2024
Intimomedial tears of the aorta heal by smooth muscle cell-mediated fibrosis without atherosclerosis
Hassab A, Hur D, Vallabhajosyula P, Tellides G, Assi R. Intimomedial tears of the aorta heal by smooth muscle cell-mediated fibrosis without atherosclerosis. JCI Insight 2024, 9: e172437. PMID: 38592807, PMCID: PMC11141924, DOI: 10.1172/jci.insight.172437.Peer-Reviewed Original ResearchConceptsDepartment of SurgerySmooth muscle cellsCellular response to injuryResponse to injuryImmunofluorescence confocal microscopyVessel wall repairPrimary lesionAscending aortaConduit functionAneurysmal diseaseDense fibrosisRadiological signsMural hematomaTear progressionMuscle cellsNon-hemorrhagicErythrocyte extravasationWall repairAortaTear completionInduce atherosclerosisHealed lesionsScattered leukocytesMinimal injuryConclusionThese findingsLiving in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis
Ram C, Yousef S, Ma W, Vallabhajosyula I, Singh S, Agarwal R, Milewski R, Assi R, Patel P, Williams M, Geirsson A, Vallabhajosyula P. Living in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis. Scientific Reports 2024, 14: 4952. PMID: 38418864, PMCID: PMC10902341, DOI: 10.1038/s41598-024-52660-w.Peer-Reviewed Original ResearchConceptsAortic valve replacementSevere aortic stenosisAfrican American raceArea Deprivation IndexAortic stenosisSevere ASArea deprivation index rankAortic valve replacement ratesAmerican raceAortic valve interventionPresentation of sepsisDiagnosis of ASADI groupValve replacementValve interventionDeprived neighbourhoodsAV interventionDisadvantaged neighborhoodsPatientsFemale genderDeprivation indexHigh-ADI groupLow-ADI groupStenosisRace
2022
Variability in surveillance practice for patients with diagnosis of bicuspid aortic valve syndrome
Kahler-Quesada A, Vallabhajosyula I, Yousef S, Mori M, Amabile A, Assi R, Geirsson A, Vallabhajosyula P. Variability in surveillance practice for patients with diagnosis of bicuspid aortic valve syndrome. Scientific Reports 2022, 12: 22009. PMID: 36539583, PMCID: PMC9768129, DOI: 10.1038/s41598-022-25571-x.Peer-Reviewed Original ResearchConceptsBicuspid aortic valveTertiary care centerAortic valveCare centerCardiovascular specialistsBicuspid aortic valve syndromeAortic pathologySurveillance imagingDisease progressionPatientsBivariate analysisEchocardiogramGuide interventionDiagnosisHigher proportionValveSurveillance practicesUrgent needGuidelinesValvulopathySpecialistsSurgeryValvularSyndromeFollowGrowth rate of ascending thoracic aortic aneurysms in a non-referral-based population
Weininger G, Mori M, Yousef S, Hur DJ, Assi R, Geirsson A, Vallabhajosyula P. Growth rate of ascending thoracic aortic aneurysms in a non-referral-based population. Journal Of Cardiothoracic Surgery 2022, 17: 14. PMID: 35109884, PMCID: PMC8812194, DOI: 10.1186/s13019-022-01761-6.Peer-Reviewed Original ResearchConceptsAneurysm growth rateAortic dilatationAortic aneurysmStudy populationCT scanInitial aneurysm sizeTrue natural historyPatients age 50High-risk patientsMedian time intervalLarge institutional databaseThoracic aortic aneurysmComputed tomography scanAortic aneurysm diseaseRisk patientsAortic sizeInstitutional databaseTomography scanAneurysm diseaseRadiologic diagnosisAneurysm sizeBackgroundPrior studiesAge 50PatientsNatural history
2021
Development and Validation of a Predictive Model to Identify Patients With an Ascending Thoracic Aortic Aneurysm
Mori M, Gan G, Deng Y, Yousef S, Weininger G, Daggula KR, Agarwal R, Shang M, Assi R, Geirsson A, Vallabhajosyula P. Development and Validation of a Predictive Model to Identify Patients With an Ascending Thoracic Aortic Aneurysm. Journal Of The American Heart Association 2021, 10: e022102. PMID: 34743563, PMCID: PMC8751931, DOI: 10.1161/jaha.121.022102.Peer-Reviewed Original ResearchConceptsThoracic aortic aneurysmAortic aneurysmPatient riskTomography scanHigher body surface areaTertiary care centerAortic valve diseaseHistory of arrhythmiaAvailable clinical informationBody surface areaScreening of patientsCross-sectional studyRisk prediction algorithmAscending Thoracic Aortic AneurysmsLogistic regression modelsClinical characteristicsAortic dissectionUnique patientsValve diseaseC-statisticFemale sexThoracic aortaCare centerComorbidity variablesMultivariable modelQuantitative not qualitative histology differentiates aneurysmal from nondilated ascending aortas and reveals a net gain of medial components
Yousef S, Matsumoto N, Dabe I, Mori M, Landry AB, Lee SR, Kawamura Y, Yang C, Li G, Assi R, Vallabhajosyula P, Geirsson A, Moeckel G, Humphrey JD, Tellides G. Quantitative not qualitative histology differentiates aneurysmal from nondilated ascending aortas and reveals a net gain of medial components. Scientific Reports 2021, 11: 13185. PMID: 34162971, PMCID: PMC8222259, DOI: 10.1038/s41598-021-92659-1.Peer-Reviewed Original ResearchConceptsMedial degenerationAortic aneurysmSporadic thoracic aortic aneurysmMedial cell numberCommon histopathological findingThoracic aortic aneurysmSmooth muscle cellsAortic dilatationHistopathological findingsAscending aortaHistopathological criteriaAneurysmal wallLumen dilatationClinical diagnosisMuscle cellsAneurysmsAortaDegenerationDilatationMural cellsMarked overlapElastic lamellaeMedial componentCell numberMedial tissueVariants of the aortic arch in adult general population and their association with thoracic aortic aneurysm disease
Yousef S, Singh S, Alkukhun A, Alturkmani B, Mori M, Chen J, Mullan CW, Brooks CW, Assi R, Gruber PJ, Cortopassi I, Geirsson A, Vallabhajosyula P. Variants of the aortic arch in adult general population and their association with thoracic aortic aneurysm disease. Journal Of Cardiac Surgery 2021, 36: 2348-2354. PMID: 33855754, DOI: 10.1111/jocs.15563.Peer-Reviewed Original ResearchConceptsAortic arch anomaliesArch anomaliesAneurysm diseaseBovine archAberrant right subclavian arteryAdult populationThoracic aortic aneurysm diseasePrevalence of TAAsRight-sided archRight subclavian arteryCharacteristics of patientsIndependent risk factorAortic valve pathologyAdult general populationGeneral adult populationAortic aneurysm diseaseLogistic regression analysisSingle health systemFisher's exact testOlder adult populationBinary logistic regressionThoracic aortopathiesSubclavian arteryCommon diagnosisThoracic aneurysmPatterns of Surveillance Imaging for Incidentally Detected Ascending Aortic Aneurysms
Weininger G, Mori M, Shang M, Degife E, Amick M, Yousef S, Assi R, Milewski R, Geirsson A, Vallabhajosyula P. Patterns of Surveillance Imaging for Incidentally Detected Ascending Aortic Aneurysms. The Annals Of Thoracic Surgery 2021, 113: 125-130. PMID: 33609548, DOI: 10.1016/j.athoracsur.2021.02.010.Peer-Reviewed Original ResearchConceptsAneurysm sizeLogistic regression modelsAortic aneurysmTomography scanCardiac surgeonsHigh-risk patient populationHigh-risk patientsAscending Aortic AneurysmLow clinical penetranceMedian aneurysm sizeYear of detectionPatterns of surveillanceMedian followCare patientsRegression modelsSurveillance imagingSurveillance intervalsPatient populationIncidental detectionFamily historyClinical penetrancePatientsPatient's aneurysmSilent killerTimely intervention
2020
Clinicopathologic Features of Tissue Granulomas in Transplant Recipients: A Single Center Study in a Nontuberculosis Endemic Region.
Nussbaum EZ, Patel KK, Assi R, Raad RA, Malinis M, Azar MM. Clinicopathologic Features of Tissue Granulomas in Transplant Recipients: A Single Center Study in a Nontuberculosis Endemic Region. Archives Of Pathology & Laboratory Medicine 2020, 145: 988-999. PMID: 33290524, DOI: 10.5858/arpa.2020-0271-oa.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedBartonellaBiopsyCommunicable DiseasesConnecticutCytomegalovirusFemaleGranulomaHematopoietic Stem Cell TransplantationHumansMaleMiddle AgedOrgan TransplantationPrevalenceRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTransplantation, HomologousTreatment OutcomeYoung AdultConceptsEpidemiologic risk factorsPresence of symptomsInfectious etiologyAsymptomatic patientsTransplant recipientsTissue granulomasClinicopathologic featuresRisk factorsAllogeneic hematopoietic stem cell transplant recipientsHematopoietic stem cell transplant recipientsStem cell transplant recipientsYale-New Haven HospitalCommon infectious etiologiesLarge transplant populationCell transplant recipientsSingle-center studyCryptogenic organizing pneumoniaNew Haven HospitalRoutine disease surveillancePaucity of literatureCytomegalovirus hepatitisPosttransplant specimensBiopsy indicationOrganizing pneumoniaTransplant patientsAssociation Between Cardiac Surgeons’ Number of Years in Practice and Surgical Outcomes in New York Cardiac Centers
Weininger G, Mori M, Brooks C, Shang M, Vinholo T, Zhang Y, Assi R, Geirsson A, Vallabhajosyula P. Association Between Cardiac Surgeons’ Number of Years in Practice and Surgical Outcomes in New York Cardiac Centers. JAMA Network Open 2020, 3: e2023671. PMID: 33141159, PMCID: PMC7610186, DOI: 10.1001/jamanetworkopen.2020.23671.Peer-Reviewed Original ResearchConceptsRisk-adjusted operative mortality ratesAnnual case volumeSurgeon annual case volumeValve proceduresCABG proceduresCardiac surgeonsYears of practiceCardiothoracic surgeonsSurgical outcomesSurgeon numberCase volumeMortality rateRisk-adjusted mortality ratesCoronary artery bypassOperative mortality rateMultivariable risk modelsDay of surgeryCardiac surgery centersCross-sectional studyRisk-adjusted outcomesCross-sectional analysisArtery bypassIndex hospitalizationValve surgeryCardiac centerDiagnosis of Thoracic Aortic Aneurysms by Computed Tomography Without Allometric Scaling
Yousef S, Mori M, Bin Mahmood SU, Assi R, Vallabhajosyula P, Geirsson A, Tellides G. Diagnosis of Thoracic Aortic Aneurysms by Computed Tomography Without Allometric Scaling. JAMA Network Open 2020, 3: e2023689. PMID: 33141157, PMCID: PMC7610193, DOI: 10.1001/jamanetworkopen.2020.23689.Peer-Reviewed Original ResearchSurgical management of thoracic aortic emergency with pre‐ and postoperative COVID‐19 disease
Mori M, Geirsson A, Vallabhajosyula P, Assi R. Surgical management of thoracic aortic emergency with pre‐ and postoperative COVID‐19 disease. Journal Of Cardiac Surgery 2020, 35: 2832-2834. PMID: 32667075, PMCID: PMC7405051, DOI: 10.1111/jocs.14865.Peer-Reviewed Original ResearchMeSH KeywordsAged, 80 and overAorta, ThoracicAortic Aneurysm, ThoracicAortic DissectionBetacoronavirusComorbidityCoronavirus InfectionsCOVID-19EmergenciesFemaleHumansMaleMiddle AgedPandemicsPneumonia, ViralPostoperative PeriodPreoperative PeriodSARS-CoV-2Tomography, X-Ray ComputedVascular Surgical ProceduresMidterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection
Bojko MM, Assi R, Bavaria JE, Suhail M, Habertheuer A, Hu RW, Harmon J, Milewski RK, Desai ND, Szeto WY, Vallabhajosyula P. Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection. Journal Of Thoracic And Cardiovascular Surgery 2020, 163: 900-910.e2. PMID: 32620395, DOI: 10.1016/j.jtcvs.2020.04.064.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAdultAgedAortic AneurysmAortic DissectionAortic ValveAortic Valve InsufficiencyBlood Vessel Prosthesis ImplantationCardiac Surgical ProceduresFemaleHumansMaleMiddle AgedPostoperative ComplicationsRecurrenceReoperationRetrospective StudiesRisk AssessmentRisk FactorsSinus of ValsalvaTime FactorsTreatment OutcomeConceptsAcute typeRoot replacementAortic dissectionAortic insufficiencyRoot repairCumulative incidenceReplacement groupPostoperative aortic insufficiencyProximal aortic reoperationsRoot replacement groupMultivariable Cox regressionSinus of ValsalvaLongitudinal mixed modelsAortic reoperationValsalva dimensionsMidterm outcomesRoot dilationCox regressionFunctional outcomeRisk factorsReoperationSinusInsufficiencyDissectionMixed effects models
2019
Measuring Uncertainty Intolerance in Surgical Residents Using Standardized Assessments
Ying LD, Harrington A, Assi R, Thiessen C, Contessa J, Hubbard M, Yoo P, Nadzam G. Measuring Uncertainty Intolerance in Surgical Residents Using Standardized Assessments. Journal Of Surgical Research 2019, 245: 145-152. PMID: 31419639, DOI: 10.1016/j.jss.2019.07.035.Peer-Reviewed Original ResearchConceptsPhysicians' risk attitudesUncertainty intoleranceNew education initiativeMBTI assessmentPersonality factorsFemale residentsSurgical residentsPras scoreOwn mental healthMale residentsUncertainty toleranceGeneral surgery residentsHigher completion ratesStages of trainingPsychological stressMental healthSurgical practiceLarger studyStandardized assessmentPhysician practicesPilot studySurgery residentsSuch interventionsPRUSignificant differences
2018
External Validation of University of Wisconsin's Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Trauma
Harrington AW, Pei KY, Assi R, Davis KA. External Validation of University of Wisconsin's Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Trauma. Journal Of Craniofacial Surgery 2018, 29: e167-e170. PMID: 29309356, DOI: 10.1097/scs.0000000000004240.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedEcchymosisFacial BonesFacial InjuriesFemaleGlasgow Coma ScaleHospitals, UniversityHumansMaleMalocclusionMiddle AgedPhysical ExaminationPractice Guidelines as TopicPredictive Value of TestsRetrospective StudiesSkull FracturesTomography, X-Ray ComputedTooth LossTrauma CentersWisconsinConceptsLevel 1 trauma centerTrauma centerFacial fracturesClinical criteriaPredictive valueAdditional cross-sectional imagingModern practice patternsPhysical examination criteriaCross-sectional imagingNegative predictive valueMaxillofacial computed tomographyPositive predictive valueElectronic medical recordsRetrospective case studyMultisystem traumaPhysical examinationMaxillofacial fracturesBoard-certified radiologistsMedical recordsPractice patternsComputed tomographyFacial bonesConfidence intervalsInternal validation studyExamination criteria
2017
Clinical and epidemiological characterization of histoplasmosis cases in a nonendemic area, Connecticut, United States
Azar MM, Zhang X, Assi R, Hage C, Wheat LJ, Malinis MF. Clinical and epidemiological characterization of histoplasmosis cases in a nonendemic area, Connecticut, United States. Medical Mycology 2017, 56: 896-899. PMID: 29228334, DOI: 10.1093/mmy/myx120.Peer-Reviewed Original ResearchConceptsHuman immunodeficiency virusHistoplasmosis casesEpidemiology of histoplasmosisNon-endemic areasSymptom onsetAntigen testingMedian timeImmunodeficiency virusActive histoplasmosisNonendemic areasRetrospective analysisEndemic areasEpidemiological characterizationHistoplasmosisNew HavenDaysPatientsEpidemiologyDiagnosisCases
2015
Fungal Mycotic Aneurysm of the Internal Carotid Artery Associated with Sphenoid Sinusitis in an Immunocompromised Patient: A Case Report and Review of the Literature
Azar MM, Assi R, Patel N, Malinis MF. Fungal Mycotic Aneurysm of the Internal Carotid Artery Associated with Sphenoid Sinusitis in an Immunocompromised Patient: A Case Report and Review of the Literature. Mycopathologia 2015, 181: 425-433. PMID: 26687073, DOI: 10.1007/s11046-015-9975-1.Peer-Reviewed Case Reports and Technical NotesConceptsInternal carotid arteryFungal mycotic aneurysmsMycotic aneurysmSphenoid sinusitisICA aneurysmsSphenoid sinusEORTC/MSG criteriaInternal Carotid Artery AssociatedFungal sphenoid sinusitisLiposomal amphotericin B.Parent vessel sacrificeInvasive fungal infectionsDuration of antimicrobialsEffective antifungal therapyDevastating complicationSurgical debridementEndoscopic resectionAngioinvasive infectionVessel sacrificeCase reportAntifungal therapyCoil embolizationIdeal treatmentCavernous sinusCarotid arteryBlastomycosis in Indiana Clinical and Epidemiologic Patterns of Disease Gleaned from a Multicenter Retrospective Study
Azar MM, Assi R, Relich RF, Schmitt BH, Norris S, Wheat LJ, Hage CA. Blastomycosis in Indiana Clinical and Epidemiologic Patterns of Disease Gleaned from a Multicenter Retrospective Study. CHEST Journal 2015, 148: 1276-1284. PMID: 26020566, DOI: 10.1378/chest.15-0289.Peer-Reviewed Original ResearchConceptsDiabetes mellitusEpidemiologic patternsIncidence of blastomycosisMulticenter retrospective studyCases of blastomycosisMultilobar pneumoniaICU admissionExtrapulmonary diseaseRetrospective studyMean ageIncidence rateFungal antigensEndemic areasLarge seriesAmphotericin BBlastomycosisTotal mortalityIncidenceMellitusPneumoniaSignificant increaseDiseaseIndiana ClinicalARDSImmunosuppressionReply
Assi R, Kim AW. Reply. The Annals Of Thoracic Surgery 2015, 100: 1511-1512. PMID: 26434472, DOI: 10.1016/j.athoracsur.2015.05.022.Peer-Reviewed Case Reports and Technical Notes
2014
Hospital Readmission After Pulmonary Lobectomy Is Not Affected by Surgical Approach
Assi R, Wong DJ, Boffa DJ, Detterbeck FC, Wang Z, Chupp GL, Kim AW. Hospital Readmission After Pulmonary Lobectomy Is Not Affected by Surgical Approach. The Annals Of Thoracic Surgery 2014, 99: 393-398. PMID: 25497070, DOI: 10.1016/j.athoracsur.2014.10.014.Peer-Reviewed Original ResearchConceptsCharlson Comorbidity IndexDays of dischargePredictors of readmissionIntensive care unitUnplanned returnPulmonary lobectomyComorbidity indexHospital readmissionSurgical approachCare unitHigher Charlson comorbidity indexMedian hospital lengthMultivariate logistic regression methodThoracic surgery serviceHigh-risk patientsPostoperative mortalityPostoperative transferHospital lengthPostoperative complicationsExpiratory volumeSurgery serviceOpen thoracotomyPathologic diagnosisUnplanned transfersMedical records