Browsing by Author "Pillai, Saila T."

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    An Emergent Nexus between Striae and Thoracic Aortic Dissection
    (MDPI, 2021) Landis, Benjamin J.; Vujakovich, Courtney E.; Elmore, Lindsey R.; Pillai, Saila T.; Lee, Lawrence S.; Everett, Jeffrey E.; Markham, Larry W.; Brown, John W.; Hess, Phillip J.; Corvera, Joel S.; Pediatrics, School of Medicine
    Current approaches to stratify the risk for disease progression in thoracic aortic aneurysm (TAA) lack precision, which hinders clinical decision making. Connective tissue phenotyping of children with TAA previously identified the association between skin striae and increased rate of aortic dilation. The objective of this study was to analyze associations between connective tissue abnormalities and clinical endpoints in adults with aortopathy. Participants with TAA or aortic dissection (TAD) and trileaflet aortic valve were enrolled from 2016 to 2019 in the setting of cardiothoracic surgical care. Data were ascertained by structured interviews with participants. The mean age among 241 cases was 61 ± 13 years. Eighty (33%) had history of TAD. While most participants lacked a formal syndromic diagnosis clinically, connective tissue abnormalities were identified in 113 (47%). This included 20% with abdominal hernia and 13% with skin striae in atypical location. In multivariate analysis, striae and hypertension were significantly associated with TAD. Striae were associated with younger age of TAD or prophylactic aortic surgery. Striae were more frequent in TAD cases than age- and sex-matched controls. Thus, systemic features of connective tissue dysfunction were prevalent in adults with aortopathy. The emerging nexus between striae and aortopathy severity creates opportunities for clinical stratification and basic research.
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    Repair of Thoracic and Thoracoabdominal Mycotic Aneurysms and Infected Aortic Grafts Using Allograft
    (Elsevier, 2018) Corvera, Joel S.; Blitzer, David; Copeland, Hannah; Murphy, Daniel; Hess, Philip J.; Pillai, Saila T.; Fehrenbacher, John W.; Surgery, School of Medicine
    Background Mycotic aneurysm of the thoracic or thoracoabdominal aorta and infection of thoracic or thoracoabdominal aortic grafts are challenging problems with high mortality. In-situ reconstruction with cryopreserved allograft(CPA) avoids placement of prosthetic material in an infected field and avoids suppressive antibiotics or autologous tissue coverage. Methods Fifty consecutive patients with infection of a thoracic or thoracoabdominal aortic graft or mycotic aneurysm underwent resection and replacement with CPA from 2006 to 2016. Intravenous antibiotics were continued postoperatively for 6 weeks. Long-term suppressive antibiotics were uncommonly used (8 patients). Follow up imaging occurred at 6, 18 and 42 months postoperatively. Initial follow up was 93% complete. Results Males comprised 64% of the cohort. The mean age was 63±14 years. The procedures performed included reoperations in 37, replacement of the aortic root, ascending aorta or transverse arch in 19, replacement of the descending or thoracoabdominal aorta in 27 and extensive replacement of the ascending, arch and descending or thoracoabdominal aorta in 4. Intraoperative cultures revealed most commonly staphylococcus 24%), enterococcus (12%), candida (6%) and gram negative rods (14%). Operative mortality was 8%, stroke 4%, paralysis 2%, hemodialysis 6%, and respiratory failure requiring tracheostomy 6%. Early reoperation for pseudoaneurysm of the CPA was necessary in 4 patients. One, two and five year survival was 84%, 76% and 64%, respectively. Conclusions Radical resection and in-situ reconstruction with CPA avoids placing prosthetic material in an infected field and provides good early and mid-term outcomes. However, early postoperative imaging is necessary given the risk of pseudoaneurysm formation.