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Safety, Effectiveness, and Hemodynamic Performance of the Bovine Pericardium Organic Valvular Bioprosthesis
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Rösler, Álvaro Machado

; Lucchese, Fernando Antonio

; Pomerantzeff, Pablo Maria Alberto

; Passos, Luiz Carlos Santana

Brazilian Journal of Cardiovascular Surgery

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2023, Volume 38 N. 6 elocation e20230015

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: To assess actual data on the safety, effectiveness, and hemodynamic performance of Bovine Pericardium Organic Valvular Bioprosthesis (BVP). Methods: The BIOPRO Trial is an observational, retrospective, non-comparative, non-randomized, and multicenter study. We collected data from 903 patients with symptomatic, moderate, or severe valve disease who underwent BVP implants in the timeframe from 2013 to 2020 at three Brazilian institutions. Death, valve-related adverse events (AEs), functional recovery, and hemodynamic performance were evaluated at the hospital, at discharge, and six months and one year later. Primary analysis compared late (> 30 days after implant) linearized rates of valve-related AEs, such as thromboembolism, valve thrombosis, major hemorrhage, major paravalvular leak, and endocarditis, following objective performance criteria (OPC). Analysis was performed to include at least 400 valve-years for each valve position (aortic and mitral) for complete comparisons to OPC. Kaplan-Meier survival and major adverse cardiovascular and cerebrovascular event analyses were also performed. Results: This retrospective study analyzed follow-up data collected from 903 patients (834.2 late patient-years) who have undergone surgery for 455 isolated aortic valve replacement (50.4%), 382 isolated mitral valve replacement (42.3%), and 66 combined valve replacement or other intervention (7.3%). The linearized rates of valve-related AEs were < 2 × OPC. One-year survival rates were 95.1% and 92.7% for aortic and mitral valve replacement, respectively. This study demonstrated an improvement in the New York Heart Association classification from baseline and hemodynamic performance within an expected range. Conclusion: According to this analysis, BVP meets world standards for safety and clinical efficacy.

https://doi.org/10.21470/1678-9741-2023-0015

Prevalence of Frailty in Patients Undergoing Cardiac Valve Surgery: Comparison of Frailty Tools
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Harada, Gabriela

; Andrade, Monique Carvalho

; Brito, Julia Nobrega

; Tavares, Caio de Assis Moura

; Tarasoutchi, Flávio

; Pomerantzeff, Pablo Maria Alberto

; Bortolotto, Luiz

; Feltrim, Maria Ignez Zanetti

International Journal of Cardiovascular Sciences

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nov 2021, Volume 34 N. 5 Pages 78 - 86

Abstract: En | Text: En | PDF: En

Abstract Background There is no consensus among tools for assessing frailty. Objective To evaluate the prevalence of frailty according to different tools in patients referred for elective valve cardiac surgery. Methods This is a cross-sectional study. All patients were ≥ 18 years of age, clinically stable. The following patients were excluded: those unable to perform the tests because of physical, cognitive, or neurological limitations; those requiring non elective/emergency procedures or hemodynamic instability. During the preoperative cardiology visit, frailty was assessed by the Short Physical Performance Battery (SPPB), the Frailty Deficit Index (FDI), handgrip strength, and gait speed 3m. For the entire analysis, the statistical significance was set at 5%. Results Our cohort consisted of 258 subjects. From the total cohort, 201 were ≤ 70 years of age (77.9%), the predominant etiology according to rheumatic disease (50.7% vs 8.8%; p=0.000) with double mitral lesion (24.9% vs 0%; p=0.000). Frailty was present in 32.9% according SPPB, 29.1% with reduced muscular strength. and 8.9% with FDI. Handgrip strength was weaker in elderly patients (26.7 vs 23.6; p=0.051) and gait speed was lower in the younger group, in which 36% were considered frail (36% vs 14%; p=0.002). Variables associated with frailty were age ≥ 70 years, female gender, aortic stenosis, and regurgitation. Conclusion Frailty in adult patients who will have elective heart valve surgery is present even in the younger groups, although the older group with comorbidities are more frail. Frailty was more clearly shown by the SPPB than by the FDI and handgrip tests.

https://doi.org/10.36660/ijcs.20200098 48 downloads

A Técnica de Duplicação de Orifício na Plastia Valvar Mitral: 35 Anos de História
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Pomerantzeff, Pablo Maria Alberto

; Brandão, Carlos Manuel de Almeida

; Riso, Arlindo

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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sep 2021, Volume 117 N. 3 Pages 424 - 425

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210067 39 downloads

Posicionamento da Sociedade Brasileira de Cardiologia para Gravidez e Planejamento Familiar na Mulher Portadora de Cardiopatia – 2020
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Avila, Walkiria Samuel

; Alexandre, Elizabeth Regina Giunco

; Castro, Marildes Luiza de

; Lucena, Alexandre Jorge Gomes de

; Marques-Santos, Celi

; Freire, Claudia Maria Vilas

; Rossi, Eduardo Giusti

; Campanharo, Felipe Favorette

; Rivera, Ivan Romero

; Costa, Maria Elizabeth Navegantes Caetano

; Rivera, Maria Alayde Mendonça

; Carvalho, Regina Coeli Marques de

; Abzaid, Alexandre

; Moron, Antonio Fernandes

; Ramos, Auristela Isabel de Oliveira

; Albuquerque, Carlos Japhet da Mata

; Feio, Claudine Maia Alves

; Born, Daniel

; Silva, Fábio Bruno da

; Nani, Fernando Souza

; Tarasoutchi, Flavio

; Costa Junior, José de Ribamar

; Melo Filho, José Xavier de

; Katz, Leila

; Almeida, Maria Cristina Costa

; Grinberg, Max

; Amorim, Melania Maria Ramos de

; Melo, Nilson Roberto de

; Medeiros, Orlando Otávio de

; Pomerantzeff, Pablo Maria Alberto

; Braga, Sérgio Luiz Navarro

; Cristino, Sonia Conde

; Martinez, Tania Leme da Rocha

; Leal, Tatiana de Carvalho Andreuci Torres

Arquivos Brasileiros de Cardiologia

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may 2020, Volume 114 N. 5 Pages 849 - 942

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20200406 10784 downloads

Analysis of >100,000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes
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Mejia, Omar A.V.

; Lisboa, Luiz Augusto Ferreira

; Caneo, Luiz Fernando

; Arita, Elisandra Trevisan

; Brandão, Carlos Manuel de Almeida

; Dias, Ricardo Ribeiro

; Costa, Roberto

; Jatene, Marcelo Biscegli

; Pomerantzeff, Pablo Maria Alberto

; Dallan, Luís Alberto Oliveira

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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apr 2020, Volume 114 N. 4 Pages 603 - 612

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: O desafio atual da cirurgia cardiovascular (CCV) é melhorar resultados em pacientes cada vez mais graves. Nesse sentido, Programas de Melhoria Contínua da Qualidade (PMCQ) tem impactado os resultados. Objetivo: Avaliar a evolução da incidência e mortalidade das CCV, assim como os resultados atuais do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor). Métodos: Análise dos resultados das CCV realizadas no InCor entre jan-1984 e jun-2019. Foram observadas as tendências dos volumes cirúrgicos e da mortalidade em 5 períodos 1º (1984-1989), 2º (1990-1999), 3º (2000-2007), 4º (2008-2015) e 5º (2016-2019). O PMCQ foi estabelecido entre 2015-2016. A análise incluiu o total de cirurgias e a evolução dos procedimentos mais frequentes. Resultados: Foram realizadas 105.599 CCV, com uma média anual de 2.964 procedimentos e mortalidade de 5,63%. Comparando o 4º com o 5º período, o volume global médio de cirurgias foi de 2.943 para 3.139 (p = 0,368), cirurgias de revascularização miocárdica (CRM) de 638 para 597 (p = 0,214), valvas cardíacas de 372 para 465 (p = 0,201) e cardiopatias congênitas de 530 para 615 (p = 0,125). A mortalidade média global passou de 7,8% para 5% (p < 0,0001), nas cirurgias de revascularização miocárdica de 5,8% para 3,1% (p < 0,0001), nas cirurgias valvares de 14% para 7,5% (p < 0,0001) e nas cirurgias de cardiopatias congênitas de 12,1% para 9,6% (p < 0,0001). Conclusão: Embora haja uma tendência recente ao aumento dos volumes cirúrgicos, houve uma diminuição significativa da mortalidade cirúrgica nos grupos analisados. Após o estabelecimento do PMCQ, as taxas de mortalidade se aproximaram a dos padrões internacionais.

Abstract Background: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.

https://doi.org/10.36660/abc.20190736 938 downloads

Mitral Valve Repair in Young Rheumatic Patients
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Pomerantzeff, Pablo Maria Alberto

Arquivos Brasileiros de Cardiologia

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oct 2019, Volume 113 N. 4 Pages 757 - 757

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20190215 652 downloads

Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery
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Arthur, Camila Perez de Souza

; Mejía, Omar Asdrúbal Vilca

; Lapenna, Gisele Aparecida

; Brandão, Carlos Manuel de Almeida

; Lisboa, Luiz Augusto Ferreira

; Dias, Ricardo Ribeiro

; Dallan, Luís Alberto Oliveira

; Pomerantzeff, Pablo Maria Alberto

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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dec 2018, Volume 33 N. 6 Pages 618 - 625

Abstract: En | Text: En | PDF: En

Abstract Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.

https://doi.org/10.21470/1678-9741-2018-0147 759 downloads

Resection of Left Atrial Myxoma in a Patient with Retrosternal Gastric Tube: a Case Report
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Pomerantzeff, Pablo Maria Alberto

; Veronese, Elinthon Tavares

; Dinato, Fabrício José

; Jatene, Fabio Biscegli

Brazilian Journal of Cardiovascular Surgery

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oct 2017, Volume 32 N. 5 Pages 438 - 441

Abstract: En | Text: En | PDF: En

Abstract The median sternotomy remains the standard approach in cardiovascular surgery but, in some conditions, it can be considered difficult to perform, especially in patients with history of esophagectomy. This case report describes a successful resection of a left atrial myxoma through a right anterolateral thoracotomy approach in a patient with a previous retrosternal gastric tube reconstruction. The decision for the best surgical approach was made after a heart surgery team discussion. Through this surgical access, a safe and excellent exposure of the left atrium was possible, and a complete resection of the myxoma was performed without any injury to the gastric tube.

https://doi.org/10.21470/1678-9741-2016-0056 432 downloads

Atualização das Diretrizes Brasileiras de Valvopatias: Abordagem das Lesões Anatomicamente Importantes
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Tarasoutchi, Flavio

; Montera, Marcelo Westerlund

; Ramos, Auristela Isabel de Oliveira

; Sampaio, Roney Orismar

; Rosa, Vitor Emer Egypto

; Accorsi, Tarso Augusto Duenhas

; Lopes, Antonio Sergio de Santis Andrade

; Fernandes, João Ricardo Cordeiro

; Pires, Lucas José Tachotti

; Spina, Guilherme Sobreira

; Vieira, Marcelo Luiz Campos

; Lavitola, Paulo de Lara

; Bignoto, Tiago Costa

; Togna, Dorival Julio Della

; Mesquita, Evandro Tinoco

; Esteves, William Antonio de Magalhães

; Atik, Fernando Antibas

; Colafranceschi, Alexandre Siciliano

; Moisés, Valdir Ambrósio

; Kiyose, Alberto Takeshi

; Pomerantzeff, Pablo Maria Alberto

; Lemos Neto, Pedro Alves

; Brito Júnior, Fábio Sândoli de

; Weksler, Clara

; Brandão, Carlos Manuel de Almeida

; Poffo, Robinson

; Simões, Ricardo

; Rassi, Salvador

; Leães, Paulo Ernesto

; Rocha, Ricardo Mourilhe

; Pena, José Luiz Barros

; Jatene, Fabio Biscegli

; Barbosa, Márcia de Melo

; Souza Neto, João David de

; Saraiva, José Francisco Kerr

; Ghorayeb, Samira Kaissar Nasr

Arquivos Brasileiros de Cardiologia

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2017, Volume 109 N. 6 Pages 1 - 34

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/abc.20180007 46086 downloads

10.

Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair
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Guedes, Marco Antônio Vieira

; Pomerantzeff, Pablo Maria Alberto

; Brandão, Carlos Manuel de Almeida

; Vieira, Marcelo Luiz Campos

; Tarasoutchi, Flávio

; Spinola, Pablo da Cunha

; Jatene, Fábio Biscegli

Brazilian Journal of Cardiovascular Surgery

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sep 2015, Volume 30 N. 3 Pages 325 - 334

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

ResumoIntrodução:A plastia valvar mitral é o tratamento de escolha para a insuficiência mitral, porém, a literatura é escassa em relação ao comportamento do anel mitral após a plástica mitral sem utilização de anéis protéticos.Objetivo:Realizar a análise morfofuncional do anel mitral de indivíduos submetidos à plastia valvar mitral pela Técnica de Duplo Teflon, sem utilização de anel protético, por meio da ecocardiografia tridimensional em tempo real.Métodos:Foram incluídos 14 pacientes com insuficiência mitral mixomatosa submetidos à plástica mitral pela técnica de Duplo Teflon. Treze pacientes encontravam-se em classe III/IV. Os pacientes foram avaliados nos períodos pré-operatório, pós-operatório imediato, 6 meses e 1 ano. Foi utilizado teste de análise de variância de medidas repetidas para o estudo estatístico, sendo considerado estatisticamente significante P<0,05.Resultados:Não houve óbito, reoperação por disfunção valvar, tromboembolismo ou endocardite durante o estudo. A planimetria posterior do anel mitral demostrou uma redução significativa (P<0,001) no pós-operatório imediato, que se manteve estável durante o estudo, apresentando redução média de 25,8% com 1 ano em relação ao pré-operatório. Houve uma redução significativa dos diâmetros ântero-posterior e médio-lateral no pós-operatório imediato (P<0,001), porém, houve um aumento significativo no diâmetro médio-lateral entre pós-operatório imediato e 1 ano. Não houve diferença na variação da área interna mitral ao longo do estudo.Conclusão:A anuloplastia segmentar reduziu significativamente o componente posterior do anel mitral, permanecendo estável no período de um ano. A variação da área valvar durante o ciclo cardíaco permaneceu estável durante o estudo.

AbstractIntroduction:Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.Objective:To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.Methods:Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05.Results:There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study.Conclusion:Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.

https://doi.org/10.5935/1678-9741.20140082 1623 downloads

11.

Late outcome analysis of the Braile Biomédica® pericardial valve in the aortic position
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Azeredo, Lisandro Gonçalves

; Veronese, Elinthon Tavares

; Santiago, José Augusto Duncan

; Brandão, Carlos Manuel de Almeida

; Pomerantzeff, Pablo Maria Alberto

; Jatene, Fabio Biscegli

Brazilian Journal of Cardiovascular Surgery

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sep 2014, Volume 29 N. 3 Pages 316 - 321

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo: A troca valvar aórtica por substitutos biológicos de pericárdio bovino Braile é realizada rotineiramente no Instituto do Coração da Faculdade de Medicina da USP desde 2006. O objetivo deste estudo é analisar os resultados da utilização da prótese aórtica Braile Biomédica® em pacientes com doença valvar aórtica. Métodos: Foram analisados, retrospectivamente, 196 pacientes portadores de valvopatia aórtica submetidos à troca valvar aórtica por prótese biológica de pericárdio bovino Braile Biomédica® entre 2006 e 2010. A idade média foi de 59,41±16,34 anos e 67,3% eram do sexo masculino. No pré-operatório, 73,4% dos pacientes estavam em classe funcional III ou IV. Resultados: A mortalidade hospitalar foi 8,16% (16 pacientes). As taxas linearizadas de óbito, endocardite, reoperação e disfunção estrutural foram de 1,065%, 0,91%, 0,68% e 0,075% pacientes/ano, respectivamente. A sobrevida actuarial foi de 90,59±2,56% em 88 meses. A curva livre de reoperação, endocardite e disfunção estrutural foi respectivamente de 91,38±2,79%, 89,84±2,92% e 98,57±0,72% em 88 meses. Conclusão: O implante da prótese aórtica de pericárdio bovino Braile Biomédica® demonstrou sobrevida e durabilidade compatível com a literatura, porém maior seguimento é necessário para avaliar a incidência de endocardite e disfunção estrutural no futuro.

Objective: Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de São Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomédica® aortic bioprosthesis in patients with aortic valve disease. Methods: We retrospectively evaluated 196 patients with aortic valve disease submitted to aortic valve replacement with Braile Biomédica® bovine pericardial prosthesis, between 2006 and 2010. Mean age was 59.41±16.34 years and 67.3% were male. Before surgery, 73.4% of patients were in NYHA functional class III or IV. Results: Hospital mortality was 8.16% (16 patients). Linearized rates of mortality, endocarditis, reintervention, and structural dysfunction were 1.065%, 0.91%, 0.68% and 0.075% patients/year, respectively. Actuarial survival was 90.59±2.56% in 88 months. Freedom from reintervention, endocarditis and structural dysfunction was respectively 91.38±2.79%, 89.84±2.92% and 98.57±0.72% in 88 months. Conclusion: The Braile Biomédica® pericardial aortic valve prosthesis demonstrated actuarial survival and durability similar to that described in the literature, but further follow up is required to assess the incidence of prosthetic valve endocarditis and structural dysfunction in the future.

https://doi.org/10.5935/1678-9741.20140081 1605 downloads

12.

O Heart Team é fundamental para o Tratamento Transcateter da Estenose Aórtica?
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Rosa, Vitor Emer Egypto

; Lopes, Antônio Sergio de Santis Andrade

; Accorsi, Tarso Augusto Duenhas

; Lemos Neto, Pedro Alves

; Pomerantzeff, Pablo Maria Alberto

; Tarasoutchi, Flávio

Arquivos Brasileiros de Cardiologia

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may 2014, Volume 102 N. 5 Pages e55 - e56

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20140060 2390 downloads

13.

EuroSCORE II e a importância de um modelo local, InsCor e o futuro SP-SCORE
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Lisboa, Luiz Augusto Ferreira

; Mejia, Omar Asdrubal Vilca

; Moreira, Luiz Felipe Pinho

; Dallan, Luís Alberto Oliveira

; Pomerantzeff, Pablo Maria Alberto

; Dallan, Luís Roberto Palma

; Massoti, Maria Raquel B.

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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mar 2014, Volume 29 N. 1 Pages 01 - 08

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Introdução: O modelo mais utilizado para predição de mortalidade em cirurgia cardíaca foi recentemente remodelado, mas dúvidas referentes à sua metodologia e desenvolvimento têm sido relatadas. Objetivo: O objetivo deste estudo foi avaliar o desempenho do EuroSCORE II na predição de mortalidade em pacientes submetidos a cirurgia de coronária e/ou valva na instituição. Métodos: Mil pacientes, operados consecutivamente de coronária e/ou valva, entre outubro de 2008 e julho de 2009, foram analisados. O desfecho de interesse foi mortalidade intra-hospitalar. A calibração foi realizada pela correlação entre mortalidade esperada e observada por meio do teste de Hosmer Lemeshow. A discriminação foi calculada pela área abaixo da curva ROC. O desempenho do EuroSCORE II foi comparado com os modelos EuroSCORE e InsCor (modelo local). Resultados: Na calibração, o teste de Hosmer Lemeshow foi inadequado para o EuroSCORE II (P=0,0003) e bom para os modelos EuroSCORE (P=0,593) e InsCor (P=0,184). No entanto, na discriminação, a área abaixo da curva ROC para o EuroSCORE II foi de 0,81 [IC 95% (0,76-0,85), P<0,001]; para o EuroSCORE foi de 0,81 [IC 95% (0,77-0,86), P<0,001] e para o InsCor foi de 0,79 [IC 95% (0,74-0,83), P<0,001], revelando-se adequada para todos. Conclusão: O EuroSCORE II se tornou mais complexo e, à semelhança com a literatura internacional, mal calibrado para predizer mortalidade nos pacientes operados de coronária e/ou valva em nosso meio. Esses dados reforçam a importância do modelo local.

Introduction: The most widely used model for predicting mortality in cardiac surgery was recently remodeled, but the doubts regarding its methodology and development have been reported. Objective: The aim of this study was to assess the performance of the EuroSCORE II to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution. Methods: One thousand consecutive patients operated on coronary artery bypass grafts or valve surgery, between October 2008 and July 2009, were analyzed. The outcome of interest was in-hospital mortality. Calibration was performed by correlation between observed and expected mortality by Hosmer Lemeshow. Discrimination was calculated by the area under the ROC curve. The performance of the EuroSCORE II was compared with the EuroSCORE and InsCor (local model). Results: In calibration, the Hosmer Lemeshow test was inappropriate for the EuroSCORE II (P=0.0003) and good for the EuroSCORE (P=0.593) and InsCor (P=0.184). However, the discrimination, the area under the ROC curve for EuroSCORE II was 0.81 [95% CI (0.76 to 0.85), P<0.001], for the EuroSCORE was 0.81 [95% CI (0.77 to 0.86), P<0.001] and for InsCor was 0.79 [95% CI (0.74-0.83), P<0.001] showing up properly for all. Conclusion: The EuroSCORE II became more complex and resemblance to the international literature poorly calibrated to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution. These data emphasize the importance of the local model.

https://doi.org/10.5935/1678-9741.20140004 8766 downloads

14.

Estratificação de risco cirúrgico como instrumento de inovação em programas de cirurgia cardíaca no Sistema Único de Saúde do Estado de São Paulo: ESTUDO SP-SCORE-SUS
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Mejía, Omar Asdrúbal Vilca

; Lisboa, Luiz Augusto Ferreira

; Dallan, Luis Alberto Oliveira

; Pomerantzeff, Pablo Maria Alberto

; Trindade, Evelinda Marramon

; Jatene, Fabio Biscegli

; Kalil Filho, Roberto

Brazilian Journal of Cardiovascular Surgery

Journal Metrics
- Sobre o periódico
- SciELO Analytics

jun 2013, Volume 28 N. 2 Pages 263 - 269

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Doenças cardiovasculares representam a maior carga de morbimortalidade para o sistema de saúde e a cirurgia cardíaca desempenha importante impacto na sua resolutividade. O agrupamento das informações demográficas e clínicas relevantes dos pacientes acometidos, no nível de estratos específicos e em correlação com os conjuntos de recursos requeridos, representa a possibilidade de adaptar, aprimorar e inovar nos programas assistenciais. Este projeto tem por objetivo remodelar o escore de risco "InsCor" para formulação do SP-SCORE (São Paulo System for Cardiac Operative Risk Evaluation), visando refletir melhor a complexidade da assistência cirúrgica cardíaca. Os hospitais participantes integram os Núcleos de Avaliação de Tecnologias da Secretaria de Estado da Saúde de São Paulo (NATSs/SES-SP). Para a elaboração do SP-SCORE, serão utilizadas as 10 variáveis do modelo InsCor e 8 outras com suposta influência no Brasil. Os desfechos primários consistem na morbidade e na mortalidade hospitalar. A técnica de bootstrap junto a procedimentos de seleção automatizada de variáveis "stepwise" será utilizada para desenvolver um modelo parcimonioso por meio da regressão logística múltipla. Este projeto visa subsidiar a sustentabilidade e o financiamento do SUS-SP para as Redes Regionalizadas de Atenção à Saúde (RRAS) de cirurgias de coronária e/ou valva, promovendo alocação equitativa, incremento do acesso e efetividade, bem como caracterizar a magnitude dos recursos disponíveis e seu impacto.

Cardiovascular diseases represent the greatest burden of morbidity and mortality for the health system and cardiac surgery has an important impact on their resolutivity. The association and correlation of patients' demographic and clinical relevant information with the resources required for each stratum represent the possibility to adapt, improve and innovate into the healthcare programs. This project aims to remodel the "InsCor" risk score for the formulation of the SP-SCORE (Sao Paulo System for Cardiac Operative Risk Evaluation) in order to better reflects the complexity of cardiac surgical care. The participating hospitals include the Health Technology Assessment Centers in of the Health Secretariat' HTA Network of São Paulo State (HTA-NATSs / SES-SP). The SP-SCORE will use 10 variables of the InsCor model and others 8 variables with presumed influence in Brazil. The primary endpoints are morbidity and mortality. Bootstrap technique besides automated selection of variables (stepwise) will be used to develop a parsimonious model by multiple logistic regression. This project will contribute for the SUS-SP regionalized health-care (RRAS) sustainability and financing of the CABG and/or heart valve surgery programs promoting equitable allocation, increasing access and effectiveness, as well as characterizing the magnitude of available resources and its impact.

https://doi.org/10.5935/1678-9741.20130037 3511 downloads

15.

Experiência inicial com a técnica de Pomerantzeff para redução do tamanho do átrio esquerdo gigante
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Sousa, Jocerlano Santos de

; Pomerantzeff, Pablo Maria Alberto

; Brandão, Carlos Manuel de Almeida

; Gonçalves, Lisandro Azeredo

; Tiveron, Marcos Gradim

; Vieira, Marcelo Luiz Campos

; Tarasoutchi, Flavio

; Stolf, Noedir Antônio Groppo

Brazilian Journal of Cardiovascular Surgery

Journal Metrics
- Sobre o periódico
- SciELO Analytics

jun 2012, Volume 27 N. 2 Pages 290 - 295

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A mais comum indicação de correção cirúrgica de átrio esquerdo gigante está associada à insuficiência da valva mitral, com ou sem fibrilação atrial. Diversas técnicas para este fim já estão descritas com resultados variáveis. OBJETIVO: Apresentar a experiência inicial com a técnica da ressecção triangular tangencial (Pomerantzeff). MÉTODOS: De 2002 a 2010, quatro pacientes foram submetidos a operação da valva mitral com redução do volume do átrio esquerdo pela técnica da ressecção triangular tangencial em nosso serviço. Três pacientes eram do sexo feminino. A idade variou de 21 a 51 anos. Os quatro pacientes encontravam-se com fibrilação atrial. A fração de ejeção do ventrículo esquerdo no pré-operatório variava de 38% a 62%. O diâmetro do átrio esquerdo variou de 78 a 140 mm. Após o tratamento da disfunção mitral, o átrio esquerdo foi reduzido por meio de ressecção triangular tangencial da sua parede posterior, entre as veias pulmonares, para evitar distorções anatômicas do anel mitral ou veias pulmonares, reduzindo a tensão na linha de sutura. RESULTADOS: Tempo médio de internação hospitalar foi de 21,5 ± 6,5 dias. O tempo de circulação extracorpórea médio foi de 130 ± 30 minutos. Não houve sangramento cirúrgico ou mortalidade no período pós-operatório. Todos os pacientes tiveram o ritmo sinusal restabelecido na saída de circulação extracorpórea, mantendo esse ritmo no pós-operatório. O diâmetro médio do átrio esquerdo foi reduzido em 50,5 ± 19,5%. A fração de ejeção do ventrículo esquerdo melhorou em todas as pacientes. CONCLUSÃO: Os resultados iniciais com essa técnica têm demonstrado redução efetiva do átrio esquerdo.

INTRODUCTION: The most common indication for surgical correction of giant left atrium is associated with mitral valve insufficiency with or without atrial fibrillation. Several techniques for this purpose are already described with varying results. OBJECTIVE: To present the initial experience with the tangential triangular resection technique (Pomerantzeff). METHODS: From 2002 to 2010, four patients underwent mitral valve operation with reduction of left atrial volume by the technique of triangular resection tangential in our service. Three patients were female. The age ranged from 21 to 51 years old. The four patients presented with atrial fibrillation. Ejection fraction of left ventricle preoperatively ranged from 38% to 62%. The left atrial diameter ranged from 78mm to 140mm. After treatment of mitral dysfunction, the left atrium was reduced by resecting triangular tangential posterior wall between the pulmonary veins to avoid anatomic distortion of the mitral valve or pulmonary veins, reducing tension in the suture line. RESULTS: Average hospital stay was 21.5 ± 6.5 days. The mean cardiopulmonary bypass time was 130 ± 30 minutes. There was no surgical bleeding or mortality in the postoperative period. All patients had sinus rhythm restored in the output of cardiopulmonary bypass, maintaining this rate postoperatively. The average diameter of the left atrium was reduced by 50.5% ± 19.5%. The left ventricular ejection fraction improved in all patients. CONCLUSION: Initial results with this technique have shown effective reduction of the left atrium.

https://doi.org/10.5935/1678-9741.20120046 3060 downloads

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