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Article ; Online: Effects of COVID-19 on primary percutaneous coronary intervention admissions: is there hidden morbidity?

Kalyanasundaram, Asanish / Asogan, Harshini / Myint, Nyan Lin

2022 Volume 22, Issue Suppl 4, Page(s) 58

MeSH term(s)	COVID-19 ; Hospitalization ; Humans ; Morbidity ; Percutaneous Coronary Intervention ; ST Elevation Myocardial Infarction ; Treatment Outcome
Language	English
Publishing date	2022-10-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.7861/clinmed.22-4-s58
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Zs.A 5439: Show issues

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Article ; Online: Genetic Overlap of Spontaneous Dissection of Either the Thoracic Aorta or the Coronary Arteries.

Jeoffrey, Syeda Manahil Haider / Kalyanasundaram, Asanish / Zafar, Mohammad A / Ziganshin, Bulat A / Elefteriades, John A

The American journal of cardiology

2023 Volume 205, Page(s) 69–74

Abstract: Ascending thoracic aortic dissection (ATAD) is a well-known vascular cause of sudden death. Spontaneous coronary artery dissections (SCAD) are emerging as an important cause of early-onset myocardial infarction and sudden death. Genetic variants in ... ...

Abstract	Ascending thoracic aortic dissection (ATAD) is a well-known vascular cause of sudden death. Spontaneous coronary artery dissections (SCAD) are emerging as an important cause of early-onset myocardial infarction and sudden death. Genetic variants in multiple connective tissue genes have been recognized to underlie ATAD; other genetic variants have similarly been recognized to underlie SCAD. Little data are available regarding any genetic commonality between ATAD and SCAD. Our objective is to determine and characterize any genetic overlap between genes coding for ATAD and SCAD. We identified and reviewed 17 retrospective and prospective genetic studies of thoracic aortic dissection and SCAD published between 2016 and 2022 identified through PubMed and Orbis. Articles highlighting the significant plausible triggers for ATAD or SCAD individually were analyzed. No previous study reviewed both ATAD and SCAD genetics together. Separate lists of causative genes were constructed for ATAD and SCAD-and then commonalities were sought. A Venn diagram was constructed to display the genetic overlap and common physiologic pathways involved. We identified a definite, meaningful overlap of 15 independent genes based on a genome-wide association study or other genetic methods. The associated genetic pathways involved various biologic processes including elastin degradation, smooth muscle cell function, and the TGFβ-pathway. The overlapping genes included the following: COL3A1, TGFB2, SMAD3, MYLK, TGFBR2, TGFBR1, LOX, FBN1, NOTCH1, ELN, COL5A1, COL5A2, COL1A2, MYH11, and TLN1. The corresponding molecular pathways were investigated and correlated for both diseases. We are not aware of other studies searching for genetic commonalities between ATAD and SCAD. We have successfully identified overlapping genes-and their corresponding molecular pathways-for ATAD and SCAD. We hope that these insights will lead to further clinical and scientific understanding of each disease through study of their fundamental commonalities.
MeSH term(s)	Humans ; Coronary Vessels ; Aorta, Thoracic ; Genome-Wide Association Study ; Prospective Studies ; Retrospective Studies ; Aortic Dissection/genetics
Chemical Substances	Collagen Type I, alpha2 Subunit
Language	English
Publishing date	2023-08-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.07.046
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Ui IV Zs.73: Show issues

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Article ; Online: Long-term follow-up of Cabrol fistula for uncontrollable bleeding: A life-saving procedure.

Raghuram, Akshay / Kalyanasundaram, Asanish / Babcock, Maryann / Zafar, Mohammad A / Ziganshin, Bulat / Elefteriades, John

JTCVS techniques

2023 Volume 21, Page(s) 1–6

Abstract: Objective: Surgeons shy away from using the Cabrol fistula (perigraft space to right atrium [RA] shunt) due to unfamiliarity, concern for persistent left-to-right shunting, and fear of "painting-over" anastomotic defects that will result in later ... ...

Abstract	Objective: Surgeons shy away from using the Cabrol fistula (perigraft space to right atrium [RA] shunt) due to unfamiliarity, concern for persistent left-to-right shunting, and fear of "painting-over" anastomotic defects that will result in later problems. We review nearly 2 decades of experience with application of the Cabrol fistula in a large thoracic aortic practice, with emphasis on precise surgical techniques, early and late outcomes, and detailed radiographic analysis. Methods: Operative records of all procedures in which the Cabrol fistula was used were retrieved and analyzed, with precise review of the details of construction of each Cabrol fistula and clinical and radiologic (echocardiographic and computed tomographic) patient follow-up. Results: The Cabrol fistula successfully controlled the bleeding in all cases. There were no late false aneurysms at any anastomotic sites. There was no continued flow through any fistula. Good perioperative and long-term survival was achieved in these complex cases that found themselves at a very dangerous crux before application of the Cabrol fistula. Conclusions: The Cabrol fistula is an important tool for the thoracic aortic surgeon to have in the toolbox. We found the Cabrol fistula to be extremely effective at controlling bleeding, with no late persistent fistula flow and no late false aneurysm formation. Without the fistula, outcome in these patients would likely have been lethal. We recommend the Cabrol fistula technique strongly for life-saving application in rare cases of bleeding uncontrollable by conventional methods.
Language	English
Publishing date	2023-07-04
Publishing country	United States
Document type	Journal Article
ISSN	2666-2507
ISSN (online)	2666-2507
DOI	10.1016/j.xjtc.2023.06.010
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Article ; Online: Frailty predicts poor longer-term outcomes in patients following lower limb open surgical revascularization.

Kalyanasundaram, Asanish / Choy, Matthew / Kotta, Alekhya / Zielinski, Lukasz P / Coughlin, Patrick A

The Journal of cardiovascular surgery

2022 Volume 63, Issue 6, Page(s) 716–723

Abstract: Background: Frailty in vascular surgery patients is increasingly recognized as a marker of poor outcome. This provides particular challenges for patients with lower limb peripheral arterial disease who require surgical revascularization. This study ... ...

Abstract	Background: Frailty in vascular surgery patients is increasingly recognized as a marker of poor outcome. This provides particular challenges for patients with lower limb peripheral arterial disease who require surgical revascularization. This study aimed to assess the impact of frailty on short- and long-term outcome in this specific patient group using a specialty specific frailty score. Methods: Patients undergoing open surgical revascularization for chronic limb ischemia (January 2015-December 2016) were assessed. Demographics, mode of admission, diagnosis, and site of surgery were recorded alongside a variety of frailty-specific characteristics. We calculated the previously validated Addenbrookes Vascular Frailty Score (AVFS) and Long AVFS (LAVFS). Primary outcome was 3-year mortality. Results: Two hundred and sixty-one patients (75% men, median age 69 years) were studied. The median length of stay was 6 days with a 3-year mortality of 23%. The predictive power of vascular frailty scores showed that for 3-year mortality, area under the receiver operator curve values (AUROC) were specific for both the AVFS score (AUROC: 0.724, 95% CI: 0.654-0.794) and LAVFS Score (AUROC: 0.741, 95%CI: 0.670-0.813). Furthermore, the cumulative AVFS and LAVFS scores both predicted mortality over the follow-up period (P=0.0001) with increased mortality among patients with higher scores. Conclusions: Incremental worsening of frailty, determined using a specialty specific frailty score, predicts mortality risk in patients undergoing lower limb surgical revascularization.
Language	English
Publishing date	2022-09-28
Publishing country	Italy
Document type	Journal Article
ZDB-ID	80143-4
ISSN	1827-191X ; 0021-9509
ISSN (online)	1827-191X
ISSN	0021-9509
DOI	10.23736/S0021-9509.22.11895-1
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Zs.A 469: Show issues

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Article ; Online: The role of anatomic shape features in the prognosis of uncomplicated type B aortic dissection initially treated with optimal medical therapy.

Liu, Minliang / Dong, Hai / Mazlout, Adam / Wu, Yuxuan / Kalyanasundaram, Asanish / Oshinski, John N / Sun, Wei / Elefteriades, John A / Leshnower, Bradley G / Gleason, Rudolph L

Computers in biology and medicine

2024 Volume 170, Page(s) 108041

Abstract: Objective: Currently, the long-term outcomes of uncomplicated type B aortic dissection (TBAD) patients managed with optimal medical therapy (OMT) remain poor. Aortic expansion is a major factor that determines patient long-term survival. The objective ... ...

Abstract	Objective: Currently, the long-term outcomes of uncomplicated type B aortic dissection (TBAD) patients managed with optimal medical therapy (OMT) remain poor. Aortic expansion is a major factor that determines patient long-term survival. The objective of this study was to investigate the association between anatomic shape features and (i) OMT outcome; (ii) aortic growth rate for TBAD patients initially treated with OMT. Methods: 108 CT images of TBAD in the acute and chronic phases were collected from 46 patients who were initially treated with OMT. Statistical shape models (SSM) of TBAD were constructed to extract shape features from the earliest initial CT scans of each patient by using principal component analysis (PCA) and partial least square (PLS) regression. Additionally, conventional shape features (e.g., aortic diameter) were quantified from the earliest CT scans as a baseline for comparison. We identified conventional and SSM features that were significant in separating OMT "success" and failure patients. Moreover, the aortic growth rate was predicted by SSM and conventional features using linear and nonlinear regression with cross-validations. Results: Size-related SSM and conventional features (mean aortic diameter: p=0.0484, centerline length: p=0.0112, PCA score c Conclusion: Size-related shape features of the earliest scan were correlated with OMT failure but led to large errors in the prediction of the aortic growth rate. SSM features in combination with nonlinear regression could be a promising avenue to predict the aortic growth rate.
MeSH term(s)	Humans ; Aortic Aneurysm, Thoracic/surgery ; Endovascular Procedures/adverse effects ; Risk Factors ; Aortic Dissection/diagnostic imaging ; Aortic Dissection/drug therapy ; Retrospective Studies ; Treatment Outcome ; Blood Vessel Prosthesis Implantation
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	127557-4
ISSN	1879-0534 ; 0010-4825
ISSN (online)	1879-0534
ISSN	0010-4825
DOI	10.1016/j.compbiomed.2024.108041
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Zs.A 653: Show issues

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Article ; Online: KIF6 Trp719Arg Genetic Variant Increases Risk for Thoracic Aortic Dissection

Velasco, Juan J. / Li, Yupeng / Ziganshin, Bulat A. / Zafar, Mohammad A. / Rizzo, John A. / Ma, Deqiong / Zang, Hui / Kalyanasundaram, Asanish / Elefteriades, John A.

Genes (Basel). 2023 Jan. 18, v. 14, no. 2

2023

Abstract: Background: KIF6 (kinesin family member 6), a protein coded by the KIF6 gene, serves an important intracellular function to transport organelles along microtubules. In a pilot study, we found that a common KIF6 Trp719Arg variant increased the propensity ... ...

Abstract	Background: KIF6 (kinesin family member 6), a protein coded by the KIF6 gene, serves an important intracellular function to transport organelles along microtubules. In a pilot study, we found that a common KIF6 Trp719Arg variant increased the propensity of thoracic aortic aneurysms (TAA) to suffer dissection (AD). The present study aims for a definite investigation of the predictive ability of KIF6 719Arg vis à vis AD. Confirmatory findings would enhance natural history prediction in TAA. Methods: 1108 subjects (899 aneurysm and 209 dissection patients) had KIF6 719Arg variant status determined. Results: The 719Arg variant in the KIF6 gene correlated strongly with occurrence of AD. Specifically, KIF6 719Arg positivity (homozygous or heterozygous) was substantially more common in dissectors (69.8%) than non-dissectors (58.5%) (p = 0.003). Odds ratios (OR) for suffering aortic dissection ranged from 1.77 to 1.94 for Arg carriers in various dissection categories. These high OR associations were noted for both ascending and descending aneurysms and for homozygous and heterozygous Arg variant patients. The rate of aortic dissection over time was significantly higher for carriers of the Arg allele (p = 0.004). Additionally, Arg allele carriers were more likely to reach the combined endpoint of dissection or death (p = 0.03). Conclusions: We demonstrate the marked adverse impact of the 719Arg variant of the KIF6 gene on the likelihood that a TAA patient will suffer aortic dissection. Clinical assessment of the variant status of this molecularly important gene may provide a valuable “non-size” criterion to enhance surgical decision making above and beyond the currently used metric of aortic size (diameter).
Keywords	alleles ; aneurysm ; death ; dissection ; heterozygosity ; homozygosity ; kinesin ; microtubules ; natural history ; organelles ; patients ; prediction ; risk
Language	English
Dates of publication	2023-0118
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article ; Online
ZDB-ID	2527218-4
ISSN	2073-4425
ISSN	2073-4425
DOI	10.3390/genes14020252
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Hospice care access inequalities: a systematic review and narrative synthesis.

Tobin, Jake / Rogers, Alice / Winterburn, Isaac / Tullie, Sebastian / Kalyanasundaram, Asanish / Kuhn, Isla / Barclay, Stephen

BMJ supportive & palliative care

2021 Volume 12, Issue 2, Page(s) 142–151

Abstract: Background: Inequalities in access to hospice care is a source of considerable concern; white, middle-class, middle-aged patients with cancer have traditionally been over-represented in hospice populations.: Objective: To identify from the literature ...

Abstract	Background: Inequalities in access to hospice care is a source of considerable concern; white, middle-class, middle-aged patients with cancer have traditionally been over-represented in hospice populations. Objective: To identify from the literature the demographic characteristics of those who access hospice care more often, focusing on: diagnosis, age, gender, marital status, ethnicity, geography and socioeconomic status. Design: Systematic literature review and narrative synthesis. Method: Searches of Medline, PsycINFO, CINAHL, Web of Science, Assia and Embase databases from January 1987 to end September 2019 were conducted. Inclusion criteria were peer-reviewed studies of adult patients in the UK, Australia, New Zealand and Canada, receiving inpatient, day, outpatient and community hospice care. Of the 45 937 titles retrieved, 130 met the inclusion criteria. Narrative synthesis of extracted data was conducted. Results: An extensive literature search demonstrates persistent inequalities in hospice care provision: patients without cancer, the oldest old, ethnic minorities and those living in rural or deprived areas are under-represented in hospice populations. The effect of gender and marital status is inconsistent. There is a limited literature concerning hospice service access for the LGBTQ+ community, homeless people and those living with HIV/AIDS, diabetes and cystic fibrosis. Conclusion: Barriers of prognostic uncertainty, institutional cultures, particular needs of certain groups and lack of public awareness of hospice services remain substantial challenges to the hospice movement in ensuring equitable access for all.
MeSH term(s)	Adult ; Aged, 80 and over ; Australia ; Ethnicity ; Hospice Care ; Hospices ; Humans ; Middle Aged ; Neoplasms
Language	English
Publishing date	2021-02-19
Publishing country	England
Document type	Journal Article ; Systematic Review
ISSN	2045-4368
ISSN (online)	2045-4368
DOI	10.1136/bmjspcare-2020-002719
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Article ; Online: KIF6

Velasco, Juan J / Li, Yupeng / Ziganshin, Bulat A / Zafar, Mohammad A / Rizzo, John A / Ma, Deqiong / Zang, Hui / Kalyanasundaram, Asanish / Elefteriades, John A

Genes

2023 Volume 14, Issue 2

Abstract: Background: KIF6 (kinesin family member 6), a protein coded by the : Methods: 1108 subjects (899 aneurysm and 209 dissection patients) had : Results: The 719Arg variant in the : Conclusions: We demonstrate the marked adverse impact of the ... ...

Abstract	Background: KIF6 (kinesin family member 6), a protein coded by the Methods: 1108 subjects (899 aneurysm and 209 dissection patients) had Results: The 719Arg variant in the Conclusions: We demonstrate the marked adverse impact of the 719Arg variant of the
MeSH term(s)	Humans ; Dissection, Thoracic Aorta ; Heterozygote ; Kinesins/genetics ; Pilot Projects
Chemical Substances	KIF6 protein, human (EC 3.6.1.-) ; Kinesins (EC 3.6.4.4)
Language	English
Publishing date	2023-01-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527218-4
ISSN	2073-4425 ; 2073-4425
ISSN (online)	2073-4425
ISSN	2073-4425
DOI	10.3390/genes14020252
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Article ; Online: Aortic Size at the Time of Type A and Type B Dissections.

Perez, Zachary G / Zafar, Mohammad A / Velasco, Juan J / Sonsino, Alexandra / Ellauzi, Hesham / John, Clerin / Kalyanasundaram, Asanish / Ziganshin, Bulat A / Elefteriades, John A

The Annals of thoracic surgery

2023 Volume 116, Issue 2, Page(s) 262–268

Abstract: Background: Aortic diameter at time of dissection remains an indispensable risk-determining characteristic for prophylactic repair of thoracic aortic aneurysms. Histograms of aortic size at the time of dissection have the potential to shed more light on ...

Abstract	Background: Aortic diameter at time of dissection remains an indispensable risk-determining characteristic for prophylactic repair of thoracic aortic aneurysms. Histograms of aortic size at the time of dissection have the potential to shed more light on this relationship. Methods: Size of the thoracic aorta at the time of dissection was determined from imaging of 407 naturally occurring, acute, flap-type ascending or descending aortic dissections treated at 1 institution (1990-2022). Histograms were constructed to depict aortic size at the time of dissection. Data were analyzed by logistic regression. Results: There were 170 (69.11%) of 246 type A dissections (median, 5.07 cm; interquartile range, 4.60-5.67 cm) and 130 (80.75%) of 161 type B dissections (median, 4.2 cm; interquartile range, 3.60-4.87 cm) that occurred at diameters <5.5 cm. By unadjusted regression, factors associated with significantly increased odds of type A dissection at diameters <5.5 cm were female sex (odds ratio [OR], 2.06; P = .023), hypertension (OR, 1.82; P = .036), and smoking (OR, 1.92; P = .029). Patients with bicuspid aortic valve had significantly decreased odds of type A dissection at diameters <5.5 cm (OR, 0.3; P = .047). The recent "left shift" to 5.0 cm in the criterion for ascending aortic intervention could prevent an additional 29.3% of type A dissections. Conclusions: Aortic diameter at the time of type A dissection is consistent with the new guidelines that recommend surgical intervention at 5.0 cm. Type B dissection occurs at small sizes and cannot be prevented with a size criterion.
MeSH term(s)	Humans ; Female ; Male ; Aortic Dissection/diagnostic imaging ; Aortic Dissection/surgery ; Aorta ; Aortic Aneurysm, Thoracic/diagnosis ; Aortic Aneurysm, Thoracic/surgery ; Aortic Aneurysm, Thoracic/complications ; Bicuspid Aortic Valve Disease/complications ; Risk Factors
Language	English
Publishing date	2023-04-14
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2023.03.037
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Zs.A 252: Show issues

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Article ; Online: Bicuspid aortopathy does not require earlier surgical intervention.

Zafar, Mohammad A / Wu, Jinlin / Vinholo, Thais Faggion / Li, Yupeng / Papanikolaou, Dimitra / Ellauzi, Hesham / Ostberg, Nicolai P / Kalyanasundaram, Asanish / Kalogerakos, Paris D / Mukherjee, Sandip K / Ziganshin, Bulat A / Rizzo, John A / Elefteriades, John A

The Journal of thoracic and cardiovascular surgery

2023

Abstract: Objectives: Guidelines for surgical correction of patients with ascending thoracic aortic aneurysm (ATAA) with a bicuspid aortic valve (BAV) have oscillated over the years. In this study, we outline the natural history of the ascending aorta in patients ...

Abstract	Objectives: Guidelines for surgical correction of patients with ascending thoracic aortic aneurysm (ATAA) with a bicuspid aortic valve (BAV) have oscillated over the years. In this study, we outline the natural history of the ascending aorta in patients with BAV and trileaflet aortic valve (TAV) ATAA followed over time, to ascertain if their behavior differs and to determine if a different threshold for intervention is required. Methods: Aortic diameters and long-term complications (ie, adverse aortic events) of 2428 patients (554 BAV and 1874 TAV) with ATAA before operative repair were reviewed. Growth rates, yearly complication rates, event-free survival, and risk of complications as a function of aortic size were calculated. Long-term follow-up and precise cause of death granularity was achieved via a comprehensive 6-pronged approach. Results: Aortic growth rate in patients with BAV vs TAV ATAA was 0.20 and 0.17 cm/year, respectively (P = .009), with the rate increasing with increasing aortic size. Yearly adverse aortic events rates increased with ATAA size and were lower for patients with BAV. The relative risk of adverse aortic events exhibited an exponential increase with aortic diameter. Patients with BAV had a lower all-cause and ascending aorta-specific adverse aortic events hazard. Age-adjusted 10-year event-free survival was significantly better for patients with BAV, and BAV emerged as a protective factor against type A dissection, rupture, and ascending aortic death. Conclusions: The threshold for surgical repair of ascending aneurysm with BAV should not differ from that of TAV. Prophylactic surgery should be considered at 5.0 cm for patients with TAV (and BAV) at expert centers.
Language	English
Publishing date	2023-04-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2023.04.017
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