Dr. Rabin Gerrah is a cardiothoracic surgeon and specializes in surgical treatment of heart diseases such as ischemic, valvular, structural and congenital heart diseases. He has been trained at Harvard University and Columbia University Hospitals. Dr. Gerrah has been involved in multiple medical research projects and has patented and developed innovative surgical devices and technologies.

Academic Appointments

Honors & Awards

  • Co-investigator on OCTRI winner project, Oregon Health and Science University (May 2015)
  • Co-author on the Winning Congenital Poster, Society of Thoracic Surgeons (STS) (January, 2014)
  • Joseph Sushchin`s Award of Medical Faculty, Outstanding Resident in Cardiothoracic Surgery, Hadassah Medical School, Hebrew University (2001)
  • Awards of Outstanding Instructor in Cardiothoracic Surgery, Hebrew University (1999, 2000, 2001, 2002)

Professional Education

  • Fellowship, Columbia University, Pediatric Cardiac Surgery (2011)
  • Fellowship, Harvard Medical School, Adult Cardiac Surgery (2007)
  • Residency, Hebrew University Hadassah Medical School, Cardiothoracic Surgery (2003)
  • Internship, Hebrew University, Surgery Medicine (1995)
  • MD, Hebrew University, Medicine (1994)

Community and International Work

  • Medical Mission, El Salvador


    Pediatric Cardiac Surgery

    Partnering Organization(s)

    Heartcare International (HCI)

    Populations Served

    Children with congenital heart disease



    Ongoing Project


    Opportunities for Student Involvement



  • Rabin Gerrah. "United States Patent 8753365 Device for harvesting a blood vessel", Jan 8, 2009
  • Rabin Gerrah. "United States Patent 826268 Device and method for performing endoluminal anastomosis", Nov 24, 2008

All Publications

  • Characterization of Surgical Movements As a Training Tool for Improving Efficiency. The Journal of surgical research Grewal, B., Kianercy, A., Gerrah, R. 2024; 296: 411-417


    Surgical experience is often reflected by efficient, fluid, and well-calculated movements. For a new trainee, learning these characteristics is possible only by observation as there is no quantification system to define these factors. We analyzed surgeons' hand movements with different experience levels to characterize their movements according to experience.Hand motions were recorded by an inertial measurement unit (IMU) mounted on the hands of the surgeons during a simulated surgical procedure. IMU data provided acceleration and Eulerian angles: yaw, roll, and pitch corresponding to hand motions as radial/ulnar deviation, pronation/supination, and extension/flexion, respectively. These variables were graphically depicted and compared between three surgeons.Participants were assigned to three groups based on years of surgical experience: group 1: >15 y; group 2: 3-10 y; and group 3: 0-1 y. Visualization of the roll motion, being the main motion during suturing, showed the clear difference in fluidity and regularity of the movements between the groups, showing minimal wasted movements for group 1. The angle of the roll motion, measured at the minimum, midpoint, and maximum points was significantly different between the groups. As expected, the experienced group completed the procedure first; however, the acceleration was not different between the groups.Surgeons' hand movements can be easily characterized and quantified by an IMU device for automatic assessment of surgical skills. These characteristics graphically visualize a surgeon's regularity, fluidity, economy, and efficiency. The characteristics of an experienced surgeon can serve as a training model and as a reference tool for trainees.

    View details for DOI 10.1016/j.jss.2023.12.053

    View details for PubMedID 38310656

  • Chest wall reconstruction after sternectomy with preservation of sternoclavicular joint function. JTCVS techniques Gerrah, R. 2023; 22: 337-342

    View details for DOI 10.1016/j.xjtc.2023.09.013

    View details for PubMedID 38152196

    View details for PubMedCentralID PMC10750873

  • Localization of coronary bypass targets in hard-to-see coronary arteries. Journal of cardiothoracic surgery Gerrah, R., Lipe, K., Vlahakes, G. J. 2023; 18 (1): 290


    Precise identification of coronary arteries and selection of anastomotic sites are critical stages of coronary bypass surgery. Visualization of coronary arteries is occasionally challenging when the heart is covered with a thick layer of fat or scar tissue. In this paper, we review the methods to localize the coronary arteries during coronary surgery.Prior publications were searched to summarize all available methods for localization of coronary arteries during coronary surgery.Five clinically recognized and three experimental techniques from the literature review are reviewed and summarized.Knowledge of various techniques of coronary artery identification in hard-to-see coronary arteries is an important asset in coronary surgery and especially useful during the most critical option of the most common heart surgery.

    View details for DOI 10.1186/s13019-023-02399-8

    View details for PubMedID 37828562

    View details for PubMedCentralID 3558356

  • Concentration of insufflated carbon dioxide during open cardiac surgery. JTCVS techniques Kamal, R., Gerrah, R. 2023; 21: 115-117

    View details for DOI 10.1016/j.xjtc.2023.07.001

    View details for PubMedID 37854818

    View details for PubMedCentralID PMC10580034

  • A Universal Device to Convert a Continuous Flow Assist Device to a Pulsatile Flow Device to Simulate Normal Blood Flow and Pressure Patterns. Surgical innovation Gerrah, R. 2022: 15533506221140534


    BACKGROUND: Continuous follow assist devices (CFAD) are the most commonly used mechanical circulatory support devices. Compared to Pulsatile flow assist devices (PFAD), CFADs deliver a non-physiologic type of flow, which might contribute to complications related to lack of pulsatility in these devices. Moreover, lack of pulsatility complicates the clinical management of these patients who often present with good perfusion but with no palpable pulse and none or a negligible pulse pressure on blood pressure measurement.METHODS AND RESULTS: Presented here is a concept of a universal converter device that can be added inline other CFADs to convert the flow from continuous to pulsatile, simulating a normal flow and pressure pattern. After initial implantation and stabilization with a CFAD, adding this converter might potentially provide the benefits of pulsatile physiologic flow. The device is made of 2 components connected in parallel, working in tandem in user determined cycles. The continuous flow through a specifically positioned openings create a smooth conversion to a pulsatile flow. This device can convert a continuous flow to a physiologic pulsatile flow to achieve a native-like flow pattern and potentially prevent some CFAD complications.CONCLUSION: This paper presents the concept of pulsatility generation and simulation for other assist devices. Such a device can be a universal add-on or a supplemental option for CFADs.

    View details for DOI 10.1177/15533506221140534

    View details for PubMedID 36441564

  • Effect of Blood Flow on Cardiac Morphogenesis and Formation of Congenital Heart Defects. Journal of cardiovascular development and disease Trinidad, F., Rubonal, F., Rodriguez de Castro, I., Pirzadeh, I., Gerrah, R., Kheradvar, A., Rugonyi, S. 2022; 9 (9)


    Congenital heart disease (CHD) affects about 1 in 100 newborns and its causes are multifactorial. In the embryo, blood flow within the heart and vasculature is essential for proper heart development, with abnormal blood flow leading to CHD. Here, we discuss how blood flow (hemodynamics) affects heart development from embryonic to fetal stages, and how abnormal blood flow solely can lead to CHD. We emphasize studies performed using avian models of heart development, because those models allow for hemodynamic interventions, in vivo imaging, and follow up, while they closely recapitulate heart defects observed in humans. We conclude with recommendations on investigations that must be performed to bridge the gaps in understanding how blood flow alone, or together with other factors, contributes to CHD.

    View details for DOI 10.3390/jcdd9090303

    View details for PubMedID 36135448

  • Utilizing the Fourth Dimension for Patient Education in Cardiovascular Surgery. The Annals of thoracic surgery Gerrah, R., Haller, S. J. 2021


    The complex three-dimensional (3D) anatomy of the cardiovascular system presents a steep learning obstacle to patients in understanding cardiovascular diseases and surgical procedures. Although 3D printed models have become very popular in surgical education, 2D cross-sections remain standard in clinical practice due to costs and availability. In this report, we demonstrate how the free 3D modeling software Meshmixer can be used to add a fourth dimension to patient education by exploiting interactive 3D modeling. This report serves as proof of concept for the feasibility and potential utility of interactive 3D modeling as an inexpensive tool for cardiovascular surgery patient education.

    View details for DOI 10.1016/j.athoracsur.2021.04.028

    View details for PubMedID 33905725

  • Computational fluid dynamics: a primer for congenital heart disease clinicians. Asian cardiovascular & thoracic annals Gerrah, R., Haller, S. J. 2020: 218492320957163


    Computational fluid dynamics has become an important tool for studying blood flow dynamics. As an in-silico collection of methods, computational fluid dynamics is noninvasive and provides numerical values for the most important parameters of blood flow, such as velocity and pressure that are crucial in hemodynamic studies. In this primer, we briefly explain the basic theory and workflow of the two most commonly applied computational fluid dynamics techniques used in the congenital heart disease literature: the finite element method and the finite volume method. We define important terminology and include specific examples of how using these methods can answer important clinical questions in congenital cardiac surgery planning and perioperative patient management.

    View details for DOI 10.1177/0218492320957163

    View details for PubMedID 32878458

  • Towards virtual surgery planning: the modified Blalock-Taussig Shunt AIMS BIOPHYSICS Haller, S., Gerrah, R., Rugonyi, S. 2020; 7 (3): 169–88
  • The Cavoatrial Anastomosis Procedure in Anomalous Connection of Superior Vena Cava to Left Atrium WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY Gerrah, R., Escalante, E., Gorenflo, M., Loukanov, T. 2019; 10 (6): 803–5


    Anomalous connection of the superior vena cava to the morphologic left atrium is a rare congenital systemic venous abnormality. As opposed to pulmonary venous anomalies, the significant right-to-left shunt in these patients warrants a correction early in life. Optimal repair technique for combined pulmonary and systemic venous anomalies is not defined yet. Herein, we describe a neonate with such a diagnosis treated with cavoatrial anastomosis, known as Warden procedure with excellent results.

    View details for DOI 10.1177/2150135119878102

    View details for Web of Science ID 000495237500025

    View details for PubMedID 31701841

  • Mechanical Concepts Applied in Congenital Heart Disease and Cardiac Surgery. The Annals of thoracic surgery Gerrah, R., Haller, S. J., George, I. 2017; 103 (6): 2005-2014


    All biological processes are governed by principles of physics that dictate the pathophysiology and even the treatment of congenital heart diseases. In this review, basic concepts such as flow, pressure, resistance, and velocity are introduced, followed by more complex laws that describe the relationship between these variables and the disease processes. Finally, physical phenomena such as turbulence, steal and runoff phenomenon, and energy loss are discussed. By application of these principles, one can accurately quantify modifications undertaken to treat diseases, for example, the size of a patch that augments a vessel and the angle of an anastomosis to allow a certain flow.

    View details for DOI 10.1016/j.athoracsur.2017.01.068

    View details for PubMedID 28457478

  • Repair of Tetralogy of Fallot in Children Less Than 4 kg Body Weight PEDIATRIC CARDIOLOGY Gerrah, R., Turner, M. E., Gottlieb, D., Quaegebeur, J. M., Bacha, E. 2015; 36 (7): 1344–49


    We reviewed our experience of surgical repair of Tetralogy of Fallot (TOF) in children weighing less than or equal to 4 kg to compare outcome of early palliation versus complete repair as the initial surgical approach. Seventy-six patients, weighing ≤ 4 kg, with TOF surgery between January 2005 and September 2013 were included in this single-center retrospective study. Twenty-five patients who underwent initial shunt procedure followed by later full repair were compared to 51 patients who had primary full repair for differences in baseline characteristics and outcomes. Shunt group patients had lower body weight, 2.76 ± 0.69 versus 3.11 ± 0.65 (kg), p = 0.03, and lower preoperative oxygen saturations, 82 ± 7 versus 90 ± 6 (%), p = 0.0001, than full repair group. A higher number of surgical procedures per patient was recorded in shunt patients, 2.29 ± 0.59 versus 1.27 ± 0.49, p = 0.00002. Thirteen of 51 patients in the full repair group required a repeat surgery. Catheterization procedures were performed in 12 patients in shunt and in 15 patients in full repair group, with interventional angioplasty in three and 11, respectively, p ≥ 0.05. Two patients, both in the shunt group, died after the surgery. Early full repair had longer hospital stay but significantly less hospitalizations 1.95 ± 1.3 versus 2.5 ± 1.4, p = 0.03. Initial complete repair of TOF in small children yielded favorable outcome with significantly less surgical procedures and subsequent hospitalizations. Cath laboratory re-interventions for residual defects were similar after both surgical approaches, and type of initial surgery does not predict freedom from re-intervention.

    View details for DOI 10.1007/s00246-015-1163-z

    View details for Web of Science ID 000361426700004

    View details for PubMedID 25835203

  • Pretreatment of synthetic vascular grafts with heparin before implantation, a simple technique to reduce the risk of thrombosis VASCULAR Gerrah, R., Sunstrom, R., Hohimer, A. R. 2015; 23 (5): 513–18


    Thrombosis of synthetic grafts commonly used in cardiovascular surgery is a major complication. We examined whether pretreatment of the graft with heparin reduces the risk of early thrombosis. A circuit was assembled to compare two pairs of shunts simultaneously in the same animal. The study shunts were pretreated with heparin. After 2 hours of circulation, clot formation was evaluated by image analysis techniques. The pretreated grafts had fewer blood clots adhered to the surface by direct visual inspection. The image analysis showed 5 vs. 39 clots, 0.01% vs. 1.8% clotted area, and 62 vs. 5630 clot pixel area between the treated and non-treated grafts respectively, p < 0.05. Pretreatment of the synthetic graft with heparin prior to implantation reduces the risk of early clot formation. This simple practice might be helpful to prevent initial thrombosis of the graft and later occlusion.

    View details for DOI 10.1177/1708538114560455

    View details for Web of Science ID 000361850400011

    View details for PubMedID 25406265

  • A Defined Management Strategy Improves Early Outcomes After the Fontan Procedure: The Portland Protocol ANNALS OF THORACIC SURGERY Sunstrom, R. E., Muralidaran, A., Gerrah, R., Reed, R. D., Good, M. K., Armsby, L. R., Rekito, A. J., Zubair, M., Langley, S. M. 2015; 99 (1): 148–55


    Patients undergoing the Fontan procedure may have extended hospital stay due to various postoperative factors including prolonged chest tube drainage. Our aim was to determine the efficacy of our Fontan management protocol in reducing chest tube drainage and length of stay.Patients who underwent a Fontan procedure at our institution from June 2008 to September 2013 were analyzed (n = 42). We currently manage our patients according to the PORTLAND protocol: Peripheral vasodilation, Oxygen, Restriction of fluids, Technique of surgery, Low-fat diet, Anticoagulation (including antithrombin III management), No ventilator, and Diuretics. Group A (n = 28) had surgery prior to initiation of this protocol; group B (n = 14) had surgery during the current protocol era.The median number of chest tube days was lower in group B (6 vs 11 days, p < 0.001) as was the total indexed drainage (126 vs 259 mL/kg, p < 0.001). Patients in group B had shorter intensive care unit length of stay (4 vs 7 days, p = 0.004) and hospital length of stay (8 vs 13 days, p = 0.001). Group B had higher preoperative common atrial pressures (7.0 vs 5.8 mm Hg, p = 0.017), end-diastolic pressures (9 vs 7 mm Hg, p = 0.026), and trended toward higher pulmonary artery pressures (11.5 vs 9.5 mm Hg, p = 0.077). There was no statistically significant difference in age, weight, transpulmonary gradient, or pulmonary vascular resistance between groups.The PORTLAND protocol has improved early outcomes after the Fontan procedure. Chest tube drainage and duration, and both intensive care unit and hospital length of stay have been reduced since initiation of this protocol.

    View details for DOI 10.1016/j.athoracsur.2014.06.121

    View details for Web of Science ID 000347030800040

    View details for PubMedID 25442983

  • Adjustment of the surgical plan in repair of congenital heart disease: the power of cross-sectional imaging and three-dimensional visualization. Congenital heart disease Gerrah, R., Bardo, D. M., Reed, R. D., Sunstrom, R. E., Langley, S. M. 2013; 9 (1): E31-6


    The purpose of this article is to study the importance of cross-sectional imaging in preoperative evaluation and surgical planning. Echocardiography is the modality of choice to diagnose cardiac diseases. However, in some cases, the data obtained from echocardiogram are insufficient or the image quality is poor. In these cases, additional modalities are being used to provide further information that can aid in guiding medical management of or surgical planning for the patient. Cross-sectional imaging has become widely available in many institutions. These imaging techniques, especially with three-dimensional reconstructions, provide realistic images that have imperative diagnostic values. Moreover, the possibility of sophisticated image-processing techniques provides important hemodynamic characteristics via less invasive methods. In this article, we present three cases in which additional cross-sectional imaging seemed to be a crucial step prior to surgical planning.

    View details for DOI 10.1111/chd.12062

    View details for PubMedID 23601962

  • The neonatal hypoplastic aortic arch: decisions and more decisions. Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual Langley, S. M., Sunstrom, R. E., Reed, R. D., Rekito, A. J., Gerrah, R. 2013; 16 (1): 43-51


    Neonatal patients with hypoplasia of the aortic arch constitute a heterogeneous group with a wide spectrum of severity. The milder end of the spectrum comprises patients with aortic coarctation and isthmus hypoplasia. At the other end of the spectrum are patients with severe transverse arch hypoplasia or hypoplastic left heart syndrome. The aim of this paper is to discuss the various strategies and surgical approaches available for this group of patients, focusing on the surgical decisions that influence individual patient management. Many of the things discussed are applicable to any neonatal arch problem. We also describe and discuss in detail our surgical technique for patients who undergo neonatal repair of a hypoplastic aortic arch via median sternotomy.

    View details for DOI 10.1053/j.pcsu.2013.01.008

    View details for PubMedID 23561817

  • In vivo quantification of clot formation in extracorporeal circuits. Studies in health technology and informatics Gerrah, R., David, O. 2013; 184: 148-50


    Clot formation is a common complication in extracorporeal circuits. In this paper we describe a novel method for clot formation analysis using image processing. We assembled a closed extracorporeal circuit and circulated blood at varying speeds. Blood filters were placed in downstream of the flow, and clotting agents were added to the circuit. Digital images of the filter were subsequently taken, and image analysis was applied to calculate the density of the clot. Our results show a significant correlation between the cumulative size of the clots, the density measure of the clot based on image analysis, and flow duration in the system.

    View details for PubMedID 23400147

  • Hypoplastic right cervical aortic arch. The Annals of thoracic surgery Gerrah, R., Shah, A., Langley, S. M., Quaegebeur, J. M. 2012; 94 (6): 2127-9


    We describe a neonate with a rare congenital anomaly of the aorta. The anomaly included a hypoplastic aortic arch that was cervical and right sided. This complex combination was treated by a Norwood type procedure reconstructing a right-sided arch and, in a later stage, a Rastelli procedure. These 2 procedures achieved a 2 ventricular repair. The diagnostic and surgical challenges of this rare anomaly are described in this case report.

    View details for DOI 10.1016/j.athoracsur.2012.04.136

    View details for PubMedID 23176933

  • Biventricular pacing improves left ventricular function by 2-D strain in right ventricular failure. The Journal of surgical research Wong, C., Cabreriza, S. E., Nugent, M., Wang, D. Y., Gerrah, R., Rusanov, A., Yalamanchi, V., Wang, A., Cheng, B., Spotnitz, H. M. 2012; 178 (2): 571-7


    We used speckle-tracking echocardiography to test the hypothesis that regional left ventricular (LV) strain would improve during optimized biventricular pacing (BiVP) in acute right ventricular (RV) pressure overload (PO).Complete heart block and RVPO were induced in five open-chest fully anesthetized pigs. BiVP was optimized by adjusting atrioventricular and interventricular delays to maximize cardiac output derived from an aortic flow probe. LV short axis views were obtained during atrio-RV pacing (RVP), atrio-LV pacing (LVP), and BiVP. Intraventricular synchrony was assessed by comparing speckle-tracking echocardiography-derived time to peak (TTP) strain in the anterior septal (AS) and posterior wall segments. Segmental function was assessed using radial strain.Cardiac output was higher with optimized (RV first) BiVP than with LVP (0.96 ± 0.26 L/min versus 0.89 ± 0.27 L/min; P = 0.05). AS TTP strain (502 ± 19 ms) during LVP was prolonged versus BiVP (392 ± 58 ms) and versus RVP (390 ± 53 ms) (P = 0.0018). AS TTP strain during LVP was prolonged versus posterior (502 ± 19 ms versus 396 ± 72 ms, P = 0.0011). No significant difference in TTP strain in these segments was seen with BiVP or RVP. Posterior strain (20% ± 5%) increased 66% versus AS strain (12% ± 6%) during BiVP (P = 0.0029). A similar increase occurred during RVP (posterior 20% ± 3% versus AS 12% ± 7%, P = 0.0002). Posterior strain did not increase during LVP.BiVP and RVP restore intraventricular LV synchrony and increase regional function versus LVP during RVPO. RV pre-excitation unloads the RV and reduces the duration of AS contraction, facilitating synchrony of all LV segments and increasing free wall LV contraction.

    View details for DOI 10.1016/j.jss.2012.06.001

    View details for PubMedID 22748597

    View details for PubMedCentralID PMC7020239

  • Management of intracranial hemorrhage in a child with a left ventricular assist device. Pediatric transplantation Haque, R., Wojtasiewicz, T., Gerrah, R., Gilmore, L., Saiki, Y., Chen, J. M., Richmond, M., Feldstein, N. A., Anderson, R. C. 2012; 16 (5): E135-9


    Pediatric patients bridged to heart transplant with LVADs require chronic anticoagulation and are at increased risk of hemorrhagic complications, including intracranial hemorrhage. In this population, intracranial hemorrhage is often fatal. We report a case of successful management of a five-yr-old-boy with DCM on an LVAD who developed a subdural hematoma. We initially chose medical management, weighing the patient's high risk of thromboembolism from anticoagulation reversal against the risk of his chronic subdural hematoma. When head CT showed expansion of the hemorrhage with increasing midline shift, we chose prompt surgical evacuation of the hematoma with partial reversal of anticoagulation, given the increased risk of acute deterioration. The patient ultimately received an orthotopic heart transplant and was discharged with no permanent neurological complications. This represents a case of a pediatric patient on an LVAD who survived a potentially fatal subdural hematoma and was successfully bridged to cardiac transplantation.

    View details for DOI 10.1111/j.1399-3046.2012.01650.x

    View details for PubMedID 22332723

  • Single dose myocardial protection technique utilizing del Nido cardioplegia solution during congenital heart surgery procedures. Perfusion Charette, K., Gerrah, R., Quaegebeur, J., Chen, J., Riley, D., Mongero, L., Corda, R., Bacha, E. 2012; 27 (2): 98-103


    The single dose cardioplegia technique for myocardial protection during congenital heart surgery is a viable alternative to multidose protocols.Thirty-four pediatric patients with aortic cross clamp times greater than 90 minutes were grouped by modified adult (MA) multidose solution or del Nido (dN) single dose solution. Also, data from eight patients where the cross clamp times were greater than two hours on one dose of dN solution were included.In the 90-minute plus arm of the study, there were no significant differences between the groups when comparing the risk adjustment for congenital heart surgery (RACHS) (p=0.6), cardiopulmonary bypass times (CPB) (p=0.5), aortic cross camp times (p=0.5), weights (p=0.7) and number of intraoperative exogenous blood units (p=0.5). There were significant differences between the groups (p<0.05) in the number of cardioplegia doses and with perioperative glucose levels. In the greater than two hours group, the incidence of complete heart block (CHB) was 0.125% and there were no deaths or mechanical circulatory support (MCS) devices used.del Nido cardioplegia solution is a reasonable tool for myocardial protection during congenital heart surgery that significantly decreased the number of cardioplegic interventions and perioperative glucose values in our study groups.

    View details for DOI 10.1177/0267659111424788

    View details for PubMedID 22005886

  • The first successful use of the Levitronix PediMag ventricular support device as a biventricular bridge to transplant in an infant. The Journal of thoracic and cardiovascular surgery Gerrah, R., Charette, K., Chen, J. M. 2011; 142 (5): 1282-3

    View details for DOI 10.1016/j.jtcvs.2011.03.026

    View details for PubMedID 21529849

  • Developing and optimizing a chronic cyanotic swine model. The Journal of surgical research Gerrah, R., Cabreriza, S. E., Rusanov, A., Romanov, A., Khan, A. R., Spotnitz, H. M. 2011; 171 (1): 170-4


    Pulmonary artery (PA)-left atrial (LA) shunt models in piglets have been described, but technical details critical to limit morbidity/mortality and promote study of chronic cyanosis are lacking. Accordingly, we describe our experience with an optimized technique.In 25 6- to 8-wk-old Yorkshire piglets, a beveled, 8 mm, polytetrafluoroethylene tube graft was anastomosed to the PA and LA. Systemic pressure was maintained at >60 mmHg. Saturation targets were met by adjusting a Teflon band on the graft and distal PA. The target oxygen saturation (SO(2)) was 85% on a 50% fraction of inspired oxygen (FiO(2)). If the SO(2) was <75% on a 50% FiO(2), the graft was constricted to achieve a SO(2) ≥ 90% on a 100% FiO(2) and 75%-80% on a 21% FiO(2). Complications affecting mortality were neutralized with a stepwise strategy to minimize risk.Thrombosis, blood loss, and arrhythmia were determinants of survival. Protocol optimization over time increased survival while assuring chronic cyanosis. Survival approached 90%, with a SO(2) of 80% to 90%, 3 to 5 wk postoperatively. Complications included bleeding, excessive hypoxemia, uncontrolled shunt flow, arrhythmias, and thrombosis.Refinement of surgical technique, shunt adjustment via graft banding, and thrombotic and arrhythmia prophylaxis are the keys to success with this model.

    View details for DOI 10.1016/j.jss.2010.03.004

    View details for PubMedID 20605592

  • Left ventricular pacing lead insertion via the coronary sinus cardioplegia cannula: a novel method for temporary biventricular pacing during reoperative cardiac surgery. The Journal of thoracic and cardiovascular surgery Wang, D. Y., Gerrah, R., Rusanov, A., Yalamanchi, V., Cabreriza, S. E., Spotnitz, H. M. 2011; 142 (1): 73-6


    Temporary biventricular pacing to treat low output states after cardiac surgery is an active area of investigation. Reoperative cases are not studied due to adhesions, which preclude left ventricular mobilization to place epicardial pacing wires. In such patients, inserting a temporary left ventricular lead via the coronary sinus cardioplegia cannula may allow for biventricular pacing. We developed a novel technique for intraoperative left ventricular lead placement.Eight domestic pigs underwent median sternotomy and pericardiotomy. Temporary pacing wires were sewn to the right atrium and right ventricle. Complete heart block was induced by ethanol ablation of the atrioventricular node. A 13-French retrograde cardioplegia catheter was introduced via the right atrial free wall into the coronary sinus. A 6-French left ventricular pacing lead was inserted into the cardioplegia catheter and advanced into the coronary sinus during biventricular pacing until left ventricular capture was detected by electrocardiogram and arterial pressure monitoring. Left ventricular capture success rate and electrical performance were recorded during five placement attempts.Left ventricular capture was achieved on 80% of insertion attempts. Left ventricular capture without diaphragmatic pacing was achieved in 7 pigs. Lead tip locations were mostly in lateral and posterior basal coronary vein branches. There were no arrhythmias, bleeding, or perforation associated with lead insertion.Intraoperative biventricular pacing with a left ventricular pacing lead inserted via the coronary sinus cardioplegia cannula is feasible, using standard instrumentation and without requiring cardiac manipulation. This approach merits further study in patients undergoing reoperative cardiac surgery.

    View details for DOI 10.1016/j.jtcvs.2010.08.028

    View details for PubMedID 20965517

    View details for PubMedCentralID PMC3432304

  • Validation of automated monitoring of cardiac output for biventricular pacing optimization. ASAIO J George, E. M., Cabreriza, S. E., Quinn, T. A., Rusanov, A., Gerrah, R., Broyles, J. M., Weinberg, A. D., Spotnitz, H. M. 2010; 56 (3): 265-9
  • Platelet Function Changes in Different Cardiac Surgery Subgroups as Evaluated With an Innovative Technology INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY Gerrah, R., Brill, A., Varon, D. 2007; 2 (4): 176–83


    : During cardiac surgery, platelets undergo substantial changes. The purpose of this study was to assess platelet function and compare these changes between different cardiac operations using an innovative technology.: Perioperative platelet function was evaluated by the Impact test [cone and plate(let) analyzer (CPA)]. The Impact test yields 2 parameters for platelet function: average size (AS, the mean size of the platelet aggregates) and surface coverage (SC, the percentage of the surface covered by the platelet aggregates), which correspond to platelet aggregation and adhesion. The study groups were compared for platelet function results in various surgery stages and correlation with bleeding.: A significant decrease in surface coverage was detected on establishment of cardiopulmonary bypass, with an increase up to preoperative values at the end of the surgery in all groups. In contrast to operations performed on bypass, in patients operated without cardiopulmonary bypass, the postoperative AS and SC were higher than the preoperative values, 30.4 ± 8.1 μmol versus 23.3 ± 6.9 μmol, P = 0.02 in AS, and 7.6 ± 3.6% versus 5.2 ± 1.8%, P = 0.04 in SC. Preoperative AS and SC were the only parameters significantly (P = 0.01) and linearly (r = 0.6) related to postoperative bleeding.: Preoperative platelet function, as evaluated by the CPA, is an independent risk factor determining postoperative bleeding. The off-pump patients presented an increased platelet function at the end of surgery, a finding that can imply a higher risk of thrombosis. The impact test appears to be a useful tool to determine perioperative platelet function and help in prediction of postoperative bleeding.

    View details for DOI 10.1097/imi.0b013e318158ccc8

    View details for Web of Science ID 000217545200002

    View details for PubMedID 22437056

  • Using cone and plate(let) analyzer to predict bleeding in cardiac surgery. Asian cardiovascular & thoracic annals Gerrah, R., Brill, A., Tshori, S., Lubetsky, A., Merin, G., Varon, D. 2006; 14 (4): 310-5


    The cone and plate(let) analyzer is an established method for assessing platelet function. It evaluates adherence of platelets on an extracellular matrix, expressed as a percentage of surface coverage and the average size of the aggregates. The purpose of this study was to determine the applicability of the cone and plate(let) analyzer in monitoring platelet function and predicting postoperative bleeding. The relationship between postoperative bleeding, perioperative platelet function, and other parameters was studied. A significant decrease in surface coverage was detected upon establishment of cardiopulmonary bypass (from 6.9% +/- 3.9% to 4.7% +/- 1.7%) with a return to preoperative values at the end of surgery. Preoperative average size and surface coverage were the only parameters that significantly and linearly correlated with postoperative bleeding. Patients with an aggregate average size < 20 microm(2) had a significantly higher incidence of severe bleeding (> 965 mL) than those with a size > 20 microm(2) (44% vs. 0%), and a higher mean blood loss (908 +/- 322 mL vs. 337 +/- 78 mL). Similar results were obtained for surface coverage < 5%, indicating the predictive value of these parameters. Preoperative platelet function as evaluated by the cone and plate(let) analyzer is an independent risk factor determining postoperative bleeding.

    View details for DOI 10.1177/021849230601400409

    View details for PubMedID 16868105

  • Stuck bioprosthetic aortic valve - A new entity? A case report HEART SURGERY FORUM Gerrah, R., Pappof, M., Shatz, Pollak, A., Gilon, D. 2005; 8 (6): E447–E448


    We describe herein a case of bioprosthetic valve malfunction, which closely imitates a stuck valve. Although the term "stuck" was used originally for the immovable mechanical valve leaflets, the echocardiographic manifestation of this malfunction is similar to those of a mechanical one. The clinical presentation of the stuck bioprosthesis is, however, far more benign than a stuck mechanical valve. Familiarity with this entity is important.

    View details for DOI 10.1532/HSF98.20051017

    View details for Web of Science ID 000234239700013

    View details for PubMedID 16283983

  • Preoperative aspirin administration improves oxygenation in patients undergoing coronary artery bypass grafting CHEST Gerrah, R., Elami, A., Stamler, A., Smirnov, A., Stoeger, Z. 2005; 127 (5): 1622–26


    Release of thromboxane (Tx) A(2) by platelets may be one of multiple factors that are responsible for lung injury after cardiopulmonary bypass, leading to pulmonary vasoconstriction and impaired oxygenation. In experimental models, the inhibition of Tx receptor or its production improved lung function. The use of aspirin, which is used widely in the treatment of ischemic heart disease because of its antiplatelet activity, is usually discontinued a week before the patient undergoes the operation to restore normal platelet hemostatic function. The purpose of this study was to determine the relationship between the time of cessation of aspirin before coronary artery bypass surgery, and postoperative oxygenation and bleeding.A prospective clinical study comparing the effect of aspirin on postoperative oxygenation in patients who had been treated or had not been treated with aspirin.Tx levels in the pericardial fluid, oxygenation, and bleeding were compared between the two groups.Thirty-two patients with coronary artery disease who were undergoing coronary artery bypass grafting. Fourteen of these patients received aspirin until the day of the operation, whereas 18 patients stopped receiving aspirin at least 1 week before undergoing the operation.Mean (+/- SD) Tx levels in the pericardial fluid were significantly lower in the aspirin group (117 +/- 47 pg/mL) compared to those in the control group (1,306 +/- 2,048 pg/mL; p = 0.02). The duration of ventilation after the operation was significantly longer in the nonaspirin group (9.6 +/- 5.6 h vs 3.8 +/- 1.4 h, respectively; p = 0.0004). Po(2) reached a higher level while patients breathed 100% O(2) in the aspirin group (235 +/- 54 mm Hg vs 176 +/- 27 mm Hg, respectively; p = 0.001). The mean amount of bleeding during the first 24 h after surgery was increased in the aspirin group (710 +/- 202 mL) compared with the nonaspirin group (539 +/- 143 mL; p = 0.01), but these patients did not require more transfusions.The administration of aspirin until the operation may improve oxygenation with only a slight increase in bleeding. This improvement is probably mediated by antiplatelet activity and Tx inhibition by aspirin.

    View details for DOI 10.1378/chest.127.5.1622

    View details for Web of Science ID 000228987600028

    View details for PubMedID 15888837

  • Beneficial effect of aspirin on renal function in patients with renal insufficiency postcardiac surgery Gerrah, R., Ehrlich, S., Tshori, S., Sahar, G. EDIZIONI MINERVA MEDICA. 2004: 545–50


    Renal function is one of the most important prognostic factors following cardiac surgery. Whether aspirin affects cardiopulmonary bypass related renal injury is investigated in this study.Ninety-four patients with impaired renal function (creatinine = or >1.5 mg/dl) undergoing coronary artery bypass grafting (CABG) were categorized into 2 groups according to aspirin administration before surgery. Serum creatinine, urinary output and creatinine clearance along with other perioperative factors were compared between the 2 groups prior to surgery, 24 hours and 48 hours following cardiopulmonary bypass.Creatinine levels increased significantly in the second postoperative day only in the non-aspirin (control) group (3.7+/-1.6 vs 2.9+/-1.7 mg/dl, p=0.03). Aspirin (study) group had lower creatinine levels in day 1 (p=0.03) and day 2 (p=0.001). Furthermore, in the study group creatinine clearance was higher in day 1 (34.3+/-14.3 vs 30.9+/-13.1 ml/min, p=0.01) and in day 2 (32.6+/-13.8 vs 26.4+/-9.8 ml, p<0.0001). Creatinine levels at discharge were elevated compared to the preoperative levels in the control group (p=0.01). However, the study group had lower creatinine levels at discharge (2.6+/-1.4 vs 3.8+/-1.6 mg/dl, p<0.0001). Urinary output was higher in the study group in the first postoperative day compared to the control group (p=0.01). Postoperative bleeding was slightly increased in the study group compared to the control group (760+/-230 ml vs 530+/-210 ml, p=0.01).Continuation of aspirin administration until the day of surgery may have a protective effect against renal injury resulting from cardiopulmonary bypass, with only a negligible increase in bleeding. Possible explanations for this effect are antiplatelet activity of aspirin during cardiopulmonary bypass causing inhibition of vasoconstrictive agents like thromboxane, and improvement of renal perfusion by reducing blood viscosity.

    View details for Web of Science ID 000228056200003

    View details for PubMedID 15746633

  • Pericardial fluid and serum VEGF in response to different types of heparin treatment INTERNATIONAL JOURNAL OF CARDIOLOGY Gerrah, R., Tshori, S., Gilon, D. 2004; 94 (2-3): 193–96


    Heparin is an important medication in the treatment of patients with unstable angina pectoris. We designed an observational study to compare the effects of standard heparin (SH) with low molecular weight heparin (LMWH) on vascular endothelial growth factor (VEGF) levels in patients undergoing coronary artery bypass grafting (CABG).Thirty-two patients with unstable angina pectoris undergoing CABG were prospectively categorized into two groups according to the type of heparin administration before surgery. VEGF levels determined by enzyme linked immunosorbent assay (ELISA) were compared between the two groups' blood samples obtained before the surgery and pericardial fluid after pericardial opening.There was no difference in preoperative characteristics between the two groups. Serum VEGF levels were similar (P=0.3) in patients treated by SH (85+/-55 pg/ml) compared to those treated with LMWH (105+/-64 pg/ml). VEGF levels in the pericardial fluid were significantly raised (P<0.0001) in patients of LMWH group (36+/-13 pg/ml) compared to SH group (13+/-6 pg/ml). A good correlation was observed between VEGF in the serum and platelet count in both SH group (r=0.8) and LMWH group (r=0.7).Local response of the ischemic myocardium, as expressed by VEGF levels, differs in patients treated with SH compared to patients treated with LMWH. VEGF levels in pericardial fluid of patients receiving LMWH were 2-3-folds higher than patients in SH group.

    View details for DOI 10.1016/j.ijcard.2003.03.022

    View details for Web of Science ID 000221168800010

    View details for PubMedID 15093980

  • Aspirin decreases vascular endothelial growth factor release during myocardial ischemia INTERNATIONAL JOURNAL OF CARDIOLOGY Gerrah, R., Fogel, M., Gilon, D. 2004; 94 (1): 25–29


    Vascular Endothelial Growth Factor (VEGF) is an important angiogenesis factor involved in pathophysiology of cardiovascular diseases. Controlling this factor's level in the serum might have significant prognostic outcomes.Twenty-four patients undergoing coronary artery bypass grafting were prospectively categorized into two groups according to aspirin administration before surgery. Vascular Endothelial Growth Factor levels were compared and correlated and adjusted with platelets count between two groups in the serum, before and after the surgery. Serum creatine kinase (CK) levels were determined before and after the operation in parallel to other clinical data.Vascular Endothelial Growth Factor levels were significantly lower in patients of the aspirin group compared to those of the non-aspirin group; 94+/-61 vs. 241+/-118 pg/ml, p=0.0003, respectively, this-despite an absence of difference in the platelet count between the groups. These titers decreased postoperatively in both groups, 94+/-61 to 10+/-9 pg/ml, p=0.001 in aspirin group and from 241+/-118 to 84+/-54 pg/ml, p=0.001 in control group. Serum creatine kinase levels were higher in the non-aspirin group, 214+/-83 u/l compared to 70+/-32 u/l in the aspirin group. Creatine kinase levels increased significantly postoperatively in both groups; however, the aspirin group had a significantly lower creatine kinase levels compared to non-aspirin group, 107+/-51 vs. 401+/-127 u/l, respectively, p=<0.0001. A significant correlation was seen between VEGF levels and platelets count in both groups, r=0.5.Aspirin treated patients have lower Vascular Endothelial Growth Factor titer levels in the perioperative course. This difference between the aspirin and the non-aspirin group is not accounted for by the platelets count.

    View details for DOI 10.1016/j.ijcard.2003.03.007

    View details for Web of Science ID 000220258900004

    View details for PubMedID 14996470

  • Platelet function changes as monitored by cone and plate(let) analyzer during beating heart surgery HEART SURGERY FORUM Gerrah, R., Snir, E., Brill, A., Varon, D. 2004; 7 (3): E191–E195


    Off-pump coronary artery bypass (OPCAB) is believed to reduce cardiopulmonary bypass (CPB)-related complications, including platelet damage. A hypercoagulable state instead of coagulopathy has been reported following OPCAB surgeries due to CPB. Whether platelet function is changed when the injurious effect of CPB is eliminated was investigated.Platelet function was determined with the cone and plate(let) analyzer (CPA) method. The 2 parameters, average size (AS) and surface coverage (SC) of platelet aggregates, were measured with the CPA method to assess platelet aggregation and adhesion. These parameters were evaluated, and their values were compared at several stages of OPCAB surgery. The correlations of postoperative bleeding with platelet function at different stages of the surgery and with other factors, such as platelet count, hematocrit, and transfusions, were studied.Both AS and SC increased during several stages of the operation, and postoperative values (mean +/- SD) were significantly higher than preoperative values (30.4 +/- 8.1 microm 2 versus 23.3 +/- 6.9 microm 2 for AS [ P =.02] and 7.6% +/- 3.6% versus 5.2% +/- 1.8% for SC [ P =.04]). The mean total bleeding volume was 875 micro 415 mL. Preoperative AS and SC were the only parameters significantly ( P =.01) and linearly ( r = 0.7) related to postoperative bleeding.An increased platelet function, as determined by the CPA method, is found following OPCAB surgery. This phenomenon is probably at least partially responsible for the thrombogenic state after OPCAB surgery. Lack of platelet injury attributed to CPB may divert the system toward a more thrombogenic state. Preoperative platelet function, as evaluated by the CPA method, is an independent risk factor determining postoperative bleeding.

    View details for DOI 10.1532/HSF98.20041010

    View details for Web of Science ID 000223999200003

    View details for PubMedID 15262600

  • Beneficial effect of aspirin on renal function post-cardiopulmonary bypass. Asian cardiovascular & thoracic annals Gerrah, R., Izhar, U. 2003; 11 (4): 304–8


    Urine thromboxane, plasma creatinine, and creatinine clearance were determined perioperatively in 20 patients undergoing coronary bypass surgery. Ten patients took aspirin until the day of surgery, and 10 discontinued aspirin at least one week before surgery. A significant increase in urine thromboxane following establishment of cardiopulmonary bypass was observed only in the control group. Plasma creatinine increased in the control group on the 1st postoperative day (from 81.9 +/- 13.2 to 97.6 +/- 13.2 micromol.L(-1), p = 0.02) and decreased next day to the preoperative level (82.7 +/- 9 micromol.L(-1), p = 0.03). In the aspirin group, creatinine remained unchanged on the 1st postoperative day (89.4 +/- 14.2 vs. 87.2 +/- 7.7 micromol.L(-1), p = 0.6), and increased significantly on the 2nd day (101.4 +/- 8.5 micromol.L(-1), p = 0.01). The aspirin group had higher creatinine levels (p < 0.0001) and lower creatinine clearance (60.2 +/- 16.5 vs. 82 +/- 25.7 mL.min(-1), p < 0.0001) than the control group on the 2nd postoperative day. A significant positive correlation was seen between urine thromboxane and creatinine on day 2 in both groups (r = 0.6). Aspirin administrated before coronary surgery may have a beneficial effect on renal function, probably mediated by its antiplatelet activity and thromboxane inhibition.

    View details for PubMedID 14681089

  • Cardiac surgery in octogenarians - A better prognosis in coronary artery disease ISRAEL MEDICAL ASSOCIATION JOURNAL Gerrah, R., Izhar, U., Elami, A., Milgalter, E., Rudis, E., Merin, G. 2003; 5 (10): 713–16


    Cardiac surgery is being performed with increasing frequency in patients aged 80 years and older.To examine the long and short-term results of surgery in this age group.We retrospectively investigated 202 consecutive patients aged 80 years or older who underwent cardiac surgery between 1991 and 1999, Ninety-six operations (48%) were urgent.The study group comprised 140 men (69%) and 62 women (31%) with a mean age of 82.1 years (range 80-89). Preoperatively, 120 patients (59%) had unstable angina, 37 (18%) had left main coronary artery disease, 22 (11%) had renal failure, 17 (8.5%) had a history of stroke and 13 (6.5%) had previous cardiac surgery. Hospital mortality for the whole group was 7.4%. Postoperative complications included: re-exploration for bleeding in 15 (7.4%), stroke in 8 (4%), sternal wound infection in 3 (1.5%), low cardiac output in 17 (8.4%), new Q wave myocardial infarction in 5 (2.5%), renal failure in 17 (8.5%), and atrial fibrillation in 71 (35%). The actuarial survival for patients discharged from the hospital was 66% at 5 years and 46% at 8 years. The type of surgical procedure was significantly associated with increased early mortality (coronary artery bypass grafting only in 2.9%, CABG + valve in 16.1%, valve only in 16.7%; P = 0.01). Significant predictors (P < 0.05) for late mortality included type of surgical procedure, congestive heart failure, and postoperative low cardiac output.When appropriately applied in selected octogenarians, cardiac surgery can be performed with acceptable mortality and good long-term results.

    View details for Web of Science ID 000185987000007

    View details for PubMedID 14719466

  • The surgical approach to infective endocarditis: 10 year experience ISRAEL MEDICAL ASSOCIATION JOURNAL Gerrah, R., Rudis, E., Elami, A., Milgalter, E., Izhar, U., Merin, G. 2003; 5 (9): 641–45


    About 40% of patients with infective endocarditis will require surgical treatment. The guidelines for such treatment were formulated by the American College of Cardiology and American Heart Association in 1998.To examine our experience with surgical treatment of infective endocarditis in light of these guidelines.Surgery was performed in 59 patients with infective endocarditis between 1990 and 1999. The patients' mean age was 48 years (range 13-80). The indications for surgery were hemodynamic instability, uncontrolled infection, and peripheral embolic events. The surgical treatment was based on elimination of infection foci and correction of the hemodynamic derangement. These objectives were met with valve replacement in the majority of patients. Whenever conservative surgery was possible, resection of vegetation and subsequent valve repair were performed and the native valve was preserved.Six patients (10%) died perioperatively from overwhelming sepsis (n = 3), low cardiac output (n = 2) and multiogran failure (n = 1). The mean hospital stay was 15.6 days. Of 59 patients, 47 (80%) underwent valve replacement and in 11 (19%) the surgical treatment was based on valve repair. After 1 year of follow-up there was no re-infection.The new guidelines for surgical treatment of infective endocarditis allow better selection of patients and timing of surgery for this aggressive disease, which consequently decreases the mortality rate. Valve repair is feasible and is preferred whenever possible. According to the new guidelines, patients with neurologic deficit in our series would not have been operated upon, potentially decreasing the operative mortality to 7%.

    View details for Web of Science ID 000185317700009

    View details for PubMedID 14509154

  • Impaired oxygenation and increased hemolysis after cardiopulmonary bypass in patients with glucose-6-phosphate dehydrogenase deficiency ANNALS OF THORACIC SURGERY Gerrah, R., Shargal, Y., Elami, A. 2003; 76 (2): 523–27


    The purpose of this study was to determine whether the damaging effects of cardiopulmonary bypass, ischemia, and reperfusion would be more pronounced in patients with glucose-6-phosphate dehydrogenase deficiency undergoing cardiac surgery.Forty-two patients with glucose-6-phosphate dehydrogenase deficiency underwent open heart procedures using cardiopulmonary bypass. This group was matched with a control group of identical size for comparison of operative course and postoperative outcome. The perioperative variables were compared between the two groups using univariate and multivariate analysis.The duration of ventilation after the operation was significantly longer in the glucose-6-phosphate dehydrogenase-deficient group (13.7 +/- 7.6 hours versus 7.7 +/- 2.8 hours; p < 0.0001). Minimal value of arterial oxygen tension was lower in patients with glucose-6-phosphate dehydrogenase deficiency (66 +/- 12 mm Hg versus 85 +/- 14 mm Hg; p < 0.0001), and more cases of hypoxia (arterial oxygen tension < 60 mm Hg) were found in this group (11 versus 1; p = 0.001). Compared with the control group, patients with glucose-6-phosphate dehydrogenase deficiency had significantly elevated hemolytic indices expressed by bilirubin levels (26 +/- 10 mmol/L versus 17 +/- 6.7 mmol/L; p < 0.0001) and lactic dehydrogenase levels (970 +/- 496 U/L versus 505 +/- 195 U/L; p < 0.0001). They also required significantly more blood transfusion perioperatively (1.9 +/- 1.4 packed cell units/patient versus 0.8 +/- 1.0 packed cell units/patient; p = 0.0001).Patients with glucose-6-phosphate dehydrogenase deficiency who are undergoing cardiac surgery may have a more complicated course with a longer ventilation time, more hypoxia, increased hemolysis, and a need for more blood transfusion. Because this difference may be caused by subnormal free radical deactivation, strategies that minimize bypass in general and free radicals specifically may be beneficial.

    View details for DOI 10.1016/S0003-4975(03)00351-5

    View details for Web of Science ID 000184616700049

    View details for PubMedID 12902098

  • Traumatic memory: A cause for postoperative delirium - A diagnostic dilemma ISRAEL MEDICAL ASSOCIATION JOURNAL Gerrah, R., Abramovitch, Y., Elami, A. 2001; 3 (11): 858–59

    View details for Web of Science ID 000173516100016

    View details for PubMedID 11729586