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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 Nº 6 elocation e20230015

Resumo: En | Texto: 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 Nº 5 Páginas 78 - 86

Resumo: En | Texto: 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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Set 2021, Volume 117 Nº 3 Páginas 424 - 425

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

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

Atualização das Diretrizes Brasileiras de Valvopatias – 2020
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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

; Santis, Antonio de

; Fernandes, João Ricardo Cordeiro

; Pires, Lucas José Tachotti

; Spina, Guilherme S.

; Vieira, Marcelo Luiz Campos

; Lavitola, Paulo de Lara

; Ávila, Walkiria Samuel

; Paixão, Milena Ribeiro

; Bignoto, Tiago

; Togna, Dorival Júlio Della

; Mesquita, Evandro Tinoco

; Esteves, William Antônio de Magalhães

; Atik, Fernando

; Colafranceschi, Alexandre Siciliano

; Moises, Valdir Ambrósio

; Kiyose, Alberto Takeshi

; Pomerantzeff, Pablo M. A.

; Lemos, Pedro A.

; Brito Junior, Fabio Sandoli de

; Weksler, Clara

; Brandão, Carlos Manuel de Almeida

; Poffo, Robinson

; Simões, Ricardo

; Rassi, Salvador

; Leães, Paulo Ernesto

; Mourilhe-Rocha, Ricardo

; Pena, José Luiz Barros

; Jatene, Fabio Biscegli

; Barbosa, Márcia de Melo

; Abizaid, Alexandre

; Ribeiro, Henrique Barbosa

; Bacal, Fernando

; Rochitte, Carlos Eduardo

; Fonseca, José Honório de Almeida Palma da

; Ghorayeb, Samira Kaissar Nasr

; Lopes, Marcelo Antonio Cartaxo Queiroga

; Spina, Salvador Vicente

; Pignatelli, Ricardo H.

; Saraiva, José Francisco Kerr

Arquivos Brasileiros de Cardiologia

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Out 2020, Volume 115 Nº 4 Páginas 720 - 775

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20201047 17824 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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Mai 2020, Volume 114 Nº 5 Páginas 849 - 942

Resumo: Pt En | Texto: 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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Abr 2020, Volume 114 Nº 4 Páginas 603 - 612

Resumo: Pt En | Texto: 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

Cardiac Magnetic Resonance Analysis of Mitral Annular Dynamics after Mitral Valve Repair
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Abdouni, Ahmad A.

; Brandão, Carlos M.A.

; Rochitte, Carlos E.

; Pomerantzeff, Pablo M.A.

; Veronese, Elinthon T.

; Pacheco, Ariane B.

; Santis, Antonio S.

; Tarasoutchi, Flávio

; Jatene, Fábio B.

Clinics

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2020, Volume 75 elocation e2428

Resumo: En | Texto: En | PDF: En

OBJECTIVES: The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR). METHODS: Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively. RESULTS: We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28±1.95 cm to 11.50±1.59 cm, and the diastolic circumference was reduced from 12.51±2.01 cm to 10.66±2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p<0.001). The mean maximum area of the MA was significantly reduced from 14.34±4.03 to 10.45±3.17 cm2 when comparing the immediate postoperative period and the 2 year follow-up (p<0.001). The same occurred with the mean minimum area of the MA, which was reduced from 12.53±3.68 cm2 to 9.23±2.84 cm2 in the same period, and this reduction was greater in the antero-posterior diameter than in the mid-lateral diameter. The mobility of the MA was preserved after surgery, ranging between 19.6% and 25.7% at 2-year follow-up. CONCLUSION: We observed a significant reduction in the MA size after MVR, with preservation of the MA mobility at the 2-year follow-up.

https://doi.org/10.6061/clinics/2020/e2428 132 downloads

Quadricuspid Aortic Valve: Three Cases Report and Literature Review
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Veronese, Elinthon Tavares

; Brandão, Carlos Manuel de Almeida

; Steffen, Samuel Padovani

; Pomerantzeff, Pablo

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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Out 2019, Volume 34 Nº 5 Páginas 637 - 639

Resumo: En | Texto: En | PDF: En

Abstract Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[1], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.

https://doi.org/10.21470/1678-9741-2018-0125 257 downloads

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

Arquivos Brasileiros de Cardiologia

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Out 2019, Volume 113 Nº 4 Páginas 757 - 757

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

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

10.

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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Dez 2018, Volume 33 Nº 6 Páginas 618 - 625

Resumo: En | Texto: 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

11.

Thrombocytopenia After Transcatheter Valve-in-Valve Implantation: Prognostic Marker or Mere Finding?
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Souza, Renato C. de

; Paim, Leonardo

; Viotto, Guilherme

; Aprigio, Joaquim

; Araújo, Lucas L.

; Ribeiro, Henrique

; Sampaio, Roney O.

; Tarasoutchi, Flavio

; Pomerantzeff, Pablo M. A.

; Palma, José Honório

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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Ago 2018, Volume 33 Nº 4 Páginas 362 - 370

Resumo: En | Texto: En | PDF: En

Abstract Objective: To analyze the behavior of platelets after transcatheter valve-in-valve implantation for the treatment of degenerated bioprosthesis and how they correlate with adverse events upon follow-up. Methods: Retrospective analysis of 28 patients who received a valve-in-valve implant, 5 in aortic, 18 in mitral and 5 in tricuspid positions. Data were compared with 74 patients submitted to conventional redo valvular replacements during the same period, and both groups' platelet curves were analyzed. Statistical analysis was conducted using the IBM SPSS Statistics(r) 20 for Windows. Results: All patients in the valve-in-valve group developed thrombocytopenia, 25% presenting mild (<150.000/µL), 54% moderate (<100.000/µL) and 21% severe (<50.000/µL) thrombocytopenia. The platelet nadir was on the 4th postoperative day for aortic ViV, 2nd for mitral and 3rd for tricuspid patients, with the majority of patients recovering regular platelet count. However, the aortic subgroup comparison between valve-in-valve and conventional surgery showed a statistically significant difference from the 7th day onwards, where valve-in-valve patients had more severe and longer lasting thrombocytopenia. This, however, did not translate into a higher postoperative risk. In our study population, postoperative thrombocytopenia did not correlate with greater occurrence of adverse outcomes and only normal preoperative platelet count could significantly predict a postoperative drop >50%. Conclusion: Although thrombocytopenia is an extremely common finding after valve-in-valve procedures, the degree of platelet count drop did not correlate with greater incidence of postoperative adverse outcomes in our study population.

https://doi.org/10.21470/1678-9741-2018-0078 823 downloads

12.

Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery?
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Arthur, Camila P. S.

; Mejia, Omar A. V.

; Osternack, Diogo

; Nakazone, Marcelo Arruda

; Goncharov, Maxim

; Lisboa, Luiz A. F.

; Dallan, Luís A. O.

; Pomerantzeff, Pablo M. A.

; Jatene, Fabio B.

Arquivos Brasileiros de Cardiologia

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Out 2017, Volume 109 Nº 4 Páginas 290 - 298

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamentos: Disfunção renal é preditor independente de morbimortalidade após cirurgia cardíaca. Para uma melhor avaliação da função renal, o cálculo do clearance de creatinina (CC) pode ser necessário. Objetivo: Avaliar objetivamente se o CC é melhor que a creatinina sérica (CS) para predizer risco nos pacientes submetidos à cirurgia cardíaca. Métodos: Análise em 3285 pacientes do Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) incluídos de forma prospectiva, consecutiva e mandatória entre novembro de 2013 e janeiro de 2015. Foram obtidos valores de CS, CC (Cockcroft-Gault) e do EuroSCORE II. Análise de associações da CS e do CC com morbimortalidade foi realizada mediante testes de calibração e discriminação. Por regressão logística múltipla, foram criados modelos multivariados independentes com CS e com CC para predição de risco de morbimortalidade após cirurgia cardíaca. Resultados: Apesar da associação entre a CS e morbimortalidade, essa não calibrou adequadamente os grupos de risco. Houve associação entre o CC e morbimortalidade com boa calibração dos grupos de risco. Na predição do risco de mortalidade, a CS ficou descalibrada com valores >1,35 mg/dL (p < 0,001). A curva ROC revelou que o CC é superior à CS na predição de risco de morbimortalidade. No modelo multivariado sem CC, a CS foi a única preditora de morbidade, enquanto que no modelo sem a CS, o CC foi preditor de mortalidade e o único preditor de morbidade. Conclusão: Para avaliação da função renal, o CC é superior que a CS na estratificação de risco dos pacientes submetidos a cirurgia cardíaca.

Abstract Background: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. Objective: To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery. Methods: Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery. Results: Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor. Conclusion: Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.

https://doi.org/10.5935/abc.20170129 996 downloads

13.

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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Out 2017, Volume 32 Nº 5 Páginas 438 - 441

Resumo: En | Texto: 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

14.

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 Nº 6 Páginas 1 - 34

Resumo: Pt | Texto: Pt | PDF: Pt

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

15.

EuroSCORE II and STS as mortality predictors in patients undergoing TAVI
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Rosa, Vitor Emer Egypto

; Lopes, Antonio Sergio de Santis Andrade

; Accorsi, Tarso Augusto Duenhas

; Fernandes, João Ricardo Cordeiro

; Spina, Guilherme Sobreira

; Sampaio, Roney Orismar

; Paixão, Milena Ribeiro

; Pomerantzeff, Pablo Maria

; Lemos Neto, Pedro Alves

; Tarasoutchi, Flávio

Revista da Associação Médica Brasileira

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Fev 2016, Volume 62 Nº 1 Páginas 32 - 37

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: STS e EuroSCORE II são os escores mais utilizados para a estratificação de risco cirúrgico e indicação do implante de válvula aórtica transcateter (TAVI). Entretanto, seu papel como ferramenta para predição de mortalidade em pacientes submetidos ao TAVI ainda é incerto. Objetivo: avaliar o desempenho do EuroSCORE II e STS como preditores de mortalidade intra-hospitalar em 30 dias em pacientes submetidos ao TAVI. Métodos: 59 pacientes com estenose aórtica importante submetidos ao TAVI entre 2010 e 2014. Variáveis foram analisadas por meio do teste t-Student e teste exato de Fisher, e o poder discriminativo foi avaliado pela curva ROC e área sob a curva, acompanhada de intervalo de confiança de 95%. Resultados: a idade média foi de 81±7,3 anos, 42,3% homens. Média do EuroSCORE II foi de 6,07±7,3%, e do STS, 20,7±10,3%. Procedimento transfemoral foi realizado em 88,13%, transapical, em 3,38% e transaórtico, em 8,47%. A mortalidade intra-hospitalar foi 10,1%, e em 30 dias, 13,5%. Os pacientes que evoluíram para óbito apresentavam STS e EuroSCORE II mais elevados que os sobreviventes (33,7±16,7% vs. 18,6±7,3%; p=0,0001 para STS e 13,9±16,1% vs. 4,8±3,8%; p=0,0007 para EuroSCORE II). O STS apresentou AUC de 0,81, e o EuroSCORE II, 0,77. Não houve diferença na capacidade de discriminação pelas curvas ROC (p=0,72). Conclusão: STS e EuroSCORE II foram preditores de mortalidade intra-hospitalar em 30 dias.

SUMMARY Introduction: the EuroSCORE II and STS are the most used scores for surgical risk stratification and indication of transcatheter aortic valve implantation (TAVI). However, its role as a tool for mortality prediction in patients undergoing TAVI is still unclear. Objective: to evaluate the performance of the EuroSCORE II and STS as predictors of in-hospital and 30-day mortality in patients undergoing TAVI. Methods: we included 59 symptomatic patients with severe aortic stenosis that underwent TAVI between 2010 and 2014. The variables were analyzed using Student's t-test and Fisher's exact test and the discriminative power was evaluated using receiver operating characteristic curve (ROC) and area under the curve (AUC) with a 95% confidence interval. Results: mean age was 81±7.3 years, 42.3% men. The mean EuroSCORE II was 7.6±7.3 % and STS was 20.7±10.3%. Transfemoral procedure was performed in 88.13%, transapical in 3.38% and transaortic in 8.47%. In-hospital mortality was 10.1% and 30-day mortality was 13.5%. Patients who died had EuroSCORE II and STS higher than the survivors (33.7±16.7vs. 18.6±7.3% p=0,0001 for STS and 13.9±16.1 vs. 4.8±3.8% p=0.0007 for EuroSCORE II). The STS showed an AUC of 0.81 and the EuroSCORE II of 0.77 and there were no differences in the discrimination ability using ROC curves (p=0.72). Conclusion: in this cohort, the STS and EuroSCORE II were predictors of in-hospital and 30-days mortality in patients with severe aortic stenosis undergoing TAVI.

https://doi.org/10.1590/1806-9282.62.01.32 5861 downloads

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