Publications by authors named "Nimesh Desai"

Objective: Thoracic endovascular repair (TEVAR) has become the treatment of choice for acute, complicated type B aortic dissections. The purpose of this study was to evaluate the 5-year outcomes of the GORE TAG 08-01 study on TEVAR for acute, complicated type B aortic dissections using the Conformable GORE® TAG® Thoracic Endoprosthesis (CTAG), and to establish if late aortic complications are avoided and remodeling is sustained.

Methods: From January 2010 to February 2017, 50 patients with acute, complicated type B aortic dissections were enrolled from 26 sites in the U.

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Article Synopsis
  • The GORE® TAG® Thoracic Branch Endoprosthesis is the only FDA-approved device for treating specific thoracic aorta conditions, and this study focuses on the neurological outcomes, particularly strokes, following its use.
  • A total of 238 patients were analyzed, revealing an overall stroke rate of 5.9% at 12 months, with aneurysm patients experiencing the highest incidence of disabling strokes.
  • The study documented that 40% of strokes occurred within 30 days after the procedure, with both hemorrhagic and ischemic types reported, while later strokes were mainly ischemic.
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Background: The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was expanded in 2017 to include more granular detail on thoracic aortic surgeries. We describe the first validated risk model in thoracic aortic surgery from the STS ACSD.

Methods: The study population consisted of patients undergoing nonemergent isolated ascending aortic aneurysm repair by open or clamped distal anastomoses, including those requiring aortic root or valve replacement.

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Background: Ascending thoracic aortic dilation is a complex heritable trait that involves modifiable and nonmodifiable risk factors. Polygenic scores (PGS) are increasingly used to assess risk for complex diseases. The degree to which a PGS can improve aortic diameter prediction in diverse populations is unknown.

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Background: Intervention on Type B dissection frequently requires landing the proximal edge of the stent graft between the left common carotid artery and left subclavian artery (LSA). The Gore® TAG® Thoracic Branch Endoprosthesis (TBE) is a technology which allows LSA preservation with a single internal branch.

Methods: This study was a prospective non-randomized single-arm clinical trial of patients with type B aortic dissection that were treated with the single branched device.

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Clinical cases referring to the EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ aim to assist physicians in selecting the best management strategies for individual patients with a given condition. These expert opinions consider the impact on patient outcomes as well as the risk-benefit ratio of different diagnostic or therapeutic methods. These cases serve as a vital tool to aid physicians in making decisions in their daily practice.

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Background: We aim to evaluate the impact of antegrade stenting of the distal arch and proximal descending aorta combined with non-total arch procedures in acute type A aortic dissection.

Methods: From 2005 to 2022, 733 nonsyndromic patients presented with acute DeBakey type I aortic dissection and underwent non-total arch procedure. Ninety-five patients underwent antegrade stenting and 638 did not.

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Background: Tissue necrosis from persistent mesenteric ischemia after aortic dissection may progress to sepsis and death without emergency laparotomy. However, the signs of mesenteric necrosis are common in patients experiencing nonsurvivable multisystem failure after aortic catastrophe. This study examined when and whether laparotomy offers a chance for meaningful survival in these patients.

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Article Synopsis
  • - The study analyzed outcomes of aortic repair techniques for descending thoracic aortic aneurysms (DTAAs) and thoracoabdominal aortic aneurysms (TAAAs) using data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database, focusing on procedures from July 2017 to June 2022.
  • - Findings revealed that 85.2% of DTAA repairs were done endovascularly, while 66.9% of TAAA repairs were conducted through open surgery. Endovascular repairs showed lower rates of operative mortality, stroke, and spinal cord injury for both types of aneurysms compared to open repairs.
  • - The research suggested that differences in outcomes between the two surgical
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  • The study examines the efficacy of traditional open-first surgery compared to a nontraditional approach of delayed repair for patients with type A aortic dissection complicated by mesenteric malperfusion syndrome.
  • Out of 1228 patients treated, 77 had mesenteric malperfusion syndrome with an in-hospital mortality rate of 29%, which was lower than the 39% for those undergoing delayed repair.
  • Despite higher early mortality in the mesenteric malperfusion group, 10-year survival rates were similar for both treatment strategies, indicating that the open-first approach may be equally effective or superior to the delayed method.
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  • This study investigates long-term outcomes of urgent thoracic endovascular aortic repair (TEVAR) for patients with ruptured thoracic aortic aneurysms (rTAA) compared to intact aneurysms (iTAA).
  • Among 321 patients treated, those with rTAA had lower short-term survival rates and higher incidences of complications, but similar long-term survival rates to iTAA patients if they survived the first 90 days.
  • The findings highlight that while immediate outcomes are worse for rTAA patients, their long-term survival becomes comparable to iTAA patients after a significant early survival period.
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Background And Aims: Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE.

Methods: All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified.

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Objectives: Traditional criterion for intervention on an asymptomatic ascending aortic aneurysm has been a maximal aortic diameter of 5.5 cm or more. The 2022 American College of Cardiology/American Heart Association aortic guidelines adopted cross-sectional aortic area/height ratio, aortic size index, and aortic height index as alternate parameters for surgical intervention.

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Background: Studies comparing transcatheter and surgical aortic valve replacement (TAVR and SAVR) for patients with trileaflet aortic stenosis (AS) have found similar or larger effective orifice area (EOA) for TAVR prostheses. To our knowledge, no studies have compared EOA in patients undergoing TAVR versus SAVR for bicuspid AS.

Methods: We retrospectively compared prosthetic valvular sizing and predicted EOA for patients with bicuspid AS undergoing TAVR or SAVR at our institution between January 1, 2016, and December 31, 2021.

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Background: There is a lack of evidence associating intraoperative transoesophageal echocardiography (TOE) use with improved outcomes among coronary artery bypass graft (CABG) surgery subpopulations.

Methods: This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses.

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Background: Cannulation strategy in acute type A dissection (ATAD) varies widely without known gold standards. This study compared ATAD outcomes of axillary vs femoral artery cannulation in a large cohort from the International Registry of Acute Aortic Dissection (IRAD).

Methods: The study retrospectively reviewed 2145 patients from the IRAD Interventional Cohort (1996-2021) who underwent ATAD repair with axillary or femoral cannulation (axillary group: n = 1106 [52%]; femoral group: n = 1039 [48%]).

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Objectives: There is an ongoing debate regarding whether patients benefit more from root replacement compared to a reconstruction of the sinuses of Valsalva in acute type A aortic dissection (aTAAD). In those with known or suspected connective tissue disorders, root replacement is considered appropriate. However, there are currently no diameter-based guidelines regarding the best approach in patients with minimally to moderately dilated root and no connective tissue disorders.

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