Information about Cardiology and Cardiovascular Surgery (2008) at Federal University of Sao Paulo – Unifesp
1) At Unifesp we do all kinds of procedures concerning coronary intervention in the cath lab. We have two rooms (a Toshiba and a Phillips) with a third one (Philips) almost ready to go, equipment already in Brazil for installation in a month or two. We have QCA, IVUS and a Siemens intracardiac ultrasound. We have taken part in several multicentric international intervention studies organized by Salim Yusuf in Canada (CURE, several OASIS), the TIMI group in Boston (EXTRACT,TRITON) or Franz van der Werf (ASSENT 3 and 4) in Europe. Our Cath Lab Chief was trained in Toronto at Mount Sinai, Toronto General and Sick Kids.
2) Brazilian centers for Acute MI treatment in Sao Paulo: we would mention Incor at the University of Sao Paulo, Dante Pazzanese Hospital and our center at Hospital Sao Paulo. At Unifesp we have been involved with trials since the late 80’s, beginning with EMERAS, the first international trial executed in South America under supervision of the Oxford group and going through ISIS 4, GISSI 3 and many others like EXTRACT, CURE several OASIS trials, ASSENT 3 and 4. We are part of the GRACE registry in which we have almost 1000 acute coronary syndrome patients registered. We have also taken part in some NIH sponsored trials like The SHOCK trial for cardiogenic shock and the recently NEJM published (December 2006) OAT trial, directed by Judith Hochman. In OAT our center was Brazilian national coordinating center .In most of these cardiology trials Brazilian participation has been very good with excellent follow up, few queries and no major difficulties. This can be easily explained because most of our main centers have as Heads people trained in the US, Canada or Europe .These centers have been audited by CRO’s like Quintiles, PPD, by the pharmaceutical industry (BMS, Sanofi Aventis) and by the NIH and FDA.
Our center is NIH licensed with an FWA approval number.We also have excellent other centers in Brazil in many cities like Porto Alegre, Rio de Janeiro, Salvador, Ribeirao Preto.
3) Expertise
I would mention next the main points of interest in research going on at our center:
a) In electrophysiology Dr Angelo De Paola is a leading investigator in Atrial
Fibrillation, with capabilities of an electro anatomical mapping CARTO system coupled to a MRI integration software. He has done research with Carlo Pappone from Milan, a leading researcher in Atrial Fib. Angelo is currently testing equipment for ablation in an FDA research program (the only center in South America to do that).
b) In Lipids Dr. Francisco Fonseca is a former fellow of Valentin Fuster at NY Mount Sinai and is working with AstraZeneca and Pfizer on HDL research and is at the steering committee of the recently published Jupiter trial. He has been director of the GOLD trial, FAPESP sponsored, studying 1200 diabetics from all Brazilian regions concerning genetic polymorphisms and risk factors in Brazil and is taking part in a Brazilian Millenium research program with Physics Department from University of Sao Paulo.
c) In stem cells Dr. Enio Buffolo, Cardiovascular Surgeon, is conducting a research in refractory angina pectoris. As of now 28 patients have been treated with the first patients already in their second follow up year. A biotechnology Brazilian company, Cryopraxis, has been associated to our program and we have begun talks to develop further research areas in this setting involving the experimental lab of Dr. Paulo Tucci, at Cardiovascular Physiology in our Institution, and future research in catheters for deploying stem cells more easily. We are also about to begin participation with stem cells in a Brazilian Ministry of Health trial in large acute MI’s as well as in a program with South of Florida University and Cryopraxis in umbilical cord stem cells in acute large anterior MI’s in anima nobile.
d) Our center is a truly national reference for diseases of the aorta and we have more than 600 cases of aortic diseases already treated with endovascular stents, under Dr. Honorio Palma leadership. These stents for aorta have been entirely developed in association with Braille biomedical from Sao Jose do Rio Preto, a leading Brazilian manufacturer of medical and surgical products. Research into development of percutaneous prosthesis for aortic and pulmonary insertion is well under way with experimentation in pigs already showing excellent survival. Human utilization of the
e) We already have in the surgical center of our Institution a full Cath Lab ready to go, to begin shortly hybrid procedures, joining Cardiology and Cardiovascular surgery for situations like treating abdominal aorta and coronary artery with stents with simultaneous thoracic aortic surgery, or for doing other different procedures involving coronary, aortic arch, carotids, peripheral vascular disease and finally for treating congenital heart disease with hybrid interventions like in hypoplastic LV, pulmonary artery stents in Fallot, etc.
f) AMI: we have been audited often due to our research in AMI, either in clinical or intervention trials. We have in GRACE results similar in most respects to other developed regions and in our center, with a 24 hour cath lab capability, we do around 45 % of primary angioplasty. We have around 250 AMI’s year treated at our center, many of them going into international multicentric trials.
We do have many areas where companies interested in developing products or devices presumably could meet their goals. Expansion could be developed to absorb new requests. We are ok concerning not only ANVISA but Fogarty regulations for dealing with US studies, as well as NIH and FDA licenses. We also have a couple of students at Johns Hopkins doing research in MRI and tagging and in ultravascular intrasound. Our fellows or ex fellows have visited Boston, Toronto, Cleveland ,Mayo, Madrid, Milan and Unifesp has increased its publication in ISI indexed journals by 379% in the last 4 years being number two in Brazil when indexing its publication number by number of professors (we are not a large Institution and are mainly focused as a Health University).
Antonio Carlos Carvalho
Full Professor and Head of Cardiology Unifesp
