsAged, 80 and overAortic ValveAortic Valve StenosisEchocardiographyFemaleHeart Septal Defects, VentricularHumansMaleOutcome and Process Assessment, Health CarePostoperative ComplicationsQuality of LifeReoperationRisk AssessmentRisk FactorsSeverity of Illness IndexTranscatheter Aortic Valve ReplacementConceptsTranscatheter aortic valve replacementLeft ventricular outflow tract calcificationSevere symptomatic aortic stenosisVentricular outflow tract calcificationSymptomatic aortic stenosisAortic valve replacementVentricular septal defectNew ventricular septal defectQuality of lifeInoperable patientsInfrequent complicationParavalvular regurgitationValve replacementAortic stenosisVascular injurySeptal defectPatientsComplicationsStudied populationRegurgitationStenosisInjuryStrokeCalcification