Meeting the Editorial Board Member of AMJ: Dr. Shahzad G. Raja

Posted On 2024-12-31 09:25:14


Shahzad G. Raja1, Jin Ye Yeo2

1Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom; 2AMJ Editorial Office, AME Publishing Company

Correspondence to: Jin Ye Yeo. AMJ Editorial Office, AME Publishing Company. Email: amj@amegroups.com

This interview can be cited as: Raja SG, Yeo JY. Meeting the Editorial Board Member of AMJ: Dr. Shahzad G. Raja. AME Med J. 2024. Available from: https://amj.amegroups.org/post/view/meeting-the-editorial-board-member-of-amj-dr-shahzad-g-raja.


Expert introduction

Dr. Shahzad G. Raja (Figure 1) graduated from King Edward Medical College, Lahore (Pakistan) as Best All-round Graduate in 1996 and carried out his basic surgical training at Mayo Hospital, Lahore (Pakistan). He received his specialty training in Cardiothoracic Surgery at Glasgow University Hospitals, Glasgow, Harefield Hospital, London, and Great Ormond Street Hospital, London. He is currently working as a Consultant Cardiac Surgeon at Harefield Hospital, London. His areas of expertise include surgical myocardial revascularization, total arterial grafting, off-pump coronary artery bypass grafting, aortic valve, and aortovascular surgery. He is an international expert in off-pump coronary artery bypass grafting.

He has vastly published in peer-reviewed medical journals with over 250 articles, contributed chapters to Cardiac Surgical Textbooks as well as edited books for undergraduate and postgraduate examinations. He is the deputy editor-in-chief of the Journal of Thoracic Disease, associate editor of the International Journal of Surgery, associate editor of IJS Case Reports, and member of the editorial board of World Journal of Methodology, Recent Patents on Cardiovascular Drug Discovery & Scientific World Journal. His interests lie in medical writing, medical education, and undergraduate and postgraduate teaching. He has a special interest in assessing the impact of off-pump coronary artery bypass surgery in improving outcomes and has edited two books entitled “Off-pump Coronary Artery Bypass Grafting: Evolution, Techniques & Technology” and “Off-pump Coronary Artery Bypass Grafting: Outcomes, Concerns & Controversies”. He is also the editor of Cardiac Surgery: A Complete Guide, a textbook that provides a succinct overview of cardiac surgery.

Figure 1 Dr. Shahzad G. Raja


Interview

AMJ: What initially inspired you to pursue a career in cardiothoracic surgery and subsequently specialize in coronary artery bypass grafting (CABG)?

Dr. Raja: My journey toward a career in cardiothoracic surgery and, ultimately, specializing in CABG has been profoundly influenced by both personal and professional experiences. Being born into a family of doctors, I was fascinated, from a very young age, by the intricate workings of the human body and the marvels of modern medicine. This curiosity was further fueled by witnessing the transformative impact that skilled surgeons could have on patients' lives, particularly in the field of cardiac care. The heart, as a vital organ, intrigued me with its complexity and its central role in sustaining life, prompting me to delve deeper into cardiology and thoracic surgery.

During my medical training, I was fortunate to have mentors who were not only exceptional surgeons but also passionate educators. Their dedication and expertise in cardiothoracic surgery left a lasting impression on me. I was especially drawn to the precision and skill required in CABG. The ability to restore blood flow to the heart and improve the quality of life for patients with coronary artery disease resonated deeply with me. I saw CABG as a perfect blend of technical challenge and the opportunity to make a significant and immediate difference in patients' lives.

Moreover, the evolving landscape of cardiovascular surgery, with advancements in techniques and technology, further solidified my commitment to this specialty. The prospect of contributing to the development of innovative surgical methods and improving patient outcomes was both exciting and motivating. Specializing in CABG has allowed me to combine my passion for surgical excellence with my desire to advance the field of cardiac care, ensuring that patients receive the best possible treatment for their conditions.

AMJ: As an international expert in off-pump coronary artery bypass grafting, what are the key advantages of this technique compared to traditional on-pump CABG, and how do you decide when it is the right approach for a patient?

Dr. Raja: As an international expert in off-pump CABG, I am often asked about the key advantages of this technique compared to traditional on-pump CABG, regarded as the gold standard, and how I determine the right approach for a patient. Off-pump CABG offers several distinct benefits over the conventional on-pump method, primarily related to its less invasive nature and its avoidance of the cardiopulmonary bypass (CPB) also known as the heart-lung machine.

One of the primary advantages of off-pump CABG is the reduction in complications associated with the use of a heart-lung machine. By performing CABG on a beating heart, off-pump CABG eliminates the need for CPB, which has been linked to several adverse effects, such as systemic inflammation, neurocognitive deficits, and multiple organ dysfunction. Avoidance of CPB can result in a smoother postoperative recovery, with lower rates of complications like stroke, renal dysfunction, and the need for blood transfusions. Additionally, patients undergoing off-pump CABG often experience shorter hospital stays and faster overall recovery times, which can be particularly beneficial for high-risk patients or those with comorbidities.

When deciding whether off-pump CABG is the right approach for a patient, I consider several factors. Patient-specific considerations, such as the presence of severe atherosclerosis of the ascending aorta (porcelain aorta), advanced age, or significant comorbidities, may make off-pump CABG a more suitable option. The complexity and location of the coronary lesions also play a crucial role in this decision. For instance, patients with diffuse coronary artery disease or challenging target vessels may benefit more from the precision and stability provided by on-pump CABG. Additionally, the surgical team's expertise and experience in performing off-pump CABG are vital, as the technique requires a high level of skill and familiarity with off-pump methods.

Ultimately, the choice between off-pump CABG and on-pump CABG should be individualized, taking into account the patient's specific clinical scenario, the anticipated benefits and risks of each technique, and the surgeon's proficiency. By carefully weighing these factors, we can optimize patient outcomes and provide the most effective and safe revascularization strategy tailored to each patient's unique needs. Despite the aforementioned selection criteria, in my clinical practice, I offer off-pump CABG to all comers as it is extremely important that off-pump CABG is performed in high volume to ensure that outcomes comparable or even superior to on-pump CABG are achieved. 

AMJ: How do you think the evolution of the techniques and technology in off-pump surgery has changed the landscape of cardiac surgery, and what developments do you foresee in the future?

Dr. Raja: The evolution of techniques and technology in off-pump CABG has significantly transformed the landscape of cardiac surgery. Technological advancements have played a pivotal role in the refinement of off-pump CABG. Innovations in surgical instruments, such as stabilizers and positioners, have enhanced the precision and stability required for operating on a beating heart. Additionally, improved imaging techniques and intraoperative monitoring systems have provided surgeons with better visualization and control, leading to more accurate graft placements and improved outcomes. These advancements have made off-pump CABG a viable and often preferred option for high-risk patients who may not tolerate the stress of CPB.

Looking to the future, several developments could further enhance the practice and adoption of off-pump surgery. Robotic-assisted surgery is one promising area, offering the potential for greater precision, reduced invasiveness, and shorter recovery times. Additionally, advancements in minimally invasive surgical techniques and the development of more sophisticated stabilizers and positioners will likely continue to improve the safety and efficacy of off-pump CABG. Furthermore, the integration of artificial intelligence and machine learning into surgical planning and intraoperative decision-making could revolutionize patient-specific treatment strategies, optimizing outcomes based on real-time data and predictive analytics.

Overall, the ongoing evolution of off-pump CABG techniques and technology has already significantly impacted cardiac surgery, offering safer and more effective treatment options for patients. As these advancements continue, we can anticipate further improvements in patient outcomes and a broader adoption of off-pump approaches in cardiac revascularization.

AMJ: Off-pump CABG has been a topic of debate within the cardiothoracic surgery community. In your opinion, what are some concerns or misconceptions about off-pump CABG that need to be addressed?

Dr. Raja: Off-pump CABG has indeed been a subject of much debate within the cardiothoracic surgery community for nearly three decades. While off-pump CABG offers several advantages, there are concerns and misconceptions that need to be addressed to provide a balanced understanding of this technique.

One significant concern is the steep learning curve associated with off-pump CABG. The procedure requires a high degree of technical skill and familiarity with specialized instruments to ensure the construction of precise coronary anastomoses on the beating heart, which can be a barrier for some surgeons. This has led to variability in outcomes, with some studies suggesting that the benefits of off-pump CABG may not be realized in centers with less experienced surgeons. Addressing this concern involves emphasizing the importance of training and the accumulation of experience, ensuring that surgeons are proficient in off-pump techniques before routinely performing them.

Another misconception is that off-pump CABG is inherently riskier than on-pump CABG. Some critics argue that the lack of a heart-lung machine makes it difficult to achieve optimal visualization and stabilization of the surgical field, potentially leading to incomplete revascularization or technical errors. However, advancements in surgical technology, such as improved stabilizers and positioners, have significantly mitigated these issues. Additionally, numerous studies have demonstrated that, in the hands of experienced surgeons, off-pump CABG can achieve outcomes comparable to, or even better than, on-pump CABG, particularly in terms of reducing postoperative complications.

There is also a perception that off-pump CABG may lead to higher rates of graft failure and the need for repeat interventions. While some early studies suggested higher re-intervention rates, more recent data indicate that long-term outcomes of off-pump CABG are comparable to those of on-pump procedures. This underscores the importance of ongoing research and the use of updated evidence to inform clinical practice. Furthermore, patient selection plays a crucial role in achieving optimal outcomes. Not all patients are ideal candidates for off-pump CABG, and careful preoperative assessment is essential to identify those who will benefit the most from this approach.

Lastly, there is a need to address the concern regarding the long-term viability and durability of off-pump CABG. While short-term benefits, such as reduced hospital stay and faster recovery, are well-documented, long-term data are still evolving. Continued follow-up studies and long-term follow-up data from randomized controlled trials are necessary to provide robust evidence on the enduring benefits of off-pump CABG.

By addressing these concerns and misconceptions through education, training, and ongoing research, the cardiothoracic community can better appreciate the potential of off-pump CABG and make informed decisions about its application in clinical practice.

AMJ: In your experience as an educator, what common challenges do students and early-career surgeons face when learning complex techniques like off-pump CABG? How can educators better support them to overcome these challenges?

Dr. Raja: In my experience as an educator, students and early-career surgeons face several common challenges when learning complex techniques like off-pump CABG. One of the primary challenges is the steep learning curve associated with mastering these intricate procedures. Off-pump CABG requires a high degree of technical skill and precision, which can be daunting for novices. The need to operate on a beating heart without the stabilizing effects of a heart-lung machine adds an extra layer of complexity, making it essential for trainees to develop excellent hand-eye coordination and dexterity.

Another significant challenge is the limited opportunity for hands-on experience. Unlike some other surgical procedures, the opportunities to practice off-pump CABG are relatively scarce, primarily due to the complexity and risk involved. This limited exposure can hinder the development of confidence and proficiency among trainees. Additionally, the pressure to perform well in high-stakes environments can contribute to anxiety and stress, further complicating the learning process.

To better support students and early-career surgeons in overcoming these challenges, educators can adopt several strategies. Firstly, incorporating simulation-based training into the curriculum can provide valuable hands-on experience in a controlled and risk-free environment. High-fidelity simulators and virtual reality platforms can replicate the intricacies of off-pump CABG, allowing trainees to practice and refine their skills without the pressures of a real-life operation.

Mentorship and guided practice are also crucial. Pairing trainees with experienced surgeons who can provide real-time feedback and guidance can significantly enhance the learning experience. Structured mentorship programs that facilitate ongoing support and regular performance assessments can help trainees progressively build their skills and confidence.

Furthermore, fostering a collaborative and supportive learning environment is essential. Encouraging open communication, teamwork, and peer learning can create a positive atmosphere where trainees feel comfortable seeking help and sharing experiences. Workshops, case discussions, and debriefing sessions can provide opportunities for reflective learning and knowledge exchange.

Finally, continuous professional development should be emphasized. Providing access to advanced training courses, workshops, and conferences can help trainees stay updated with the latest advancements and techniques in off-pump CABG. Encouraging a culture of lifelong learning ensures that surgeons remain proficient and adaptable throughout their careers.

By addressing these challenges through comprehensive training programs, simulation-based practice, strong mentorship, and a supportive learning environment, educators can better equip students and early-career surgeons with the skills and confidence needed to excel in complex techniques like off-pump CABG.

AMJ: Looking back, what has been the most rewarding aspect of your work in cardiac surgery?

Dr. Raja: Looking back, the most rewarding aspect of my work in cardiac surgery has been the opportunity to develop a specialist coronary surgery program that emphasizes off-pump coronary artery bypass grafting (OPCAB) and the use of multiple arterial grafts. This endeavor has not only allowed me to refine and advance my surgical techniques but also to contribute significantly to the field by improving patient outcomes and setting new standards in coronary surgery.

One of the highlights of my career has been the successful implementation of OPCAB within our program. By focusing on this technique, we have been able to reduce the risks associated with cardiopulmonary bypass, thereby providing our patients with safer and more effective treatment options. The use of multiple arterial grafts, particularly the left and right internal mammary arteries and the radial artery, has further enhanced the durability and longevity of the surgical outcomes, offering our patients better long-term survival and quality of life.

Equally gratifying has been the role I have played in training numerous residents and early-career surgeons in advanced coronary surgery techniques. Mentoring the next generation of cardiac surgeons has been an incredibly fulfilling experience. Watching them develop their skills, gain confidence, and ultimately become proficient in these complex procedures has been a source of immense pride. Through structured training programs, simulation-based learning, and hands-on surgical experience, we have equipped our trainees with the knowledge and expertise required to excel in the field of coronary surgery.

In essence, the most rewarding aspect of my work has been the ability to make a lasting impact on both patient care and the professional growth of aspiring surgeons. By advancing surgical techniques, improving patient outcomes, and fostering a culture of excellence in cardiac surgery, I feel privileged to have contributed to the evolution of this field and to have left a positive legacy for future generations.

AMJ: How has your experience been as an Editorial Board Member of AMJ?

Dr. Raja: Serving as an Editorial Board Member of AMJ has been an incredibly enriching and rewarding experience. Being part of the editorial team has allowed me to engage deeply with cutting-edge research and developments in the medical field, particularly in cardiothoracic surgery and related disciplines. This role has provided me with the unique opportunity to critically appraise and influence the dissemination of high-quality scientific knowledge, ensuring that only the most rigorous and impactful studies reach the wider medical community.

One of the most fulfilling aspects of this role has been the collaborative environment fostered within the editorial board. Working alongside esteemed colleagues from diverse backgrounds and specialties has broadened my perspectives and enriched my understanding of various medical advancements. Our collective efforts to uphold the journal's standards have been instrumental in maintaining its reputation for excellence. This collaborative spirit has also enabled us to tackle complex issues and make informed decisions about the publication of groundbreaking research, ultimately contributing to the advancement of medical science.

Additionally, my involvement with the AMJ has allowed me to mentor aspiring researchers and clinicians. Providing constructive feedback and guidance to authors, particularly those early in their careers, has been a deeply satisfying part of my role. Watching these individuals refine their work and succeed in publishing their research has been immensely gratifying. It reinforces the importance of fostering a supportive academic community where emerging voices can thrive. Overall, my experience as an Editorial Board Member has not only enhanced my professional growth but also reaffirmed my commitment to advancing the field of medicine in general and cardiothoracic surgery in particular through collaborative and rigorous scholarship.

AMJ: As an Editorial Board Member, what are your expectations and aspirations for AMJ?

Dr. Raja: As an Editorial Board Member of AMJ, my expectations and aspirations for the journal are deeply rooted in the commitment to advancing medical knowledge and fostering a culture of rigorous scientific inquiry. Firstly, I expect the AMJ to uphold the highest standards of academic integrity and excellence. This entails ensuring that all published research is meticulously reviewed, methodologically sound, and contributes meaningfully to the existing body of medical knowledge. By maintaining these standards, the journal can continue to serve as a trusted resource for clinicians, researchers, and policymakers.

I also aspire for the AMJ to be at the forefront of disseminating innovative and impactful research that addresses contemporary challenges in medicine. This includes prioritizing studies that offer novel insights into disease mechanisms, treatment modalities, and healthcare delivery systems. By fostering a platform that welcomes groundbreaking research, the AMJ can play a crucial role in shaping the future of medical practice and improving patient outcomes globally.

Another important aspiration is to enhance the diversity and inclusivity of the journal's contributions. I envision AMJ as a platform that represents a wide range of voices from different geographical regions, professional backgrounds, and research disciplines. This inclusivity not only enriches the journal's content but also ensures that diverse perspectives are considered in the advancement of medical science.

Furthermore, I am committed to supporting the development of early-career researchers and clinicians. Through mentorship, constructive feedback, and opportunities for publication, the AMJ can nurture the next generation of medical professionals and scholars. This support is vital for sustaining a vibrant and innovative medical community.

Lastly, I aspire for the AMJ to leverage technological advancements to enhance its accessibility and reach. Embracing digital platforms and open-access models can democratize access to high-quality medical research, enabling a broader audience to benefit from the knowledge shared within the journal.