2023
Genetic Overlap of Spontaneous Dissection of Either the Thoracic Aorta or the Coronary Arteries
Jeoffrey S, Kalyanasundaram A, Zafar M, Ziganshin B, Elefteriades J. Genetic Overlap of Spontaneous Dissection of Either the Thoracic Aorta or the Coronary Arteries. The American Journal Of Cardiology 2023, 205: 69-74. PMID: 37591066, DOI: 10.1016/j.amjcard.2023.07.046.Peer-Reviewed Original ResearchMeSH KeywordsAorta, ThoracicAortic DissectionCoronary VesselsGenome-Wide Association StudyHumansProspective StudiesRetrospective StudiesConceptsCorresponding molecular pathwaysSpontaneous coronary artery dissectionGenetic overlapMolecular pathwaysGenome-wide association studiesGenetic commonalityGenetic variantsThoracic aortic dissectionIndependent genesGenetic pathwaysSmooth muscle cell functionGenetic methodsAortic dissectionMuscle cell functionAssociation studiesGenetic studiesSudden deathConnective tissue genesGenesTGFβ pathwayCausative genesCoronary artery dissectionTissue genesEarly-onset myocardial infarctionBiologic processesFate 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 ResearchMeSH KeywordsAortaAortic AneurysmAortic Aneurysm, ThoracicAortic DissectionAortic RuptureHumansRetrospective StudiesRisk FactorsUniversitiesConceptsAdverse 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 criteria
2022
Long‐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 archBovine 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 ResearchMeSH KeywordsAneurysmAorta, ThoracicAortic Aneurysm, ThoracicFemaleHumansIncidenceLikelihood FunctionsMaleRetrospective StudiesConceptsBovine 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 studiesChestA machine learning approach for predicting complications in descending and thoracoabdominal aortic aneurysms
Ostberg NP, Zafar MA, Mukherjee SK, Ziganshin BA, Elefteriades JA. A machine learning approach for predicting complications in descending and thoracoabdominal aortic aneurysms. Journal Of Thoracic And Cardiovascular Surgery 2022, 166: 1011-1020.e3. PMID: 35120761, DOI: 10.1016/j.jtcvs.2021.12.045.Peer-Reviewed Original ResearchMeSH KeywordsAortic Aneurysm, ThoracicAortic Aneurysm, ThoracoabdominalHumansHypertensionRetrospective StudiesConceptsType B dissectionThoracoabdominal aortic aneurysmsB dissectionCause mortalityAortic aneurysmReceiver operator curveAortic diameterOperator curveInitial patient encounterOccurrence of dissectionSurgical intervention criteriaMean followPatient sexMyocardial infarctionPatient encountersRetrospective dataEnd pointPatientsAneurysmsDissectionMortalityRisk predictionComplicationsIntervention criteriaRupture
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 diametersFate of Preserved Aortic Root Following Acute Type A Aortic Dissection Repair
Ellauzi H, Zafar MA, Wu J, Papanikolaou D, Buntin J, Ziganshin BA, Elefteriades JA. Fate of Preserved Aortic Root Following Acute Type A Aortic Dissection Repair. Seminars In Thoracic And Cardiovascular Surgery 2021, 34: 419-427. PMID: 33979665, DOI: 10.1053/j.semtcvs.2021.04.002.Peer-Reviewed Original ResearchConceptsSevere aortic insufficiencyAortic insufficiencyAortic rootAcute typeAortic dissectionAortic replacementFree ruptureAdverse eventsAcute Type A Aortic Dissection RepairType A Aortic Dissection RepairProximal aortic suture lineSatisfactory long-term outcomeAortic dissection repairAortic root pseudoaneurysmAortic suture lineNon-reoperated patientsProximal aortic reoperationsAortic root diameterLong-term outcomesLong-term survivalAortic reoperationDissection repairOperative mortalityPrior surgeryOverall survival
2020
Increased Virulence of Descending Thoracic and Thoracoabdominal Aortic Aneurysms in Women
Chen JF, Zafar MA, Wu J, Li Y, Rizzo JA, Papanikolaou D, Kalogerakos P, Abdelbaky M, Ellauzi H, Rohde S, Vinholo TF, Charilaou P, Buntin J, Mukherjee SK, Ziganshin BA, Elefteriades JA. Increased Virulence of Descending Thoracic and Thoracoabdominal Aortic Aneurysms in Women. The Annals Of Thoracic Surgery 2020, 112: 45-52. PMID: 33075319, DOI: 10.1016/j.athoracsur.2020.08.026.Peer-Reviewed Original ResearchConceptsThoracoabdominal aortic aneurysmsAortic deathFatal complicationAortic sizeAortic aneurysmFaster aneurysm growthMean aortic diameterComplication rateComposite endpointAortic diameterSurgical interventionCurrent guidelinesAneurysm sizeSex considerationsNatural historyAneurysm growthThoracicWomenDissectionYearly rateComplicationsDeathAneurysmsHigh rateSex differences
2019
Chronologic and Climatic Factors of Acute Aortic Dissection: Study of 1642 Patients in Two Continents
Ma WG, Li B, Zhang W, Sarkar AEH, Tufail R, Peterss S, Zheng J, Zafar MA, Ziganshin B, Zhu JM, Sun LZ, Elefteriades JA. Chronologic and Climatic Factors of Acute Aortic Dissection: Study of 1642 Patients in Two Continents. The Annals Of Thoracic Surgery 2019, 110: 575-581. PMID: 31891696, DOI: 10.1016/j.athoracsur.2019.11.013.Peer-Reviewed Original ResearchNatural history of descending thoracic and thoracoabdominal aortic aneurysms
Zafar MA, Chen JF, Wu J, Li Y, Papanikolaou D, Abdelbaky M, Vinholo T, Rizzo JA, Ziganshin BA, Mukherjee SK, Elefteriades JA, Investigators Y, Charilaou P, Saeyeldin A, Imran M, Gryaznov A, Tanweer M, Buntin J, Peterss S. Natural history of descending thoracic and thoracoabdominal aortic aneurysms. Journal Of Thoracic And Cardiovascular Surgery 2019, 161: 498-511.e1. PMID: 31982126, DOI: 10.1016/j.jtcvs.2019.10.125.Peer-Reviewed Original ResearchRoutine anterior spinal artery visualization prior to descending and thoracoabdominal aneurysm repair: High detection success
Abdelbaky M, Zafar MA, Saeyeldin A, Wu J, Papanikolaou D, Vinholo TF, Huber S, Buntin J, Ziganshin BA, Mojibian H, Elefteriades JA. Routine anterior spinal artery visualization prior to descending and thoracoabdominal aneurysm repair: High detection success. Journal Of Cardiac Surgery 2019, 34: 1563-1568. PMID: 31705825, DOI: 10.1111/jocs.14310.Peer-Reviewed Original ResearchConceptsAnterior spinal arterySpinal cord blood supplyMagnetic resonance angiographyCT angiographyAneurysm repairTransient lower extremity weaknessThoracoabdominal aortic aneurysm repairLower paraplegia ratesThoracoabdominal aneurysm repairLower extremity weaknessAortic aneurysm repairOpen surgical repairModality of choiceParaplegia rateTAAA repairExtremity weaknessPermanent paraplegiaSpinal arteryEnhanced imaging techniquesSurgical repairSpinal angiographySurgical techniqueBlood supplyDual-energy CT scanningModern imaging technologiesNatural history and management of Kommerell's diverticulum in a single tertiary referral center
Erben Y, Brownstein AJ, Velasquez CA, Li Y, Rizzo JA, Mojibian H, Tanweer M, Zafar MA, Ziganshin BA, Elefteriades JA. Natural history and management of Kommerell's diverticulum in a single tertiary referral center. Journal Of Vascular Surgery 2019, 71: 2004-2011. PMID: 31708305, DOI: 10.1016/j.jvs.2019.08.260.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAortaAortic RuptureAortographyCardiovascular AbnormalitiesComputed Tomography AngiographyConnecticutDatabases, FactualDisease ProgressionDiverticulumFemaleHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesRisk FactorsSex FactorsSubclavian ArteryTertiary Care CentersTreatment OutcomeVascular MalformationsVascular Surgical ProceduresYoung AdultConceptsAberrant subclavian arteryKommerell's diverticulumNatural historyOperative interventionBack painCT scanChest/back painLeft aberrant subclavian arteryRight aberrant subclavian arterySingle tertiary referral centerRight-sided aortaSingle-center experienceTertiary referral centerDeep vein thrombosisSerial CT scansComputed tomography scanMultivariable regression analysisRare developmental abnormalityAsymptomatic patientsHemorrhagic transformationDistal emboliEndovascular repairIschemic strokeMost patientsReferral centerAscending Aortic Length and Risk of Aortic Adverse Events The Neglected Dimension
Wu J, Zafar MA, Li Y, Saeyeldin A, Huang Y, Zhao R, Qiu J, Tanweer M, Abdelbaky M, Gryaznov A, Buntin J, Ziganshin BA, Mukherjee SK, Rizzo JA, Yu C, Elefteriades JA. Ascending Aortic Length and Risk of Aortic Adverse Events The Neglected Dimension. Journal Of The American College Of Cardiology 2019, 74: 1883-1894. PMID: 31526537, DOI: 10.1016/j.jacc.2019.07.078.Peer-Reviewed Original ResearchConceptsAortic height indexAortic elongationAdverse eventsAortic diameterAortic lengthAneurysmal ascending aortaThoracic aortic aneurysmLogistic regression modelsATAA patientsRisk stratificationAscending aortaAortic aneurysmNatural historyYearly riskLongitudinal changesHeight indexNovel predictive toolYearly rateIntervention criteriaAverage yearly rateDissectionRegression modelsLittle informationRiskPatientsSubacute/chronic type A aortic dissection: a retrospective cohort study
Wu J, Xie E, Qiu J, Huang Y, Jiang W, Zafar MA, Zhang L, Yu C. Subacute/chronic type A aortic dissection: a retrospective cohort study. European Journal Of Cardio-Thoracic Surgery 2019, 57: 388-396. PMID: 31317195, DOI: 10.1093/ejcts/ezz209.Peer-Reviewed Original ResearchConceptsChronic TAADAcute TAADLate survival ratesPropensity scoreAortic dissectionChronic typeClinical presentationSurvival rateRetrospective cohort studyEarly mortality rateCurrent surgical strategiesFifteen patientsMild painChest tightnessCohort studySharp painSurgical treatmentSurgical strategyExcellent outcomesLate outcomesTAADMortality ratePainPatientsTypical symptoms
2018
Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application?
Saeyeldin A, Zafar MA, Li Y, Tanweer M, Abdelbaky M, Gryaznov A, Brownstein AJ, Velasquez CA, Buntin J, Thombre K, Ma WG, Erben Y, Rizzo JA, Ziganshin BA, Elefteriades JA. Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application? Journal Of Thoracic And Cardiovascular Surgery 2018, 157: 1733-1745. PMID: 30579535, DOI: 10.1016/j.jtcvs.2018.09.124.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAlgorithmsAortic Aneurysm, ThoracicAortic DissectionAortic RuptureClinical Decision-MakingComorbidityDatabases, FactualDecision Support TechniquesDisease ProgressionFemaleHumansMaleMiddle AgedPatient CompliancePatient SelectionPredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsTreatment OutcomeTriageVascular Surgical ProceduresConceptsThoracic aortic aneurysmAortic aneurysmAortic diameterMean aortic diameterRisk of ruptureAortic causesAortic eventsSymptomatic aneurysmsElective surgeryMedical managementSafe patientsClinical effectivenessPreemptive surgerySurgical recommendationsWorse outcomesPatientsSurgeryAneurysmsClinical settingAneurysm increasesMedical observationComorbiditiesClinical applicationSymptomsTotalPrevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention
Mansour AM, Peterss S, Zafar MA, Rizzo JA, Fang H, Charilaou P, Ziganshin BA, Darr UM, Elefteriades JA. Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention. Cardiology 2018, 139: 139-146. PMID: 29346780, DOI: 10.1159/000481930.Peer-Reviewed Original ResearchConceptsRisk of dissectionAortic sizeAortic dissectionAortic diameter increaseGuideline-recommended thresholdNatural history analysisEffect of dissectionConsecutive patientsMultivariable analysisAneurysm patientsMultivariate regression modelControl groupImaging studiesAortaDissectionMultiple studiesAverage timePatientsRiskRegression modelsProportional estimatesStudyPrevention
2017
Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm
Zafar MA, Li Y, Rizzo JA, Charilaou P, Saeyeldin A, Velasquez CA, Mansour AM, Bin Mahmood SU, Ma WG, Brownstein AJ, Tranquilli M, Dumfarth J, Theodoropoulos P, Thombre K, Tanweer M, Erben Y, Peterss S, Ziganshin BA, Elefteriades JA. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. Journal Of Thoracic And Cardiovascular Surgery 2017, 155: 1938-1950. PMID: 29395211, DOI: 10.1016/j.jtcvs.2017.10.140.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAortic Aneurysm, ThoracicBody HeightBody Surface AreaDatabases, FactualDecision Support TechniquesDisease ProgressionFemaleHumansMaleMiddle AgedPredictive Value of TestsProgression-Free SurvivalRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsYoung AdultConceptsAortic size indexBody surface areaAortic height indexAortic diameterAortic aneurysmYearly riskComplication-free survivalLong-term complicationsRisk of complicationsRisk estimationAortic dissectionComplication rateAortic sizeRisk stratificationComplicationsPredictive valueConcordance statisticInternational guidelinesNatural complicationsPatientsHeight indexSignificant predictorsAneurysmsTAAARiskPositive family history of aortic dissection dramatically increases dissection risk in family members
Ma WG, Chou AS, Mok SCM, Ziganshin BA, Charilaou P, Zafar MA, Sieller RS, Tranquilli M, Rizzo JA, Elefteriades JA. Positive family history of aortic dissection dramatically increases dissection risk in family members. International Journal Of Cardiology 2017, 240: 132-137. PMID: 28502736, DOI: 10.1016/j.ijcard.2017.04.080.Peer-Reviewed Original ResearchConceptsFirst-degree relativesAortic dissectionFamily historyExposure yearsMore first-degree relativesNew aortic dissectionFamily membersDetailed family history informationPositive family historyLower mean ageTime of dissectionFamily history informationAOD patientsPrognostic valueMean ageIndex patientsHigh riskDissection riskPatientsYounger ageDissectionAgeShort durationRiskFHADsElective surgery for ascending aortic aneurysm in the elderly: should there be an age cut-off?†
Peterss S, Mansour AM, Zafar MA, Thombre K, Rizzo JA, Ziganshin BA, Darr UM, Elefteriades JA. Elective surgery for ascending aortic aneurysm in the elderly: should there be an age cut-off?†. European Journal Of Cardio-Thoracic Surgery 2017, 51: 965-970. PMID: 28369431, DOI: 10.1093/ejcts/ezw437.Peer-Reviewed Original ResearchConceptsOperative mortalityLow cardiac output syndromeYounger counterpartsElective aneurysm repairHigh operative riskMid-term survivalMulti-organ failureMultivariate regression analysisOutput syndromeElderly patientsOperative riskSurgical groupAneurysm repairIndependent predictorsOperative outcomesSurgical riskElective surgeryOrgan failureSurgical outcomesAortic aneurysmAdvanced ageHigh incidencePatientsAgeRegression analysis
2012
Are Thromboembolic and Bleeding Complications a Drawback for Composite Aortic Root Replacement?
Zafar MA, Farkas EA, Javier A, Anderson M, Gilani O, Elefteriades JA. Are Thromboembolic and Bleeding Complications a Drawback for Composite Aortic Root Replacement? The Annals Of Thoracic Surgery 2012, 94: 737-743. PMID: 22626762, DOI: 10.1016/j.athoracsur.2012.04.007.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAnalysis of VarianceAortic ValveBioprosthesisCirculatory Arrest, Deep Hypothermia InducedCohort StudiesFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHospital MortalityHumansIncidenceKaplan-Meier EstimateMaleMiddle AgedPostoperative ComplicationsPostoperative HemorrhagePrognosisProportional Hazards ModelsRetrospective StudiesRisk AssessmentSafety ManagementSurvival AnalysisThromboembolismTreatment OutcomeUltrasonographyConceptsComposite aortic root replacementAortic root replacementComposite graft replacementAortic root reconstructionRoot replacementGraft replacementRoot reconstructionValve-preserving aortic root reconstructionSocial Security Death IndexSex-matched populationKaplan-Meier curvesMechanical valve conduitBleeding complicationsHospital mortalityDistal embolismLatest followAortic databaseBiologic conduitDeath IndexPatient interviewsMinimal morbidityAortic rootExcellent survivalNative valveValve conduits