NOEDIR ANTONIO GROPPO STOLF
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
18 resultados
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- Geraldo Verginelli, the search for elegance and perfectionism in cardiovascular surgery(2015) STOLF, Noedir A. G.; BRAILE, Domingo M.
- Aperfeiçoamento em técnica de perfusão cardioplégica no pinçamento único de aorta - resultados iniciais(2014) SOBRAL, Marcelo Luiz Peixoto; SANTOS JÚNIOR, Sérgio Francisco dos; SÁ, Juliano Cavalcante de; TERRAZAS, Anderson da Silva; TROMPIERI, Daniel Francisco de Mendonça; SOUSA, Thierry Araújo Nunes de; SANTOS, Gilmar Geraldo dos; STOLF, Noedir Antonio GroppoIntroduction: The most common method used for myocardial protection is administering cardioplegic solution in the coronary circulation. Nevertheless, protection may be achieved by intermittent perfusion of the coronary system with patient's own blood. The intermittent perfusion may be performed by multiple sequences of clamping and opening of the aortic clamp or due single clamping and accessory cannulation of the aortic root as in the improved technique proposed in this study, reperfusion without the need for multiple clamping of the aorta. Objective: To evaluate the clinical outcome and the occurrence of neurological events in in-hospital patients submitted to myocardial revascularization surgery with the ""improved technique"" of intermittent perfusion of the aortic root with single clamping. Methods: This is a prospective, cross-sectional, observational study that describes a myocardial management technique that consists of intermittent perfusion of the aortic root with single clamping in which 50 patients (mean age 58.5±7.19 years old) have been submitted to the myocardial revasculrization surgery under the proposed technique. Clinical and laboratory variables, pre- and post-surgery, have been assessed. Results: The mean peak level of post-surgery CKMB was 51.64±27.10 U/L in the second post-surgery and of troponin I was 3.35±4.39 ng/ml in the fourth post-surgery, within normal limits. No deaths have occurred and one patient presented mild neurological disorder. Hemodynamic monitoring has not indicated any changes. Conclusion: The myocardial revascularization surgery by perfusion with the improved technique with intermittent aortic root with single clamping proved to be safe, enabling satisfactory clinical results.
- Incidência de acidente vascular encefálico e insuficiência renal aguda em pacientes com fibrilação atrial no pós-operatório de cirurgia de revascularização do miocárdio(2013) BARBIERI, Lucas Regatieri; SOBRAL, Marcelo Luiz Peixoto; GERONIMO, Glaucio Mauren da Silva; SANTOS, Gilmar Geraldo dos; SBARAINI, Evandro; DORFMAN, Fabio Kirzner; STOLF, Noedir Antonio GroppoIntroduction: Postoperative atrial fibrillation is the most common arrhythmia in cardiac surgery, its incidence range between 20% and 40%. Objective: Quantify the occurrence of stroke and acute renal insufficiency after myocardial revascularization surgery in patients who had atrial fibrillation postoperatively. Methods: Cohort longitudinal bidirectional study, performed at Portuguese Beneficent Hospital (SP), with medical chart survey of patients undergoing myocardial revascularization surgery between June 2009 to July 2010. From a total of 3010 patients were weaned 382 patients that presented atrial fibrillation preoperatively and/or associated surgeries. The study was conducted in accordance with national and international following resolutions: ICH Harmonized Tripartite Guidelines for Good Clinical Practice - 1996; CNS196/96 Resolution, and Declaration of Helsinki. Results: The 2628 patients included in this study were divided into two groups: Group I, who didn't show postoperative atrial fibrillation, with 2302 (87.6%) patients; and group II, with 326 (12.4%) who developed postoperative atrial fibrillation. The incidence of stroke in patients was 1.1% without postoperative atrial fibrillation vs. 4% with postoperative atrial fibrillation (P<0.001). Postoperative acute renal failure was observed in 12% of patients with postoperative atrial fibrillation and 2.4% in the group without postoperative atrial fibrillation (P<0.001), that is a relation 5 times greater. Conclusion: In this study there was a high incidence of stroke and acute renal failure in patients with postoperative atrial fibrillation, with rates higher than those reported in the literature.
- Comparative experimental study of myocardial protection with crystalloid solutions for heart transplantation(2012) LIMA, Melchior Luiz; FIORELLI, Alfredo Inacio; VASSALLO, Dalton Valentim; PINHEIRO, Bruno Botelho; STOLF, Noedir Antonio Groppo; GOMES, Otoni MoreiraBackground: There is a growing need to improve myocardial protection, which will lead to better performance of cardiac operations and reduce morbidity and mortality. Therefore, the objective of this study was to compare the efficacy of myocardial protection solution using both intracellular and extracellular crystalloid type regarding the performance of the electrical conduction system, left ventricular contractility and edema, after being subjected to ischemic arrest and reperfusion. Methods: Hearts isolated from male Wistar (n=32) rats were prepared using Langendorff method and randomly divided equally into four groups according the cardioprotective solutions used Krebs-Henseleit-Buffer (KHB), Bretschneider-HTK (HTK), St. Thomas-1 (STH-1) and Celsior (CEL). After stabilization with KHB at 37 degrees C, baseline values (control) were collected for heart rate (HR), left ventricle systolic pressure (LVSP), maximum first derivate of rise left ventricular pressure (+dP/dt), maximum first derivate of fall left ventricular pressure (-dP/dt) and coronary flow (CF). The hearts were then perfused at 10 degrees C for 5 min and kept for 2 h in static ischemia at 20 degrees C in each cardioprotective solution. Data evaluation was done using analysis of variance in completely randomized One-Way ANOVA and Tukey's test for multiple comparisons. The level of statistical significance chosen was P<0.05. Results: HR was restored with all the solutions used. The evaluation of left ventricular contractility (LVSP, +dP/dt and -dP/dt) showed that treatment with CEL solution was better compared to other solutions. When analyzing the CF, the HTK solution showed better protection against edema. Conclusion: Despite the cardioprotective crystalloid solutions studied are not fully able to suppress the deleterious effects of ischemia and reperfusion in the rat heart, the CEL solution had significantly higher results followed by HTK>KHB>STH-1.
- The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts(2013) GAIOTTO, Fabio Antonio; VIANNA, Caio B.; BUSNARDO, Fabio F.; PARGA, Jose R.; DALLAN, Luis Alberto de Oliveira; CESAR, Luis A. M.; STOLF, Noedir A. G.; JATENE, Fabio B.Introduction: The descending branch of the lateral femoral circumflex artery is an option for coronary artery bypass grafting. Objective: To evaluate the early patency and adaptation of lumen diameter using multidetector computed angiotomography. Methods: Thirty-two patients were selected to undergo coronary artery bypass grafting using the descending branch of the lateral circumflex artery, the internal thoracic artery, and other grafts. Evaluations were carried out through high resolution computed tomography performed on the 7th and 90th postoperative day. Diameters of the descending branch of the lateral circumflex artery and the left internal thoracic artery were measured 3 cm before the distal anastomosis, in the middle portion, and 3 cm after the proximal anastomosis. Diameters were compared using paired t-test (P<0.05). Results: Descending branch of the lateral femoral circumflex artery wDescending branch of the lateral femoral circumflex artery was used in 26 patients, as its use was not viable in six patients (18%). It was used as composite graft in all cases. The anterior descending branch was revascularized by the left internal thoracic artery in all cases. Patency rates of the descending branch of the lateral femoral circumflex artery were 96% and 92%, respectively. No occlusions were observed in the left internal thoracic artery (LITA) and no ischemic events were observed in the descending branch of the lateral circumflex. Descending branch of the lateral femoral circumflex artery increased the lumen diameter in the middle (P=0.001) and distal portions (P=0.006); the left internal thoracic artery (LITA) increased in the middle portion (P=0.001). Conclusion: Similar to the left internal thoracic artery, the descending branch of the lateral femoral circumflex artery showed high patency rate and positive luminal adaptation. This early evaluation confirms the descending branch of the lateral femoral circumflex artery as a potential alternative for grafting. Due to anatomical variations, preoperative femoral angiographic evaluation appears to be mandatory.
- Ruptured thoracic aortic aneurysm in patient with systemic lupus erythematosus(2011) CONTI, Daniel Oliveira De; DIAS, Ricardo Ribeiro; FIORELLI, Alfredo Inacio; STOLF, Noedir A. G.It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.
- Euryclides de Jesus Zerbini: uma biografia(2012) STOLF, Noedir A. G.; BRAILE, Domingo M.
article 5 Citação(ões) na Scopus Long term results of septal myectomy in the treatment of obstructive hypertrophic cardiomyopathy(2011) LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; OLIVEIRA, Sergio Almeida de; JATENE, Fabio Biscegli; STOLF, Noedir Antonio GroppoObjectives: This study analyzed the clinical and echocardiographic late outcomes of surgical septal myectomy in patients with obstructive hypertrophic cardiomyopathy (OHCM). Methods: We examined, retrospectively, 34 consecutive adult patients (age 55.7 +/- 15.2 years) with OHCM operated on in our institution from 1988 to 2008. Only four (11.8%) patients had family history of OHCM. Nine (26.5%) patients were in New York Heart Association (NYHA) funcional class IV. Thirty (88.2%) patients had solely OHCM, and four (11.8%) had OHCM associated with coronary insufficiency. The surgical technique used in all patients was septal myectomy performed through an aortotomy. Results: In 26 (76.5%) patients the mitral insufficiency due to systolic anterior motion, decreased after the myectomy. Eight (23.5%) patients had mitral valve procedures. There was one hospitalar death (2.9%). Two (5.9%) patients required permanent pacemaker for complete heart block after the myectomy. The mean peak preoperative left ventrilcular outflow tract (LVOT) obstruction gradient was 84.9 +/- 29.0 mmHg, and decreased to 27.8 +/- 12.9 mmHg in the early postoperative and it was 19.2 +/- 11.2 mmHg in the late postoperative period (49.0 +/- 33.0 months). The NYHA functional class improved from 3.1 +/- 0.8 to 1.4 +/- 0.5 in the postoperative period. Survival free from death was 87.9% and survival free from cardiovascular events was 77.7% with mean follow-up 9.6 +/- 8.4 years. Conclusions: Surgical septal myectomy can be performed safely, with excellent survival, improvement from symptoms and relief for LVOT obstruction in patients with OHCM. The early benefits were remained at long term.- Fatores de risco pré-operatórios para mediastinite após cirurgia cardíaca: análise de 2768 paciente(2012) TIVERON, Marcos Gradim; FIORELLI, Alfredo Inacio; MOTA, Eduardo Moeller; MEJIA, Omar Asdrubal Vilca; BRANDAO, Carlos Manuel de Almeida; DALLAN, Luis A. O.; POMERANTZEFF, Pablo A. M.; STOLF, Noedir A. G.Background: Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. Objective: The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. Methods: This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. Results: Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 +/- 13.5 years and the EuroSCORE of 4.5 +/- 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.861, P = 0.012) and extracardiac vascular intervention (OR 4.39,95% CI [1.64 to 11.761,P = 0.003). Conclusion: This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.
- Long-term evolution of mitral commissurotomy in rheumatic patients with low echocardiographic score(2011) SOUZA, Luciano Rapold; BRANDAO, Carlos Manuel de Almeida; POMERANTZEFF, Pablo Maria Alberto; LEITE FILHO, Osanam Amorim; CARDOSO, Luiz Francisco; STOLF, Noedir Antonio GroppoIntroduction: The good results of open mitral commissurotomy are well known and there is a hypothesis that it could provide better results in patients selected by echocardiographic score. Objective: The purpose of this study is to analyze the late results with open mitral commissurotomy in patients selected by score and to identify variables influencing these results. Methods: From January 1990 to August 1994,50 patients were submitted to open mitral commissurotomy due to rheumatic mitral stenosis in Heart Institute of University of Sao Paulo Medical School. Patients with age < 60 years, in functional class II, III or IV (New York Heart Association) and echocardiographic score 9 were included. The mean age was 32.7 8.3 years and 41 patients (82%) were female. The functional class was II in three patients (6%), III in 46 (92%) and IV in one (2%). Forty six patients (92%) were in sinus rhythm and four (8%) were in atrial fibrillation. The mean mitral valve area was 0.9 +/- 0.2 cm(2). Results: There was no hospital mortality. There were two late deaths, one related to valve disease. Actuarial survival was 95.5 +/- 3.1 %, freedom from reoperation was 62.3 +/- 11,8% and freedom from tromboembolism was 88,2 +/- 5,0% in 18 years. There was no endocarditis. The grade of the echocardiographic score had no significant influence on the reoperations in late evolution. Conclusion: Open mitral commissurotomy presented excelent long term results in rheumatic patients with low echocardiographic score.