The Aortic Institute at Yale-New Haven: Milestones Achieved

1. The Center incorporates a database of 5,000 patients, 15,000 patient years of follow-up, and 15,000 imaging studies. We believe this is the largest thoracic aortic database extant.
2. Developed massive tissue bank for thoracic aortic specimens, supplying material to universities worldwide.
3. Articulated “Complication-Specific Approach” for Type B aortic dissection, now generally adopted worldwide.
4. Determined size at which thoracic aorta ruptures or dissects, permitting evidence-based criteria for surgical intervention, which are used throughout the world.
5. Identified inherited, genetic nature of thoracic aortic aneurysm and dissection.
6. Identified phenomenon of aortic dissection in young weight lifters.
7. Identified inciting events for acute aortic dissection (exertion, emotion).
8. Developed first general screening blood test for thoracic aortic aneurysm (molecular biologic “RNA Signature” test).
9. Identified role of MMPs in pathogenesis of thoracic aortic aneurysm (as well as other molecular pathophysiologic mechanisms).
10. Located the specific mutations (SNPs, or single nucleotide polymorphisms) that underlie thoracic aneurysm disease, via a Yale-driven collaboration with Celera Genomics, including patient recruitment on two continents.
11. Described mechanical (engineering) alterations in the aortic wall that underlie aortic dissection and rupture.
12. Developed novel spinal “Cooling Catheter” for prevention of paraplegia in aortic surgery (supported by grants from the National Science Foundation).
13. Demonstrated that suspended animation (Deep Hypothermic Circulatory Arrest – DHCA) is a very safe technique for aortic arch operations.
14. Disseminated information about aortic dissection to the medical community via chapters, monographs, articles, books, and Yale-sponsored symposia.
15. Disseminated information about aortic dissection to the lay public through multiple magazine, newspaper, and TV articles (and via collaboration with The Wall Street Journal in a Pulitzer Prize winning series by Kevin Helliker). http://online.wsj.com/public/resources/documents/PulitzerKH04052004.htm
16. Identified the utility of statin drugs in preventing progression and complications of thoracic aortic aneurysm.
17. First identified that bovine aortic arch and other arch vessel branching anomalies predispose to thoracic aortic aneurysm.
18. Founded medical journal AORTA, reaching 11,500 readers in ninety-four countries.
19. Developed first widespread Next Generation routine genetic testing program for mutations leading to thoracic aortic aneurysm and dissection (based on Whole Exome Sequencing).
20. Demonstrated near-curative impact of composite graft replacement surgery in restoring normal life expectancy for patients with aortic root aneurysm.
21. Demonstrated markedly increased risk of aortic dissection (3x) once a first dissection has occurred in a family member.
22. Demonstrated that having an ascending aortic aneurysm protects strongly against arteriosclerosis.

All of the above milestones are reported in scientific publications in top medical and surgical journals and in the book Acute Aortic Disease (John A. Elefteriades, M.D., Informa Healthcare, 2007) chronicles many of the above milestones.

A comprehensive review of some of these milestones is also published in the following two publications:

Elefteriades JA, Farkas EA. Thoracic aortic aneurysm: clinically pertinent controversies and uncertainties. Journal of the American College of Cardiology 2010;55(9):841-57.

Ziganshin BA, Elefteriades JA. Yale milestones in reading the playbook of thoracic aortic aneurysms. Connecticut Medicine. 2012;76(10):589-98

A review specially prepared for a lay audience can be found in Scientific American magazine (Elefteriades JA. Beating a sudden killer. Scientific American. 2005;293:64-71.)