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
2022
Bovine 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 ResearchConceptsBovine 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 studiesChestEngineering analysis of aortic wall stress and root dilatation in the V-shape surgery for treatment of ascending aortic aneurysms
Dong H, Liu M, Qin T, Liang L, Ziganshin B, Ellauzi H, Zafar M, Jang S, Elefteriades J, Sun W. Engineering analysis of aortic wall stress and root dilatation in the V-shape surgery for treatment of ascending aortic aneurysms. Interdisciplinary CardioVascular And Thoracic Surgery 2022, 34: 1124-1131. PMID: 35134955, PMCID: PMC9159430, DOI: 10.1093/icvts/ivac004.Peer-Reviewed Original ResearchConceptsRoot dilatationAortic rootAortic wall stressAortic aneurysmWall stressComputed tomography imagesTime pointsAortic root diameterTomography imagesSignificant reductionPost-surgery statesWhole aortaAortic wallSurgeryDilatationClinical cardiacPatientsAverage dilatationStudy objectiveAneurysmsAortaBiomechanical analysisTreatment
2021
Lipid profiles help to explain protection from systemic atherosclerosis in patients with ascending aortic aneurysm
Weininger G, Ostberg N, Shang M, Zafar M, Ziganshin BA, Liu S, Erben Y, Elefteriades JA. Lipid profiles help to explain protection from systemic atherosclerosis in patients with ascending aortic aneurysm. Journal Of Thoracic And Cardiovascular Surgery 2021, 163: e129-e132. PMID: 34635315, DOI: 10.1016/j.jtcvs.2021.09.031.Peer-Reviewed Original ResearchRoot 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 diametersAccuracy of the “Thumb-Palm Test” for Detection of Ascending Aortic Aneurysm
Blumel R, Patel K, Rizzo JA, Mok S, Barrett A, Wu J, Zafar MA, Ziganshin BA, Elefteriades JA. Accuracy of the “Thumb-Palm Test” for Detection of Ascending Aortic Aneurysm. The American Journal Of Cardiology 2021, 150: 114-116. PMID: 34020772, DOI: 10.1016/j.amjcard.2021.03.041.Peer-Reviewed Original ResearchConceptsAscending aortic diameterAortic aneurysmTransesophageal echocardiographyPalm testAortic diameterIntra-operative transesophageal echocardiographyAscending Aortic AneurysmThoracic aortic aneurysmStandard physical examinationThousands of patientsVariety of disordersAscending aneurysmCardiac surgeryAneurysm patientsPhysical examinationPositive testPatientsNegative testAneurysmsHigher likelihoodNegative resultsAscAASubstantial likelihoodSignsEchocardiographyFate 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 survivalIs Aortic Z-score an Appropriate Index of Beneficial Drug Effect in Clinical Trials in Aortic Aneurysm Disease?
Elkinany S, Weismann C, Curtis A, Smith T, Zafar MA, Breen T, Li Y, Tranquilli M, Rizzo JA, Mukherjee SK, Ziganshin BA, Elefteriades JA. Is Aortic Z-score an Appropriate Index of Beneficial Drug Effect in Clinical Trials in Aortic Aneurysm Disease? The American Journal Of Cardiology 2021, 143: 145-153. PMID: 33352210, DOI: 10.1016/j.amjcard.2020.12.025.Peer-Reviewed Original ResearchConceptsBody mass indexAortic Z-scoresZ-score decreaseBeneficial drug effectsZ-scoreMarfan patientsClinical trialsAneurysm diseaseDrug effectsChild's ageEcho examAortic dilation rateDecreased Z-scoreConnective tissue diseaseBody surface areaEffects of medicationAortic aneurysm diseaseClinical drug trialsMass indexTissue diseaseAortic diseaseAneurysmal pathologyDrug trialsInvestigational drugsSpontaneous decrease
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 differencesDirect measurement of ascending aortic diameter by intraoperative caliper assessment
Faggion Vinholo T, Zafar MA, Papanikolaou D, Chung J, Ellauzi H, Ziganshin BA, Elefteriades JA. Direct measurement of ascending aortic diameter by intraoperative caliper assessment. Journal Of Thoracic And Cardiovascular Surgery 2020, 161: e143-e146. PMID: 32891453, DOI: 10.1016/j.jtcvs.2020.08.001.Peer-Reviewed Original ResearchCine-Computed Tomography for the Evaluation of Prosthetic Heart Valve Function
Hsu C, Bourganos K, Zafar MA, Huber S, Buntin J, Ziganshin BA, Mojibian H, Elefteriades JA. Cine-Computed Tomography for the Evaluation of Prosthetic Heart Valve Function. Cardiology 2020, 145: 439-445. PMID: 32454507, DOI: 10.1159/000507182.Peer-Reviewed Original ResearchConceptsAortic valve replacementAortic stenosisTransvalvular velocityValve functionECG-gated computed tomographyProsthetic heart valve functionProsthetic valve dysfunctionProsthetic valve functionCine CTHeart valve functionAVR patientsValve thrombosisCardiac eventsRepeat surgeryValve dysfunctionValve replacementSingle surgeonSurgical interventionRepeat evaluationProsthetic valvesComputed tomographyLeaflet excursionFurther evaluationLeaflet functionPatientsNonusefulness of Antithrombotic Therapy After Surgical Bioprosthetic Aortic Valve Replacement
Gryaznov AA, Saeyeldin A, Abdelbaky M, Zafar MA, Tanweer M, Papanikolaou D, Imran M, Li Y, Ziganshin BA, Elefteriades JA. Nonusefulness of Antithrombotic Therapy After Surgical Bioprosthetic Aortic Valve Replacement. The American Journal Of Cardiology 2020, 129: 71-78. PMID: 32605717, DOI: 10.1016/j.amjcard.2020.05.018.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAnticoagulantsAortic ValveAortic Valve InsufficiencyAortic Valve StenosisAspirinAtrial FibrillationBicuspid Aortic Valve DiseaseBioprosthesisCoronary Artery DiseaseFactor Xa InhibitorsFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemorrhageHumansKaplan-Meier EstimateMaleMiddle AgedMortalityPlatelet Aggregation InhibitorsPostoperative CareProportional Hazards ModelsPurinergic P2Y Receptor AntagonistsStrokeThromboembolismWarfarinYoung AdultConceptsAortic valve replacementBiological aortic valve replacementAntithrombotic regimensValve replacementSurgical bioprosthetic aortic valve replacementCox proportional hazards regression modelSurgical aortic valve replacementBioprosthetic aortic valve replacementConsecutive adult patientsCoronary artery diseaseKaplan-Meier analysisIncidence of deathHazards regression modelsAntiplatelet groupAVR patientsRoutine anticoagulationAntithrombotic therapyCardiovascular eventsThromboembolic eventsAdult patientsAdverse eventsAnticoagulation groupArtery diseaseTreatment regimensTherapy group
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 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 informationRiskPatientsFate of preserved bicuspid valves at time of ascending aortic aneurysmectomy
Vinholo T, Zafar MA, Baldwin GE, Buntin J, Mansour A, Imran M, Papanikolaou D, Ziganshin BA, Elefteriades JA. Fate of preserved bicuspid valves at time of ascending aortic aneurysmectomy. Journal Of Cardiac Surgery 2019, 34: 318-322. PMID: 30900354, DOI: 10.1111/jocs.14024.Peer-Reviewed Original ResearchConceptsBicuspid aortic valveAortic valveAortic stenosisConcomitant bicuspid aortic valveAortic aneurysm surgeryAortic valve replacementAortic aneurysm patientsIntraoperative transesophageal echocardiographyAortic aneurysmectomyPostoperative echocardiogramsPreoperative echocardiogramValve replacementSingle surgeonAneurysm surgeryBicuspid valveTransesophageal echocardiographyAneurysm patientsSignificant abnormalitiesStudy groupValve functionPatientsSurgeryEchocardiogramStenosisAverage time
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