The clinical research at the Aortic Institute spans over a decade and includes thousands of patient cases. Some clinical findings have been groundbreaking, as in the studies of ascending aortic aneurysm preventing arteriosclerosis and the connection between weight lifting and aortic dissection.
Spotlight on research:
Molecular genetics of thoracic aortic aneurysm disease
John Elefteriades, MD and his research team, in collaboration with Dr. Olga Iakoubova and colleagues at Celera Genomics in California, are conducting advanced research into the molecular genetics of thoracic aortic aneurysm disease.
They have developed a 31-RNA gene chip that is 85 percent accurate in determining — from a blood test only — whether a patient harbors a thoracic aneurysm. It is hoped that after further testing this gene chip test may become a widely applied screening test, like the PSA test for prostate cancer. The team has also recently identified DNA mutations that produce thoracic aortic aneurysms.
If you are interested in a non-paid research fellowship at the Aortic Institute, please send a brief introductory note and your CV to Dr. John Elefteriades at firstname.lastname@example.org.
Below is a summary of the 10 most-referenced articles published by Dr. Elefteriades and the aortic research team:
Deep Hypothermic Circulatory Arrest in Patients With High Cognitive Needs: Full Preservation of Cognitive Abilities
Selected for Faculty of 1000 Medicine as one of most important articles published in medicine.
Percy A, Widman S, Rizzo JA, Tranquilli M, Elefteriades JA.
Deep hypothermic circulatory arrest (DHCA) is the practice of packing a patient's head in ice in order to let the surgeon operate in a bloodless field. The deep hypothermic arrest keeps brain activity at a minimum. DHCA has become an accepted practice for the purpose of short-to moderate duration cerebral protection, without the effects of impaired mental or physical functioning. Evidence provided by direct patient feedback shows that patients who undergo aortic surgery using DHCA experience no change in their cognitive abilities. The quality of work demonstrated by patients who undergo DHCA and those who do not offers no significant differences. Varying age groups, DHCA duration periods and genders do not offer contrasting results after DHCA as well. Although results do not support prolonged DHCA, they do show that high-cognitive patients who have had short-to moderate durations of DHCA show no change in overall cognitive abilities.
Ann Thorac Surg. 87(1):117-23, 2009.
Weight lifting and aortic dissection: more evidence for a connection.
Davies RR, Kaple RK, Mandapati D, Gallo A, Botta DM Jr, Elefteriades JA, Coady MA.
Ascending aortic aneurysms, when coupled with a bicuspid aortic valve, present with a faster rate of growth. The presence of a bicuspid aortic valve is a congenital defect, meaning it was present at birth, and is different from a normal aortic valve because it has 2 cusps rather than the 3 cusps of a trileaflet aortic valve. It is not unusual for individuals with bicuspid aortic valves to develop a dilatation of the aortic root and/or ascending aorta. When faced with aortic stenosis, aneurysmal patients with bicuspid aortic valves have a significant added risk. Patients with bicuspid aortic valves have similar rates of aortic rupture, dissection, and death, along with improved long-term survival when compared to patients with normally functioning aortic valves.
Ann Thorac Surg. 83(4):1338-44, 2007.
Familial thoracic aortic aneurysms and dissections—incidence, modes of inheritance, and phenotypic patterns.
Albornoz G, Coady MA, Roberts M, Davies RR, Tranquilli M, Rizzo JA, Elefteriades JA.
This article describes the outcome of a project analyzing the genetic nature and phenotypic features of thoracic aortic aneurysms. It was performed by conducting interviews with patients in order to compile pedigrees. The outcome defines thoracic aortic aneurysm as frequently a familial disease with an inheritance pattern that is largely autosomal dominant. The age of onset is relatively early (58.2 years). Aneurysms in relatives may be seen in the thoracic aorta, abdominal aorta, or in the cerebral circulation. The outcome of the analysis leads us to believe that screening of first-order relatives of the proband (affected individual) is highly recommended.
Ann Thorac Surg. 82(4):1400-5, 2006.
Familial patterns of thoracic aortic aneurysms.
Coady MA, Davies RR, Roberts M, Goldstein LJ, Rogalski MJ, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA.
Patients with a history of familial inheritance exhibit different manifestations of the disease when compared with sporadic thoracic aortic aneurysm and patients with Marfan Syndrome. The study explores the role of genetic factors in development of thoracic aortic aneurysm and shows a faster aneurysmal growth rate for familial thoracic aortic aneurysm patients. There are several modes of inheritance that have been uncovered including autosomal dominant and X-linked dominant, along with some presentation of recessive modes of inheritance.
Arch Surg. 134(4): 361-7, 1999.
Symptoms plus family history trump size in thoracic aortic aneurysm.
Elefteriades JA, Tranquilli M, Darr U, Cardon J, Zhu BQ, Barrett P.
This article documents a case study indicating that a symptomatic individual with significant family history should be approached with resection in mind, regardless of the size of the aneurysm. Size criteria are designed for use in the case of an asymptomatic patient diagnosed with a thoracic aortic aneurysm.
Ann Thorac Surg. 80(3):1098-100, 2005.
Indications, timing, and prognosis of operative repair of aortic dissection.
Gallo A, Davies RR, Coe MP, Elefteriades JA, Coady MA.
A novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms.
This article looks at the classification of aortic dissections in an effort to devise guidelines for appropriate treatment planning, operative indications, and timing. It is important to look at each patient's case individually though, in general, treatment for type A dissections is operative and treatment for type B dissections is medical management.
Semin Thorac Cardiovasc Surg. 17(3): 224-35, 2005.
Davies RR, Gallo A, Coady MA, Tellides G, Botta DM, Burke B, Coe MP, Kopf GS, Elefteriades JA.
This study took 410 patients and calculated their relative aortic size by using their body surface area information. Using this "aortic size index," the authors were able to divide the patients into three risk groups (low, moderate, and high risk of rupture). The study indicates that a thoracic aortic aneurysm is a lethal disease and that, because of its ability to classify risk groups, determining relative aortic size is important when making appropriate surgical decisions.
Ann Thorac Surg. 81(1): 169-77, 2006.
What is the appropriate size criterion for resection of thoracic aortic aneurysms?
Coady MA, Rizzo JA, Hammond GL, Mandapati D, Darr U, Kopf GS, Elefteriades JA.
Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.
This article discusses a high priority topic among surgeons and patients. Two hundred thirty patients were tracked from 1985 to 1996. Their aneurysm size at initial presentation, median size at time of rupture or dissection and mortality rates throughout growth of the aneurysm were analyzed. The end recommendation, all things considered, is that 5.5 cm for elective resection of ascending aortic aneurysms is acceptable, and 6.5 cm for descending aortic aneurysms.
J Thorac Cardiovasc Surg.113(3): 476-91, 1997.
Davies RR, Goldstein LJ, Coady MA, Tittle SL, Rizzo JA, Kopf GS, Elefteriades JA.
This paper discusses an analysis of the connection between size of an aneurysm and the rated of rupture or dissection. It is made clear that the aneurysm size is an important predictor for, and has some responsibility for, rupture, dissection and death. One marker they include and press is that a patient with an aorta greater than 6 cm in diameter has "a yearly rate of rupture or dissection of at least 6.9% and a death rate of 11.8%." The authors recommend careful screenings and follow-ups to keep track of growth; they also support elective surgical intervention.
Ann Thorac Surg. 73(1): 17-28, 2002.
Ascending thoracic aneurysms are associated with decreased systemic atherosclerosis.
Achneck H, Modi B, Shaw C, Rizzo J, Albornoz G, Fusco D, Elefteriades J.
Investigative Milestones achieved at the Aortic Institute
In clinical practice it has become increasingly apparent that patients with aortic root aneurysms and dissections have little systemic atherosclerosis. This discovery led the authors to investigate the possibility of a negative association between ascending thoracic aortic aneurysms and systemic atherosclerosis. A total of 64 aortic root aneurysm patients and 86 control subjects had non-contrast CT images of the chest taken and evaluated in order to analyze the degree of calcification in the aorta and coronary arteries. The results showed that individuals diagnosed with ascending aortic aneurysms might be protected against systemic atherosclerosis.
CHEST. 128(3): 1580-6, 2005.
- First designated thoracic aortic center of which we are aware
- Articulated "Complication-Specific Approach" for Type B aortic dissection - now generally adopted worldwide
- Determined size at which thoracic aorta ruptures or dissects, permitting evidence-based criteria for surgical intervention, which are used throughout the world.
- Identified inherited, genetic nature of thoracic aortic aneurysm and dissection.
- Identified phenomenon of aortic dissection in young weight lifters.
- Identified inciting events for acute aortic dissection (exertion, emotion).
- Developed first general screening blood tests for thoracic aortic aneurysm (our molecular biologic "RNA Signature" test).
- Identified role of MMPs in pathogenesis of thoracic aortic aneurism (as well as other molecular pathophysiologic mechanisms).
- Described mechanical (engineering) alterations in aortic wall that underlie aortic dissection and rupture.
- Developed novel spinal "Cooling Catheter" for prevention of paraplegia in aortic surgery (supported by grant from National Science Foundation).
- Demonstrated safety of Deep Hypothermic Circulatory Arrest for brain preservation in aortic arch surgery.
- Demonstrated that thoracic aneurysm patients are also at risk for brain aneurysms.