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
2023
One-Year Results of a Low-Profile Endograft in Acute, Complicated Type B Aortic Dissection
Rossi P, Desai N, Malaisrie S, Lyden S, Nassiri N, Reece T, Adams J, Moanie S, Shults C, Investigators R, Vallabhajosyula P, Panneton J, Kumins N, Sharafuddin M, Toursavadkohi S, Ullery B, Duwayri Y, Han S, Rahimi S, Meisner R, Dryjski M, Starnes B, Fukuhara S, Cheema M. One-Year Results of a Low-Profile Endograft in Acute, Complicated Type B Aortic Dissection. The Annals Of Thoracic Surgery 2023, 117: 336-343. PMID: 37769702, DOI: 10.1016/j.athoracsur.2023.08.035.Peer-Reviewed Original ResearchConceptsType B aortic dissectionComplicated type B aortic dissectionMajor adverse eventsB aortic dissectionAdverse eventsCause mortalityAortic dissectionTechnical successEnd pointAortic diameter growthFalse lumen perfusionPrimary end pointSecondary end pointsKaplan-Meier analysisOne-year resultsParaplegia/paraparesisLong-term outcomesUnited States CentersMedian hospitalizationAortic expansionPatency lossRenal failurePivotal trialsRetrograde dissectionIliac artery
2018
Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection
Kreibich M, Bavaria JE, Branchetti E, Brown CR, Chen Z, Khurshan F, Siki M, Vallabhajosyula P, Szeto WY, Desai ND. Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection. The Annals Of Thoracic Surgery 2018, 107: 1174-1180. PMID: 30444990, DOI: 10.1016/j.athoracsur.2018.09.065.Peer-Reviewed Original ResearchMeSH KeywordsAgedAortic Aneurysm, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationCohort StudiesCoronary Artery BypassCoronary Artery DiseaseCoronary CirculationFemaleGermanyHeart Arrest, InducedHospital MortalityHospitals, UniversityHumansKaplan-Meier EstimateLength of StayMaleMiddle AgedPostoperative ComplicationsPrognosisRetrospective StudiesRisk AssessmentStatistics, NonparametricSurvival AnalysisTreatment OutcomeConceptsCoronary artery malperfusionType B patientsType C patientsAntegrade cardioplegiaC patientsB patientsAortic dissectionCoronary ostiumDissection flapCA diseaseA Aortic DissectionType C lesionsManagement of patientsType B lesionsLong-term survivalCA bypassBypass GraftingPerioperative mortalityC lesionsComplete avulsionB lesionsLandmark analysisMalperfusionSuture repairPatientsFunctional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring
Ko H, Bavaria JE, Habertheuer A, Augoustides JG, Siki MA, Freas M, Komlo C, Milewski K, Desai ND, Szeto WY, Vallabhajosyula P. Functional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring. The Annals Of Thoracic Surgery 2018, 107: 68-75. PMID: 30086284, DOI: 10.1016/j.athoracsur.2018.06.056.Peer-Reviewed Original ResearchConceptsSubcommissural annuloplastyAortic insufficiencyAortic valve repairTransvalvular gradientValve repairAortic ringsLeaflet prolapseAnnular stabilizationVentricular outflow tract diameterBicuspid aortic valve patientsBicuspid aortic valve repairOutflow tract diameterSevere aortic insufficiencyMean transvalvular gradientIntraoperative transesophageal echocardiographyAortic valve patientsLV outflow tractAortic root complexPostprocedure outcomesValve patientsTract diameterFunctional outcomeLV dimensionsTransesophageal echocardiographyOutflow tractPredictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair
Habertheuer A, Milewski RK, Bavaria JE, Siki M, Freas M, Desai N, Szeto W, Ram C, Hu R, Vallabhajosyula P. Predictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair. The Annals Of Thoracic Surgery 2018, 106: 1316-1324. PMID: 30055138, DOI: 10.1016/j.athoracsur.2018.06.026.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAdultAgedAortic ValveAortic Valve InsufficiencyBicuspid Aortic Valve DiseaseCardiac Valve AnnuloplastyDatabases, FactualFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHumansLogistic ModelsMaleMiddle AgedPredictive Value of TestsRecurrenceReoperationRetrospective StudiesRisk AssessmentSurvival RateTreatment OutcomeDistinct macrophage populations direct inflammatory versus physiological changes in adipose tissue
Hill DA, Lim HW, Kim YH, Ho WY, Foong YH, Nelson VL, Nguyen HCB, Chegireddy K, Kim J, Habertheuer A, Vallabhajosyula P, Kambayashi T, Won KJ, Lazar MA. Distinct macrophage populations direct inflammatory versus physiological changes in adipose tissue. Proceedings Of The National Academy Of Sciences Of The United States Of America 2018, 115: e5096-e5105. PMID: 29760084, PMCID: PMC5984532, DOI: 10.1073/pnas.1802611115.Peer-Reviewed Original ResearchConceptsMultiple distinct populationsUnique tissue distributionTissue macrophage subsetsChromatin landscapeDistinct macrophage populationsTranscriptional mechanismsGene programObese fat tissueGene expressionDistinct populationsFunctional differencesAdipocyte physiologyCrown-like structuresAdipose tissueMacrophage populationsFunctional heterogeneityATM populationsTissue distributionHuman adipose tissueMacrophage subsetsPhysiological changesFat cellsAdoptive transferBody massTranscriptomeHybrid arch surgery challenges other forms of arch treatment
Wallen TJ, Bavaria JE, Vallabhajosyula P. Hybrid arch surgery challenges other forms of arch treatment. The Journal Of Cardiovascular Surgery 2018, 59: 554-558. PMID: 29687970, DOI: 10.23736/s0021-9509.18.10516-7.Peer-Reviewed Original ResearchConceptsHybrid arch proceduresHigh-risk patientsArch proceduresArch replacementRisk patientsTotal arch replacement procedureAcceptable postoperative outcomesSignificant comorbid burdenSignificant operative riskAortic arch replacementProspective randomized trialsTotal arch replacementAortic arch pathologiesOptimal surgical managementHybrid procedureArch surgeryComorbid burdenPostoperative mortalityAortic remodelingArch pathologiesOperative riskPostoperative outcomesSignificant comorbiditiesCirculatory arrestCase seriesTricuspid valve endocarditis in the era of the opioid epidemic
Wallen TJ, Szeto W, Williams M, Atluri P, Arnaoutakis G, Fults M, Sultan I, Desai N, Acker M, Vallabhajosyula P. Tricuspid valve endocarditis in the era of the opioid epidemic. Journal Of Cardiac Surgery 2018, 33: 260-264. PMID: 29663522, DOI: 10.1111/jocs.13600.Peer-Reviewed Original ResearchConceptsTricuspid valve endocarditisOpioid epidemicTricuspid endocarditisValve endocarditisRight heart endocarditisThirty-day mortalityTricuspid valve replacementCommon causative agentIndex hospitalizationRenal failureValve replacementSurgical volumeInstitutional experienceCommon isolatesExclusion criteriaEndocarditisAverage agePatientsStudy periodCausative agentStaphylococcus aureusEpidemicFivefold increaseReoperationHospitalizationOutcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients
Kreibich M, Rylski B, Bavaria JE, Branchetti E, Dohle D, Moeller P, Vallabhajosyula P, Szeto WY, Desai ND. Outcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients. The Annals Of Thoracic Surgery 2018, 106: 491-497. PMID: 29673638, DOI: 10.1016/j.athoracsur.2018.03.035.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAortic AneurysmAortic DissectionBody Mass IndexBody WeightCohort StudiesComorbidityFemaleHospital MortalityHumansLogistic ModelsMaleMiddle AgedObesity, MorbidOdds RatioPostoperative ComplicationsPrognosisReference ValuesRetrospective StudiesRisk AssessmentSurvival AnalysisTreatment OutcomeConceptsAortic dissection type AMorbidly obese patientsNormal weight patientsObese patientsSurgical repairWeight patientsDistal aortic repairImmediate surgical approachMore obese patientsCalculated blood volumeBody mass indexIntensive care unitLength of stayType AHospital mortalityHospital stayPostoperative complicationsAortic repairPostoperative outcomesCare unitClinical featuresClinical presentationMass indexNormal weightAdverse outcomesHemodynamic Effects of Valve Asymmetry in Sapien 3 Transcatheter Aortic Valves.
Mangels DR, Siki M, Menon R, Bavaria J, Anwaruddin S, Giri J, Desai N, Szeto WY, Vallabhajosyula P, Herrmann HC. Hemodynamic Effects of Valve Asymmetry in Sapien 3 Transcatheter Aortic Valves. Journal Of Invasive Cardiology 2018, 30: 138-143. PMID: 29610444.Peer-Reviewed Original ResearchConceptsStructural valve deteriorationTranscatheter aortic valve replacementSAPIEN 3 valveParavalvular leakTransthoracic echocardiogramAortic insufficiencySAPIEN 3 transcatheter aortic valveAortic valve gradientSapien 3 prosthesisAortic valve replacementRetrospective cohort analysisTranscatheter aortic valveAI severityValve gradientAnnular calcificationHemodynamic effectsValve replacementValve deteriorationSmall prosthesisSingle institutionAortic valveAV gradientCohort analysisHigh incidenceSignificant differencesAssociation of Tricuspid Regurgitation With Transcatheter Aortic Valve Replacement Outcomes: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
McCarthy FH, Vemulapalli S, Li Z, Thourani V, Matsouaka RA, Desai ND, Kirtane A, Anwaruddin S, Williams ML, Giri J, Vallabhajosyula P, Li RH, Herrmann HC, Bavaria JE, Szeto WY. Association of Tricuspid Regurgitation With Transcatheter Aortic Valve Replacement Outcomes: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. The Annals Of Thoracic Surgery 2018, 105: 1121-1128. PMID: 29502934, DOI: 10.1016/j.athoracsur.2017.11.018.Peer-Reviewed Original ResearchConceptsTranscatheter aortic valve replacementHeart failure readmissionCardiology Transcatheter Valve Therapy RegistryThoracic Surgeons/American CollegeTranscatheter Valve Therapy RegistrySevere TRVentricular ejection fractionTricuspid regurgitationMild TRRisk patientsEjection fractionTR severityAmerican CollegeEffectiveness of TAVRInhospital major adverse cardiac eventsTranscatheter Aortic Valve Replacement OutcomesModerate TRMajor adverse cardiac eventsTricuspid regurgitation severityAdverse cardiac eventsAortic valve replacementHigh-risk patientsLow-risk patientsNumber of comorbiditiesIntensive care unitManagement of the moderately dilated sinus of Valsalva: To cut or not to cut?
Milewski RK, Habertheuer A, Bavaria JE, Vallabhajosyula P. Management of the moderately dilated sinus of Valsalva: To cut or not to cut? Journal Of Thoracic And Cardiovascular Surgery 2018, 155: 526-527. PMID: 29415375, DOI: 10.1016/j.jtcvs.2017.10.002.Peer-Reviewed Original ResearchPredicting Distal Aortic Remodeling After Endovascular Repair for Chronic DeBakey III Aortic Dissection
Sultan I, Siki MA, Bavaria JE, Dibble TR, Savino DC, Kilic A, Szeto W, Vallabhajosyula P, Fairman RM, Jackson BM, Wang GJ, Desai ND. Predicting Distal Aortic Remodeling After Endovascular Repair for Chronic DeBakey III Aortic Dissection. The Annals Of Thoracic Surgery 2018, 105: 1691-1696. PMID: 29391144, DOI: 10.1016/j.athoracsur.2018.01.006.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAortic Aneurysm, ThoracicAortic DissectionBlood Vessel Prosthesis ImplantationChronic DiseaseCohort StudiesComputed Tomography AngiographyFemaleHospitals, UniversityHumansImaging, Three-DimensionalLogistic ModelsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsPrognosisRetrospective StudiesRisk AssessmentSeverity of Illness IndexSex FactorsSurvival RateTreatment OutcomeConceptsDeBakey III aortic dissectionAortic remodelingAortic dissectionVisceral vesselsTotal thrombosisGreater curveExact testDistal aortic remodelingOpen aortic reconstructionPositive aortic remodelingMultivariable logistic regressionNegative predictorFisher's exact testMultivariate logistic modelTomography angiography scansWilcoxon rank sumEndovascular aortic graftingAortic centersChronic dissectionAortic reconstructionCeliac axisAortic graftingEndovascular repairPrimary tearAortic size
2017
The role of extracorporeal membrane oxygenator therapy in the setting of Type A aortic dissection
Sultan I, Habertheuer A, Wallen T, Siki M, Szeto W, Bavaria JE, Williams M, Vallabhajosyula P. The role of extracorporeal membrane oxygenator therapy in the setting of Type A aortic dissection. Journal Of Cardiac Surgery 2017, 32: 822-825. PMID: 29216679, DOI: 10.1111/jocs.13245.Peer-Reviewed Original ResearchConceptsPost-operative dayAortic dissectionTAAD repairECMO supportPennsylvania Health Care Cost Containment Council databaseDiagnosis/procedure codesType A Aortic DissectionFirst post-operative dayAcute cardiopulmonary failurePost-cardiotomy shockSame hospital visitA Aortic DissectionAcute aortic dissectionSame dayWide clinical spectrumSalvage therapyTAAD surgeryECMO implantationCardiopulmonary failureHemodynamic stabilityCardiovascular collapseOpen repairOverall mortalityMedian timeClinical spectrumManagement of coronary obstruction following transcatheter aortic valve replacement
Sultan I, Siki M, Wallen T, Szeto W, Vallabhajosyula P. Management of coronary obstruction following transcatheter aortic valve replacement. Journal Of Cardiac Surgery 2017, 32: 777-781. PMID: 29143378, DOI: 10.1111/jocs.13252.Peer-Reviewed Original ResearchConceptsTranscatheter aortic valve replacementAortic valve replacementValve replacementCoronary arterySelf-expanding transcatheter aortic valve replacementLeft coronary arteryTAVR casesCoronary ostiumCoronary obstructionHigh riskMortality rateComplicationsArteryOcclusionPreventionManagementReplacementOstiumObstructionMortalityIncidenceConscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement
Hyman MC, Vemulapalli S, Szeto WY, Stebbins A, Patel PA, Matsouaka RA, Herrmann HC, Anwaruddin S, Kobayashi T, Desai ND, Vallabhajosyula P, McCarthy FH, Li R, Bavaria JE, Giri J. Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement. Circulation 2017, 136: 2132-2140. PMID: 28864443, DOI: 10.1161/circulationaha.116.026656.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnesthesia, GeneralAortic Valve StenosisComparative Effectiveness ResearchConscious SedationFemaleHospital MortalityHumansIntention to Treat AnalysisLength of StayMalePatient DischargePractice Patterns, Physicians'RegistriesRisk AssessmentRisk FactorsTime FactorsTranscatheter Aortic Valve ReplacementTreatment OutcomeUnited StatesConceptsTranscatheter aortic valve replacementAortic valve replacementConscious sedationIntensive care unitGeneral anesthesiaHospital lengthValve replacementProcedural successCare unitEnd-point analysisPercutaneous transfemoral transcatheter aortic valve replacementConscious Sedation Versus General AnesthesiaTransfemoral transcatheter aortic valve replacementCardiology Transcatheter Valve Therapy RegistryThoracic Surgeons/American CollegeDeath/stroke ratePacemaker/defibrillator implantationTranscatheter Valve Therapy RegistryInverse probabilityConscious sedation groupDeath/strokeTreatment-weighted adjustmentTreatment-weighted analysisLower procedural successComparative effectiveness analysisStroke After Transcatheter Aortic Valve Replacement: Incidence, Definitions, Etiologies and Management Options
Patel PA, Patel S, Feinman JW, Gutsche JT, Vallabhajosyula P, Shah R, Giri J, Desai ND, Zhou E, Weiss SJ, Augoustides JG. Stroke After Transcatheter Aortic Valve Replacement: Incidence, Definitions, Etiologies and Management Options. Journal Of Cardiothoracic And Vascular Anesthesia 2017, 32: 968-981. PMID: 29174745, DOI: 10.1053/j.jvca.2017.08.034.Peer-Reviewed Educational MaterialsConceptsTranscatheter aortic valve replacementAortic valve replacementValve replacementEtiology of strokeEmbolic protection devicesCardiovascular clinical trialsPerioperative pathwayNeurologic complicationsNeurologic eventsNeurologic injuryClinical trialsInvestigational approachesCardiovascular interventionsStrokeEtiologyTriphasic approachManagement optionsComplicationsThrombosisReplacementInjuryNovel guidelinesIncidenceDiagnosisTrialsConcomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling
Sultan I, Wallen TJ, Habertheuer A, Siki M, Arnaoutakis GJ, Bavaria J, Szeto WY, Milewski R, Vallabhajosyula P. Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. Journal Of Cardiac Surgery 2017, 32: 581-592. PMID: 28795434, DOI: 10.1111/jocs.13192.Peer-Reviewed Original ResearchConceptsTrue lumen diameterTEVAR groupTrue lumenThoracic aortaLumen diameterHemiarch reconstructionAortic remodelingStent graftingOpen repairAortic diameterAcute DeBakey I aortic dissectionDeBakey I aortic dissectionFalse lumen thrombosis rateThree-dimensional computed tomography scansAortic dissection repairDeBakey I dissectionsDistal aortic remodelingTotal aortic diameterFalse lumen thrombosisAbdominal aortic diameterEndovascular stent graftingEndovascular aortic repairComputed tomography scanArch tearDeBakey ICentral cannulation strategy for extent I thoracoabdominal aneurysm repair of chronic type B aortic dissection
Hobbs RD, Wallen TJ, Komlo CM, Moeller PJ, Pochettino A, Bavaria JE, Vallabhajosyula P. Central cannulation strategy for extent I thoracoabdominal aneurysm repair of chronic type B aortic dissection. Journal Of Cardiac Surgery 2017, 32: 494-499. PMID: 28691213, DOI: 10.1111/jocs.13171.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAorta, ThoracicAortic Aneurysm, ThoracicAortic DissectionCardiopulmonary BypassCatheterization, Central VenousChronic DiseaseCirculatory Arrest, Deep Hypothermia InducedEchocardiographyFemaleFemoral ArteryHumansMaleMiddle AgedSafetySurgery, Computer-AssistedThoracotomyTreatment OutcomeVascular Surgical ProceduresConceptsChronic type B dissectionThoracoabdominal aortic aneurysmsType B dissectionExtent I thoracoabdominal aortic aneurysmLeft thoracotomy incisionCannulation strategyB dissectionGroup IIGroup IThoracotomy incisionFemoral vesselsChronic type B aortic dissectionDeep hypothermic circulatory arrestType B aortic dissectionAlternative cannulation siteCentral aortic cannulationProximal aortic reconstructionThoracoabdominal aneurysm repairB aortic dissectionCirculatory arrest timeHypothermic circulatory arrestActuarial survivalCPB timeGroin incisionTAAA repair