tribute to 100 years of the bir th of professor zerbini

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Noedir A. G. Stolf1, Domingo M. Braile2

Rev Bras Cir Cardiovasc 2012;27(1):137-47SPECIAL 100 YEARS PROFESSOR ZERBINI

Euryclides de Jesus Zerbini: uma biografia

Euryclides de Jesus Zerbini: a biography

RBCCV 44205-1361DOI: 10.5935/1678-9741.20120020

Professor Euryclides de Jesus Zerbini, E. J. Zerbini, ashe liked to be quoted, is undoubtedly one of the great figuresof Brazilian Medicine. His contributions to the Thoracicand Cardiovascular Surgery, as well as his legacy as ateacher and opinion maker, grant him an ideal place forposterity. Reviewing the steps and the circumstances thatshaped the temper of this pioneer means another tribute tothe master, also covered with an educational nature forfuture generations. Zerbini was born May 7, 1912 in thecity of Guaratinguetá, Vale do Paraíba. He was the sixthchild (the youngest) of Eugênio and Ernestina Zerbini(Figure 1), he who was born in the small Italian town ofSerravalle, in Emilia-Romagna and she registered inArgentina, daughter of Genoese fathers. Eugene, aprofessor, ostensibly cultivated the discipline and

dedication of the children to school. Zerbini studied untilthe first year of high school in his hometown. With thetransfer from father to Campinas, he finished the ScientificCourse, at Colégio Diocesano Santa Maria, in that city(Figure 2).

According Zerbini’s own words, as he didn’t believe itwas his vocation to a career, his father suggested he couldstudy medicine. Thus, from Campinas he moved to thehouse of his sister, Eunice, in São Paulo, preparing for thedifficult entrance exam. In 1930, he was approved for one ofthe 50 seats of the Faculty of Medicine, University of SãoPaulo (USP), ranked among the top 10! At the time, FMUSPhad an excellent reputation, which was supported in partby the Rockefeller Foundation [1]. Studying Medicine inSão Paulo was not cheap, even considering that the Collegewas free. To alleviate the financial burden of his father, he

1. Titular Professor of the Discipline of Cardiovascular Surgery atFaculty of Medicine of the University of São Paulo.

2. Emeritus Professor of the State Faculty of Medicine of Rio Pretoand Senior Professor at Faculty of Medical Sciences of UNICAMP.

Fig. 1 - The couple Eugênio and Ernestina Zerbini and children.Dr. Zerbini is the first at right, standing

Fig. 2 - Zerbini at the time of completion of high school course inCampinas

TRIBUTE TO 100 YEARS OF THE BIR TH OF PROFESSOR ZERBINI

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Stolf NAG & Braile DM - Euryclides de Jesus Zerbini: a biography Rev Bras Cir Cardiovasc 2012;27(1):137-47

taught Chemistry, Physics and Natural History in pre-university courses, already during his first year in college.FMUSP, which was held in the city center, moved to thebuilding of Dr. Arnaldo Avenue in following year, 1931. The“Hospital School” of the College was the Santa Casa deMisericórdia de São Paulo, where Zerbini has been actingas an academic procedure in the 17th Chair of Surgery,headed by icons of the time, sequentially: Professors JoãoAlves Meira, Benedito Montenegro and finally, AlípioCorrêa Netto, his master and mentor (Figure 3). During thecourse, and the Constitutional Revolution of 1932, therewas a great mobilization of teachers and students inFMUSP, and Zerbini participated in the movement at Valedo Paraíba. In 1935, he graduated doctor (Figure 4). In 1939,still at Santa Casa, when the Faculty of Dr. Edmundo Etzel’steam left, just four years after graduation, Zerbini wasappointed to be the Head of Division, occupying the highlycoveted post of first assistant, a position immediately belowof Titular Professor. Professor Alípio Corrêa Netto couldhave chosen for that important position, one of his olderassistants. But, surprisingly, he chose to name the youngZerbini, seeing in him the great capacity that the futurewould prove to be true. In 1941, he was 29 years old andwas submitted to this contest for Full Professor, studyinghard for a year, when normally required at least five yearsof preparation. The theme chosen for his lecture was:Supratentorial Brain Tumors, and was approved with note9.41 on a scale of 10 (Zerbini, 2010).

First contact with the heartAlthough its activity was mainly in General Surgery, he

worked at Hospital São Luiz Gonzaga in the suburb ofJaçanã, performing Thoracic Surgery in patients withtuberculosis, which was highly prevalent. In February 1942,a fortuitous event would mark his first contact with thesurgical approach to heart. At that time, the heart was stillan anatomical fiction, which could only be seen or touchedin autopsy rooms.

A seven-year-old boy called Disnei was received in acritical condition in the Emergency Department of SantaCasa, with a metallic shrapnel which penetrated theprecordium. They team decided to call Dr. Zerbini, who asalways, was in the hospital. The case was unusual, andtherefore they consulted their master. They decided tooperate on the patient! It dealt with heart wounds, involvingthe anterior descending coronary artery that was occludedin the suture. The patient survived the procedure and thesurgeon himself. It was the first suture, successfully, of aheart wounds in the country, earning internationalpublication in the Journal of Cardiac Surgery, in 1943,entitled: “Coronary ligation in wounds of the heart”. It wasalso the first procedure on the heart of this pioneer of heartsurgery in Latin America.

Fig. 4 - Graduation at the Faculty of Medicine, University of SãoPaulo in 1935

Fig. 3 – Prof. Dr. Alípio Corrêa Neto

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To the United StatesDespite this historical event, Dr. Zerbini continued to

devote himself to the Thoracic Surgery. Dissatisfied withthe limitations of it, which acted only on the chest wall andpleura to perform pneumothorax and thoracoplasty, in orderto collapse the lung with tuberculous caverns, Zerbinidecided, with the support of Prof. Alípio, to visit the UnitedStates. He attended the service of Dr. Evarts Graham, whohad performed the world’s first pneumonectomy fortreatment of lung cancer, in St. Louis at Barnes Hospital.Excited by what he saw, asked the Cultural Union Brazil-United States and the Institute of International Educationa scholarship in te U.S. State Department. He receivedapproval on January 17, 1944, and six months later, he wentto the United States for an initial period of one year(embedded in a Douglas DC-3, which took three days toreach the destination).

At Barnes Hospital, surrounded by leaders of hisspecialty at the time, having at its disposal the latestsurgical technology available, Zerbini felt like he was inanother world.

As always, very lucky! He found little competition fromAmerican residents, since most young doctors had beencalled to the Armed Forces during World War II. Havingcompleted six months at Barnes Hospital, Zerbini moved toBoston, where he remained for another six months underthe guidance of Professor Oliver Cope, at MassachusettsGeneral Hospital. Between July and September 1945, Zerbinialso visited several U.S. departments of surgery, includingDr. Alfred Blalock in Baltimore.

The principle of allWith the knowledge gained, Zerbini brought to Brazil

the fundaments for Thoracic Surgery and the beginningsof modern heart surgery. With its pioneering spirit heperformed at the Clinics Hospital, USP, the second surgery,modified Blalock-Taussig shunt in Brazil. The first had beenperformed in Santos, by Dr. Domingos Pinto, who had beentrained by Dr. Charles Bailey, and had instruments suitablefor intervention. Soon after, Zerbini performed the firstligation of a patent ductus arteriosus in a 18-year-old young,having been the first to repair an aortic coarctation in thecountry. In mid-1952 when the World Heart Surgery tookits first steps to penetrate the heart cavities, Zerbini startedintracardiac procedures with moderate hypothermia to treatsimple congenital heart diseases, such as interatrialcommunications, which had been performed recently,pioneered by Lewis, Varco and Taufic (the latter, Brazilian),in Minneapolis [2].

Rheumatic fever, epidemic in the world, including theUnited States, was also prevalent in Brazil, causing severesequelae of the heart valves, especially mitral stenosis. Thisdisease was treated blindly with the introduction of the

index finger of the surgeons, who were easily recognizedby failing to grow, for obvious reasons, the nail of thatfinger. In addition the nail, in more complicated cases, theyused small flexible knives, difficult to handle. The valveopening provided excellent results, but the methodsrequired a lot of poor diagnostic accuracy of clinicalauscultation because it was essential for the indication ofthe intervention. The electrocardiogram helped to indirectlyassess the presence of severe pulmonary hypertension.

We remember Professor always asked in discussionshow was the R wave in V1 – pure R wave contraindicatedthe surgery. The same occurred with atrial fibrillation,because the possibility of preventing atrial thrombi intreatment. History shows us that it is difficult to be aheadof time. We can imagine Elliot Cutler, from Boston, on May20, 1923, and Sir Henry Souttar, London, on May 6, 1925,who had successfully performed such interventions in atime that surgery, as science, took its first steps. Thesememorable experiences were only revived in the late 40’s,when Charles P. Bailey, in Philadelphia, followed by DwightE. Harken in Boston, began the modern era of mitralcommissurotomy and Cardiac Surgery.

Open surgerySoon after, in the early 50s, Zerbini began a major world

experiences in the treatment of mitral stenosis. It is worthingrevealing that a medical student named Adib DomingosJatene participated on the first intervention,, who wasenchanted by the new Cardiac Surgery. This made all thedifference: 32 years later, he would replace Prof. Zerbini asProfessor at FMUSP in 1983. One of the authors of thisstudy, Domingo Braile, in 1958, was commissioned to do asurvey of patients undergoing mitral commissurotomy bythat date. There were more than 1,500, with results thatcompete with international statistics.

In his lectures and conferences, Prof. Zerbini didacticallydivided the Cardiac Surgery in the periods. The first, whichdealt with the disease “around the heart” and, second, onwhich the defects were corrected with the heart opened,under direct vision of defects. On May 6, 1953, John Gibbon,in Thomas Jefferson University Hospital, in Philadelphia,successfully performed the first heart surgery withcardiopulmonary bypass. The chambers of the heart wereopened and the immense field of Cardiac Surgery of ourAge. Zerbini, always attentive to the progress anddevelopment of specialty and supported by the institutionof higher scientific weight in Latin America, the Universityof São Paulo, followed by meetings of his group, showedthe way to be followed [2].

The wide development of open heart surgery in theUnited States occurred in 1955 with the development ofreproducible techniques by Dr. Clarence Walton Lilleheiand Richard DeWall. In Brazil, interest was growing, with


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the completion of experimental procedures, allowing thedeployment of new technologies in the short term. Withthese bases well established, Professor. Zerbini,accompanied by physician Dr. Dirce Costa Zerbini (his wife),traveled to Minneapolis in 1957, the Mecca of cardiacsurgery at the time to familiarize himself withcardiopulmonary bypass and techniques involving thecomplex intracardiac operations.

Ar tificial Hear t-Lung WorkshopBack in Brazil, along with his assistants Delmont

Bittencourt, Geraldo Verginelli, Adib Jatene, Edgar San Juan,Rubens Arruda, Dirce Costa Zerbini and Antonio Geraldode Freitas Neto, immediately began operations withcardiopulmonary bypass in the room “C” of the ClinicsHospital, USP, which was gave him only once a week. Soonafter, other enthusiasts of Cardiac Surgery added to thegroup, as Euclides Marques, Seigo Tsuzuki, MagnusCoelho de Sousa, Dagoberto Conceição, Ruy Gomide doAmaral, Domingo Braile and Noedir Stolf, among others,and dedicated technicians. The mood was of highcommitment to the patient during operations and duringthe often stormy postoperative period.

The operations lasted all day and often progressed intothe night, with results not always satisfactory. Most of theinstruments and equipment were imported, very expensivefor the Brazilian reality. Their maintenance was almostimpossible, depended on American technicians to repairthem, which generated even more costs and large waitingtime. With a rare sight for a professional academic, Zerbinichose to create in the basement of the Clinics Hospital, theArtificial Heart-Lung Office. Such a unit would be for theconstruction and maintenance of equipment for heartsurgery, rather than buy them outside Brazil. That made ahuge difference, as proven over time. With his simplicity,he said: “Dismantle these huge machines that we sell forhigh prices, and you will see that they are black boxes withhalf a dozen components inside, and that we can develophere without any problem”. In 1954, Dr. Adib Jatene left thecapital to exercise his profession at Triângulo Mineiro,where his family had moved after his father’s death inXapuri, Acre, where he was born.

In Uberaba, was Professor of Topographical Anatomy,but remained interested in cardiac surgery, and there hasdeveloped a heart lung machine.

In 1960, Zerbini, aware of the deed, invited him to rejointhe group, returning to the Clinics Hospital and FMUSP,where he graduated.

I quote here the words of Professor. Adib, chroniclingthe beginning of a Brazilian epic moment:

“I went back and established in the Clinics Hospital, asmall workshop (which initially was in the elevator machineroom side Rebouças).

There I made the first model of artificial heart-lung’sClinical Hospital, which used a disk oxygenator and a rollerpump. Then they arranged a maintenance area and Iestablished what I called the Workshop and ExperimentalResearch, and we produced and systematizedcardiopulmonary bypass”.

The Workshop began to work with an engineer andthree employees: two turners, who were brothers, and anadjuster, and some curious students of electronics andmechanics: Gerônimo, Waldomiro, Benvindo and Eng.Nemésio (Figure 5).

This unit was the incipient embryo of the BioengineeringDivision, Heart Institute (InCor). At the same time and inthe same way, an Experimental Laboratory, specific for testsof equipment and development of pioneering techniques,was created together with the Department of SurgicalTechnique.


Fig. 5 - Artificial Heart-Lung Workshop – “Basement” of HC-USP - São Paulo. From left to right, Benvindo - drill, Eng. Nemésio- Electronics, Waldomiro – press and Braile - planer

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A

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This enabled all products, as well as new techniqueswere tested by the team, usually dogs, before starting in1958, the continued use in patients. The two authors ofthis study, Noedir Stolf and Domingo Braile, had theopportunity and honor to work in the early and well-equipped, for the time, laboratory, even when medicalstudents in FMUSP.

Nothing can resist WorkIn those days of pioneering, despite all the effort,

dedication and studies, mortality was high, as we see in thearticle “Cardiovascular Surgery in Brazil: Achievements andPossibilities” [3], published when the thousandth surgerywith cardiopulmonary bypass was performed by the team.Many were the reasons for failure and little was known ofthe metabolic consequences induced by cardiopulmonarybypass itself. Zerbini, worried, instructed Dr. Ruy VazGomide do Amaral, anesthesiologist, to study the reasonsfor the failures. This, after training in the United States,showed that one cause of death was a result of acidosisthat followed the procedures. Zerbini bought immediatelythe first unit of gasometry of Brazil, installing it in theanteroom of the operating room, with technicians available24 hours a day! It was a huge breakthrough. From suchknowledge, others were added to gradually do away withthe stigma that haunted heart surgeries that often resultedin failure and patient death, to the dismay of the entireteam.

Dr. Ruy Vaz Gomide do Amaral was rewarded, had abrilliant career, becoming Professor of Anesthesiology atFMUSP.

Times were hard, it wasnecessary to have courage toface the criticism that would notforgive scientific advances. Thisunfortunately does not jump,but results from the daily workof idealists who believeovercome the difficulties withstudy and work, hard work. It isworth mentioning that we haveinherited the aphorism ofProfessor Zerbini: “Nothing canresist work”. It had fundamentalimportance in the developmentprocess, the Professor of the 1stSurgical Clinic, Professor AlípioCorrêa Netto, who alwaysbelieved in Prof. Zerbini and histeam, offering full support sothat even facing difficulties, thegroup could succeed.

Fig. 6 - Zerbini Caravan (Belém, 1960)

“Zerbini Caravans”With better results, the number of patients who

underwent surgery by Prof. Zerbini was growing alongsidehis prestige in Brazil, Latin America, and even in the concertof nations. The influx of surgeons, mainly from Hispano-America, seeking training was increasing. There was a timeon which Castilian was more spoken in the operating roomthat Portuguese, many were foreigners who were here tolearn high quality surgical techniques practiced.

For wider disclosure of technics and feasibility ofCardiac Surgery as a reality accessible to everyone in theearly 60s, Professor created “Zerbini Caravan”. They movedup throughout Brazil and many countries in South America,with a full team of surgeons, perfusionists,anesthesiologists and cardiologists. They carried all theequipment necessary for the diagnosis and treatment ofheart disease in hospitals in cities that were not preparedto live the new reality. The results were equal to the sacrificeand work such moves accounted for their leader and all hisexcited team (Figure 6).

Hilarious facts and situations of great tension werealways with those who had the opportunity to participatein this democratic demonstration of patriotism anddedication to colleagues and patients. It would be possibleto cite dozens of unusual events during the Caravan, butwe will mention only one. The team was doingdemonstrations in the capital of Goiás. Everything wasdoing well during the patient’s surgery with tetralogy ofFallot, when the heart lung machine caught fire! Theperfusionist was Dr. Dirce Costa Zerbini. The panic wasgeneral, many fled in terror, while she remained calm. The


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only liquid near was a bottle with urine of the patient beingoperated. She had no doubts: threw urine from the flamesthat, miraculously, became extinct. The surgeons, aware ofthe operative field, did not even realize what had happenedand the surgery was completed without incident. And itwas a miracle because the machine worked with anelectronic valve (Tyretron) which produced 20,000 volts!After this occurrence, the pump circuit was completelychanged, from Brazilian technology, which eliminated thepossibility of new fires.

BSCVS and BJCVSToday, Heart Surgery is in all capitals and major cities

from north to south and east-west Brazil. The number ofheart surgeries is the second largest in the world, performedby more than 1,000 surgeons, meeting at the BrazilianSociety of Cardiovascular Surgery (BSCVS). Founded in1969, BSCVS had Professor Zerbini as its first president.He has been in such position for 15 years, offering his workand dedication until the association became strong andcould evolve under the command of new leaders. Thisdemonstrates the spirit of the master, who has alwayssupported the associative activity, making it an element ofreconciliation and development of colleagues in the art. Hespared no effort to honor the scientific activity within theBSCVS, attending all meetings, demanding discipline withthe times, always sitting in the front row and ready to guidethe work and discussions.

In 1986, Professor Zerbini was one of those who pushedthe board to BSCVS had its own scientific journal. Thus,the Journal of Cardiovascular Surgery (BJCVS) was born,with the first Chief Editor Prof. Adib Domingos Jatene. Sincethen, both the Congress of BSCVS and BJCVS grownexponentially, setting an example for other societies. Butan event would bring visibility to the extraordinary figureof Dr. Zerbini and his group.

Heart TransplantOn December 3, 1967, Dr. Christiaan N. Barnard, in Cape

Town, South Africa, performed the first heart transplantbetween humans in the world. Although the patient livedonly 18 days, in spite of negative reviews, this feat arousedenormous interest in heart surgery centers around the world.In the U.S., at the same month of December, Kantrowitzperformed transplantation in a child without success.

Immediately, Professor Zerbini met the team and otherexperts to start prepararation, with great care, from everypoint of view, to perform the transplant. From January 1968,other centers began to perform heart transplants. The teamled by Prof. Zerbini would perform the first transplant onMay 26, 1968, or slightly more than five months afterhistorical transplantation in South Africa

On two occasions, in 1967, Brazil has not just become a

pioneer in heart transplantation. At first, it was barred bythe Council of the Clinics Hospital, USP. In the second, wecould not find donors for a heart attack victim whose heartdid not work even with direct massage on the open chest[4]. Then, on May 26, 1968, João Ferreira da Cunha, JoãoBoiadeiro, received the heart of Luis Fernando de Barros,victim of trampling.

The procedure began with the long wait until the donor’sbrain did not present more signs of activity. Then the twoteams (41 people in total) into action. It was dawn whenProf. Zerbini pulled John’s heart and at the same time, Luís’sheart came on a platter. We decided to leave the donorheart at normal temperature, irrigated by machine perfusion,for better protection, unlike the cooling technique used byBarnard. The transplant ended at 7:53 a.m.. The transplantedheart was beating in the chest of João Boiadeiro! The nextday, newspapers splashed the feat, weaving praise forProfessor Zerbini, who was also compared to Leonardo daVinci, in an editorial on the front page of O Globonewspaper.

Despite the criticism, and the patient lived only 28 days,the effect was overwhelmingly positive. The proof is thatthe governor of São Paulo Abreu Sodré, went to the ClinicsHospital in the dawn of the transplant (Figure 7). Later,with enthusiastic scientific achievement, the governorapproved the release of funds for the construction of theHeart Institute (InCor), one of the largest hospital complexesin the world dedicated to diagnosis, treatment and researchof cardiovascular diseases. The design of its creation hadbeen previously approved, and the area had already beendonated. Luiz Venere Décourt was founder of the creationof the Heart Institute, along with Professor Zerbini.

Until 1969, two more patients were transplanted, thesecond lived more than 400 days and the third 60 days. Theinterest generated by the heart transplant, inside andoutside of Brazil, was very high, both compared to the laypublic, as with the medical and scientific community.Internationally, Brazil and the Clinics Hospital of theUniversity of São Paulo were inserted between the centersof the new pioneering achievement. In a Symposium heldin Cape Town, Professor Zerbini was among the 13pioneering surgeons, discussing aspects of this treatmentstage. He would participate in other scientific events onthe same topic. Dr. Christian Barnard, although stillcontroversial, no doubt, a celebrity in the world in terms ofmedical and social point of view, visited the Faculty ofMedicine and Clinics Hospital in 1969 (Figure 8). On thatoccasion, he was also received with Dr. Zerbini’s team, atthe residence of the governor Abreu Sodré.

With the compulsory retirement of Prof. Alípio CorrêaNetto, Professor of Clinical Surgery, extinguished the chairat the University of São Paulo, it was opened public tenderfor the post of Professor of Clinical Surgery. Although he


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was the only candidate registered, Prof. Zerbini, as a markof his personality, prepared with extreme care. At that time,the contest included: Thesis, Curriculum Test, Memorialand Public Hearing. He, who always believed in teams,called several employees of cardiology and surgery to helpin the preparation of the thesis “Late results of repair oftetralogy of Fallot”. And, also, to prepare the points to theCurriculum Test, lesson to be drawn 24 hours before,including all surgical specialties. In 1969, the tender ended,he became Titular Professor of Clinical Surgery at FMUSP(Figure 9). That same year, 1969, Professor. Zerbini wasinvited as the first Brazilian to receive the title of “HonoredGuest of the American Association of Thoracic Surgery(AATS)”, featuring the “Honored Guest Conference: Thesurgical treatment of Fallot complex: late results”.

InCorSince the year 1968, a commission had

been planning the realization of a dreamof Professor Zerbini and his team: theproject design and implementation of theHeart Institute with ongoing meetings andvisits abroad made by Dr. DelmontBittencourt, nurse Clarice Ferrarini andarchitect Nelson Daruj. This was followedby the construction (Figure 10) theinstallation of equipment and, sequentially,in 1976, the Division of Bioengineering wassettled. In 1977, the clinic (consultation)began activities and, in 1978, the projectwas completed, with the hospitalization ofpatients and the full functioning of theSurgical Center.

Although the InCor had advancedequipment and facilities for the time, the operation wasstruggling with budget difficulties, as received insufficientresources, in reality, only a small fraction of what wasmanaged by the large complex of Clinics Hospital. That’swhen the idea of creating a foundation of private, nonprofit,for supporting InCor arose. The process was conductedpersonally by Prof. Zerbini, mobilizing many politicians andbusinessmen, and relying on the large participation of Prof.Décourt, Professor of Cardiology.

This move sparked strong opposition from leaders ofmajor complex of the Clinics Hospital/FMUSP. Finally, withthe mediation of prominent personalities in the Medicaland Civil Society, the desired agreement occurred.Pioneering project was approved, the Foundation hasreceived the initial name of “Foundation for the

Fig. 7 - Morning of the first transplant at the Clinics Hospital, attended by the GovernorAbreu Sodré

Fig. 9 - Tenure as Titular Professor of Clinical Surgery in 1969.With the presence of Director Prof. João Alves Meira and SecretaryDante Nese

Fig. 8 - Visit of Dr. Christian Barnard at Clinics Hospital in 1969.In the foreground, Zerbini and Barnard


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Development of Bioengineering” (FUNDEBE). Later, infairness, was transformed into “Zerbini Foundation”,worshiping the name of its creator. Over the years, manyadvanced projects and major developments in the field ofcardiovascular surgery there had generated internationalattention, contributing so conspicuous, for the evolutionof the specialty in Brazil and Latin America.

Retirement and WorkingAt age 70, after his mandatory retirement in 1982,

Professor Zerbini continued with intense surgical activity.He operated with his team in the Hospital BeneficênciaPortuguesa in Sao Paulo, and led personally, among others,a successful heart transplantation program, in the secondphase of this technique, after the advent of cyclosporineand the like, which managed to reduce the large problem ofrejection. Even in the condition of “retired”, Professor madea point of keeping his resumé and Memorial updated. Suchthat, during a tribute received in a Congress of the BSCVSshowed that in the five years following retirement hadcollected more scientific and academic activities in the fiveyears that preceded it. Participated actively in allmembership activities; traveled throughout Brazil, neverrefusing an invitation, even small entities in cities awayfrom the large centers. Humility and love of work were histrademarks.

The end of the dayAmid this intense professional activity, he had a

neurological condition and the diagnosis of a brain tumor.He underwent surgery and found to treat metastasis ofmelanoma. A tough and short day followed with

chemotherapy and resection of peripherallesions and lymph nodes, first with localanesthetic and then with general anesthesiafor inguinal and cervical dissections.Colleagues testify that Professor Zerbinibehaved with discipline and considerationfacing therapeutic procedures and difficultdecisions, like going to treat the UnitedStates or stay in São Paulo, devoting himselfmore leisure and family. On October 23, 1993,died at InCor, which he created and operatedas an exemplary institution. He was buriedin the cemetery of Araçá, accompanied byhis peers, colleagues, disciples andadmirers, greeted by fellow countryman,Professor Carlos da Silva Lacaz and hisfuture successor, Professor Adib Jatene.

A life of so intense activity, ideallyshould be supported by a familyconstellation and harmonic support.Professor Zerbini met his wife, a medical

student, and married Dr. Dirce Costa, in 1949. Of Portuguesedescent and temper, was partner of all times. Collaboratedin the establishment of cardiopulmonary bypass, and tothis area of activity devoted herself for many years, formingthe first disciples of the specialty. They had three children,chronologically: Roberto, Eduardo and Ricardo. Two ofthem, engineers, and one, Eduardo, graduated in PaulistaMedical School (now UNIFESP) (Figure 11), was approvedfor the residence of Surgery at the Clinics Hospital ofFMUSP. Unfortunately, before starting it, died in a tragictraffic accident, an extraordinarily painful loss for Dr. Zerbini,his family and all his many friends. The teacher always hada very close relationship with his sister, Eunice, due to theproximity of the families’ homes, her invaluable activity asguardian of the “boys” during their studies, as a teachershe was, and also because Dona Eunice was dedicatedvolunteer of InCor, Division of Bioengineering.

Master with HonoursProfessor Zerbini made a huge number of trips for

participation in scientific events in all parts of the world,and some travel as part of Brazilian delegations, oninvitation, for example, of the Chinese government. He wasreceived by the Pope, invited to discuss with colleagues ofgreat prestige, organ donation at the Academy of Sciencesof the Vatican. Had the honor to be bestowed by countlesshonors, honors and awards from national and foreigninstitutions, including the title of Doctor Honoris Causa bythe University of Coimbra (Figure 12).

Dr. Zerbini had some leisure activities. He played tennisregularly in the form of classes or matches, with colleaguesand friends at Clube Pinheiros. He went on his farm in

Fig. 10 - Final phase of construction of the Heart Institute, Clinics Hospital, Faculty ofMedicine, University of São Paulo


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Fig. 12 - Zerbini received the title of Doctor Honoris Causa by theUniversity of Coimbra

Fig. 11 - Dr. Zerbini and Dr. Dirce with their children Roberto,Eduardo and Ricardo

Cunha, near his hometown, Guaratinguetá, and especiallyliked the sound of water, lying in lush waterfall, right besideyour cottage.

Zerbini’s LegacyThe greatness of a man is measured by his achievements

and successes, but most of all, by his legacy. The role ofProfessor Zerbini in the development of Cardiac Surgery inBrazil and Latin American is well known and recognized, aswell as the many scientific contributions to the specialty,which had international repercussions. The contributionsof Professor Zerbini transcend borders and extend forsuccessive generations. The creation of a unit tomanufacture products for cardiac surgery, instead of gettingthose products in the United States, gave rise to theBioengineering Division of InCor. It was an initiative thathad consequences of immense importance. He representedthe model for the creation of similar units in other leadinginstitutions such as the Institute of Cardiology in São PauloState, later, Dante Pazzanese Institute of Cardiology.

Another consequence was the national production ofthe full range of equipment for heart surgery at a costcompatible with the Brazilian reality. A host of surgeons inBrazil and Latin-America, formed in the service of ProfessorZerbini and the Institute of Cardiology in São Paulo State,could only start its activities in the art (in Brazil or in theircountries) because such surgeons could rely on equipmentmade in these institutions, which had no profit. Finally, thepioneer of the Heart Workshop established a philosophyof creativity and entrepreneurship in the professionals thatattended it.

From this, companies have created material for cardiacsurgery or have other consultants. The number of thesecompanies in the country is appreciable. They supply theBrazilian market, export and play a key role in developingnew products. It was another dream held by Professor: makeBrazil, from importer of technology to exporter. Today,Brazilian and multinational companies that employBrazilians, supply throughout the international market,taking away the name of Brazil. They represent a real markerof the strength of this country that Zerbini loved so much.

More Fruits

In order to specify a little more the importance of theBioengineering Division at InCor in the consolidation ofthis activity in Brazil, we can emphasize that the metalprosthesis of Starr-Edwards ball model was developed andproduced under the baton of Professor Adib Jatene, foruse by the Institute and others , which allowed surgery toreplace heart valves on a large scale. He innovated with theprosthesis of human dura mater preserved in glycerin, whichhad worldwide repercussions, assembled and used in allcardiac surgery services in Brazil. This was, undoubtedly,the initial step in the production of biological prostheses,such as bovine pericardium and porcine aortic valve,pioneered manufactured by Brazilian companies.

It also developed a cardiac pacemaker in 70s, allowingthe implant in poor patients, who at that time dependedonly on the charity to be treated. The first artificial ventricleof Latin America had its research and production performedin the workshops of InCor. It was implemented in theinstitution, as the initial experience in this field in LatinAmerica in 1992, with full success. Subsequently, the patientwas transplanted when a compatible donor and his betterconditions allowed. The creation of the Unit ofBioengineering was thus the seed of important Braziliancompanies and successful products for Cardiac Surgery.


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Fig 13 - Photo of the participants of the Meeting of Professor Zerbini Disciples, in London

Emphasizing the invaluablefruits of Professor Zerbini, wemust insist on which the creationof InCor represented. The projectof creation had been approved,the area ceded by the state, butwithout performing the first hearttransplant and the personalprestige of the master, thefinancial resource would nothave been released. Asmentioned, the creation of theZerbini Foundation to supportthe InCor was the key lever forthe growth of this pioneeringinstitution in Latin America.

The Disciples of ProfessorZerbini

Perhaps the greatest legacy has been the formation ofdisciples. It is estimated that more than 400 surgeons formedwith Professor. Zerbini. They came from all over Brazil, fromHispano-America, from Mexico to South America and othercountries, like Portugal, Spain, India and even Japan Thelatter sent five interns to do all their training incardiovascular surgery in a country still consideredperipheral, but whose heart surgery has loomed as one ofmarkers of its glorious destiny. From Brazil they came fromall States and today they are the best university professors,heads of major units and innovative services withinternational recognition. The consideration, respect andaffection for Professor Zerbini reached such a level thatresulted in the establishment of a scientific event calledDisciples of Professor Zerbini Meeting, held annually. Tohim, all the direct disciples were connected, including manyfrom abroad, as well as surgeons who, although havingperformed other training services, publicly declaredthemselves disciples for adoption (Figure 13).

So, to paraphrase the celebrated writer, illustrator andFrench pilot Antoine-Jean-Baptiste-Marie-RogerFoscolombe of Saint-Exupéry: “Each one that passes inour life, going alone, because each person is unique andreplaces any other. Each one that passes in our life, goingalone, but it will not only not us alone. Take a little ofourselves, let a little of themselves. There are those whotake it, but there are those who do not take anything. Thisis the greatest responsibility of our lives, and the proofthat two souls are not random. You become responsibleforever for what you have tamed.”

Professor Euryclides de Jesus Zerbini is includedamong those who spend our lives in an unforgettable way,make it abundantly, engage us and become responsible,forever, for our destinies.

Authors note:Full Professor Noedir G. Stolf was the disciple who

stood by Professor Zerbini. He graduated with distinctionin FMUSP and held all offices of the University in abrilliant career. From September 2006, winning the tenderfor Professor of Cardiovascular Surgery, FMUSP, wasChairman of the Board and Member of the Board ofTrustees of the Heart Institute, Director of the Division ofSurgery at Heart Institute, Clinics Hospital, FMUSP andMember of the Board of that hospital. In addition, he wasDepartment Coordinator of the Brazilian Association ofOrgan Transplantation, responsible for HeartTransplantation at InCor. Thus, it was fulfilled theprophecy of Professor Zerbini, who always saw thepotential in him as a great surgeon and professor of innatequalities. He devoted with much emphasis on teachingand research, being an icon respected nationally andinternationally. The performance of Noedir Stolf as ascientist, class leader and great supporter of youngpeople, can be evaluated for his production, and he haspublished over 558 papers in journals of national andinternational impact, 137 book chapters, six books of thespecialty. He participated in 350 scientific meetings inBrazil and in many foreign nations. Along with his grouppresented 1500 studies in Congress. Organized over 60scientific events. He participated in examination boardsin more than 80 doctoral, master’s theses and tenders,and 3 were related to selection of professors and 8 ofhabilitation. Supervised 17 doctors and currently another3. He belongs to the editorial board of 10 internationaljournals and is reviewer of many. He operates in six linesof advanced research.

Full Professor Domingo Braile, formed in FMUSP, wasthe disciple who chose new challenges. Implemented a


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Department of Cardiac Surgery in São José do Rio Preto,back in 1963, which served as an example for thedissemination of expertise in all corners of Brazil. He wasone of the founders of the State Faculty of Medicine of RioPreto, where he retired as Professor. Emeritus, where he iscurrently the Dean of Postgraduation Department. Heintroduced more than a dozen units of Cardiac Surgery inthe inner cities and capitals. He was Professor at theFaculty of Medicine of Catanduva and Faculty of MedicalSciences of UNICAMP, and is now Senior Professor atUniversity of Campinas. Since 2002, is Chief Editor of theBrazilian Journal of Cardiovascular Surgery, the onlyinternationally recognized journal in the specialty in theSouthern Hemisphere, including also Mexico and theCaribbean. He founded a company of cardiovascularsurgery products that supplies Brazil and many othercountries with supplie for the specialty.

REFERENCES

1. Lima R, Lucchese FA, Braile DM, Salerno TA. A tribute toEuryclides de Jesus Zerbini, MD. Ann Thorac Surg.2001;72(5):1789-92.

2. Braile DM, Godoy MF. História da Cirurgia Cardíaca. ArqBras Cardiol. 1996; 66(1):329-37.

3. Zerbini, EJ. A Cirurgia Cardiovascular no Brasil: Realizações ePossibilidades. Rev Bras Cir Cardiovasc, 2010; 25(2): 264-77.

4. Araujo CS. Dr. Zerbini o operário do coração. Bandeirante:São Paulo; 1988. p.220.


Professor Noedir and Professor Braile, following theexample of the master, were presidents of the BrazilianSociety of Cardiovascular Surgery.

Note: Pictures belonging to the personal collection of Profs. Noedir Stolf and Domingo Braile.

tribute to 100 years of the bir th of professor zerbini

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