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Article ; Online: Single versus bilateral internal thoracic artery grafting in patients with impaired renal function.

Farkash, Ariel / Gordon, Amit / Mohr, Rephael / Sela, Orr / Pevni, Dmitri / Ziv-Baran, Tomer / Grupper, Ayelet / Kfir, Jonathan E / Ben-Gal, Yanai

PloS one

2024 Volume 19, Issue 2, Page(s) e0297194

Abstract: Objective: The optimal strategy for surgical revascularization in patients with impaired renal function is inconclusive. We compared early and late outcomes between bilateral internal thoracic artery (BITA) and single ITA (SITA) grafting in patients ... ...

Abstract	Objective: The optimal strategy for surgical revascularization in patients with impaired renal function is inconclusive. We compared early and late outcomes between bilateral internal thoracic artery (BITA) and single ITA (SITA) grafting in patients with renal dysfunction. Methods: This is a retrospective analysis of all the patients with multivessel disease and impaired renal function (estimated glomerular filtration rate <60mL/min/1.73m2) who underwent isolated coronary artery bypass graft (CABG) in our center during 1996-2011, utilizing either BITA or SITA revascularization. Results: Of the 5301 patients with multivessel disease who underwent surgical revascularization during the study period, 391 were with impaired renal function: 212 (54.2%) underwent BITA, 179 (45.8%) underwent SITA. Patients who underwent BITA were less likely to have comorbidities. Statistically significant differences were not observed between the BITA and SITA groups in 30-day mortality (5.6% vs. 9.0%, p = 0.2) and in rates of early stroke, myocardial infarction, and sternal infection (4.5% vs. 6.1%, p = 0.467; 1.7% vs. 2.8%, p = 0.517; and 2.2% vs. 5.7%, p = 0.088, respectively). Long-term survival of the BITA group was better: median 8.36 vs. 4.14 years, p<0.001. In multivariable analysis, BITA revascularization was associated with decreased late mortality (HR = 0.704, 95% CI: 0.556-0.89, p = 0.003). In analysis of a matched cohort (134 pairs), early outcomes did not differ between the groups; however, in multivariable analysis, BITA revascularization was associated with decreased late mortality ‎‎(HR = 0.35 (95%CI 0.18-0.68), p = 0.002)‎. Conclusions: BITA revascularization did not impact early outcome in patients with CRF, but demonstrated a significant protective effect on long-term survival ‎in the unmatched and matched cohorts.
MeSH term(s)	Humans ; Retrospective Studies ; Mammary Arteries/transplantation ; Treatment Outcome ; Coronary Artery Bypass/adverse effects ; Kidney/surgery ; Coronary Artery Disease/complications ; Coronary Artery Disease/surgery ; Risk Factors
Language	English
Publishing date	2024-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0297194
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Article ; Online: Is gender a risk factor for bilateral internal thoracic artery grafting? A twenty-year follow-up.

Pevni, Dmitry / Kramer, Amir / Farkash, Ariel / Ben-Gal, Yanai

Journal of cardiac surgery

2020 Volume 36, Issue 2, Page(s) 551–557

Abstract: Background: Although bilateral internal thoracic artery (BITA) grafting is associated with improved survival, many surgeons are reluctant to use this technique, especially in female patients, due to its greater complexity and potential increased risk of ...

Abstract	Background: Although bilateral internal thoracic artery (BITA) grafting is associated with improved survival, many surgeons are reluctant to use this technique, especially in female patients, due to its greater complexity and potential increased risk of sternal infection. The aim of this study was to compare the outcomes of male and female patients who underwent BITA grafting. Methods: We evaluated at the early outcome and late mortality, 551 female versus 2525 male patients who underwent isolated BITA grafting between January 1996 and December 2011. To adjust for differences in demographic and clinical characteristics, a multivariate risk analysis and propensity score matching were performed. Kaplan-Meier analysis was performed for the entire cohort and for the matched cohort. Results: Female patients were older and were more likely than males to have congestive heart failure, unstable angina pectoris, and diabetes. Sternal infection was more frequent in females than males (3.3% vs. 1.8%; p = .04). Differences were not observed in operative mortality (2.9% vs. 1.9%; p = .15) and stroke incidence (3.4% vs. 2.6; p = .30). After multivariate risk analysis and propensity score matching, the female gender was not found to be a predictor of worse outcomes. There was no difference in median survival among female and male patients (14.3 and 14.2 years, respectively; p = .68). Conclusion: Our results support the routine use of BITA grafting in proper selected female patients who undergo myocardial revascularization.
MeSH term(s)	Coronary Artery Disease ; Female ; Follow-Up Studies ; Humans ; Male ; Mammary Arteries ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2020-12-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.15255
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Book ; Online: Reducing Risk of Model Inversion Using Privacy-Guided Training

Goldsteen, Abigail / Ezov, Gilad / Farkash, Ariel

2020

Abstract: Machine learning models often pose a threat to the privacy of individuals whose data is part of the training set. Several recent attacks have been able to infer sensitive information from trained models, including model inversion or attribute inference ... ...

Abstract	Machine learning models often pose a threat to the privacy of individuals whose data is part of the training set. Several recent attacks have been able to infer sensitive information from trained models, including model inversion or attribute inference attacks. These attacks are able to reveal the values of certain sensitive features of individuals who participated in training the model. It has also been shown that several factors can contribute to an increased risk of model inversion, including feature influence. We observe that not all features necessarily share the same level of privacy or sensitivity. In many cases, certain features used to train a model are considered especially sensitive and therefore propitious candidates for inversion. We present a solution for countering model inversion attacks in tree-based models, by reducing the influence of sensitive features in these models. This is an avenue that has not yet been thoroughly investigated, with only very nascent previous attempts at using this as a countermeasure against attribute inference. Our work shows that, in many cases, it is possible to train a model in different ways, resulting in different influence levels of the various features, without necessarily harming the model's accuracy. We are able to utilize this fact to train models in a manner that reduces the model's reliance on the most sensitive features, while increasing the importance of less sensitive features. Our evaluation confirms that training models in this manner reduces the risk of inference for those features, as demonstrated through several black-box and white-box attacks.
Keywords	Computer Science - Machine Learning ; Computer Science - Cryptography and Security ; Statistics - Machine Learning ; I.2.6 ; K.6.5
Subject code	005
Publishing date	2020-06-29
Publishing country	us
Document type	Book ; Online
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Article ; Online: Is the Use of BITA vs SITA Grafting Safe and Beneficial in Octogenarians?

Pevni, Dmitry / Ziv-Baran, Tomer / Kramer, Amir / Farkash, Ariel / Ben-Gal, Yanai

The Annals of thoracic surgery

2020 Volume 111, Issue 6, Page(s) 1998–2003

Abstract: Background: Bilateral internal thoracic artery (BITA) grafting is questionable in octogenarians because of shorter life expectancy and increased risk of perioperative complications. The aim of this study was to examine the safety and effectiveness of ... ...

Abstract	Background: Bilateral internal thoracic artery (BITA) grafting is questionable in octogenarians because of shorter life expectancy and increased risk of perioperative complications. The aim of this study was to examine the safety and effectiveness of performing BITA and single internal thoracic artery (SITA) grafts in patients older than 80 years of age. Methods: This study compared outcomes in 201 consecutive octogenarians who underwent isolated BITA grafting with those of 280 consecutive octogenarians who underwent SITA and saphenous vein grafting during 1996 to 2011. Insulin-dependent diabetes, ejection fraction <30, and emergency operations were more common among patients who underwent SITA, and the prevalence of left main coronary artery disease was lower. Propensity score matching was used to control for these differences, thus generating well-matched groups of 190 patients each. Results: There were no significant differences in early mortality between the unmatched groups: 3.2% in the BITA group and 8.6% in the SITA group (P = .12). Rates of sternal wound infection were also similar, 1.5% vs 1.7%, respectively. Differences were not observed in the occurrences of perioperative stroke (3.5% vs 2.5%; P = .999) and myocardial infarction (1.5% vs 3.6%; P = .166). The results were similar for the matched groups. Long-term survival between the unmatched groups and survival between the matched groups were not significantly different. Conclusions: This study shows equal long-term survival for BITA and SITA grafting in octogenarians. BITA is an acceptable alternative to SITA grafting in low-risk octogenarians and in the presence of a calcified aorta or poor-quality saphenous vein graft.
MeSH term(s)	Age Factors ; Aged, 80 and over ; Coronary Artery Disease/complications ; Coronary Artery Disease/mortality ; Coronary Artery Disease/surgery ; Female ; Humans ; Internal Mammary-Coronary Artery Anastomosis/adverse effects ; Internal Mammary-Coronary Artery Anastomosis/methods ; Male ; Patient Selection ; Postoperative Complications/epidemiology ; Propensity Score ; Retrospective Studies ; Survival Rate ; Treatment Outcome
Language	English
Publishing date	2020-09-29
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2020.07.041
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Article ; Online: Applying Artificial Intelligence Privacy Technology in the Healthcare Domain.

Goldsteen, Abigail / Farkash, Ariel / Moffie, Micha / Shmelkin, Ron

Studies in health technology and informatics

2017 Volume 294, Page(s) 121–122

Abstract: Regulations set out strict restrictions on processing personal data. ML models must also adhere to these restrictions, as it may be possible to infer personal information from trained models. In this paper, we demonstrate the use of two novel AI Privacy ... ...

Abstract	Regulations set out strict restrictions on processing personal data. ML models must also adhere to these restrictions, as it may be possible to infer personal information from trained models. In this paper, we demonstrate the use of two novel AI Privacy tools in a real-world healthcare application.
MeSH term(s)	Artificial Intelligence ; Delivery of Health Care ; Health Facilities ; Privacy ; Technology
Language	English
Publishing date	2017-10-05
Publishing country	Netherlands
Document type	Journal Article
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI220410
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Book ; Online: Data Minimization for GDPR Compliance in Machine Learning Models

Goldsteen, Abigail / Ezov, Gilad / Shmelkin, Ron / Moffie, Micha / Farkash, Ariel

2020

Abstract: The EU General Data Protection Regulation (GDPR) mandates the principle of data minimization, which requires that only data necessary to fulfill a certain purpose be collected. However, it can often be difficult to determine the minimal amount of data ... ...

Abstract	The EU General Data Protection Regulation (GDPR) mandates the principle of data minimization, which requires that only data necessary to fulfill a certain purpose be collected. However, it can often be difficult to determine the minimal amount of data required, especially in complex machine learning models such as neural networks. We present a first-of-a-kind method to reduce the amount of personal data needed to perform predictions with a machine learning model, by removing or generalizing some of the input features. Our method makes use of the knowledge encoded within the model to produce a generalization that has little to no impact on its accuracy. This enables the creators and users of machine learning models to acheive data minimization, in a provable manner.
Keywords	Computer Science - Machine Learning ; Computer Science - Cryptography and Security ; I.2.6 ; K.6.5
Publishing date	2020-08-06
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Anonymizing Machine Learning Models

Goldsteen, Abigail / Ezov, Gilad / Shmelkin, Ron / Moffie, Micha / Farkash, Ariel

2020

Abstract: There is a known tension between the need to analyze personal data to drive business and privacy concerns. Many data protection regulations, including the EU General Data Protection Regulation (GDPR) and the California Consumer Protection Act (CCPA), set ...

Abstract	There is a known tension between the need to analyze personal data to drive business and privacy concerns. Many data protection regulations, including the EU General Data Protection Regulation (GDPR) and the California Consumer Protection Act (CCPA), set out strict restrictions and obligations on the collection and processing of personal data. Moreover, machine learning models themselves can be used to derive personal information, as demonstrated by recent membership and attribute inference attacks. Anonymized data, however, is exempt from the obligations set out in these regulations. It is therefore desirable to be able to create models that are anonymized, thus also exempting them from those obligations, in addition to providing better protection against attacks. Learning on anonymized data typically results in significant degradation in accuracy. In this work, we propose a method that is able to achieve better model accuracy by using the knowledge encoded within the trained model, and guiding our anonymization process to minimize the impact on the model's accuracy, a process we call accuracy-guided anonymization. We demonstrate that by focusing on the model's accuracy rather than generic information loss measures, our method outperforms state of the art k-anonymity methods in terms of the achieved utility, in particular with high values of k and large numbers of quasi-identifiers. We also demonstrate that our approach has a similar, and sometimes even better ability to prevent membership inference attacks as approaches based on differential privacy, while averting some of their drawbacks such as complexity, performance overhead and model-specific implementations. This makes model-guided anonymization a legitimate substitute for such methods and a practical approach to creating privacy-preserving models.
Keywords	Computer Science - Cryptography and Security ; Computer Science - Machine Learning ; I.2.6 ; K.6.5
Subject code	006
Publishing date	2020-07-26
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Does bilateral versus single thoracic artery grafting provide survival benefit in female patients?

Pevni, Dmitry / Nesher, Nahum / Kramer, Amir / Paz, Yosef / Farkash, Ariel / Ben-Gal, Yanai

Interactive cardiovascular and thoracic surgery

2019 Volume 28, Issue 6, Page(s) 860–867

Abstract: Objectives: Bilateral internal thoracic artery (BITA) grafting is associated with improved survival, but this technique is reluctantly used in women due to an increased risk of sternal wound infection. The aim of this study was to compare the long-term ... ...

Abstract	Objectives: Bilateral internal thoracic artery (BITA) grafting is associated with improved survival, but this technique is reluctantly used in women due to an increased risk of sternal wound infection. The aim of this study was to compare the long-term survival of women who underwent BITA grafting and single internal thoracic artery (SITA) grafting. Methods: We performed a retrospective analysis of 556 consecutive female BITA patients and 685 female SITA patients. Results: SITA patients were older and more likely to have comorbidities (diabetes mellitus, chronic lung disease, chronic renal failure, peripheral vascular disease and cerebral vascular disease). Operative mortality showed a trend towards a benefit for BITA (2.9% vs 5.0% for SITA, P = 0.06). The sternal wound infection rates were similar (3.4% vs 2.9%, P = 0.6); however, the occurrence of stroke was significantly lower in the SITA group (3.4% vs 1.2%, P = 0.007). The median survival of the BITA group was significantly better {13.8 years [95% confidence interval (CI) 12.8-14.9] vs 10.3 years [95% CI 9.6-11.1], P = 0.001}. After propensity score matching (491 pairs), the assignment to BITA was not associated with increased early mortality or complication rates, and the choice of BITA grafting was associated with better survival [14.5 years (95% CI 13.3-15.6) vs 11.8 years (95% CI 10.7-12.9)]. Only the choice of conduits was associated with increased late mortality (multivariable analysis, hazard ratio 1.28, 95% CI 1.024-1.591; P = 0.03). Conclusions: The low early mortality and complication rate, and the long-term survival benefit of BITA compared to SITA grafting, support the use of BITA grafting in women.
MeSH term(s)	Aged ; Coronary Artery Bypass, Off-Pump/methods ; Coronary Artery Disease/mortality ; Coronary Artery Disease/surgery ; Female ; Humans ; Incidence ; Israel/epidemiology ; Mammary Arteries/transplantation ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Propensity Score ; Retrospective Studies ; Survival Rate/trends ; Treatment Outcome
Language	English
Publishing date	2019-02-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivy367
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Article ; Online: Axial to Centrifugal Continuous Flow LVAD Pump Exchange Using Minimally Invasive Technique.

Pawale, Amit A / Farkash, Ariel / Pandis, Dimosthenis / Anyanwu, Anelechi C

Innovations (Philadelphia, Pa.)

2017 Volume 12, Issue 6, Page(s) 496–498

Abstract: Driveline or device infection may complicate left ventricular assist device implants, and only curative option may be pump exchange. Replacement with similar device may be liable to reinfection, because pump configuration is such that the new device and ... ...

Abstract	Driveline or device infection may complicate left ventricular assist device implants, and only curative option may be pump exchange. Replacement with similar device may be liable to reinfection, because pump configuration is such that the new device and driveline may partly lie within the pocket of the previous pump. One approach to overcome this is using a different pump design such that the new pump would lie in a different location from the old pump. We describe treatment of severe HeartMate II (Abbott, [St Jude Thoratec Corp], Pleasanton, CA USA) left ventricular assist device infection by minimally invasive exchange to an intrapericardial HVAD (HeartWare International, Inc, Framingham, MA USA) left ventricular assist device.
MeSH term(s)	Device Removal/methods ; Heart Failure/therapy ; Heart-Assist Devices ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/methods ; Prosthesis Implantation/methods ; Prosthesis-Related Infections/surgery ; Staphylococcal Infections/surgery ; Staphylococcus epidermidis
Language	English
Publishing date	2017-12-15
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	1559-0879
ISSN (online)	1559-0879
DOI	10.1097/IMI.0000000000000429
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Article ; Online: Successful conservative management of left ventricular assist device candidates.

Havakuk, Ofer / Hochstadt, Aviram / Sadon, Sapir / Laurel Perl, Michal / Sadeh, Ben / Milwidsky, Assi / Ran Sapir, Orly / Granot, Yoav / Lupu, Lior / Levi, Erez / Farkash, Ariel / Ben Gal, Yanai / Banai, Shmuel / Topilsky, Yan

ESC heart failure

2022 Volume 10, Issue 1, Page(s) 601–615

Abstract: Aims: Clinical trials comparing LVADs vs. conservative therapy were performed before the availability of novel medications or used suboptimal medical therapy. This study aimed to report that long-term stabilization of patients entering a left ... ...

Abstract	Aims: Clinical trials comparing LVADs vs. conservative therapy were performed before the availability of novel medications or used suboptimal medical therapy. This study aimed to report that long-term stabilization of patients entering a left ventricular assist device (LVAD) programme is possible with the use of aggressive conservative therapy. This is important because the excellent clinical stabilization provided by LVADs comes at the expense of significant complications. Methods and results: This study was a single-centre prospective evaluation of consecutive patients with advanced heart failure (HF) fulfilling criteria for LVAD implantation based on clinical and echocardiographic characteristics, cardiopulmonary exercise test, and right heart catheterization results. Their initial therapy included inotropes, thiamine, beta-blockers, digoxin, spironolactone, hydralazine, and nitrates followed by the introduction of novel HF therapies. Coronary revascularization and cardiac resynchronization therapy were performed when indicated, and all patients were closely followed at our outpatient clinic. During the study period, 28 patients were considered suitable for LVAD implantation (mean age 63 ± 10.8 years, 92% men, 78% ischaemic, median HF duration 4 years). Clinical stabilization was achieved and maintained in 21 patients (median follow-up 20 months, range 9-38 months). Compared with baseline evaluation, cardiac index increased from 2.05 (1.73-2.28) to 2.88 (2.63-3.55) L/min/m Conclusions: Notwithstanding the small size of our cohort, our results suggest that LVAD implantation could be safely deferred in the majority of LVAD candidates.
MeSH term(s)	Male ; Humans ; Middle Aged ; Aged ; Female ; Conservative Treatment ; Treatment Outcome ; Heart-Assist Devices/adverse effects ; Heart Failure ; Echocardiography
Language	English
Publishing date	2022-11-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2814355-3
ISSN	2055-5822 ; 2055-5822
ISSN (online)	2055-5822
ISSN	2055-5822
DOI	10.1002/ehf2.14223
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