2023
Aortic 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 ResearchMeSH KeywordsAortaAortic Aneurysm, ThoracicAortic DissectionBicuspid Aortic Valve DiseaseFemaleHumansMaleRisk FactorsConceptsType 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 typesFate 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 criteria
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
Natural 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 ResearchNatural 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 informationRiskPatientsNonsyndromic Thoracic Aortic Aneurysms and Dissections—Is Screening Possible?
Faggion Vinholo T, Zafar MA, Ziganshin BA, Elefteriades JA. Nonsyndromic Thoracic Aortic Aneurysms and Dissections—Is Screening Possible? Seminars In Thoracic And Cardiovascular Surgery 2019, 31: 628-634. PMID: 31212014, DOI: 10.1053/j.semtcvs.2019.05.035.Peer-Reviewed Original ResearchConceptsThoracic aortic aneurysmTAAD patientsAortic aneurysmFatal natural historySerologic screening testsProphylactic surgical interventionNormal life expectancyObvious clinical signsRoutine genetic testingWhole-exome sequencingTAAD casesSurgical interventionClinical signsTimely diagnosisScreening testClinical settingNatural historyGenetic testingTAADExome sequencingDisease-causing genesGenetic mutationsLife expectancyDiagnosisPatientsA systematic review and meta-analysis of isolated abdominal aortic dissection
Wu J, Zafar M, Qiu J, Huang Y, Chen Y, Yu C, Elefteriades JA. A systematic review and meta-analysis of isolated abdominal aortic dissection. Journal Of Vascular Surgery 2019, 70: 2046-2053.e6. PMID: 31204217, DOI: 10.1016/j.jvs.2019.04.467.Peer-Reviewed Original ResearchConceptsIsolated abdominal aortic dissectionType B aortic dissectionAbdominal aortic dissectionAortic dissectionB aortic dissectionPrevalent risk factorsRisk factorsAverage aortic diameterComplication-specific approachEndovascular aortic repairAbdominal painChest painLate mortalityAortic repairClinical characteristicsConservative managementBack painPooled prevalenceRenal arteryAbdominal examinationAortic diameterAortic diseaseClinical symptomsCommon symptomsOpen surgery
2018
Diabetes Mellitus: Is It Protective against Aneurysm? A Narrative Review
Patel K, Zafar MA, Ziganshin BA, Elefteriades JA. Diabetes Mellitus: Is It Protective against Aneurysm? A Narrative Review. Cardiology 2018, 141: 107-122. PMID: 30453299, DOI: 10.1159/000490373.Peer-Reviewed Original ResearchConceptsAbdominal aortic aneurysmAortic aneurysmDiabetic patientsAortic dissectionDipeptidyl peptidase-4 inhibitorsCommon antidiabetic medicationsPrevalence of TAAsPeptidase-4 inhibitorsAneurysm growth rateSmaller aneurysm diameterAortic wall stressRate of mortalityLow rupture ratesAntidiabetic medicationsAortic surgeryHospital stayDiabetic stateAortic growthAneurysm diameterAntidiabetic agentsDecreased lengthAneurysmsProtective roleRupture rateMatrix metalloproteinasesDecision-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
Carotid Intima-Media Thickness Provides Evidence that Ascending Aortic Aneurysm Protects against Systemic Atherosclerosis
Hung A, Zafar M, Mukherjee S, Tranquilli M, Scoutt LM, Elefteriades JA. Carotid Intima-Media Thickness Provides Evidence that Ascending Aortic Aneurysm Protects against Systemic Atherosclerosis. Cardiology 2012, 123: 71-77. PMID: 23006774, DOI: 10.1159/000341234.Peer-Reviewed Original ResearchConceptsIntima-media thicknessCarotid intima-media thicknessAortic aneurysmCalcium scoreAortic calcium scoreAverage intima-media thicknessAortic aneurysm patientsCarotid IMT valuesDegree of atherosclerosisPositive family historyAortic aneurysm developmentDevelopment of atherosclerosisCommon carotid arterySystemic atherosclerosisAneurysm patientsIMT valuesMale genderRisk factorsCarotid arteryFamily historyMultiple linear regression analysisAtherosclerosisEarly markerAneurysm developmentAneurysms