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 findingsLiving in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis
Ram C, Yousef S, Ma W, Vallabhajosyula I, Singh S, Agarwal R, Milewski R, Assi R, Patel P, Williams M, Geirsson A, Vallabhajosyula P. Living in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis. Scientific Reports 2024, 14: 4952. PMID: 38418864, PMCID: PMC10902341, DOI: 10.1038/s41598-024-52660-w.Peer-Reviewed Original ResearchConceptsAortic valve replacementSevere aortic stenosisAfrican American raceArea Deprivation IndexAortic stenosisSevere ASArea deprivation index rankAortic valve replacement ratesAmerican raceAortic valve interventionPresentation of sepsisDiagnosis of ASADI groupValve replacementValve interventionDeprived neighbourhoodsAV interventionDisadvantaged neighborhoodsPatientsFemale genderDeprivation indexHigh-ADI groupLow-ADI groupStenosisRace
2023
TAVR explant with aortic root replacement using a homograft for an aortic rupture.
Singh S, Vallabhajosyula P, Geirsson A, Assi R. TAVR explant with aortic root replacement using a homograft for an aortic rupture. Multimedia Manual Of Cardio-Thoracic Surgery 2023, 2023 PMID: 36644957, DOI: 10.1510/mmcts.2022.101.Peer-Reviewed Original ResearchConceptsLeft coronary buttonAortic ruptureCoronary buttonsAortic rootAortic root replacementTranscatheter aortic valve prosthesisAortic valve prosthesisTAVR explantRoot replacementMale presentingCase reportTranscatheter prosthesesValve prosthesisStent frameBovine pericardiumProsthesisRuptureHaemopericardiumPseudoaneurysmHomograftsPresenting
2022
Variability in surveillance practice for patients with diagnosis of bicuspid aortic valve syndrome
Kahler-Quesada A, Vallabhajosyula I, Yousef S, Mori M, Amabile A, Assi R, Geirsson A, Vallabhajosyula P. Variability in surveillance practice for patients with diagnosis of bicuspid aortic valve syndrome. Scientific Reports 2022, 12: 22009. PMID: 36539583, PMCID: PMC9768129, DOI: 10.1038/s41598-022-25571-x.Peer-Reviewed Original ResearchConceptsBicuspid aortic valveTertiary care centerAortic valveCare centerCardiovascular specialistsBicuspid aortic valve syndromeAortic pathologySurveillance imagingDisease progressionPatientsBivariate analysisEchocardiogramGuide interventionDiagnosisHigher proportionValveSurveillance practicesUrgent needGuidelinesValvulopathySpecialistsSurgeryValvularSyndromeFollowDirect relationship between transvalvular velocity and cardiac dysfunction, morbidity, and mortality in patients with aortic stenosis
Yousef S, Amabile A, Ram C, Singh S, Agarwal R, Milewski R, Assi R, Patel P, Krane M, Geirsson A, Vallabhajosyula P. Direct relationship between transvalvular velocity and cardiac dysfunction, morbidity, and mortality in patients with aortic stenosis. Journal Of Cardiac Surgery 2022, 37: 5052-5062. PMID: 36378856, DOI: 10.1111/jocs.17199.Peer-Reviewed Original ResearchConceptsDegree of ASCardiac structural changesAortic stenosisSevere symptomatic aortic stenosisEnd-organ morbiditiesStructural cardiac changesSymptomatic aortic stenosisEnd-organ diseaseKaplan-Meier curvesRisk of mortalityTransvalvular flow velocityCochran-Armitage testCause mortalityPatient characteristicsCardiac changesCardiac dysfunctionPatient morbidityTransvalvular velocityCurrent guidelinesGroup BGroup ACaucasian raceHigh riskCox modelEarly interventionLong‐term risk of arch complications in Loeys Dietz syndrome patients undergoing proximal ascending aortic replacement
Weininger G, Zafar M, Ziganshin BA, Mori M, Papanikolaou D, Sekar RB, Amabile A, Degife E, O'Marr J, Geirsson A, Elefteriades JA, Assi R, Vallabhajosyula P. Long‐term risk of arch complications in Loeys Dietz syndrome patients undergoing proximal ascending aortic replacement. Journal Of Cardiac Surgery 2022, 37: 3688-3692. PMID: 35989525, DOI: 10.1111/jocs.16855.Peer-Reviewed Original ResearchConceptsLoeys-Dietz syndromeProximal aortic replacementAortic replacementLDS patientsLong-term riskLoeys-Dietz syndrome patientsPathogenic variantsUnknown significanceLower long-term riskRare connective tissue disorderAscending Aortic ReplacementTotal arch replacementAortic valve replacementRecords of patientsConnective tissue disordersWhole-exome genetic testingArch replacementMedian followLatest followValve replacementOperative coursePatient chartsAortic diameterAortic dimensionsAortic archCommentary: The first operative risk score for contemporary aortic arch surgery
Assi R, Geirsson A, Vallabhajosyula P. Commentary: The first operative risk score for contemporary aortic arch surgery. Journal Of Thoracic And Cardiovascular Surgery 2022, 167: 609-610. PMID: 35489833, DOI: 10.1016/j.jtcvs.2022.03.017.Commentaries, Editorials and LettersGrowth rate of ascending thoracic aortic aneurysms in a non-referral-based population
Weininger G, Mori M, Yousef S, Hur DJ, Assi R, Geirsson A, Vallabhajosyula P. Growth rate of ascending thoracic aortic aneurysms in a non-referral-based population. Journal Of Cardiothoracic Surgery 2022, 17: 14. PMID: 35109884, PMCID: PMC8812194, DOI: 10.1186/s13019-022-01761-6.Peer-Reviewed Original ResearchConceptsAneurysm growth rateAortic dilatationAortic aneurysmStudy populationCT scanInitial aneurysm sizeTrue natural historyPatients age 50High-risk patientsMedian time intervalLarge institutional databaseThoracic aortic aneurysmComputed tomography scanAortic aneurysm diseaseRisk patientsAortic sizeInstitutional databaseTomography scanAneurysm diseaseRadiologic diagnosisAneurysm sizeBackgroundPrior studiesAge 50PatientsNatural history
2021
Socioeconomic disparities in surveillance and follow‐up of patients with thoracic aortic aneurysm
Shang M, Weininger G, Mori M, Kahler‐Quesada A, Degife E, Brooks C, Yousef S, Williams M, Assi R, Geirsson A, Vallabhajosyula P. Socioeconomic disparities in surveillance and follow‐up of patients with thoracic aortic aneurysm. Journal Of Cardiac Surgery 2021, 37: 831-839. PMID: 34873754, DOI: 10.1111/jocs.16173.Peer-Reviewed Original ResearchConceptsAortic aneurysmArea Deprivation IndexCardiovascular specialistsSocioeconomic statusSurgical interventionAneurysm sizeReferral of patientsRisk of deathSignificant risk factorsThoracic aortic aneurysmComputed tomography scanLowest socioeconomic quartileLow socioeconomic statusLower Socioeconomic StatusADI quartileAortic surveillanceAortic dissectionConsecutive patientsPrimary outcomeSpecialist referralSurgical repairTimely followSurveillance imagingRisk regressionRisk factorsDevelopment and Validation of a Predictive Model to Identify Patients With an Ascending Thoracic Aortic Aneurysm
Mori M, Gan G, Deng Y, Yousef S, Weininger G, Daggula KR, Agarwal R, Shang M, Assi R, Geirsson A, Vallabhajosyula P. Development and Validation of a Predictive Model to Identify Patients With an Ascending Thoracic Aortic Aneurysm. Journal Of The American Heart Association 2021, 10: e022102. PMID: 34743563, PMCID: PMC8751931, DOI: 10.1161/jaha.121.022102.Peer-Reviewed Original ResearchConceptsThoracic aortic aneurysmAortic aneurysmPatient riskTomography scanHigher body surface areaTertiary care centerAortic valve diseaseHistory of arrhythmiaAvailable clinical informationBody surface areaScreening of patientsCross-sectional studyRisk prediction algorithmAscending Thoracic Aortic AneurysmsLogistic regression modelsClinical characteristicsAortic dissectionUnique patientsValve diseaseC-statisticFemale sexThoracic aortaCare centerComorbidity variablesMultivariable modelTelemedicine in the era of coronavirus 19: Implications for postoperative care in cardiac surgery
Sallam A, Shang M, Vallabhajosyula I, Mori M, Chinian R, Assi R, Bonde P, Geirsson A, Vallabhajosyula P. Telemedicine in the era of coronavirus 19: Implications for postoperative care in cardiac surgery. Journal Of Cardiac Surgery 2021, 36: 3731-3737. PMID: 34338360, PMCID: PMC8446997, DOI: 10.1111/jocs.15875.Peer-Reviewed Original ResearchConceptsCardiac surgery patientsPostoperative appointmentsCardiac surgeryPostoperative careSurgery patientsOpen cardiac surgeryPatient satisfaction surveySatisfaction surveyCoronavirus-19 pandemicPostoperative patientsTelehealth visitsTelemedicine appointmentsProvider satisfactionTelemedicine usePatientsTelemedicine modalitiesCoronavirus-19SurgeryCareAppointmentsTelemedicineSurgeonsHome ordersSurvey administrationStayQuantitative not qualitative histology differentiates aneurysmal from nondilated ascending aortas and reveals a net gain of medial components
Yousef S, Matsumoto N, Dabe I, Mori M, Landry AB, Lee SR, Kawamura Y, Yang C, Li G, Assi R, Vallabhajosyula P, Geirsson A, Moeckel G, Humphrey JD, Tellides G. Quantitative not qualitative histology differentiates aneurysmal from nondilated ascending aortas and reveals a net gain of medial components. Scientific Reports 2021, 11: 13185. PMID: 34162971, PMCID: PMC8222259, DOI: 10.1038/s41598-021-92659-1.Peer-Reviewed Original ResearchConceptsMedial degenerationAortic aneurysmSporadic thoracic aortic aneurysmMedial cell numberCommon histopathological findingThoracic aortic aneurysmSmooth muscle cellsAortic dilatationHistopathological findingsAscending aortaHistopathological criteriaAneurysmal wallLumen dilatationClinical diagnosisMuscle cellsAneurysmsAortaDegenerationDilatationMural cellsMarked overlapElastic lamellaeMedial componentCell numberMedial tissueVariants of the aortic arch in adult general population and their association with thoracic aortic aneurysm disease
Yousef S, Singh S, Alkukhun A, Alturkmani B, Mori M, Chen J, Mullan CW, Brooks CW, Assi R, Gruber PJ, Cortopassi I, Geirsson A, Vallabhajosyula P. Variants of the aortic arch in adult general population and their association with thoracic aortic aneurysm disease. Journal Of Cardiac Surgery 2021, 36: 2348-2354. PMID: 33855754, DOI: 10.1111/jocs.15563.Peer-Reviewed Original ResearchConceptsAortic arch anomaliesArch anomaliesAneurysm diseaseBovine archAberrant right subclavian arteryAdult populationThoracic aortic aneurysm diseasePrevalence of TAAsRight-sided archRight subclavian arteryCharacteristics of patientsIndependent risk factorAortic valve pathologyAdult general populationGeneral adult populationAortic aneurysm diseaseLogistic regression analysisSingle health systemFisher's exact testOlder adult populationBinary logistic regressionThoracic aortopathiesSubclavian arteryCommon diagnosisThoracic aneurysmSurgery for aortic dissection: An international case for universal coverage?
Pichert M, Geirsson A, Assi R. Surgery for aortic dissection: An international case for universal coverage? Journal Of Cardiac Surgery 2021, 36: 2044-2044. PMID: 33682946, DOI: 10.1111/jocs.15455.Commentaries, Editorials and LettersPatterns of Surveillance Imaging for Incidentally Detected Ascending Aortic Aneurysms
Weininger G, Mori M, Shang M, Degife E, Amick M, Yousef S, Assi R, Milewski R, Geirsson A, Vallabhajosyula P. Patterns of Surveillance Imaging for Incidentally Detected Ascending Aortic Aneurysms. The Annals Of Thoracic Surgery 2021, 113: 125-130. PMID: 33609548, DOI: 10.1016/j.athoracsur.2021.02.010.Peer-Reviewed Original ResearchConceptsAneurysm sizeLogistic regression modelsAortic aneurysmTomography scanCardiac surgeonsHigh-risk patient populationHigh-risk patientsAscending Aortic AneurysmLow clinical penetranceMedian aneurysm sizeYear of detectionPatterns of surveillanceMedian followCare patientsRegression modelsSurveillance imagingSurveillance intervalsPatient populationIncidental detectionFamily historyClinical penetrancePatientsPatient's aneurysmSilent killerTimely interventionPhysician-modified Endograft for the Urgent Treatment of High-risk Chronic Dissecting Thoracoabdominal Aneurysms
Pichert M, Assi R. Physician-modified Endograft for the Urgent Treatment of High-risk Chronic Dissecting Thoracoabdominal Aneurysms. The Annals Of Thoracic Surgery 2021, 112: 1208-1209. PMID: 33600788, DOI: 10.1016/j.athoracsur.2020.12.074.Commentaries, Editorials and LettersThe relationship between cardiac surgeon experience and average patient risk profile: CA and NY statewide analysis
Weininger G, Einarsson A, Mori M, Brooks C, Shang M, Assi R, Vallabhajosyula P, Geirsson A. The relationship between cardiac surgeon experience and average patient risk profile: CA and NY statewide analysis. Journal Of Cardiac Surgery 2021, 36: 1189-1193. PMID: 33462886, DOI: 10.1111/jocs.15333.Peer-Reviewed Original ResearchConceptsLow-risk casesPatient outcomesCardiac surgeonsLow-risk coronary artery bypassSurgeon yearsMedian annual case volumeCoronary artery bypassPatient risk profileAnnual case volumeCross-sectional studyBetter patient outcomesRegression modelsLinear regression modelsCABG casesMedian surgeonArtery bypassMid-career surgeonsMortality ratioMedian numberSurgeon experienceOutcome dataCase volumeExperienced surgeonsMortality rateOnline registry
2020
Clinicopathologic Features of Tissue Granulomas in Transplant Recipients: A Single Center Study in a Nontuberculosis Endemic Region.
Nussbaum EZ, Patel KK, Assi R, Raad RA, Malinis M, Azar MM. Clinicopathologic Features of Tissue Granulomas in Transplant Recipients: A Single Center Study in a Nontuberculosis Endemic Region. Archives Of Pathology & Laboratory Medicine 2020, 145: 988-999. PMID: 33290524, DOI: 10.5858/arpa.2020-0271-oa.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedBartonellaBiopsyCommunicable DiseasesConnecticutCytomegalovirusFemaleGranulomaHematopoietic Stem Cell TransplantationHumansMaleMiddle AgedOrgan TransplantationPrevalenceRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTransplantation, HomologousTreatment OutcomeYoung AdultConceptsEpidemiologic risk factorsPresence of symptomsInfectious etiologyAsymptomatic patientsTransplant recipientsTissue granulomasClinicopathologic featuresRisk factorsAllogeneic hematopoietic stem cell transplant recipientsHematopoietic stem cell transplant recipientsStem cell transplant recipientsYale-New Haven HospitalCommon infectious etiologiesLarge transplant populationCell transplant recipientsSingle-center studyCryptogenic organizing pneumoniaNew Haven HospitalRoutine disease surveillancePaucity of literatureCytomegalovirus hepatitisPosttransplant specimensBiopsy indicationOrganizing pneumoniaTransplant patientsDiagnosis of Thoracic Aortic Aneurysms by Computed Tomography Without Allometric Scaling
Yousef S, Mori M, Bin Mahmood SU, Assi R, Vallabhajosyula P, Geirsson A, Tellides G. Diagnosis of Thoracic Aortic Aneurysms by Computed Tomography Without Allometric Scaling. JAMA Network Open 2020, 3: e2023689. PMID: 33141157, PMCID: PMC7610193, DOI: 10.1001/jamanetworkopen.2020.23689.Peer-Reviewed Original ResearchAssociation Between Cardiac Surgeons’ Number of Years in Practice and Surgical Outcomes in New York Cardiac Centers
Weininger G, Mori M, Brooks C, Shang M, Vinholo T, Zhang Y, Assi R, Geirsson A, Vallabhajosyula P. Association Between Cardiac Surgeons’ Number of Years in Practice and Surgical Outcomes in New York Cardiac Centers. JAMA Network Open 2020, 3: e2023671. PMID: 33141159, PMCID: PMC7610186, DOI: 10.1001/jamanetworkopen.2020.23671.Peer-Reviewed Original ResearchConceptsRisk-adjusted operative mortality ratesAnnual case volumeSurgeon annual case volumeValve proceduresCABG proceduresCardiac surgeonsYears of practiceCardiothoracic surgeonsSurgical outcomesSurgeon numberCase volumeMortality rateRisk-adjusted mortality ratesCoronary artery bypassOperative mortality rateMultivariable risk modelsDay of surgeryCardiac surgery centersCross-sectional studyRisk-adjusted outcomesCross-sectional analysisArtery bypassIndex hospitalizationValve surgeryCardiac center