Jorge A Farran

Instituto Dante Pazzanese de Cardiologia - Fundação Adib Jatene, San Paulo, São Paulo, Brazil

Are you Jorge A Farran?

Claim your profile

Publications (6)7.1 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic kidney disease (CKD) is a predictor of increased mortality in patients undergoing coronary artery bypass surgery (CABG). To evaluate the characteristics and predictors of increased mortality in the CKD population submitted to CABG. To compare in-hospital outcomes between patients with and without CKD, and with and without development of acute renal failure (ARF). Retrospective analysis of a prospective database of all isolated CABG performed in a single public tertiary hospital from 1999 to 2007. CKD was considered when creatinine > 1.5 mg/dl. Clinical characteristics, mortality and post-operative complications were evaluated according to renal function. Of 3,890 patients, 362 (9.3%) had CKD. This population was older, presented grater prevalence of hypertension, left ventricular dysfunction, previous stroke, peripheral vascular disease and three-vessel disease. In-hospital outcomes revealed greater incidence of stroke (5.5% vs 2.1%), atrial fibrillation (16 vs 8.3%), low cardiac ouput syndrome (14.4% vs 8.5%), longer stay in intensive care unit (4.04 vs 2.83 days), and greater mortality (10.5% vs 3.8%). Logistic regression: female gender, smoking, diabetes and peripheral vascular disease were associated with higher in-hospital mortality within the CKD group. Patients who did not develop post-operative ARF presented 3.5% mortality; non-dialytic ARF: 35.4%; dialytic ARF: 66.7% mortality. Mortality was directly related to the stage of CKD, according to glomerular filtration rate. CKD patients submitted to CABG represent a high risk population, with increased incidence of complications and mortality. Post-operative ARF is a strong in-hospital mortality predictor. Glomerular filtration rate was inversely related to mortality.
    Arquivos brasileiros de cardiologia 06/2011; 97(3):249-53. · 1.32 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJETIVO: Avaliar a morbimortalidade de homens e mulheres submetidos à cirurgia de revascularização miocárdica isolada e os fatores relacionados às diferenças eventualmente encontradas. MÉTODOS: Análise comparativa de 2032 pacientes, 1402 (69%) homens e 630 (31%) mulheres submetidos consecutivamente à cirurgia, de janeiro 1999 a dezembro 2002. RESULTADOS: As mulheres apresentaram idade média mais elevada, maior número de fatores de risco e taxas de angina instável. Enxertos com artéria torácica interna foram mais freqüentemente usados nos homens, 85,6% vs. 78,3%, p<0,001. Não houve diferenças nas taxas de complicações pós operatórias, exceto as infecções, mais freqüentes nas mulheres. A mortalidade hospitalar foi de 4,1% e 6,3%, para homens e mulheres respectivamente, p=0,026. Na análise multivariada o sexo feminino não foi identificado como fator prognóstico independente para óbito, assim como o uso de enxertos com artéria torácica não foi também isoladamente identificado como fator protetor, porém a interação sexo-artéria torácica interna foi significativa; foram ainda selecionados, idade (OR 1,03; [IC] 95% 1,01 a 1,06; p=0,004), insuficiência renal no pré-operatório (OR 1.82; [IC] 95% 1,07 a 3,11; p=0,028) e cirurgia de urgência/emergência (OR 2,85; [IC] 95% 1,32 a 6,14; p=0,008). CONCLUSÃO: O sexo feminino apresentou maior mortalidade operatória porém não se mostrou fator prognóstico independente para óbito; o uso de enxertos com artéria torácica mostrou-se protetor; pacientes mais idosos, com insuficiência renal e em situação emergencial apresentaram maiores índices de óbito hospitalar.
    Arquivos Brasileiros de Cardiologia 01/2005; 83 Spec No:14-20. · 1.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUÇÃO: Os enxertos compostos têm sido freqüentemente utilizados na cirurgia de revascularização do miocárdio (RM). Entretanto, permanece indefinido se essa técnica é capaz de oferecer o mesmo fluxo sangüíneo (Q) aos ramos da artéria coronária esquerda (CE) que a técnica convencional. O objetivo é comparar o Q total aos ramos revascularizados pelas artérias torácica interna esquerda (ATIE) e radial (AR) nas técnicas compostas e convencional. MÉTODO: Estudamos 42 pacientes distribuídos, aleatoriamente, conforme a técnica de RM utilizada. Grupo A ou ATIE e AR composta em Y(n=14). Grupo B ou ATIE e AR composta modificada [enxerto intercoronariano com AR e anastomose da ATIE sobreposta a AR ao nível da artéria interventricular anterior (DA), n=14]. Grupo C ou ATIE pediculada para DA e AR em posição aorto-coronariana (n=14). Trinta e um pacientes foram submetidos a fluxometria (Fx) com cateter-guia doppler de 12-MHz (0,014 polegada, Flowire, Jometrics Inc.), no pós-operatório imediato. A reserva de fluxo coronariano (RFC) foi calculada pela determinação da média da velocidade de pico (APV) em hiperemia após administração de adenosina. RESULTADOS: A APV em repouso no início da ATIE foi, no grupo A, 28,4±4,8 cm/s; no grupo B, 34,4±7,9 cm/s (p=0,0384 x C) e, no grupo C, 25,8± 8,6 cm/s. A RFC foi de 2,1 ± 0,4, 2 ± 0,3 e 2±0,4 nos grupos A, B e C, (p=0,7208). O Q total distribuído aos ramos da CE revascularizados foi, no grupo A, 110±30 ml/min, no grupo B, 145±59 ml/min e, no grupo C, 133±58 ml/min (p=0,3232 A, B x C). CONCLUSÕES: Não houve diferença significativa do Q total oferecido ao território da CE revascularizado pelas técnicas de EC e convencional. A RFC da ATIE nos grupos compostos foi satisfatória.
    Brazilian Journal of Cardiovascular Surgery 01/2004; 19(4).
  • Source
    Arquivos Brasileiros De Cardiologia - ARQ BRAS CARDIOL. 01/2004; 83.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management. The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital-based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI. A total of 1279 pairs, matched by age (+/- 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: > or =5 cigarettes per day (odds ratio [OR] 4.90, P <.00001); glucose > or =126 mg/dL (OR 2.82, P <.00001); waist/hip ratio > or =0.94 (OR 2.45, P <.00001); family history of CAD (OR 2.29, P <.00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P <.00001); reported hypertension (OR 2.09, P <.00001); <5 cigarettes per day (OR 2.07, P =.0171); low-density lipoprotein-cholesterol >120 mg/dL (OR 1.75, P <.00001); reported diabetes mellitus (OR 1.70, P =.0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P =.0212); alcohol intake (up to 2 days/week) (OR 0.75, P <.0309); alcohol intake (3-7 days/week) (OR 0.60, P =.0085); family income R$600 to R$1200 and college education (OR 2.92, P =.0499); family income >R$1200 and college education (OR 0.68, P = 0.0239) The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.
    American heart journal 08/2003; 146(2):331-8. · 4.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Composite grafting techniques for coronary artery bypass grafts (CABG) have been widely used. However, it remains unclear whether this technique provides similar blood flow to the left coronary artery when compared to the conventional alternative. We sought to compare the total blood flow to the left coronary branches that are revascularized with left internal thoracic (LITA) and radial artery (RA) grafts using composite and non-composite techniques. Method: A total of 42 patients were randomly assigned to three groups according to the CABG technique to be used: Group A or composite LITA-RA in a Y format (n=14); Group B or modified composite LITA-RA intercoronary graft with RA and LITA to RA at the left anterior descending artery (LAD- n=14)); and Group C or pedicled LITA to the LAD and aorto- coronary RA (n=14). The patients were submitted to postoperative blood flow velocity analysis using a 0.014 inch 12 MHz Doppler flowire. Coronary flow reserve (CFR) was calculated by determining the average hyperemic peak velocity (APV) after an injection of adenosine.