Hazim J. Safi

Hazim J. Safi
Born	Baghdad, Iraq
Education	Baghdad University College of Medicine
Years active	1970s–2010s
Medical career
Profession	physician
Institutions	Baylor College of Medicine, Memorial Hermann–Texas Medical Center, The University of Texas Health Science Center at Houston
Sub-specialties	surgical treatment of aortic diseases
Research	cardiovascular disease

Hazim J. Safi is a physician and surgeon 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.^[1] 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.

Education[]

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Born in Baghdad, Safi was raised within the city limits by his mother. He graduated valedictorian from his high school, before attending Baghdad University College of Medicine. 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. While attending a conference in England, Safi was introduced to Michael DeBakey, who extended Safi an invitation to work alongside of him at Baylor College of Medicine in Houston, TX.^[2] From 1979 to 1983, Safi completed a second surgical residency and fellowship training at Baylor.

Early career[]

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Prior to joining the surgical faculty team at Baylor, Safi developed an interest in the aorta, specifically the causes and treatments for thoracoabdominal aortic (TAA) diseases. Working as a protege under Denton Cooley and Michael DeBakey, Safi committed himself to advancing surgical care and post-operative recovery for patients with thoracoabdominal aortic diseases. In 1956, Cooley and DeBakey reported the first successful operation for resection and graft replacement of the ascending aorta using cardiopulmonary bypass.^[3] At the time of Safi's surgical training in the 70s and 80s, surgical treatment of thoracic aortic disease often led to an increased risk of spinal cord ischemic injury. Additionally, postoperative complications including stroke, paraplegia, and death were common. From 1983 to 1998 under the Baylor umbrella, Safi authored and co-authored several research papers in peer-reviewed journals citing best practices and identified determinants for outcomes in patients receiving surgical repair of the aorta. The American College of Cardiology, New England Journal of Medicine, and the Oxford University Press' European Heart Journal have since cited Safi's work as clinical standard for care, when treating patients for TAA.^[4][5][6]

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 TAA. Safi and his team identified factors such as myocardial infarction, respiratory failure, renal failure, and stroke as a primary causes of death and morbidity after thoracic aorta surgery.^[3] Patient's with a history of smoking and the presence of chronic pulmonary disease are also important predictors of respiratory failure after cardiovascular surgical procedures; His work showcased that these determinants are common among patients who undergo surgery for the descending thoracic and thoracoabdominal aorta requiring a lateral thoracotomy.^[3][7][6] Prior to surgical techniques created by the team at Baylor, patients often would suffer from spinal cord injuries leading to paraplegia, or paresis. Throughout the 90s, Safi and his colleagues at Baylor, developed a surgical technique using distal aortic perfusion and cerebrospinal fluid drainage.^[8][9]

In 2008, Safi participated in a landmark study that reviewed "the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts," and offered "suggestions for treatment".^[10] This paper further provided evidence indicating repair of an asymptomatic aorta in men before 5.5 centimeters.^[10]

A retrospective analysis by Safi and colleagues also concluded that Cerebrospinal Fluid Pressure drainage was advantageous in reducing the risk of spinal cord injury in open TAA repairs.^[4] In 2003, Safi and his team published an article in the Annals of Surgery, highlighting favorable patient outcomes using distal aortic perfusion and cerebrospinal fluid drainage for TAA repair.^[8] Their study included data from January 1991 to February 2003, during which time, the team performed 1004 thoracoabdominal or descending thoracic repairs. That following year, Safi's methods were reinforced by other surgeons treating thoracic aortic disease^[8] and became recognized as a standardized surgical technique for surgeons performing open TAA repair.^[5]

Later career[]

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

In March 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. The festschrift will be published in the Journal of Vascular Surgery in Summer of 2021.^[11]

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 Google Scholar, his work has been referenced in over 23,000 scholarly papers, and has an h-index of 77. According to researcher and scientist John Ioannidis, Safi is included in a 2020 list of the world's top 2% contributors in the world to the field of science. This analysis was reviewed and annotated by Meta-Research Innovation Center at Stanford.^[12] One of his papers, published in 1993 in the Journal of Vascular Surgery, has been cited over 1400 times, and provided evidence supporting best practices for improving 30 day survival and outcomes for patients receiving surgery to repair the aorta.^[1]

Selected works[]

• Svensson, Lars G.; Crawford, E.Stanley; Hess, Kenneth R.; Coselli, Joseph S.; Safi, Hazim J. (February 1993). "Experience with 1509 patients undergoing thoracoabdominal aortic operations". Journal of Vascular Surgery. 17 (2): 357–370. doi:10.1016/0741-5214(93)90421-h. ISSN 0741-5214. PMID 8433431.
• Crawford, E. S.; Crawford, J. L.; Safi, H. J.; Coselli, J. S.; Hess, K. R.; Brooks, B.; Norton, H. J.; Glaeser, D. H. (March 1986). "Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients". Journal of Vascular Surgery. 3 (3): 389–404. doi:10.1067/mva.1986.avs0030389. ISSN 0741-5214. PMID 3951025.
• Svensson, Lars G.; Kouchoukos, Nicholas T.; Miller, D. Craig; Bavaria, Joseph E.; Coselli, Joseph S.; Curi, Michael A.; Eggebrecht, Holger; Elefteriades, John A.; Erbel, Raimund; Gleason, Thomas G.; Lytle, Bruce W. (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): S1–41. doi:10.1016/j.athoracsur.2007.10.099. ISSN 1552-6259. PMID 18083364.
• Svensson, L. G.; Crawford, E. S.; Hess, K. R.; Coselli, J. S.; Raskin, S.; Shenaq, S. A.; Safi, H. J. (July 1993). "Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients". The Journal of Thoracic and Cardiovascular Surgery. 106 (1): 19–28, discussion 28–31. ISSN 0022-5223. PMID 8321002.
• Guo, Dong-Chuan; Pannu, Hariyadarshi; Tran-Fadulu, Van; Papke, Christina L.; Yu, Robert K.; Avidan, Nili; Bourgeois, Scott; Estrera, Anthony L.; Safi, Hazim J.; Sparks, Elizabeth; Amor, David (December 2007). "Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections". Nature Genetics. 39 (12): 1488–1493. doi:10.1038/ng.2007.6. ISSN 1546-1718. PMID 17994018.

References[]