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1.
IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva
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Tomazini, Bruno M
; Nassar Jr, Antonio Paulo
; Lisboa, Thiago Costa
; Azevedo, Luciano César Pontes de
; Veiga, Viviane Cordeiro
; Catarino, Daniela Ghidetti Mangas
; Fogazzi, Debora Vacaro
; Arns, Beatriz
; Piastrelli, Filipe Teixeira
; Dietrich, Camila
; Negrelli, Karina Leal
; Jesuíno, Isabella de Andrade
; Reis, Luiz Fernando Lima
; Mattos, Renata Rodrigues de
; Pinheiro, Carla Cristina Gomes
; Luz, Mariane Nascimento
; Spadoni, Clayse Carla da Silva
; Moro, Elisângela Emilene
; Bueno, Flávia Regina
; Sampaio, Camila Santana Justo Cintra
; Silva, Débora Patrício
; Baldassare, Franca Pellison
; Silva, Ana Cecilia Alcantara
; Veiga, Thabata
; Barbante, Leticia
; Lambauer, Marianne
; Campos, Viviane Bezerra
; Santos, Elton
; Santos, Renato Hideo Nakawaga
; Laranjeiras, Ligia Nasi
; Valeis, Nanci
; Santucci, Eliana
; Miranda, Tamiris Abait
; Patrocínio, Ana Cristina Lagoeiro do
; Carvalho, Andréa de
; Sousa, Eduvirgens Maria Couto de
; Sousa, Ancelmo Honorato Ferraz de
; Malheiro, Daniel Tavares
; Bezerra, Isabella Lott
; Rodrigues, Mirian Batista
; Malicia, Julliana Chicuta
; Silva, Sabrina Souza da
; Gimenes, Bruna dos Passos
; Sesin, Guilhermo Prates
; Zavascki, Alexandre Prehn
; Sganzerla, Daniel
; Medeiros, Gregory Saraiva
; Santos, Rosa da Rosa Minho dos
; Silva, Fernanda Kelly Romeiro
; Cheno, Maysa Yukari
; Abrahão, Carolinne Ferreira
; Oliveira Junior, Haliton Alves de
; Rocha, Leonardo Lima
; Nunes Neto, Pedro Aniceto
; Pereira, Valéria Chagas
; Paciência, Luis Eduardo Miranda
; Bueno, Elaine Silva
; Caser, Eliana Bernadete
; Ribeiro, Larissa Zuqui
; Fernandes, Caio Cesar Ferreira
; Garcia, Juliana Mazzei
; Silva, Vanildes de Fátima Fernandes
; Santos, Alisson Junior dos
; Machado, Flávia Ribeiro
; Souza, Maria Aparecida de
; Ferronato, Bianca Ramos
; Urbano, Hugo Corrêa de Andrade
; Moreira, Danielle Conceição Aparecida
; Souza-Dantas, Vicente Cés de
; Duarte, Diego Meireles
; Coelho, Juliana
; Figueiredo, Rodrigo Cruvinel
; Foreque, Fernanda
; Romano, Thiago Gomes
; Cubos, Daniel
; Spirale, Vladimir Miguel
; Nogueira, Roberta Schiavon
; Maia, Israel Silva
; Zandonai, Cassio Luis
; Lovato, Wilson José
; Cerantola, Rodrigo Barbosa
; Toledo, Tatiana Gozzi Pancev
; Tomba, Pablo Oscar
; Almeida, Joyce Ramos de
; Sanches, Luciana Coelho
; Pierini, Leticia
; Cunha, Mariana
; Sousa, Michelle Tereza
; Azevedo, Bruna
; Dal-Pizzol, Felipe
; Damasio, Danusa de Castro
; Bainy, Marina Peres
; Beduhn, Dagoberta Alves Vieira
; Jatobá, Joana D’Arc Vila Nova
; Moura, Maria Tereza Farias de
; Rego, Leila Rezegue de Moraes
; Silva, Adria Vanessa da
; Oliveira, Luana Pontes
; Sodré Filho, Eliene Sá
; Santos, Silvana Soares dos
; Neves, Itallo de Lima
; Leão, Vanessa Cristina de Aquino
; Paes, João Lucidio Lobato
; Silva, Marielle Cristina Mendes
; Oliveira, Cláudio Dornas de
; Santiago, Raquel Caldeira Brant
; Paranhos, Jorge Luiz da Rocha
; Wiermann, Iany Grinezia da Silva
; Pedroso, Durval Ferreira Fonseca
; Sawada, Priscilla Yoshiko
; Prestes, Rejane Martins
; Nascimento, Glícia Cardoso
; Grion, Cintia Magalhães Carvalho
; Carrilho, Claudia Maria Dantas de Maio
; Dantas, Roberta Lacerda Almeida de Miranda
; Silva, Eliane Pereira
; Silva, Antônio Carlos da
; Oliveira, Sheila Mara Bezerra de
; Golin, Nicole Alberti
; Tregnago, Rogerio
; Lima, Valéria Paes
; Silva, Kamilla Grasielle Nunes da
; Boschi, Emerson
; Buffon, Viviane
; Machado, André Sant’Ana
; Capeletti, Leticia
; Foernges, Rafael Botelho
; Carvalho, Andréia Schubert de
; Oliveira Junior, Lúcio Couto de
; Oliveira, Daniela Cunha de
; Silva, Everton Macêdo
; Ribeiro, Julival
; Pereira, Francielle Constantino
; Salgado, Fernanda Borges
; Deutschendorf, Caroline
; Silva, Cristofer Farias da
; Gobatto, Andre Luiz Nunes
; Oliveira, Carolaine Bomfim de
; Dracoulakis, Marianna Deway Andrade
; Alvaia, Natália Oliveira Santos
; Souza, Roberta Machado de
; Araújo, Larissa Liz Cardoso de
; Melo, Rodrigo Morel Vieira de
; Passos, Luiz Carlos Santana
; Vidal, Claudia Fernanda de Lacerda
; Rodrigues, Fernanda Lopes de Albuquerque
; Kurtz, Pedro
; Shinotsuka, Cássia Righy
; Tavares, Maria Brandão
; Santana, Igor das Virgens
; Gavinho, Luciana Macedo da Silva
; Nascimento, Alaís Brito
; Pereira, Adriano J
; Cavalcanti, Alexandre Biasi
.
ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.
RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.
2.
Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021
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Nicolau, José Carlos
; Feitosa Filho, Gilson Soares
; Petriz, João Luiz
; Furtado, Remo Holanda de Mendonça
; Précoma, Dalton Bertolim
; Lemke, Walmor
; Lopes, Renato Delascio
; Timerman, Ari
; Marin Neto, José A.
; Bezerra Neto, Luiz
; Gomes, Bruno Ferraz de Oliveira
; Santos, Eduardo Cavalcanti Lapa
; Piegas, Leopoldo Soares
; Soeiro, Alexandre de Matos
; Negri, Alexandre Jorge de Andrade
; Franci, Andre
; Markman Filho, Brivaldo
; Baccaro, Bruno Mendonça
; Montenegro, Carlos Eduardo Lucena
; Rochitte, Carlos Eduardo
; Barbosa, Carlos José Dornas Gonçalves
; Virgens, Cláudio Marcelo Bittencourt das
; Stefanini, Edson
; Manenti, Euler Roberto Fernandes
; Lima, Felipe Gallego
; Monteiro Júnior, Francisco das Chagas
; Correa Filho, Harry
; Pena, Henrique Patrus Mundim
; Pinto, Ibraim Masciarelli Francisco
; Falcão, João Luiz de Alencar Araripe
; Sena, Joberto Pinheiro
; Peixoto, José Maria
; Souza, Juliana Ascenção de
; Silva, Leonardo Sara da
; Maia, Lilia Nigro
; Ohe, Louis Nakayama
; Baracioli, Luciano Moreira
; Dallan, Luís Alberto de Oliveira
; Dallan, Luis Augusto Palma
; Mattos, Luiz Alberto Piva e
; Bodanese, Luiz Carlos
; Ritt, Luiz Eduardo Fonteles
; Canesin, Manoel Fernandes
; Rivas, Marcelo Bueno da Silva
; Franken, Marcelo
; Magalhães, Marcos José Gomes
; Oliveira Júnior, Múcio Tavares de
; Filgueiras Filho, Nivaldo Menezes
; Dutra, Oscar Pereira
; Coelho, Otávio Rizzi
; Leães, Paulo Ernesto
; Rossi, Paulo Roberto Ferreira
; Soares, Paulo Rogério
; Lemos Neto, Pedro Alves
; Farsky, Pedro Silvio
; Cavalcanti, Rafael Rebêlo C.
; Alves, Renato Jorge
; Kalil, Renato Abdala Karam
; Esporcatte, Roberto
; Marino, Roberto Luiz
; Giraldez, Roberto Rocha Corrêa Veiga
; Meneghelo, Romeu Sérgio
; Lima, Ronaldo de Souza Leão
; Ramos, Rui Fernando
; Falcão, Sandra Nivea dos Reis Saraiva
; Dalçóquio, Talia Falcão
; Lemke, Viviana de Mello Guzzo
; Chalela, William Azem
; Mathias Júnior, Wilson
.
https://doi.org/10.36660/abc.20210180
3052 downloads
3.
Oral Use of Phenytoin to Reduce Calcification in Bovine Pericardium and Porcine Aortic Leaflets Implants in Rats
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Arruda Filho, Mauro Barbosa
; Aguiar, Lamartine Daniel
; Marques, Silvio Romero de Barros
; Cavalcanti, Luiz Rafael Pereira
; Sá, Michel Pompeu B. O.
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Introduction: This study aims to test the effect of phenytoin as an inhibitor of the process of dystrophic calcification in bovine pericardium and porcine leaflets implanted in the subcutaneous tissue of rats. Methods: Isolated segments of biomaterials were implanted subcutaneously in young rats. The study groups received 500 mg phenytoin per kilogram of diet per day. After 90 days, samples were collected and quantitative calcification assessment by optical microscopy, radiological studies with mammography, and atomic emission spectrometry were performed. Results: Inflammatory reaction was a frequent finding in all groups when analyzed by optical microscopy. The calcium level assessed by atomic absorption spectrophotometry was significantly lower in the study groups using phenytoin compared to the control groups (control bovine pericardium group X=0.254±0.280 µg/mg; study bovine pericardium group X=0.063±0.025 µg/mg; control porcine aortic leaflets group X=0.640±0.226 µg/mg; study porcine aortic leaflets group X=0.056±0.021 µg/mg; P<0.05). Radiologic studies revealed a statistically significant difference between the groups treated with and without phenytoin (not only regarding the bovine pericardium but also the porcine leaflets). Conclusion: The results obtained suggest that phenytoin reduces the calcification process of bovine pericardium segments and porcine aortic leaflets in subdermal implants in rats; also, the incidence of calcification in bovine pericardium grafts was similar to that of porcine aortic leaflets.
https://doi.org/10.21470/1678-9741-2020-0252
67 downloads
4.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
5.
Coronary Artery Bypass Graft Surgery Improves Survival Without Increasing the Risk of Stroke in Patients with Ischemic Heart Failure in Comparison to Percutaneous Coronary Intervention: A Meta-Analysis With 54,173 Patients
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Sá, Michel Pompeu Barros Oliveira
; Perazzo, Álvaro Monteiro
; Saragiotto, Felipe Augusto Santos
; Cavalcanti, Luiz Rafael Pereira
; Almeida Neto, Antônio Carlos Escorel
; Campos, Jéssica Cordeiro Siqueira
; Braga, Paulo Guilherme Bezerra
; Rayol, Sérgio da Costa
; Diniz, Roberto Gouvea Silva
; Sá, Frederico Browne Correia Araújo
; Lima, Ricardo Carvalho
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Objective: To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF). Methods: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke. Results: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459). Conclusion: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke.
https://doi.org/10.21470/1678-9741-2019-0170
574 downloads
6.
Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients
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Sá, Michel Pompeu Barros Oliveira
; Cavalcanti, Luiz Rafael Pereira
; Sarargiotto, Felipe Augusto Santos
; Perazzo, Álvaro Monteiro
; Rayol, Sérgio da Costa
; Diniz, Roberto Gouveia Silva
; Sá, Frederico Browne Correia Araújo
; Menezes, Alexandre Motta
; Lima, Ricardo Carvalho
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Objectives: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). Methods: Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. Results: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). Conclusion: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.
https://doi.org/10.21470/1678-9741-2019-0073
453 downloads
7.
Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement: Neither Uncommon nor Harmless
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Rayol, Sérgio da Costa
; Sá, Michel Pompeu Barros Oliveira
; Cavalcanti, Luiz Rafael Pereira
; Saragiotto, Felipe Augusto Santos
; Diniz, Roberto Gouvea Silva
; Sá, Frederico Browne Correia de Araujo e
; Menezes, Alexandre Motta
; Silva, Frederico Pires Vasconcelos
; Lima, Ricardo Carvalho
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.
https://doi.org/10.21470/1678-9741-2019-0008
734 downloads
8.
Prosthesis-Patient Mismatch Negatively Affects Outcomes after Mitral Valve Replacement: Meta-Analysis of 10,239 Patients
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Sá, Michel Pompeu Barros Oliveira
; Cavalcanti, Luiz Rafael Pereira
; Rayol, Sérgio da Costa
; Diniz, Roberto Gouvea Silva
; Menezes, Alexandre Motta
; Clavel, Marie-Annick
; Pibarot, Philippe
; Lima, Ricardo Carvalho
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Objective: This study sought to evaluate the impact of prosthesis-patient mismatch on the risk of perioperative and long-term mortality after mitral valve replacement. Methods: Databases were researched for studies published until December 2018. Main outcomes of interest were perioperative and 10-year mortality and echocardiographic parameters. Results: The research yielded 2,985 studies for inclusion. Of these, 16 articles were analyzed, and their data extracted. The total number of patients included was 10,239, who underwent mitral valve replacement. The incidence of prosthesis-patient mismatch after mitral valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and 4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI 1.194-1.931, P<0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P<0.001) mortality was increased in patients with prosthesis-patient mismatch. Patients with prosthesis-patient mismatch after mitral valve replacement had higher systolic pulmonary artery pressure and transprosthethic gradient and lower indexed effective orifice area and left ventricle ejection fraction. Conclusion: Prosthesis-patient mismatch increases perioperative and long-term mortality. Prosthesis-patient mismatch is also associated with pulmonary hypertension and depressed left ventricle systolic function. The findings of this study support the implementation of surgical strategies to prevent prosthesis-patient mismatch in order to decrease mortality rates.
https://doi.org/10.21470/1678-9741-2019-0069
630 downloads
9.
Current Practice of State-of-the-Art Coronary Revascularization in Patients with Heart Failure
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Rayol, Sérgio Costa
; Sá, Michel Pompeu Barros Oliveira
; Cavalcanti, Luiz Rafael Pereira
; Saragiotto, Felipe Augusto Santos
; Diniz, Roberto Gouvea Silva
; Sá, Frederico Browne Correia de Araújo e
; Menezes, Alexandre Motta de
; Lima, Ricardo Carvalho
.
Abstract The best treatment for patients with ischemic heart failure (HF) is still on debate. There is growing evidence that coronary artery bypass graft (CABG) benefits these patients. The current recommendations for revascularization in this context are that CABG is reasonable when it comes to decreasing morbidity and mortality rates for patients with severe left ventricular dysfunction (ejection fraction <35%), and significant coronary artery disease (CAD) and should be considered in patients with operable coronary anatomy, regardless whether or not there is a viable myocardium (class IIb). Percutaneous coronary intervention (PCI) does not have enough data to allow the panels to reach a conclusion. The Korean Acute Heart Failure registry (KorAHF) had its data released recently, showing that patients with acute HF who underwent CABG had lower death rates, more complete revascularization and less adverse outcomes compared with patients treated with PCI. Recent ESC/EACTS guidelines on myocardial revascularization clearly recommended CABG as the first choice of revascularization strategy in patients with multivessel disease and acceptable surgical risk to improve prognosis in this scenario of left ventricular dysfunction. However, a high peri-procedural risk must be compared with the benefit of late mortality, and pros and cons of each strategy (either PCI or CABG) must be weighed in the decision-making process. Spurred on by the publication of the above-mentioned article and the release of new guidelines, we went on to write an overview of the current practice of state-of-the-art coronary revascularization options in patients with HF.
https://doi.org/10.21470/1678-9741-2018-0335
1191 downloads
10.
Updated Meta-analysis on the Closure of Patent Foramen Ovale in Reduction of Stroke Rates: the DEFENSE-PFO Trial Does not Change the Scenario
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Sá, Michel Pompeu Barros Oliveira
; Vieira, Erik Everton Silva
; Cavalcanti, Luiz Rafael Pereira
; Diniz, Roberto Gouveia Silva
; Rayol, Sérgio da Costa
; Menezes, Alexandre Motta de
; Lins, Ricardo Felipe de Albuquerque
; Lima, Ricardo Carvalho
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Objective: We aimed to analyze whether patent foramen ovale (PFO) closure reduces the risk of stroke, assessing also some safety outcomes after the publication of a new trial. Introduction: The clinical benefit of closing a PFO has been an open question, so it is necessary to review the current state of published medical data in regards to this subject. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were used to search for randomized controlled trials (RCTs) that reported any of the following outcomes: stroke, death, major bleeding or atrial fibrillation. Six studies fulfilled our eligibility criteria and included 3560 patients (1889 for PFO closure and 1671 for medical therapy. Results: The risk ration (RR) for stroke in the “closure” group compared with the “medical therapy” showed a statistically significant difference between the groups, favouring the “closure” group (RR 0.366; 95%CI 0.171–0.782, P=0.010). There was no statistically significant difference between the groups regarding the safety outcomes, death and major bleeding, but we observed an increase in the risk of atrial fibrillation in the “closure” group (RR 4.131; 95%CI 2.293–7.443, P<0.001). We also observed that the larger the proportion of effective closure, the lower the risk of stroke. Conclusion: This meta-analysis found that stroke rates are lower with percutaneously implanted device closure than with medical therapy alone, being these rates modulated by the rates of hypertension, atrial septal aneurysm and effective closure. The publication of a new trial did not change the scenario in the medical literature.
https://doi.org/10.21470/1678-9741-2018-0194
862 downloads
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