NOEDIR ANTONIO GROPPO STOLF

(Fonte: Lattes)
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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina

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Indexador: MEDLINE × Assunto: cardiac-surgery ×

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Agora exibindo 1 - 7 de 7
  • article 13 Citação(ões) na Scopus
    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 Groppo
    Introduction: 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.
  • article 156 Citação(ões) na Scopus
    Kidney Function After Off-Pump or On-Pump Coronary Artery Bypass Graft Surgery A Randomized Clinical Trial
    (2014) GARG, Amit X.; DEVEREAUX, P. J.; YUSUF, Salim; CUERDEN, Meaghan S.; PARIKH, Chirag R.; COCA, Steven G.; WALSH, Michael; NOVICK, Richard; COOK, Richard J.; JAIN, Anil R.; PAN, Xiangbin; NOISEUX, Nicolas; VIK, Karel; STOLF, Noedir A.; RITCHIE, Andrew; FAVALORO, Roberto R.; PARVATHANENI, Sirish; WHITLOCK, Richard P.; OU, Yongning; LAWRENCE, Mitzi; LAMY, Andre
    IMPORTANCE Most acute kidney injury observed in the hospital is defined by sudden mild or moderate increases in the serum creatinine concentration, which may persist for several days. Such acute kidney injury is associated with lower long-term kidney function. However, it has not been demonstrated that an intervention that reduces the risk of such acute kidney injury better preserves long-term kidney function. OBJECTIVES To characterize the risk of acute kidney injury with an intervention in a randomized clinical trial and to determine if there is a difference between the 2 treatment groups in kidney function 1 year later. DESIGN, SETTING, AND PARTICIPANTS The Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularisation Study (CORONARY) enrolled 4752 patients undergoing first isolated coronary artery bypass graft (CABG) surgery at 79 sites in 19 countries. Patients were randomized to receive CABG surgery either with a beating-heart technique (off-pump) or with cardiopulmonary bypass (on-pump). From January 2010 to November 2011, 2932 patients (from 63 sites in 16 countries) from CORONARY were enrolled into a kidney function substudy to record serum creatinine concentrations during the postoperative period and at 1 year. The last 1-year serum creatinine concentration was recorded on January 18, 2013. MAIN OUTCOMES AND MEASURES Acute kidney injury within 30 days of surgery (>= 50% increase in serum creatinine concentration from prerandomization concentration) and loss of kidney function at 1 year (>= 20% loss in estimated glomerular filtration rate from prerandomization level). RESULTS Off-pump (n = 1472) vs on-pump (n = 1460) CABG surgery reduced the risk of acute kidney injury (17.5% vs 20.8%, respectively; relative risk, 0.83 [95% CI, 0.72-0.97], P = .01); however, there was no significant difference between the 2 groups in the loss of kidney function at 1 year (17.1% vs 15.3%, respectively; relative risk, 1.10 [95% CI, 0.95-1.29], P = .23). Results were consistent with multiple alternate continuous and categorical definitions of acute kidney injury or kidney function loss, and in the subgroup with baseline chronic kidney disease. CONCLUSIONS AND RELEVANCE Use of off-pump compared with on-pump CABG surgery reduced the risk of postoperative acute kidney injury, without evidence of better preserved kidney function with off-pump CABG surgery at 1 year. In this setting, an intervention that reduced the risk of mild to moderate acute kidney injury did not alter longer-term kidney function. Copyright 2014 American Medical Association. All rights reserved.
  • article 24 Citação(ões) na Scopus
    InsCor: um método simples e acurado para avaliação do risco em cirurgia cardíaca
    (2013) MEJA, Omar A. V.; LISBOA, Luiz A. F.; PUIG, Luiz B.; MOREIRA, Luiz Felipe P.; DALLAN, Luis A. O.; POMERANTZEFF, Pablo M. A.; JATENE, Fabio B.; STOLF, Noedir A. G.
    Background: Risk scores show difficulties to attain the same performance in different populations. Objective: To create a simple and accurate risk assessment model for patients submitted to surgery due to coronary and/or valvular disease at Instituto do Coracao da Universidade de Sao Paulo (InCor-HCFMUSP). Methods: Between 2007 and 2009, 3,000 patients were submitted to surgical procedure due to coronary artery and/or valvular disease at InCor-HCFMUSP. From this record, data of 2/3 of the patients were used for model development (bootstrap technique), and 1/3 for internal validation of the model. The performance of the model (InsCor) was compared to the 2000 Bernstein-Parsonnet (2000BP) and EuroSCORE (ES) complexes. Results: Only 10 variables were selected: age > 70 years, female sex; coronary revascularization + valve, myocardial infarction < 90 days; reoperation; surgical treatment of aortic valve; surgical treatment of tricuspid valve; creatinine < 2mg/dL; ejection fraction < 30%, and events. The Hosmer Lemeshow test for the InsCor was 0.184, indicating excellent calibration. The area under the ROC curve was 0.79 for the InsCor, 0.81 for the ES and 0.82 for 2000BP, confirming that the models are good and have similar discrimination. Conclusions: The InsCor and ES performed better than 2000BP at all stages of validation, but the new model, in addition to showing identification with the local risk factors, is simpler and more objective for mortality prediction in patients undergoing surgery due to coronary and/or valvular disease at InCor-HCFMUSP (Arq Bras Cardiol. 2013;100(3):246-254).
  • article 21 Citação(ões) na Scopus
    Intervenção Coronariana Percutânea Prévia como Fator de Risco para Revascularização Miocárdica
    (2012) LISBOA, Luiz Augusto Ferreira; MEJIA, Omar Asdrubal Vilca; DALLAN, Luis Alberto Oliveira; MOREIRA, Luiz Felipe Pinho; PUIG, Luiz Boro; JATENE, Fabio Biscegli; STOLF, Noedir Antonio Groppo
    Background: Percutaneous coronary intervention (PCI) has increased as the initial revascularization strategy in chronic coronary artery disease. Consequently, more patients undergoing coronary artery bypass grafting (CABG) have history of coronary stent. Objective: Evaluate the impact of previous PCI on in-hospital mortality after CABG in patients with multivessel coronary artery disease. Methods: Between May/2007 and June/2009, 1099 consecutive patients underwent CABG on cardiopulmonary bypass. Patients with no PCI (n=938, 85.3%) were compared with patients with previous PCI (n=161, 14.6%). Logistic regression models and propensity score matching analysis were used to assess the risk-adjusted impact of previous PCI on in-hospital mortality. Results: Both groups were similar, except for the fact that patients with previous PCI were more likely to have unstable angina (16.1% x 9.9%, p=0.019). In-hospital mortality after CABG was higher in patients with previous PCI (9.3% x 5.1%, p=0.034) and it was comparable with EuroSCORE and 2000 Bernstein-Parsonnet risk score. Using multivariate logistic regression analysis, previous PCI emerged as an independent predictor of postoperative in-hospital mortality (odds ratio 1.94, 95% CI 1.02-3.68, p=0.044) as strong as diabetes (odds ratio 1.86, 95% CI 1.07-3.24, p=0.028). After computed propensity score matching based on preoperative risk factors, in-hospital mortality remained higher among patients with previous PCI (odds ratio 3.46, 95% CI 1.10-10.93, p=0.034). Conclusions: Previous PCI in patients with multivessel coronary artery disease is an independent risk factor for in-hospital mortality after CABG. This fact must be considered when PCI is indicated as initial alternative in patients with more severe coronary artery disease. (Arq Bras Cardiol 2012;99(1):586-595)
  • article 11 Citação(ões) na Scopus
    Coronary artery bypass grafting in acute myocardial infarction: analysis of predictors of in-hospital mortality
    (2012) MEJIA, Omar Asdrubal Vilca; LISBOA, Luiz A. Ferreira; TIVERON, Marcos Gradim; SANTIAGO, Jose Augusto Duncan; TINELI, Rafael Angelo; DALLAN, Luis Alberto Oliveira; JATENE, Fabio Biscegli; STOLF, Noedir Antonio Groppo
    Objective: Coronary artery bypass grafting (CABG) during the acute phase of infarction (AMI) is associated with increased operative risk. The aim of this study was to determine predictors of in-hospital mortality in patients undergoing CABG in AMI. Methods: During three years, all patients undergoing CABG in AMI were retrospectively analyzed of the institutional database. Sixty variables per patient were evaluated: 49 preoperative variables from the 2000 Bernstein-Parsonnet and EuroSCORE models, 4 preoperative variables not considered in these models (time between AMI and CABG, maximum CKMB, Troponin maximum and ST-segment elevation) and 7 intraoperative variables [(cardiopulmonary bypass (CPB), CPB time, type of cardioplegia, endarterectomy, number of grafts, use of internal thoracic artery and complete revascularization]. Univariate and multivariate analysis for the outcome of in-hospital mortality were performed. Results: The mean time between AMI and CABG was 3.8 +/- 3 days. The overall mortality was 19%. In the multivariate analysis: age > 65 years OR [16.5 (CI 1.8 to 152), P=0.013]; CPB > 108 minutes [OR 40 (CI 2.7 to 578), P=0.007], creatinine > 2 mg/dl [OR 35.5 (CI 1.7 to 740), P=0.021] and systolic pulmonary pressure > 60 mmHg [OR 31 (CI 1.6 to 591), P=0.022] were predictors of in-hospital mortality. Conclusion: Conventional preoperative variables such as age > 65 years, creatinine > 2 mg/dl and systolic pulmonary pressure > 60 mmHg were predictive of in-hospital mortality in patients underwent CABG in AMI.
  • article 14 Citação(ões) na Scopus
    Os escores 2000 Bernstein-Parsonnet e EuroSCORE são similares na predição da mortalidade no Instituto do Coração-USP
    (2011) MEJIA, Omar Asdrubal Vilca; LISBOA, Luiz A. Ferreira; PUIG, Luiz Boro; DIAS, Ricardo Ribeiro; DALLAN, Luis A.; POMERANTZEFF, Pablo M.; STOLF, Noedir A. G.
    Objective: To evaluate the performance of 2000 Bernstein-Parsonnet (2000BP) and additive EuroSCORE (ES) for predicting surgical mortality at the Heart Institute, University of Sao Paulo. Methods: A prospective observational design. Seven hundred and seventy four patients were operated for coronary artery bypass graft, valve or combined procedure between May and October, 2007, were analyzed. The mortality was estimated with the 2000BP and ES. The correlation between expected mortality and observed mortality was validated through calibration and discrimination test. Results: The patients were stratified into five groups for the 2000BP and three for the ES. The Hosmer-Lemeshow test for 2000BP (P = 0.70) and for ES (P = 0.39) indicate a good calibration. The ROC curve for the 2000BP = 0.84 and for the ES = 0.81 confirms that the models are good predictors (P < 0.001). Conclusion: Both models are similar and adequate in predicting surgical mortality at the InCor-USP.
  • article 14 Citação(ões) na Scopus
    Validação do 2000 Bernstein-Parsonnet e EuroSCORE no Instituto do Coração - USP
    (2012) MEJIA, Omar Asdrubal Vilca; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; MOREIRA, Luiz Felipe Pinho; JATENE, Fabio Biscegli; STOLF, Noedir Antonio Groppo
    Objective: To validate the 2000 Bernstein Parsonnet (2000BP) and additive EuroSCORE (ES) to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the Heart Institute, University of Sao Paulo (InCor/HC-FMUSP). Methods:A prospective observational design. We analyzed 3000 consecutive patients who underwent coronary bypass surgery and/or heart valve surgery, between May 2007 and July 2009 at the InCor/HC-FMUSP. Mortality was calculated with the 2000BP and ES models. The correlation between estimated mortality and observed mortality was validated by calibration and discrimination tests. Results: There were significant differences in the prevalence of risk factors between the study population, 2000BP and ES. Patients were stratified into five groups for 2000BP and three for the ES. In the validation of models, the ES showed good calibration (P = 0396), however, the 2000BP (P = 0.047) proved inadequate. In discrimination, the area under the ROC curve proved to be good for models, ES (0.79) and 2000BP (0.80). Conclusion: In the validation, 2000BP proved questionable and ES appropriate to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the InCor/HC-FMUSP.