Alexis E Shafii

Baylor Health Care System, Dallas, Texas, United States

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Publications (25)79.19 Total impact

  • Haytham Elgharably, Alexis E Shafii, David P Mason
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    ABSTRACT: Lung transplantation (LTx) is the definitive treatment of patients with end-stage lung disease. Availability of donor lungs remains the primary limitation and leads to substantial wait-list mortality. Efforts to expand the donor pool have included a resurgence of interest in the use of donation after cardiac death (DCD) lungs. Unique in its physiology, lung viability seems more tolerant to the variable durations of ischemia that occur in DCD donors. Initial experience with DCD LTx is promising and, in combination with ex vivo lung perfusion systems, seems a valuable opportunity to expand the lung donor pool.
    Thoracic Surgery Clinics 01/2015; 25(1):35-46. · 0.77 Impact Factor
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    ABSTRACT: Background Recent studies using United Network for Organ Sharing data suggest that lung transplantation in patients with high lung allocation scores (LAS) may lead to organ and resource wastage. Therefore, to determine whether a LAS cutoff value should be considered, we evaluated the relation of LAS to waitlist and posttransplant mortality in our center to determine if it could identify patients for whom listing for transplantation may be futile. Methods From May 1, 2005 to July 1, 2010, 537 adults were listed and 426 underwent primary lung transplantation at our institution. Endpoints were mortality before and after lung transplantation. The relationships of LAS at listing to waitlist mortality and of pretransplant LAS to posttransplant mortality were both analyzed by multiphase hazard function methodology. Results Higher LAS was strongly associated with waitlist mortality (p < 0.0001), with the highest quartile (LAS ranging from 47 to 95) experiencing 75% mortality within a year of listing. Although early (p = 0.05), but not late (p = 0.4), posttransplant survival was associated with higher LAS at transplantation, once other clinical characteristics predictive of early mortality were accounted for, neither waitlist nor pretransplant LAS was independently related to posttransplant mortality (p = 0.12). Conclusions Higher LAS strongly predicts higher mortality on the lung transplantation waitlist, underscoring the value of LAS in prioritizing patients with the highest scores for transplantation. Early posttransplant mortality is modestly higher with higher pretransplant LAS, but the data of our center do not suggest a value above which transplantation should be denied as futile. This suggests that donor organs and resources are not being wasted.
    The Annals of Thoracic Surgery 09/2014; · 3.63 Impact Factor
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    ABSTRACT: Limb-related complications are major contributors to extracorporeal membrane oxygenation-associated complications. Early detection of limb ischemia and or compartment syndrome is paramount to minimizing the adverse effects. With the absence of pulsatile flow, bedside Doppler examination of distal arterial waveforms is an impractical and an unreliable method of monitoring limb perfusion. We describe a new application of near-infrared spectroscopy monitoring of tissue oxygenation for the early detection of limb complications in extracorporeal membrane oxygenation.
    Asian cardiovascular & thoracic annals 06/2014;
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    ABSTRACT: The purpose of this study is to compare outcomes associated with the use of Impella and TandemHeart short-term support devices with venoarterial extracorporeal membrane oxygenation (ECMO) therapy for postinfarction- or decompensated cardiomyopathy-related cardiogenic shock. Between January 2006 and September 2011, 79 patients were supported with either an Impella axial flow pump (n = 7) or a TandemHeart centrifugal pump (n = 11), or with ECMO (n = 61) therapy for cardiogenic shock in a single institution. Pertinent variables and postprocedural events were analyzed in this cohort of patients using a prospectively maintained clinical database. The in-hospital mortality, successful weaning from mechanical circulatory support, bridge to long-term destination support device and heart transplantation, and limb complications did not differ between the 2 groups based on intention-to-treat analysis. Age was the only independent predictor for in-hospital survival. In this cohort of patients, short-term support devices and ECMO achieved comparable results. In the modern era of medical cost restraints, ECMO may be more cost effective for patients with postinfarction- or decompensated cardiomyopathy-related cardiogenic shock. Larger randomized trials may be necessary to further elucidate this topic.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 10/2013; · 1.39 Impact Factor
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    ABSTRACT: Objective To determine the safety, efficacy, and frequency of side graft axillary artery cannulation for extracorporeal membrane oxygenation support and compare it with other cannulation techniques. Methods From January 2001 to October 2011, 308 adult patients were supported with extracorporeal membrane oxygenation at a single center. In 81 patients (26.3%), the extracorporeal membrane oxygenation circuit was composed of an arterial inflow by a side graft sewn to the axillary artery. Of the 308 patients, 166 (53.9%) underwent femoral arterial cannulation and 61 (19.8%) underwent ascending aortic cannulation The pertinent variables and postprocedural events were retrospectively analyzed in this cohort of patients. Results The most common complication in the axillary artery group was hyperperfusion syndrome of the ipsilateral upper extremity (n = 20, 24.7%), followed by bleeding from the arterial outflow graft (n = 14, 17.3%). Lower extremity ischemia and fasciotomy were more frequent after femoral arterial cannulation (n = 27, 16%, and n = 18, 10.8%, respectively). The predictors for a poor in-hospital outcome for the entire group of patients were age and postoperative cerebral vascular accident. The cannulation method was not a predictor of in-hospital outcomes. Conclusions Extracorporeal membrane oxygenation support with side graft axillary artery technique was more frequently associated with hyperperfusion syndrome than other cannulation sites. Lower extremity ischemia and compartment syndrome was more common after femoral arterial cannulation.
    The Journal of thoracic and cardiovascular surgery 04/2013; 145(4):1088–1092. · 3.41 Impact Factor
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    ABSTRACT: Purpose Despite thorough radiologic evaluation prior to lung transplantation (LTx), explanted lungs occasionally harbor non-small cell lung cancer (NSCLC). However, the incidence and outcomes for this phenomenon are unknown. We describe our center’s experience with unexpected explant NSCLC and its impact on post-transplant survival. Methods and Materials From April 2007 to April 2012, 522 patients underwent LTx at the Cleveland Clinic. Review of medical records was performed which included surgical pathology of the explanted lung(s), pathologic cancer staging and postoperative course. Specific attention was given to cancer progression and recurrence. Overall survival was determined using Kaplan-Meier method. Results Thirteen patients (2.5% incidence) were noted to have explant NSCLC. Listing diagnosis was UIP in 9 (69%) and COPD in 4 (31%) with 8 undergoing double LTx and 5 undergoing single LTx. Mean age at transplantation was 63 ± 6 years. Time from the last chest CT scan to transplantation was 103 ± 83 days. All malignancies were primary NSCLC with adenocarcinoma in 9 (69%) and squamous cell carcinoma in 4 (31%). 8 patients were Stage I, 4 Stage II and 1 Stage IV. 7 (53%) patients underwent post-transplant cancer treatment. Progression of disease occurred in 8 (62%) patients at a mean follow-up of 9.9 ± 6.5 months, with overall survival 14% at 2 years. [figure 1] Conclusions Despite heightened screening, incidence of unsuspected NSCLC is surprisingly high. Moreover, despite the complete resection afforded by native pneumonectomy and adjuvant therapy, overall survival is poor due to rapid malignant progression. A unique pre-transplant surveillance screening program needs to be devised for this high risk population
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):214. · 5.61 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 02/2013; · 3.41 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the outcomes of using the ROTAFLOW as a temporary right ventricular assist device (RVAD) support in patients who develop right ventricular dysfunction (RVD) at the time of left ventricular assist device (LVAD) implantation with the HeartMate (HM) II. We conducted a retrospective chart review of patients in whom the ROTAFLOW system was used for RV support during HM II implantation from October 2009 to September 2011. Twelve patients received a ROTAFLOW as an RVAD at the time of HM II implantation; 83% had preoperative echocardiography evidence of either moderate or severe RVD. The most common complications in the postoperative period were the need for tracheostomy because of respiratory failure (45%) and mediastinal bleeding requiring exploration (36%). Ninety-one percent of patients survived to discharge, and all were alive at 1 year follow-up. Our results show that temporary RVAD support with the ROTAFLOW system in the setting of RVD at the time of HM II implantation is feasible and effective.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 01/2013; 59(4):456-460. · 1.39 Impact Factor
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    ABSTRACT: Background Heparin is routinely administered to brain-dead donors before cardiac arrest, although it is not universally allowed for donation after cardiac death (DCD) donors due to concerns that death may be hastened. The lack of heparin may lead to thrombosis and compromised graft function. We evaluated the impact of timing of heparin administration and thrombi formation in a DCD pig model.Methods Eight domestic adult pigs were administered systemic heparin (30,000 IU): four prior to cardiac arrest through intravenous injection (prearrest heparin) and four after cardiac arrest via injection into the right atrium followed by open cardiac massage (postarrest heparin). Pigs were euthanized with potassium chloride and a minimum of 5 minutes of cardiac silence allowed before organ procurement. Lungs were flushed with antegrade and retrograde Perfadex, and pulmonary preservation solution effluent was evaluated for gross thrombi. Organs were fixed in formalin, sagittally sectioned, and evaluated by a pulmonary pathologist blinded to treatment.Results Antegrade and retrograde flushes demonstrated no significant thrombi. Gross pathologic evaluation revealed no occlusive central thrombi. Scant peripheral thrombi were detected in both treatment groups. No microscopic thrombi were noted in either treatment group.Conclusions Delayed heparin administration after cardiac death does not affect thrombus formation in an animal model of lung procurement after cardiac death. Concern about clinically significant thrombosis occurring when heparin is not given before cardiac arrest appears unfounded. These findings suggest that DCD lungs can be used regardless of antemortem heparin administration.
    The Thoracic and Cardiovascular Surgeon 12/2012; · 0.93 Impact Factor
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    ABSTRACT: BACKGROUND: Combined heart-liver transplantation (CHLT) has been utilized as a life-saving procedure in those with end-stage cardiac and hepatic pathology. Techniques and outcomes of this procedure are varied. We sought to review the Cleveland Clinic experience with CHLT. METHODS: This study is a retrospective chart review of patients who received simultaneous heart and liver transplantation between January 2006 and December 2012. RESULTS: Five patients received CHLT. The mean age was 49 (± 20) years. All cardiac pathology was nonischemic cardiomyopathy, with a mean ejection fraction of 0.36 (± 0.13). Three of the 5 were on preoperative inotropic support, 1 of which required placement of a total artificial heart for support pretransplant. Liver pathology was amyloid in 1 patient and hepatitis C in the remaining 4. Mean Model for End-Stage Liver Disease score was 17 (± 5), and mean Childs-Pugh score was 8 (± 1). Survival, now at a mean of 38 (± 20) months remains 100%, with no cardiac or hepatic graft dysfunction or episodes of rejection. One hospital readmission was required for gastroenteritis at 15 months posttransplant. CONCLUSIONS: These results suggest that excellent outcomes can be achieved in this extremely sick cohort of patients, and add to the growing literature of perioperative management of CHLT recipients.
    The Annals of thoracic surgery 11/2012; · 3.45 Impact Factor
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    ABSTRACT: Extracorporeal membrane oxygenation (ECMO) is rarely used as a bridge to lung transplantation (BTT) because of its associated morbidity and mortality. However, recent advancements in perfusion technology and critical care have revived interest in this application of ECMO. We retrospectively reviewed our utilization of ECMO as BTT and evaluated our early and midterm results. Nineteen patients were placed on ECMO with the intent to transplant of which 14 (74%) were successfully transplanted. Early and midterm survival of transplanted patients was 75% (1 year) and 63% (3 years), respectively, with the most favorable results observed in interstitial lung disease patients supported in the venovenous configuration. Extracorporeal membrane oxygenation-bridged transplant survival rates were equivalent to nonbridged recipients, but early morbidity and mortality are high and the failure to bridge to transplant is significant. Overall, successfully bridged patients can derive a tangible benefit, albeit with considerable consumption of resources.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 08/2012; 58(5):526-9. · 1.39 Impact Factor
  • Alexis E Shafii, Kenneth R McCurry
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    ABSTRACT: Extracorporeal membrane oxygenation (ECMO) has demonstrated utility in the management of adult respiratory failure refractory to mechanical ventilation. The recent introduction of a bicaval dual-lumen ECMO cannula has improved the efficiency of venovenous ECMO and has enabled the concept of full extracorporeal respiratory support in place of mechanical ventilation. Standard placement of this cannula through the right internal jugular vein is particularly troublesome in individuals of short stature, because of excess cannula length. We describe a method for cannula placement through the left subclavian vein that is well suited for smaller patients and convenient for patient mobility.
    The Annals of thoracic surgery 08/2012; 94(2):663-5. · 3.45 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 07/2012; 144(4):988-9. · 3.41 Impact Factor
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    ABSTRACT: Acute pulmonary embolism (PE) compromises oxygenation and is typically considered a contraindication to lung donation for transplantation. We report the use of ex vivo lung perfusion (EVLP) to evaluate and possibly improve a pair of donor lungs with PE and poor oxygen exchange to a condition that might have been suitable for subsequent transplantation. A pair of donor lungs was procured for research after being declined for clinical use and placed on the EVLP circuit for 7 hours. Functional monitoring of the lungs revealed an increase in the partial pressure of oxygen to fraction of inspired oxygen ratio (P/F ratio) from 268 in situ to 458 after EVLP. While on the circuit, pulmonary vascular resistance decreased as dynamic compliance of the lungs increased, suggesting they might have been acceptable for transplantation.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 05/2012; 58(4):432-4. · 1.39 Impact Factor
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    ABSTRACT: Degenerative mitral valve disease is the leading cause of mitral regurgitation in North America. Surgical intervention has hinged on the symptoms and ventricular changes that develop as compensatory ventricular remodeling occurs. In the present study, we sought to characterize the temporal response of left ventricular (LV) morphology and function to mitral valve surgery for degenerative disease and to identify the preoperative factors that influence reverse remodeling. From 1986 to 2007, 2,778 patients with isolated degenerative mitral valve disease underwent valve repair (n = 2,607 [94%]) or replacement (n = 171 [6%]) and had ≥1 postoperative transthoracic echocardiogram; 5,336 transthoracic echocardiograms were available for analysis. Multivariate longitudinal repeated-measures analysis was performed to identify the factors associated with reverse remodeling. The LV dimensions decreased in the first year after surgery (end-diastolic from 5.7 ± 0.80 to 4.9 ± 1.4 cm; end-systolic from 3.4 ± 0.71 to 3.1 ± 1.4 cm). The LV mass index decreased from 139 ± 44 to 112 ± 73 g/m(2). The reduction in LV hypertrophy was less pronounced in patients with greater preoperative left heart enlargement (p <0.0001) and a greater preoperative LV mass (p <0.0001). The postoperative LV ejection fraction initially decreased from 58 ± 7.0% to 53 ± 20%, increased slightly during the first postoperative year, and was negatively influenced by preoperative heart failure symptoms (p <0.0001) and a lower preoperative LV ejection fraction (p <0.0001). The risk-adjusted response of LV morphology and function to valve repair and replacement was similar (p >0.2). In conclusion, a positive response toward normalization of LV morphology and function after mitral valve surgery is greatest in the first year. The best response occurs when surgery is performed before left heart dilation, LV hypertrophy, or LV dysfunction develop.
    The American journal of cardiology 04/2012; 110(3):403-408.e3. · 3.58 Impact Factor
  • The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 04/2012; 31(6):672-3. · 5.61 Impact Factor
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    ABSTRACT: The constellation of Takayasu's disease most commonly includes aortitis with resultant coarctations and aneurysm formation. Surgical repair of these lesions can be compromised by the chronic inflammation of Takayasu's arteritis. We present a case of a 22-year-old female with Takayasu's disease who had undergone an ascending and aortic hemiarch replacement then subsequently developed anastomotic dehiscence and re-expansion of the previous aneurysmal sac. Complete aneurysm resection and replacement of the ascending aorta and aortic arch was performed on repeated surgery.
    The Annals of thoracic surgery 01/2012; 93(1):300-2. · 3.45 Impact Factor
  • Alexis E Shafii, Gonzalo Gonzalez-Stawinski
    The Annals of thoracic surgery 10/2011; 92(4):1529. · 3.45 Impact Factor
  • The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 09/2011; 30(12):1421-2. · 5.61 Impact Factor
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    Journal of the American College of Cardiology 06/2010; 55(23):2607. · 15.34 Impact Factor