Hazim J. Safi

Last updated
Hazim Jawad Safi

MD, FACS
Hazim J. Safi and Michael DeBakey.jpg
Hazim J. Safi (left)
Born1946
Baghdad, Iraq [1]
EducationBaghdad University College of Medicine
Years active1970–present
Medical career
ProfessionPhysician
FieldCardiothoracic surgery
Institutions Baylor College of Medicine, Memorial Hermann–Texas Medical Center, The University of Texas Health Science Center at Houston
Sub-specialtiesSurgical correction of aortic aneurysms
ResearchAortic dissection
Website med.uth.edu/cvs/faculty/hazim-j-safi-md-facs

Hazim J. Safi, MD, FACS, (born 1946) [2] is a physician and surgeon who is well known for his research in the surgical treatment of aortic disease. Safi and his colleagues at Baylor College of Medicine were the first to identify variables associated with early death and postoperative complications in patients undergoing thoracoabdominal aortic operations. [3] Safi now serves as professor of cardiothoracic surgery, and founding chair at McGovern Medical School at The University of Texas Health Science Center in Houston, TX.

Contents

Education

Born in Baghdad, Safi was raised within the city limits by his mother. He graduated valedictorian from his high school, before completing a master's degree at Baghdad University College of Medicine in 1970. In 1975, he completed a surgical residency at the Medical City Teaching Hospital in Baghdad, followed by a surgical fellowship at St. James Hospital in London, England in 1977. [4] While attending a conference in England, Safi was introduced to Michael DeBakey, who extended Safi an invitation to work alongside him at Baylor College of Medicine in Houston, TX. [5] In 1981 and 1983, Safi completed two surgical fellowships at Baylor.

Early career

Prior to joining the surgical faculty team at Baylor, Safi developed an interest in the aorta, specifically the causes and treatments of thoracoabdominal aortic aneurysms (TAAAs). While completing his fellowship at Baylor, Safi worked in the early 1980s as a protégé under Dr. Stanley Crawford https://pubmed.ncbi.nlm.nih.gov/6231006/ with the goal of advancing surgical care and post-operative recovery for patients with TAAA. [6] From 1983 to 1998, while working at Baylor, Safi authored and co-authored several research papers with Crawford in peer-reviewed journals citing best practices and identifying determinants for outcomes in patients receiving surgical repair of the aorta. The American College of Cardiology, the New England Journal of Medicine, and the European Heart Journal have since cited his work as the clinical standard for care when treating patients for TAAAs. [7] [8] [9]

Thoracic Aortic Disease

In the late 80s and throughout the 90s, Safi worked to identify significant influences in pre-operative evaluations and treatments, as well as modifications in operations and post-operations, to improve patient outcomes after surgical repair of the aorta. He and his team identified myocardial infarction, respiratory failure, renal failure, and stroke as the primary causes of death and morbidity after thoracic aorta surgery, indicating that the assessment of the function of those organs is essential to increasing the probability of survival after surgery. [6] His work showcased that a history of smoking and the presence of chronic pulmonary disease are common predictors of post-surgery respiratory failure among patients who undergo surgery for the descending thoracic and thoracoabdominal aorta, requiring a lateral thoracotomy. [6] [10] [9] In the 90s, Safi and his colleagues at Baylor developed a surgical technique for TAAA repair using distal aortic perfusion and cerebrospinal fluid drainage. [11] [12]

In 2008, Safi participated in a study that reviewed factors correlated with post-surgery outcomes for the repair of the thoracic aorta by stent graft and offered suggestions for treatment. [13] The paper provided evidence that open repair of the descending thoracic aorta does not require reoperation and remains durable for over 13 years after treatment. [13]

A retrospective analysis by Safi and colleagues concluded that cerebrospinal fluid pressure drainage was advantageous in reducing the risk of spinal cord injury in open aneurysm repairs. [7] In 2003, Safi and his team published an article in the Annals of Surgery, highlighting favorable patient outcomes, especially in reducing immediate neurological deficit, when using distal aortic perfusion and cerebrospinal fluid drainage for thoracoabdominal and descending thoracic aortic aneurysm repair. [11] Their study included data from January 1991 to February 2003, during which time the team performed 1004 thoracoabdominal or descending thoracic aortic repairs. That following year, Safi's methods were reinforced by other surgeons treating aortic disease [11] and became recognized as a standardized surgical technique for surgeons performing open thoracic aortic aneurysm repair. [8]

Later career

In 1999, Safi left his faculty appointment at Baylor to help build and develop the Heart and Vascular Institute at Memorial Hermann–Texas Medical Center. Safi was a professor and the first chair of the department of cardiothoracic and vascular surgery at the University of Texas Health Science Center at Houston (UTHealth). In 2019, Safi stepped down as chair and appointed cardiothoracic surgeon Anthony Estrera, MD as his successor. Safi holds his faculty position as a professor at UTHealth and is still active in research and trials to advance the treatment of aortic disease.

On March 4, 2020, Safi was presented with a festschrift during a lecture of contributing writers. Attended by nearly 200 guests, the event paid tribute to his contributions to academic medicine and the field of cardiothoracic and vascular surgery. [14]

Scholarly work and contributions to science

Safi has authored and co-authored over 30 book chapters and has published nearly 300 articles in medical journals. According to a meta-research paper by Stanford Medicine researcher and scientist John Ioannidis, Safi was one of the world's top 2% contributors to the field of science in 2020. This analysis was reviewed and annotated by the Meta-Research Innovation Center at Stanford. [15] Counting self-citations, the paper indicated that Safi's work had been cited 16,244 times in 9,941 distinct papers, and calculated that his h-index was 71 as of 2020. One of Safi's articles, published in 1993 in the Journal of Vascular Surgery, has been cited over 1,000 times as of 2020 and provides evidence supporting best practices for improving 30-day survival and outcomes for patients receiving surgery to repair the aorta. [3]

Selected works

Related Research Articles

<span class="mw-page-title-main">Brachiocephalic artery</span> Artery of the mediastinum

The brachiocephalic artery, brachiocephalic trunk, or innominate artery is an artery of the mediastinum that supplies blood to the right arm, head, and neck.

<span class="mw-page-title-main">Aortic dissection</span> Injury to the innermost layer of the aorta

Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Vomiting, sweating, and lightheadedness may also occur. Damage to other organs may result from the decreased blood supply, such as stroke, lower extremity ischemia, or mesenteric ischemia. Aortic dissection can quickly lead to death from insufficient blood flow to the heart or complete rupture of the aorta.

<span class="mw-page-title-main">Aneurysm</span> Bulge in the wall of a blood vessel

An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus for clot formation (thrombosis) and embolization. As an aneurysm increases in size, the risk of rupture, which leads to uncontrolled bleeding, increases. Although they may occur in any blood vessel, particularly lethal examples include aneurysms of the circle of Willis in the brain, aortic aneurysms affecting the thoracic aorta, and abdominal aortic aneurysms. Aneurysms can arise in the heart itself following a heart attack, including both ventricular and atrial septal aneurysms. There are congenital atrial septal aneurysms, a rare heart defect.

<span class="mw-page-title-main">Vascular surgery</span> Medical specialty, operative procedures for the treatment of vascular disorders

Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.

<span class="mw-page-title-main">Aortic aneurysm</span> Excessive enlargement of the human aorta

An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size. They usually cause no symptoms except when ruptured. Occasionally, there may be abdominal, back, or leg pain. The prevalence of abdominal aortic aneurysm ("AAA") has been reported to range from 2 to 12% and is found in about 8% of men more than 65 years of age. The mortality rate attributable to AAA is about 15,000 per year in the United States and 6,000 to 8,000 per year in the United Kingdom and Ireland. Between 2001 and 2006, there were approximately 230,000 AAA surgical repairs performed on Medicare patients in the United States.

<span class="mw-page-title-main">Aneurysm of sinus of Valsalva</span> Medical condition

Aneurysm of the aortic sinus, also known as the sinus of Valsalva, is a rare abnormality of the aorta, the largest artery in the body. The aorta normally has three small pouches that sit directly above the aortic valve, and an aneurysm of one of these sinuses is a thin-walled swelling. Aneurysms may affect the right (65–85%), non-coronary (10–30%), or rarely the left coronary sinus. These aneurysms may not cause any symptoms but if large can cause shortness of breath, palpitations or blackouts. Aortic sinus aneurysms can burst or rupture into adjacent cardiac chambers, which can lead to heart failure if untreated.

<span class="mw-page-title-main">Abdominal aortic aneurysm</span> Medical condition

Abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal. An AAA usually causes no symptoms, except during rupture. Occasionally, abdominal, back, or leg pain may occur. Large aneurysms can sometimes be felt by pushing on the abdomen. Rupture may result in pain in the abdomen or back, low blood pressure, or loss of consciousness, and often results in death.

<span class="mw-page-title-main">Thoracic aortic aneurysm</span> Medical condition

A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the thorax.

Aortic valve replacement is a procedure whereby the failing aortic valve of a patient's heart is replaced with an artificial heart valve. The aortic valve may need to be replaced because:

Interrupted aortic arch is a very rare heart defect in which the aorta is not completely developed. There is a gap between the ascending and descending thoracic aorta. In a sense it is the complete form of a coarctation of the aorta. Almost all patients also have other cardiac anomalies, including a ventricular septal defect (VSD), aorto-pulmonary window, and truncus arteriosus. There are three types of interrupted aortic arch, with type B being the most common. Interrupted aortic arch is often associated with DiGeorge syndrome.

<span class="mw-page-title-main">Annuloaortic ectasia</span> Medical condition

Annuloaortic ectasia is characterized by pure aortic valve regurgitation and aneurysmal dilatation of the ascending aorta. Men are more likely than women to develop idiopathic annuloaortic ectasia, which usually manifests in the fourth or sixth decades of life. Additional factors that contribute to this condition include osteogenesis imperfecta, inflammatory aortic diseases, intrinsic valve disease, Loeys-Dietz syndrome, Marfan syndrome, and operated congenital heart disease.

<span class="mw-page-title-main">Traumatic aortic rupture</span> Medical condition

Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as a result of trauma to the body. The condition is frequently fatal due to the profuse bleeding that results from the rupture. Since the aorta branches directly from the heart to supply blood to the rest of the body, the pressure within it is very great, and blood may be pumped out of a tear in the blood vessel very rapidly. This can quickly result in shock and death. Thus traumatic aortic rupture is a common killer in automotive accidents and other traumas, with up to 18% of deaths that occur in automobile collisions being related to the injury. In fact, aortic disruption due to blunt chest trauma is the second leading cause of injury death behind traumatic brain injury.

<span class="mw-page-title-main">Endovascular aneurysm repair</span> Surgery used to treat abdominal aortic aneurysm

Endovascular aneurysm repair (EVAR) is a type of minimally-invasive endovascular surgery used to treat pathology of the aorta, most commonly an abdominal aortic aneurysm (AAA). When used to treat thoracic aortic disease, the procedure is then specifically termed TEVAR for "thoracic endovascular aortic/aneurysm repair." EVAR involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. In 2003, EVAR surpassed open aortic surgery as the most common technique for repair of AAA, and in 2010, EVAR accounted for 78% of all intact AAA repair in the United States.

<span class="mw-page-title-main">Randall B. Griepp</span> American cardiothoracic surgeon (1940–2022)

Randall Bertram Griepp was an American cardiothoracic surgeon who collaborated with Norman Shumway in the development of the first successful heart transplant procedures in the U.S. He had an international reputation for contributions to the surgical treatment of aortic aneurysms and aortic dissection and in heart and lung transplantations. He received nearly $8 million in grants from the National Heart, Lung, and Blood Institute.

<span class="mw-page-title-main">Hybrid cardiac surgery</span>

A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional, more invasive surgical part with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy imaging in a hybrid operating room (OR) without interruption. The hybrid technique has a reduced risk of surgical complications and has shown decreased recovery time. It can be used to treat numerous heart diseases and conditions and with the increasing complexity of each case, the hybrid surgical technique is becoming more common.

<span class="mw-page-title-main">Open aortic surgery</span> Surgical technique

Open aortic surgery (OAS), also known as open aortic repair (OAR), describes a technique whereby an abdominal, thoracic or retroperitoneal surgical incision is used to visualize and control the aorta for purposes of treatment, usually by the replacement of the affected segment with a prosthetic graft. OAS is used to treat aneurysms of the abdominal and thoracic aorta, aortic dissection, acute aortic syndrome, and aortic ruptures. Aortobifemoral bypass is also used to treat atherosclerotic disease of the abdominal aorta below the level of the renal arteries. In 2003, OAS was surpassed by endovascular aneurysm repair (EVAR) as the most common technique for repairing abdominal aortic aneurysms in the United States.

<span class="mw-page-title-main">Charles Rob</span> British surgeon (1913–2001)

Charles Granville Rob was a British surgeon who pioneered techniques in the repair of damaged blood vessels, particularly the operation to unblock arteries of the neck, known as carotid endarterectomy and of the aorta when treating aortic aneurysms.

Gustavo S. Oderich is a Brazilian American vascular and endovascular surgeon who serves as a professor and chief of vascular and endovascular surgery, and is the director of the Advanced Endovascular Aortic Program at McGovern Medical School at The University of Texas Health Science Center at Houston and Memorial Hermann Health System. He previously served as chair of vascular and endovascular division at the Mayo Clinic in Rochester, Minnesota. Oderich is recognized for his work in minimally invasive endovascular surgery and research in fenestrated and branched stent-graft technology to treat complex aortic aneurysms and dissections.

Spinal cord stroke is a rare type of stroke with compromised blood flow to any region of spinal cord owing to occlusion or bleeding, leading to irreversible neuronal death. It can be classified into two types, ischaemia and haemorrhage, in which the former accounts for 86% of all cases, a pattern similar to cerebral stroke. The disease is either arisen spontaneously from aortic illnesses or postoperatively. It deprives patients of motor function or sensory function, and sometimes both. Infarction usually occurs in regions perfused by anterior spinal artery, which spans the anterior two-thirds of spinal cord. Preventions of the disease include decreasing the risk factors and maintaining enough spinal cord perfusion pressure during and after the operation. The process of diagnosing the ischemic and hemorrhagic spinal cord stroke includes applying different MRI protocols and CT scan. Treatments for spinal cord stroke are mainly determined by the symptoms and the causes of the disease. For example, antiplatelet and corticosteroids might be used to reduce the risk of blood clots in ischaemic spinal stroke patients, while rapid surgical decompression is applied to minimize neurological injuries in haemorrhagic spinal stroke patients instead. Patients may spend years for rehabilitation after the spinal cord stroke.

Joseph S. Coselli is an American cardiothoracic surgeon who was the 96th president of the American Association for Thoracic Surgery (AATS), succeeding Pedro J. del Nido and preceding Thoralf M. Sundt, III. Coselli is a Professor and Executive Vice Chair in the Department of Surgery and the Cullen Foundation Endowed Chair at the Baylor College of Medicine.

References

  1. ↑ "Hazim J. Safi". eventscribe.com. Retrieved 2022-03-26.
  2. ↑ Petrowski, Roman (16 March 2020). "Festschrift: Honoring the Legacy of Hazim J. Safi, MD". Office of Communications. John P. and Kathrine G. McGovern Medical School at UTHealth. Retrieved 2022-03-25.
  3. 1 2 Svensson, Lars G.; Crawford, E. Stanley; Hess, Kenneth R.; Coselli, Joseph S.; Safi, Hazim J. (1 February 1993). "Experience with 1509 Patients Undergoing Thoracoabdominal Aortic Operations". Journal of Vascular Surgery . 17 (2). Elsevier: 357–370. doi: 10.1016/0741-5214(93)90421-H . ISSN   0741-5214. PMID   8433431.
  4. ↑ "Hazim J. Safi, MD, FACS". McGovern Medical School Department of Cardiothoracic & Vascular Surgery Faculty Listing. Retrieved 2022-03-26.
  5. ↑ Miller, Craig Alan (11 November 2019), "Epilogue", A Time for All Things: The Life of Michael E. DeBakey , Oxford University Press, pp. 591–596, doi:10.1093/med/9780190073947.003.0012, ISBN   9780190073947
  6. 1 2 3 Kouchoukos, Nicholas T.; Dougenis, Dimitrios (June 1997). "Surgery of the Thoracic Aorta" . The New England Journal of Medicine . 336 (26). Massachusetts Medical Society: 1876–1889. doi:10.1056/NEJM199706263362606. ISSN   0028-4793. PMID   9197217.
  7. 1 2 Hiratzka, Loren F.; Bakris, George L.; Beckman, Joshua A.; Bersin, Robert M.; Carr, Vincent F.; Casey, Donald E.; et al. (6 April 2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease". Journal of the American College of Cardiology . 55 (14). Elsevier: e27–e129. doi: 10.1016/j.jacc.2010.02.015 . PMID   20359588.
  8. 1 2 Clouse, William Darrin; Hallett, John W. Jr.; Schaff, Hartzell V.; Gayari, Michelle M.; Ilstrup, Duane M.; Melton, L. Joseph III (9 December 1998). "Improved Prognosis of Thoracic Aortic Aneurysms". JAMA . 280 (22). American Medical Association: 1926–1929. doi: 10.1001/jama.280.22.1926 . ISSN   0098-7484. PMID   9851478.
  9. 1 2 Erbel, Raimund; Aboyans, Victor; Boileau, Catherine; Bossone, Eduardo; Di Bartolomeo, Roberto; Eggebrecht, Holger; et al. (29 August 2014). "2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult". European Heart Journal . 35 (41). England: Oxford University Press: 2873–2926. doi: 10.1093/eurheartj/ehu281 . ISSN   0195-668X. PMID   25173340.
  10. ↑ Cain, Harold D.; Stevens, Paul M.; Adaniya, Roy (1 August 1979). "Preoperative Pulmonary Function and Complications After Cardiovascular Surgery". Chest . 76 (2). Elsevier: 130–135. doi:10.1378/chest.76.2.130. ISSN   0012-3692. PMID   456050.
  11. 1 2 3 Safi, Hazim J.; Miller, Charles C.; Huynh, Tam T. T.; Estrera, Anthony L.; Porat, Eyal E.; Winnerkvist, Anders N.; Allen, Bradley S.; Hassoun, Heitham T.; Moore, Frederick A. (September 2003). "Distal Aortic Perfusion and Cerebrospinal Fluid Drainage for Thoracoabdominal and Descending Thoracic Aortic Repair: Ten Years of Organ Protection". Annals of Surgery . 238 (3): 372–381. doi:10.1097/01.sla.0000086664.90571.7a. ISSN   0003-4932. PMC   1422700 . PMID   14501503.
  12. ↑ Coselli, Joseph S.; LeMaire, Scott A.; Köksoy, Cüneyt; Schmittling, Zachary C.; Curling, Patrick E. (April 2002). "Cerebrospinal Fluid Drainage Reduces Paraplegia After Thoracoabdominal Aortic Aneurysm Repair: Results of a Randomized Clinical Trial". Journal of Vascular Surgery . 35 (4). Elsevier: 631–639. doi: 10.1067/mva.2002.122024 . ISSN   0741-5214. PMID   11932655.
  13. 1 2 Svensson, Lars G.; Kouchoukos, Nicholas T.; Miller, D. Craig; Bavaria, Joseph E.; Coselli, Joseph S.; Curi, Michael A.; et al. (1 January 2008). "Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-grafts" . The Annals of Thoracic Surgery . 85 (1 Suppl). Netherlands: Elsevier: S1–S41. doi:10.1016/j.athoracsur.2007.10.099. ISSN   0003-4975. PMID   18083364.
  14. ↑ Ferguson, Caliann (13 March 2020). "Hazim J. Safi, MD Honored with a Festschrift". Department of Cardiothoracic & Vascular Surgery. John P. and Kathrine G. McGovern Medical School at UTHealth. Retrieved 2022-03-24.
  15. ↑ Ioannidis, John P. A.; Boyack, Kevin W.; Baas, Jeroen (16 October 2020). "Updated Science-wide Author Databases of Standardized Citation Indicators". PLOS Biology . 18 (10). PLOS: e3000918. doi: 10.1371/journal.pbio.3000918 . ISSN   1544-9173. PMC   7567353 . PMID   33064726.
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