2023
“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 treatmentAortic 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 types
2016
Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors
Kleiman N, Maini B, Reardon M, Conte J, Katz S, Rajagopal V, Kauten J, Hartman A, McKay R, Hagberg R, Huang J, Popma J, Adams D, Ad N, Aharonian V, Anderson W, Applegate R, Bafi A, Bajwa T, Bakhos M, Ball S, Batra S, Beohar N, Brachinsky W, Brinster D, Brown J, Byrne J, Byrne T, Casale A, Caskey M, Chawla A, Cohen H, Coselli J, Costa M, Cheatham J, Chetcuti S, Crestanello J, Davis T, Michael Deeb G, Diez J, Dauerman H, Elefteriades J, Fail P, Feinberg E, Fontana G, Forrest J, Galloway A, Giacomini J, Gleason T, Guadiani V, Harrison J, Hebeler R, Heimansohn D, Heiser J, Heller L, Henry S, Hermiller J, Hockmuth D, Hughes G, Joye J, Kafi A, Kar B, Khabbaz K, Kipperman R, Kliger C, Kon N, Lamelas J, Lee J, Leya F, Londono J, Macheers S, Mangi A, de Marchena E, Markowitz A, Matthews R, Merhi W, Mumtaz M, O’Hair D, Petrossian G, Pfeffer T, Raybuck B, Resar J, Robbins M, Robbins R, Robinson N, Ring M, Salerno T, Schreiber T, Schmoker J, Sharma S, Siwek L, Skelding K, Slater J, Starnes V, Stoler R, Subramanian V, Tadros P, Thompson C, Waksman R, Watson D, Yakubov S, Zhao D, Zorn G. Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors. Circulation Cardiovascular Interventions 2016, 9: e003551. PMID: 27601429, DOI: 10.1161/circinterventions.115.003551.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAortic ValveAortic Valve StenosisBalloon ValvuloplastyBioprosthesisCalcinosisCardiac Pacing, ArtificialClinical Trials as TopicFemaleHeart Valve ProsthesisHumansIncidenceIntracranial EmbolismKaplan-Meier EstimateMaleProportional Hazards ModelsRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeTime FactorsTranscatheter Aortic Valve ReplacementTreatment OutcomeConceptsTranscatheter aortic valve replacementAortic valve replacementValve replacementEarly strokePrior coronary artery bypass surgeryHealth Stroke Scale scoreSelf-expanding CoreValve bioprosthesisCoronary artery bypass surgerySmaller body surface areaLower body mass indexContinued Access StudySevere aortic calcificationStroke Scale scoreTransient ischemic attackArtery bypass surgeryPeripheral vascular diseasePredictors of strokeBody mass indexBody surface areaIdentification of predictorsCoreValve bioprosthesisIschemic attackPrior strokeBypass surgeryAortic calcification
2015
Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR
Koyner JL, Coca SG, Thiessen-Philbrook H, Patel UD, Shlipak MG, Garg AX, Parikh CR, Consortium T, Raman J, Jeevanandam V, Akhter S, Devarajan P, Bennett M, Ma Q, Griffiths R, Edelstein C, Passik C, Nagy J, Swaminathan M, Chu M, Goldbach M, Guo L, McKenzie N, Myers M, Novick R, Quantz M, Schumann V, Webster L, Zappitelli M, Palijan A, Dewar M, Darr U, Hashim S, Elefteriades J, Geirsson A, Garwood S, Kemp R, Butrymowicz I. Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR. American Journal Of Kidney Diseases 2015, 66: 1006-1014. PMID: 26386737, PMCID: PMC4658239, DOI: 10.1053/j.ajkd.2015.07.027.Peer-Reviewed Original ResearchConceptsAcute kidney injurySevere acute kidney injuryPost-operative dialysisBaseline eGFRKidney injuryInterleukin-18Urinary biomarkersDevelopment of AKIAKI Network stage 1Clinical acute kidney injuryPerioperative acute kidney injuryKidney injury molecule-1Liver-type fatty acid binding proteinBaseline kidney functionImpact of PreoperativeSerum creatinine levelsHours of surgeryInjury molecule-1Prospective cohort studyGlomerular filtration rateNumber of patientsPerformance of biomarkersFatty acid binding proteinAdjusted RRsPreoperative eGFRMultimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance
Goldstein SA, Evangelista A, Abbara S, Arai A, Asch FM, Badano LP, Bolen MA, Connolly HM, Cuéllar-Calàbria H, Czerny M, Devereux RB, Erbel RA, Fattori R, Isselbacher EM, Lindsay JM, McCulloch M, Michelena HI, Nienaber CA, Oh JK, Pepi M, Taylor AJ, Weinsaft JW, Zamorano JL, Editors C, Dietz H, Eagle K, Elefteriades J, Jondeau G, Rousseau H, Schepens M. Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. Journal Of The American Society Of Echocardiography 2015, 28: 119-182. PMID: 25623219, DOI: 10.1016/j.echo.2014.11.015.Peer-Reviewed Original Research
2013
Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery
Coca SG, Garg AX, Swaminathan M, Garwood S, Hong K, Thiessen-Philbrook H, Passik C, Koyner JL, Parikh CR, Consortium O, Jai R, Jeevanandam V, Akhter S, Devarajan P, Bennett M, Edelsteinm C, Patel U, Chu M, Goldbach M, Guo L, McKenzie N, Myers M, Novick R, Quantz M, Zappitelli M, Dewar M, Darr U, Hashim S, Elefteriades J, Geirsson A. Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery. Nephrology Dialysis Transplantation 2013, 28: 2787-2799. PMID: 24081864, PMCID: PMC3811062, DOI: 10.1093/ndt/gft405.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAdultAgedAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsBiomarkersCardiac Surgical ProceduresCoronary Artery DiseaseFemaleHumansIncidenceKidney Function TestsMaleMiddle AgedPreoperative CarePrognosisProspective StudiesReceptors, AngiotensinUnited StatesConceptsStructural acute kidney injuryAcute kidney injuryAngiotensin-converting enzyme inhibitorAngiotensin receptor blockersACEI/angiotensin receptor blockerACEI/ARB exposureKidney injurySerum creatinineARB exposureCardiac surgeryUrinary biomarkersEnzyme inhibitorsPreoperative angiotensin-converting enzyme inhibitorACEI/ARB usageAngiotensin receptor blocker useFunctional acute kidney injuryPostoperative acute kidney injuryACEI/ARB useAKI stage 1New urinary biomarkersMorning of surgeryReceptor blocker useCo-primary outcomesProspective cohort studyARB usage
2009
Deep Hypothermic Circulatory Arrest in Patients With High Cognitive Needs: Full Preservation of Cognitive Abilities
Percy A, Widman S, Rizzo JA, Tranquilli M, Elefteriades JA. Deep Hypothermic Circulatory Arrest in Patients With High Cognitive Needs: Full Preservation of Cognitive Abilities. The Annals Of Thoracic Surgery 2009, 87: 117-123. PMID: 19101283, DOI: 10.1016/j.athoracsur.2008.10.025.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAorta, ThoracicAortic Aneurysm, ThoracicBlood Vessel Prosthesis ImplantationCase-Control StudiesCirculatory Arrest, Deep Hypothermia InducedCognitionCognition DisordersFemaleFollow-Up StudiesHumansMaleMiddle AgedPatient SatisfactionPostoperative CarePreoperative CareProbabilityPsychometricsRadiographyReference ValuesRetrospective StudiesRisk AssessmentSurveys and QuestionnairesTreatment OutcomeVascular Surgical ProceduresConceptsDeep hypothermic circulatory arrestHypothermic circulatory arrestAortic surgeryCirculatory arrestStudy groupStraight deep hypothermic circulatory arrestYale-New Haven HospitalOpen distal anastomosisThoracic aortic surgeryTotal arch replacementArch replacementCerebral protectionPreoperative statusDistal anastomosisSuch patientsFunctional outcomeControl subjectsPatientsSurgeryControl groupAdverse effectsSignificant differencesCognitive changesDaily activitiesOverall score
2008
Unilateral diaphragm paralysis: etiology, impact, and natural history.
Elefteriades J, Singh M, Tang P, Siegel MD, Kenney B, Pandey A, Kopf GS. Unilateral diaphragm paralysis: etiology, impact, and natural history. The Journal Of Cardiovascular Surgery 2008, 49: 289-95. PMID: 18431352.Peer-Reviewed Original ResearchConceptsUnilateral diaphragm paralysisDiaphragm paralysisChronic obstructive pulmonary diseaseNatural historyBilateral diaphragm paralysisIntact phrenic nerveObstructive pulmonary diseaseSpirometric improvementClinical improvementExpiratory volumePulmonary infectionDiaphragm resectionLeft diaphragmOccasional patientPhrenic nervePulmonary diseaseSurgical explorationDiaphragm functionLower lobeVital capacityClinical recordsClinical spectrumMean durationNeurogenic atrophyBest therapy
2007
What Is the Optimal Management of Late-Presenting Survivors of Acute Type A Aortic Dissection?
Davies RR, Coe MP, Mandapati D, Gallo A, Botta DM, Elefteriades JA, Coady MA. What Is the Optimal Management of Late-Presenting Survivors of Acute Type A Aortic Dissection? The Annals Of Thoracic Surgery 2007, 83: 1593-1602. PMID: 17462364, DOI: 10.1016/j.athoracsur.2006.12.018.Peer-Reviewed Original ResearchConceptsLong-term survivalOperative repairAortic dissectionGroup AAcute Type A Aortic DissectionType A Aortic DissectionImproved long-term survivalOptimal managementExcellent long-term resultsA Aortic DissectionInitial medical managementCongestive heart failureCoronary artery diseaseOnset of symptomsLong-term resultsImmediate operative repairAcute typeSurgical emergencySymptom onsetArtery diseaseHeart failurePulmonary diseaseMedical managementSingle institutionGroup B
2006
Familial Thoracic Aortic Aneurysms and Dissections—Incidence, Modes of Inheritance, and Phenotypic Patterns
Albornoz G, Coady MA, Roberts M, Davies RR, Tranquilli M, Rizzo JA, Elefteriades JA. Familial Thoracic Aortic Aneurysms and Dissections—Incidence, Modes of Inheritance, and Phenotypic Patterns. The Annals Of Thoracic Surgery 2006, 82: 1400-1405. PMID: 16996941, DOI: 10.1016/j.athoracsur.2006.04.098.Peer-Reviewed Original ResearchConceptsThoracic aortic aneurysmAbdominal aortic aneurysmFamilial thoracic aortic aneurysmsAortic aneurysmMarfan syndromeAortic growth rateNon-Marfan patientsIncidence of hypertensionAggressive clinical entityPredominant inheritance patternSporadic groupMarfan groupStudy patientsCerebral circulationClinical entityThoracic aortaAbdominal aortaInheritance patternMFS groupMFS patientsTAA groupLarge cohortAneurysm sitePatientsAneurysms
2005
Mechanical deterioration underlies malignant behavior of aneurysmal human ascending aorta
Koullias G, Modak R, Tranquilli M, Korkolis DP, Barash P, Elefteriades JA. Mechanical deterioration underlies malignant behavior of aneurysmal human ascending aorta. Journal Of Thoracic And Cardiovascular Surgery 2005, 130: 677.e1-677.e9. PMID: 16153912, DOI: 10.1016/j.jtcvs.2005.02.052.Peer-Reviewed Original ResearchConceptsMechanical characteristicsMechanical deteriorationHuman ascending aortaAortic aneurysmAortic wall stressNormal aortaAneurysmal aortaAortic distensibilityAscending aortaMalignant behaviorAortic wallWall stressMaximal tensile strengthMechanical propertiesCoronary artery bypassTensile strengthTime of surgeryAortic wall thicknessAscending Aortic AneurysmMalignant clinical behaviorElastic modulusHuman ascending aortic aneurysmsEngineering analysisAneurysmal aortic wallMechanical substrateLate-onset dysphagia lusoria assessed by 3-dimensional computed tomography of an aortic arch abnormality
Koullias G, Korkolis D, Iams W, Elefteriades J. Late-onset dysphagia lusoria assessed by 3-dimensional computed tomography of an aortic arch abnormality. Diseases Of The Esophagus 2005, 18: 60-63. PMID: 15773845, DOI: 10.1111/j.1442-2050.2005.00449.x.Peer-Reviewed Original ResearchConceptsAberrant left subclavian arteryLeft-sided ligamentum arteriosumRight-sided aortic archLate-onset dysphagiaSymptomatic vascular ringsLeft subclavian arteryAortic arch abnormalitiesHelical CT scansArch aortogramDysphagia lusoriaSubclavian arteryIntraoperative findingsPatient's symptomsLigamentum arteriosumAnatomic abnormalitiesAortic archArch abnormalitiesVascular ringComplete decompressionCT scanComputed tomographyThree-dimensional reconstruction softwareDysphagiaSymptomsAbnormalities
2001
Stroke in surgery of the thoracic aorta: Incidence, impact, etiology, and prevention
Goldstein L, Davies R, Rizzo J, Davila J, Cooperberg M, Shaw R, Kopf G, Elefteriades J. Stroke in surgery of the thoracic aorta: Incidence, impact, etiology, and prevention. Journal Of Thoracic And Cardiovascular Surgery 2001, 122: 935-945. PMID: 11689799, DOI: 10.1067/mtc.2001.117276.Peer-Reviewed Original ResearchConceptsDeep hypothermic circulatory arrestHypothermic circulatory arrestThoracic aortaCirculatory arrestEmergency operationAge-adjusted survivalAntegrade cerebral perfusionThoracic aortic operationsPrevention of strokeIntensive care unitPostoperative stayAortic atheromaAortic manipulationAortic operationsPostoperative deathsCardiopulmonary bypassCerebral perfusionFemoral perfusionNeurologic consultationCare unitElective operationsHeart bypassThorough debridementOperative reportsLeft heartMyocardial Revascularization as a Therapeutic Strategy in the Patient with Advanced Ventricular Dysfunction
Mitropoulos F, Elefteriades J. Myocardial Revascularization as a Therapeutic Strategy in the Patient with Advanced Ventricular Dysfunction. Heart Failure Reviews 2001, 6: 163-175. PMID: 11391034, DOI: 10.1023/a:1011416929501.Peer-Reviewed Original ResearchConceptsCoronary artery bypassVentricular dysfunctionArtery bypassPerioperative managementEjection fractionPatient selectionAdvanced ventricular dysfunctionRight ventricular dysfunctionLeft ventricular dysfunctionLow ejection fractionOptimal perioperative managementSevere ventricular dysfunctionCareful patient selectionCoronary artery diseaseLong-term outcomesNumber of patientsQuality of lifeSurgical revascularizationHeart transplantationPulmonary hypertensionMyocardial revascularizationOverall prognosisArtery diseaseMedical managementRedo bypassSingle-clamp technique does not protect against cerebrovascular accident in coronary artery bypass grafting⋆
Kim R, Mariconda D, Tellides G, Kopf G, Dewar M, Lin Z, Elefteriades J. Single-clamp technique does not protect against cerebrovascular accident in coronary artery bypass grafting⋆. European Journal Of Cardio-Thoracic Surgery 2001, 20: 127-132. PMID: 11423285, DOI: 10.1016/s1010-7940(01)00765-5.Peer-Reviewed Original ResearchConceptsSingle-clamp techniqueCoronary artery bypassPostoperative strokeArtery bypassStroke preventionCerebrovascular accidentSide-biting aortic clampAdverse myocardial effectsCross-clamp timePostoperative adverse eventsPerioperative myocardial infarctionCoronary bypass operationsLogistic regression analysisEmbolic consequencesHospital mortalityAdverse eventsAortic clampMyocardial effectsBypass operationMyocardial infarctionMyocardial protectionClinical practiceClamp techniqueSecond surgeonStroke
2000
Effect of left ventricular volume on results of coronary artery bypass grafting
Kim R, Ugurlu B, Tereb D, Wackers F, Tellides G, Elefteriades J. Effect of left ventricular volume on results of coronary artery bypass grafting. The American Journal Of Cardiology 2000, 86: 1261-1264. PMID: 11090805, DOI: 10.1016/s0002-9149(00)01216-9.Peer-Reviewed Original ResearchConceptsCoronary artery bypassArtery bypassSignificant left ventricular dilationLeft ventricular dilationLV chamber sizeLV ejection fractionMedium-term survivalSurgical revascularizationAngina symptomsEjection fractionIschemic cardiomyopathyLV dilationVentricular dilationVentricular sizeVentricular volumePatientsSignificant reductionBypassChamber sizeDilationRevascularizationCardiomyopathySymptomsSafety of left innominate vein division during aortic arch surgery
Sudhakar C, Elefteriades J. Safety of left innominate vein division during aortic arch surgery. The Annals Of Thoracic Surgery 2000, 70: 856-858. PMID: 11016323, DOI: 10.1016/s0003-4975(00)01498-3.Peer-Reviewed Original ResearchConceptsLeft innominate veinUpper extremity edemaExtremity edemaMediastinal tumorNeurologic symptomsSignificant long-term morbidityAortic arch surgeryDistal aortic anastomosisLong-term morbidityArch replacementArch surgeryExtent of involvementMultiorgan dysfunctionInnominate veinVein divisionEarly patientsMedian sternotomyAortic anastomosisMean ageSurgical approachAortic archMediastinal structuresArm elevationPatientsLocal anatomy
1999
DEVELOPING SURGICAL INTERVENTION CRITERIA FOR THORACIC AORTIC ANEURYSMS
Coady M, Rizzo J, Elefteriades J. DEVELOPING SURGICAL INTERVENTION CRITERIA FOR THORACIC AORTIC ANEURYSMS. Cardiology Clinics 1999, 17: 827-839. PMID: 10589349, DOI: 10.1016/s0733-8651(05)70118-1.Peer-Reviewed Original ResearchConceptsSurgical interventionAcute ascending aortic dissectionAscending aortic dissectionConcomitant aortic insufficiencyIntervention criteriaLarger patient numbersAppropriate clinical careThoracic aortic aneurysmSize criteriaSurgical intervention criteriaOverall physical conditionAortic insufficiencyAdverse eventsAortic dissectionPatient ageAortic sizeOrgan compressionPatient enrollmentPatient numbersAortic aneurysmThoracic aortaSymptomatic stateClinical careClinical experienceLife expectancyPATHOLOGIC VARIANTS OF THORACIC AORTIC DISSECTIONS Penetrating Atherosclerotic Ulcers and Intramural Hematomas
Coady M, Rizzo J, Elefteriades J. PATHOLOGIC VARIANTS OF THORACIC AORTIC DISSECTIONS Penetrating Atherosclerotic Ulcers and Intramural Hematomas. Cardiology Clinics 1999, 17: 637-657. PMID: 10589337, DOI: 10.1016/s0733-8651(05)70106-5.Peer-Reviewed Original ResearchConceptsClassic aortic dissectionAcute aortic pathologyIntramural hematomaAortic dissectionAortic lumenAtherosclerotic ulcerAortic lesionsIMH patientsAortic pathologyClassic dissectionRupture rateType B aortic dissectionTypical aortic dissectionB aortic dissectionDistinct clinical entityThoracic aortic dissectionTypical patient profileMore superficial locationHigher rupture rateBranch-vessel compromiseLarger aortasMinimal arteriosclerosisTypical dissectionIschemic manifestationsThoracoabdominal aortaFailure to Improve Left Ventricular Function After Coronary Revascularization for Ischemic Cardiomyopathy Is Not Associated With Worse Outcome
Samady H, Elefteriades J, Abbott B, Mattera J, McPherson C, Wackers F. Failure to Improve Left Ventricular Function After Coronary Revascularization for Ischemic Cardiomyopathy Is Not Associated With Worse Outcome. Circulation 1999, 100: 1298-1304. PMID: 10491374, DOI: 10.1161/01.cir.100.12.1298.Peer-Reviewed Original ResearchConceptsVentricular functionIschemic cardiomyopathyGroup AHeart failure scoreLeft ventricular functionIschemic LV dysfunctionPoor patient outcomesB. Group ALack of improvementBaseline LVEFEffective revascularizationImproved LVEFCoronary revascularizationLV dysfunctionConsecutive patientsIntraoperative variablesPostoperative improvementCardiac deathLV functionPoor outcomeViable myocardiumLVEF assessmentIschemic myocardiumPatient outcomesWorse outcomes