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Профессор Оз Шапира - заведующий отделением кардиоторакальной хирургии больницы Хадасса. К нему на консультации и лечение поступают самые тяжелые пациенты, как из Израиля, так и со всего мира. Под его руководством проводятся сложнейшие кардиологические операции, в том числе на открытом сердце для взрослых и детей.
Видео - сердечная благодарность профессору Шапира от Даниэля и его семьи, за проведенную сложнейшую операцию на открытом сердце - после того, как другие больницы отказались дать пациенту шанс...
Hebrew University, Hadassah Medical School, Jerusalem, Israel
Rotating Internship Kaplan Hospital, Rehovot, Israel
1984 - Graduate: Medical Doctor (M.D.) M.D. Thesis: Electrocardiographic changes and cardiac arrhythmias before and during 24 hours after dialysis in chronic hemodialysis patients. Advisor: Y. Bar-Khayim M.D., Head of Nephrology Unit, Kaplan Hospital Rehovot, Israel
Service in Other Academic and Research Institutions
1985-1991 Residency-General Surgery, Department of Surgery B, Kaplan Hospital Rehovot, Israel, Affiliated to the Hebrew University, Hadassah Medical School , Jerusalem, Israel. Professor and Chairman: R. Pfeffermann, M.D.
Sep. 1989 Feb. 1990 Research-Immunology, Department of Cell Biology, The Weizmann Institute of Science, Rehovot, Israel. Thesis: Prolongation of rat skin and cardiac allograft survival by treatment of animals with low doses of heparin and T-cell vaccination. Advisor: I.R. Cohen, M.D., Professor of Immunology, Department of Cell Biology, The Weizmann Institute of Science, Rehovot, Israel
Jan 1991-July 1991 Senior Surgeon, Dept. of Surgery B, Kaplan Hospital, Rehovot, Israel
Affiliated to the Hebrew University-Hadassah Medical School, Jerusalem, Israel
July 1991- Dec 1994 Residency – Cardiothoracic Surgery, Boston University Medical Center, Boston, MA, USA. Professor and Chairman: Richard J. Shemin, M.D, Including rotations at: The Lahey Clinic Medical Center, Burlington, MA. Chairman: David M, Shahian M.D. Boston Children’s Hospital, Boston, MA, USA. Professor and Chairman: Aldo R. Castaneda M.D.
Jan. 1995- Feb 2001 Attending Cardiothoracic Surgeon, Boston University Medical Center. Attending Cardiothoracic Surgeon, Boston Veterans Administration Hospital, Boston, MA, USA
July 1999- Feb 2001 Associate Director of the Cardiothoracic Surgery Training Program, Boston University School of Medicine, Boston, MA, USA
March 2001- July, 2002 Professor and Chairman. Department of Cardiothoracic Surgery Carmel Medical Center. Haifa, Israel
July, 2002 Clinical Director, Department of Cardiothoracic Surgery, Boston Medical Center
Boston, MA, USA/ Associate Director of the Cardiothoracic Surgery Training Program, Boston University School of Medicine.
В настоящее время: Director
Department of Cardiothoracic Surgery
Hadassah University Hospital
My scientific biography reflects my career as an academic cardiothoracic surgeon. Over the years I was engaged both in clinical and basic science research. In both areas I focused on topics that are close and relevant to my clinical practice. Collaboration with other disciplines was key to achieve high-quality research.
The early phase of my clinical research is characterized by a series of retrospective analyses of cohorts of patients that were unique because of clinical presentation, the surgical procedure, or unusual complication. Typically these studies were single-center retrospective studies. Most of these studies included evaluation of long-term outcomes with follow-up of ten years or longer. Examples of such studies include assessment of the long-term outcome of patients undergoing allograft aortic valve replacement using various techniques (Ref. # 11, 12, 13), comparison of linear repair vs. endoaneurysmorrhaphy for left ventricular aneurysm (Ref. # 19), long term outcomes of patients undergoing coronary endarterectomy (Ref. # 35), outcomes of valve surgery in the elderly (Ref. # 22) and more.
Another category of clinical studies include those I initiated to assess our institutional experience with a new technique. Examples include evaluation of our initial results with the use of the radial artery for coronary artery bypass grafting (Ref. # 27), the use of heparin-bonded cardiopulmonary bypass circuits and reduced systemic anticoagulation in patients undergoing valve surgery (Ref. # 18) or complex aortic operations (Ref. # 39) and the use of U-Clips™ for coronary anastomoses (Ref.# 43).
At a later stage I started to design, conduct and participate in single-center prospective randomized trials aimed to answer specific clinical questions. Typical examples in this category include a study evaluating the impact of reduction of cardiopulmonary bypass prime volume on transfusion and clinical outcomes of patient undergoing cardiac surgery (Ref. # 24), comparison of Diltiazem and Nitroglycerin in the prevention of radial artery spasm in patients undergoing coronary artery bypass grafting (CABG) (Ref. # 36), the role of calcium (Ref. # 42) or GIK (Ref. # 54) in the prevention of post CABG diastolic dysfunction and comparison of heparin-bonded and conventional cardiopulmonary bypass circuits in patients undergoing CABG (Ref. # 17). In many of these studies I was the Principal Investigator. Some of these studies had a major impact on clinical practice, at least in the United States. Examples include the conversion to IV nitroglycerin in the 1st 24 hours post- CABG to prevent radial artery spasm by many surgeons, the adoption of "retrograde autologous priming” method and switching to heparin-bonded cardiopulmonary bypass circuits.
More recently I became more involved in multi-center prospective randomized trials in which I am a Co-investigator. Examples include the NIH-sponsored STICH trial evaluating medical versus surgical treatment of patients with ischemic heart disease and poor left ventricular ejection fraction, the NIH-sponsored FREEDOM trial comparing percutaneous coronary interventions (PCI) with drug-eluting stents and CABG in diabetic patients with multi-vessel disease and the randomized, double-blind placebo-controlled study of the safety and efficacy of human recombinant soluble complement receptor Type 1 (TP-10) inhibitor in adult women undergoing CABG (Ref. # 55).
There is no doubt that I will continue to be engaged in clinical research. My current projects include a retrospective study comparing minimally invasive vs. conventional aortic valve replacement, a prospective randomized trial comparing single and biventricular pacing modes in patients undergoing CABG, and others. I am also looking at expanding the scope of my clinical research to include more epidemiology and process improvement. One example is an on-going study I initiated as the Principal Investigator in collaboration with the Massachusetts General Hospital and the Harvard School of Public Health evaluating the impact of race, health insurance and socioeconomic status on utilization rates and outcomes after CABG and PCI in the Commonwealth of Massachusetts. An abstract of preliminary results of this work was recently presented at the American Heart Association Annual Scientific Sessions.
It is my strong belief that an academic surgeon should be engaged in basic science research in areas related to the specialty. During my General Surgery training anticipating a career path that will include organ transplantation, I embarked in research in the field of transplantation immunology. I spent 2 1/2 years at the Weizmann Institute of Science and used a model of heterotopic heart transplantation in rats to conduct two separate studies assessing the effect of T-cell vaccination (Ref. # 9) and mini doses of low molecular weight heparin (Ref. # 31) on allograft survival with very encouraging results.
Shifting my focus to cardiovascular surgery and practicing in a setting not engaged in organ transplantation my research interests have changed. During the past decade my basic research is focused on vascular biology. In an attempt to identify physiological factors explaining the superior long-term patency of arterial conduit compared to vein grafts I initiated a collaborative study characterizing the Nitric Oxide (NO) system in human internal mammary artery, radial artery and saphenous vein, the most commonly used conduits for CABG. We showed that arterial conduits produce significantly more NO in response to receptor-mediated and non-receptor mediated stimuli (Ref. # 34).
In another study we evaluated the effect of different vasodilators on the radial artery (Ref. # 30). In an initial set of experiments using organ-chamber methodology we demonstrated that nitroglycerin is a much more potent radial artery vasodilator compared to the calcium channel antagonist Diltiazem. We then extended these in-vitro experiments into a study in volunteers with known CAD. We infused the tested drug in one arm and used high resolution ultrasound to assess the vasodilatory effects of the drugs on the contra-lateral radial artery. The results of these studies formed the base of a clinical prospective randomized trial (Ref. # 36).
To better understand the human vascular NO system and the signaling mechanisms involved in its activation / suppression I collaborated with our cardiologist group in another set of experiments. We have studied the effects of black tea polyphenols on endothelial cells and identified p38 MAP kinase as a key component of eNOS activation (Ref. # 46). In a related study we have shown that black-tea activation of eNOS via MAP kinase is dependent on estrogen receptor alpha pathway (Ref. # 47).
In line with my deep interest in the vascular biology of commonly used coronary artery bypass conduits and my desire to characterize the ideal conduit, I participated in a series of experiments in collaboration with the Boston Children’s Hospital and Harvard Medical school implementing techniques of tissue engineering to construct small-caliber blood vessels. The first step was to create a vessel skeleton devoid of cellular components. In a feasibility study we coated these skeletonized vessels consisting of extra-cellular matrix only with human endothelial cells obtained from saphenous vein segments harvested during CABG operation (Ref. # 52). We then used this concept in a sheep model (Ref. # 38). We used extra-cellular matrix small vessels as the scaffold and coated them with circulating progenitor endothelial cells. We were able to show in vitro that these genetically-engineered vessels had many of the histological and physiological characteristics of native vessels with active live endothelium. We then grafted these vessels in sheep and demonstrated excellent patency up to 3 months post grafting.
I plan to continue to be engaged in basic science research. In fact, this was one of the main factors that stimulated my interest in Hadassah Medical Center, being aware of the strong research programs in the hospital and the proximity to the Medical School. The Department of Cardiothoracic Surgery at Hadassah Medical Center has traditionally been involved in research, having an active laboratory in collaboration with the Division of Cardiology. I hope to continue some of the on-going studies. In one such project our group is currently evaluating another important system that plays a major role in vascular homeostasis - the natriuretic peptide system. We characterize the response of different vessels to different natriuretic peptides, assess the mechanisms of activation and possible interaction with the NO system, and examine the expression of the natriuretic peptide receptors. Similar to this line of investigations we are exploring the use of proteomic techniques to characterize the different vessels. In another NIH-sponsored four-year study we are currently evaluating the determinants of shear-stress-mediated arterial remodeling using the changes in the ulnar artery that occur after harvesting the ipsi-lateral radial artery with the contra-lateral arm serving as the internal control. In addition to evaluation of impact of various clinical factors we are investigating the correlation of shear-stress-induced arterial remodeling with endothelial function at various levels including mitochondrial function, circulating endothelial cells and other possible factors.
It is very difficult to summarize more than two decades of clinical and basic science research. More than the details of one study or other I hope that I was able to convey my deep commitment to both clinical and basic science research. Research is an integral part of my professional career.
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