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Enio Buffolo

Publications and source records attributed to Enio Buffolo.

At least 19 recordsLinked to original sources
PubMed2006

End-stage cardiomyopathy and secondary mitral insufficiency surgical alternative with prosthesis implant and left ventricular restoration.

BACKGROUND: Secondary mitral insufficiency is a strong risk factor for death in end-stage cardiomyopathy. The possible correction of mitral regurgitation has now been accepted as an alternative to cardiac transplantation in a special subset of patients. We propose a new surgical approach that consists of implantation of a mitral prosthesis that is smaller than the annulus, and preservation and traction of the papillary muscles to reduce sphericity of the left ventricle. METHODS: Between December 1995 and September 2005, 116 patients with dilated cardiomyopathy underwent this procedure, with the following etiologic factors: ischemic (68), idiopathic (43), Chagas disease (3), viral (1), and postpartum (1). The patients were analyzed according to clinical criteria, echocardiographic findings, and morphology of left ventricle. RESULTS: All patients were in an end-stage phase, requiring >2 hospital admissions over the past 3 months, despite receiving full medication. Furthermore, seven were in intensive care unit receiving intravenous drugs or intra-aortic balloon counterpulsation, and one was in cardiogenic shock. Hospital mortality was 16.3% (19/116), yet midterm follow-up showed a relatively flat late survival curve, with evidence of improved clinical status, better echocardiographic parameters, and reduction in ventricular sphericity. CONCLUSIONS: The high early mortality rate related to other clinical conditions at the time of surgery. However, the resultant flat survival after this early interval offers a promising long-term therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy that is associated with moderate or severe secondary mitral regurgitation.

Adult↗
PubMed2006

[Cardiac transplantation and neoplasms: experiences at Escola Paulista de Medicina of the Federal University of São Paulo].

OBJECTIVE: To study the occurrence and types of neoplasms developed by patients who underwent an orthotopic cardiac transplantation under the Program of Cardiac Transplantation of Escola Paulista de Medicina, Federal University of São Paulo. METHODS: This is an observational study of 106 patients who underwent orthotopic cardiac transplantation from November 1986 to September 2002 and survived at least thirty days following the procedure. The triple immunosuppressive regimen given included cyclosporin A, azathioprine and a corticosteroid agent. Only two patients received OKT3 in addition to the regimen established. Mean follow-up was 61.4 months (ranging from two months to 192 months). RESULTS: Twenty-three patients (21.3%) developed neoplasms--56.5% of these were skin neoplasm, 30.1%, solid tumors, and 13.4% of post-transplant lymphoproliferative disease (PTLD). Mean interval between transplantation and diagnosis of neoplasm was: 54.9 months for skin neoplasm; 24.8 months for solid tumors and 70.3 months for PTLD. CONCLUSION: Malignant neoplasms are relatively common in the population studied. Skin cancer was the most common type compared to the other types of neoplasms. Solid tumors were more frequently diagnosed than the lymphoproliferative diseases in the population examined.

Adolescent↗
PubMed2006

Off-pump myocardial revascularization: critical analysis of 23 years' experience in 3,866 patients.

BACKGROUND: Surgical myocardial revascularization without cardiopulmonary bypass (CPB) is not new, with the first consecutive series of patients appearing in the early eighties. There has been increased interest in this alternative approach, especially in patients with comorbidities. There is controversy regarding advantages, risks, and usefulness of this method of myocardial revascularization. We herein report a consecutive series of 3,866 patients, from the first case in September 1981 to the last in November 2004, analyzing applicability, mortality, morbidity, and surgical technique. METHODS: From September 1981 to November 2004, 3,866 consecutive patients were revascularized without CPB. This figure represents an overall applicability of 30.8% considering a total of 12,553 revascularization procedures performed during this time. There were 2,822 males (73%) with ages from 12 to 93 years (median, 62 +/- 14). Mean grafts per patient was 1.9, and the internal mammary artery was used in 87.3% of cases. The main indications for surgery were chronic coronary insufficiency (89% of cases) and failure of angioplasty or stenting. RESULTS: Hospital mortality was 1.9%, with low incidence of cerebrovascular accident (5 cases in the entire series). Morbidity, considering major postoperative complications, occurred in 12.5% of the patients. The applicability of the off-pump technique was 18% of cases in the beginning of our experience, increasing to 49% in the last 5 years with the use of stabilizers and maneuvers to expose posterior coronary branches. CONCLUSIONS: Off-pump coronary surgery is an alternative method of myocardial revascularization that should be considered for every patient. The preference of this technique over conventional revascularization should be based on the surgeon's own experience, on the patient's preoperative condition and on the coronary anatomy. Off-pump myocardial revascularization represents an important development in coronary artery surgery. Over the years it has evolved into a valid form of surgery with the same safety as the conventional operation and with more advantages in high risk patients.

Adolescent↗
PubMed2006

Coronary stenting and inflammation: implications for further surgical and medical treatment.

The introduction of percutaneous coronary interventions (PCI) with stent implant has substantially shifted the treatment of coronary artery disease. The current approach to coronary artery disease treatment includes first-choice PCI in selected subgroups; and once this therapy fails, frequently the patient is referred for coronary artery bypass graft surgery. However, evidence of chronic inflammatory reaction and endothelial dysfunction after PCI has been emerging and that might be interfering with patient outcome when surgical or medical treatments are subsequently required. The clinical significance of these complications after PCI, herein examined, has been less studied and needs better assessment. Also, the premise that coronary artery bypass graft surgery can safely be performed in patients with coronary stenting failure may not hold true, as graft patency might be adversely affected. Furthermore, the superimposed inflammatory reaction may blunt the efficacy of medical treatment.

Angioplasty, Balloon, Coronary↗
PubMed2005

[Sildenafil improves right ventricular function in a cardiac transplant recipient].

We report the case of a male patient who underwent orthotopic cardiac transplantation. A marginal donor was used, because the recipient's clinical condition was critical. He experienced cardiogenic shock due to right ventricular dysfunction secondary to pulmonary hypertension associated with vasoplegia. After the introduction of sildenafil, the patient recovered hemodynamically, his pulmonary vascular resistance decreased, the vasoactive drugs were withdrawn, and his right ventricular function improved.

Adult↗
PubMed2005

Inflammatory reaction after sirolimus-eluting stent implant.

Sirolimus-eluting stents (SES) are supposed to attenuate cell proliferation and reduce restenosis rate. Histologic finding from coronary artery after SES implant showed fibrosis and inflammatory infiltrate, revealing a chronic inflammatory reaction. Extension of coronary inflammatory reaction after stenting needs clarification. The long-term consequences are unknown.

Anti-Bacterial Agents↗
PubMed2005

Invited commentary.

Explore the source record for details and available documents.

Aortic Dissection↗
PubMed2004

Cryopreserved aortic homograft for aortic valve replacement: immediate results.

OBJECTIVE: To assess immediate clinical and echocardiographic results of the use of cryopreserved aortic homografts for aortic valve replacement. METHODS: Eighteen patients with aortic valve disease underwent aortic valve replacement, receiving a cryopreserved aortic homograft, 15 were male, 10 had aortic regurgitation, and 8 had aortic stenosis. Age ranged from 18 to 65 years (mean, 44.5 +/- 18.14 years). Four patients had infective endocarditis, 12 patients were in functional class II, and 6 patients were in functional class III (NYHA). Left ventricular function was normal in 15 patients. RESULTS: Hospital mortality was 5.5% (1 patient) due to respiratory distress; the other patients were discharged from the hospital between the fifth and eighth postoperative days in functional class I. Maximal aortic transvalvular gradient, on echocardiography, ranged from 0 to 30 mmHg, with a mean of 10.9 +/- 9.2 mmHg. Five patients did not have any degree of regurgitation through the aortic homograft, 11 patients (61.1%) had minimal regurgitation, and 2 had mild regurgitation. Duration of extracorporeal circulation ranged from 130 to 220 minutes (mean, 183.9 +/- 36.7 minutes). Duration of aortic clamping ranged from 102 to 168 minutes (mean, 139.14 +/- 25.10 minutes). Bleeding in the postoperative period ranged from 210 to 1220 mL, with a mean of 511.4 +/- 335.1 mL. Reoperations were not necessary. Duration of orotracheal intubation ranged from 2 hours 50 minutes to 17 hours with a mean of 9.14 +/- 3.6 hours. CONCLUSION: Cryopreserved aortic homografts may be routinely used with low hospital morbidity and mortality.

Adolescent↗
PubMed2004

Combined repair of extensive aneurysm of the ascending aorta, arch, and descending aorta.

A 50-year-old man with an extensive aneurysm of the ascending aorta with extension through the transverse arch and of the descending thoracic aorta had this segment repaired by insertion of multiple stent grafts and, 2 days later, of the arch and ascending segment by an open-surgical procedure. The stents covered the segment from the takeoff of the left subclavian artery to the thoracoabdominal transition. The procedure consisted of insertion of a Dacron tube graft that covered the segment from the proximal edge of the first stent to the aortic root. The patient has had an event-free recovery.

Aortic Aneurysm↗
PubMed2004

Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial.

BACKGROUND: To evaluate hospital mortality and morbidity after myocardial revascularization in a prospective and multicenter study, comparing on-pump versus off-pump in a special subset of patients with lesions in the left descending artery, alone or associated with the right coronary artery. METHODS: A multicenter prospective randomized study was performed. One hundred and sixty selected low-risk patients were enrolled; 80 patients were operated on-pump (coronary artery bypass grafting [CABG], group I) and 80 patients were operated off-pump (off-pump coronary artery bypass [OPCAB], group II). One hundred and five were male and ages ranged from 39 to 70 years old; mean 58.81 +/- 9.31 and median 59. Preoperative clinical characteristics were similar in both groups; only previous myocardial infarction was higher in the OPCAB group. Patients with severe left ventricular dysfunction (FE </= 35%), renal failure and lesions of the circumflex artery and its branches were excluded, as well as patients with significant comorbidities that were inappropriate for randomization because we selected them for OPCAB procedures. RESULTS: Hospital mortality was 2.5%, three patients (3.7%) in group I (on-pump) and one patient (1.2%) in group II (off-pump) (ns). The number of grafts per patients in group I was 1.81 +/- 0.6, and 1.77 +/- 0.68 in group II (p = 0.833). There was no difference in the total operation time 205.10 +/- 54.30 minutes in group I and 189.50 +/- 55.44 in group II (ns). Six patients (7.5%) had myocardial infarction in group I and three (3.7%) in group II (ns). Bleeding in the postoperative period was 680.50 +/- 434.1 mL in the on-pump group and 678.6 +/- 357.0 mL in the off-pump group (ns). Three patients (3.7%) presented transient neurologic dysfunction in group I and six patients (7.5%) in group II (ns). Intensive care stay was 2.4 +/- 1.0 days in the CABG and 2.3 +/- 0.98 days in the OPCAB group (ns). CONCLUSIONS: We did not find any statistical difference in hospital mortality and morbidity using on-pump or off-pump techniques for low-risk patients.

Adult↗
PubMed2003

A change in the treatment of abdominal aortic aneurysms.

OBJECTIVE: One of the most exciting potential applications of percutaneous therapy is the treatment of abdominal aneurysms. METHODS: Of 230 patients treated with a self-expanding polyester-lined stent-graft for different aortic pathologies at our institution, we selected 80 abdominal aneurysm cases undergoing treatment (from May 1997 to December 2002). The stent was introduced through the femoral artery, in the hemodynamic laboratory, with the patient under general anesthesia, with systemic heparinization, and induced hypotension. RESULTS: The procedure was successful in 70 (92.9%) cases; 10 patients with exclusion of abdominal aortic aneurysms were documented immediately within the hemodynamic room and 5 patients persisted with a residual leak. Two surgical conversions were necessary. Additional stent-grafts had to be inserted in 3 (3.7%) cases. In the follow-up, 91.4% of patients were alive at a mean follow-up of 15.8 months. CONCLUSION: We believe that stent-grafts are an important tool in improving the treatment of abdominal aneurysms, and this new policy may change the conventional medical management of these patients.

Aged↗
PubMed2003

Coronary artery and myocardial inflammatory reaction induced by intracoronary stent.

BACKGROUND: Intracoronary stents have been extensively used in percutaneous coronary revascularization. However, despite the breakthroughs and developments associated with this new technology, novel complications and findings have emerged compelling the cardiac surgeon to cope with this new scenario. The presence of an intracoronary foreign body (stent) might induce an inflammatory reaction to the coronary artery and surrounding cardiac muscle. METHODS: Six patients who previously (2 to 72 weeks) underwent stent insertion and subsequently coronary artery bypass graft surgery had a biopsy taken from the grafted coronary artery distal to the stent and from the adjacent muscle. The samples were processed and stained with hematoxylin and eosin and histologically studied. RESULTS: Histologic examination of the coronary artery distal to the stent revealed chronic inflammation and an intimal acute inflammatory infiltrate, with polymorphonuclear leukocytes. The myocardium adjacent to the stent exhibited a significant chronic inflammatory infiltrate and fibrosis, compatible with myocarditis. CONCLUSIONS: The presence of an intracoronary stent induces a persistent, acute and chronic inflammatory reaction, with involvement of the distal coronary artery and surrounding myocardium. This may have implications when choosing the optimal site distal to the stent for coronary artery bypass grafting.

Aged↗
PubMed2003

Vasoplegic syndrome after off-pump coronary artery bypass surgery.

OBJECTIVE: The vasoplegic syndrome (VS) has been implicated in life-threatening complications after open heart surgery, where the whole-body inflammatory reaction is attributed to the cardiopulmonary bypass (CPB). Off-pump coronary artery bypass grafting (OPCAB) has been recently achieving growing enthusiasm mainly due avoiding the side effects of CPB. However herein the occurrence of VS in OPCAB is reported. METHODS: The vasoplegic syndrome usual findings occurring in the early postoperative period include severe hypotension, tachycardia, normal or elevated cardiac output and low systemic vascular resistance. Four patients underwent to OPCAB presented all the signs of VS intraoperatively or within the first 6 postoperative h. RESULTS: The patients needed aggressive vasoactive drug support for hemodynamic stabilization and all of them developed complications. These patients also had tendency to require administration of blood and blood derivatives due to diffuse and oozing type bleeding. Mean intensive care unit stay of surviving patients was 70 h and mean period of postoperative hospitalization was 9 days. Tumor necrosis factor-alpha blood levels in one patient were elevated postoperatively though no signs of infection were observed. One patient died. CONCLUSIONS: Although vasoplegic syndrome can complicate OPCAB surgery, the rationale for avoiding CPB remains valid considering the benefits provided by OPCAB.

Aged↗