ANTONIO ESTEVES FILHO
Índice h a partir de 2011
5
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
conferenceObject Head-to-head comparison between coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS) tridimensional models: a geometric point of view(2016) BEZERRA, Cristiano G.; TALOU, Gonzalo Maso; BULANT, Carlos A.; MARIANI JR., Jose; PINTON, Fabio A.; FALCAO, Breno A. A.; FILHO, Antonio E.; FEIJOO, Raul A.; LEMOS, Pedro A.; BLANCO, Pablo J.- Remoção Precoce do Introdutor Arterial Após Intervenção Coronária Percutânea por Via Femoral: Estudo de Segurança e Eficácia(2014) ZAGO, Gabriel; TRENTIN, Fabio; PRADO JR., Guy F. A.; SPADARO, Andre Gasparini; SILVA, Expedito Eustáquio Ribeiro da; CAMPOS, Carlos Magalhães; PERIN, Marco Antonio; FALCÃO, Breno de Alencar Araripe; ESTEVES-FILHO, Antonio; KAJITA, Luiz Junya; GAMA, Marcus Nogueira da; MARCHIORI, Gilberto; HORTA, Pedro Eduardo; TAKIMURA, Celso Kiyochi; MARIANI JR., Jose; GALON, Micheli Zanotti; SOARES, Paulo Rogerio; ZALC, Silvio; KALIL-FILHO, Roberto; LEMOS NETO, Pedro AlvesIntroduction: We evaluated the safety and efficacy of protamine administration, guided by activated clotting time, for the immediate femoral arterial sheath removal in patients undergoing percutaneous coronary intervention with unfractionated heparin in order to propose an algorithm for clinical practice. Methods: Prospective study with consecutive patients with stable angina or low-to-moderate risk acute coronary syndrome. We compared patients with an early removal of the arterial sheath to those whose sheath removal was based on a standard protocol. Results: The early removal group (n = 149) had lower access manipulation time than the conventional group (58.3 ± 21.4 minutes vs. 355.0 ± 62.9 minutes; p < 0.01), mainly due to a reduced time to sheath removal (42.3 ± 21.1 minutes vs. 338.6 ± 61.5 minutes; p < 0.01), with no impact on the duration of femoral compression (16.0 ± 3.6 minutes vs. 16.4 ± 5.1 minutes; p = 0.49). There was no stent thrombosis during hospitalization and no significant differences in the incidence of major vascular or bleeding events. The incidence of other bleeding events leading to a prolonged in-hospital length of stay was lower in the early removal group (1.3% vs. 5.1%; p = 0.05). Conclusions: The selective use of an approach for immediate femoral sheath removal, based on activated clotting time guidance and protamine administration, is a safe and effective option in patients undergoing percutaneous coronary intervention by femoral access.
- Renal denervation in patients with heart failure secondary to Chagas' disease: A pilot randomized controlled trial(2019) SPADARO, Andre G.; BOCCHI, Edimar A.; SOUZA, Germano E.; FILHO, Antonio E.; MARIANI JR., Jose; CAMPOS, Carlos M.; LEMOS, Pedro A.Introduction Chagas disease is one of the most relevant endemic parasitic diseases in Latin America, affecting approximately 6 million people. Overt Chagas heart disease is an ominous condition, occurring in 20-30% of infected individuals, which has besides the persistent myocarditis a peculiar intracardiac ganglionic neuronal depletion and dysautonomy. This study aims to evaluate the safety and feasibility of renal denervation for patients with advanced symptomatic Chagas cardiomyopathy. Methods Open-label prospective pilot study that randomized patients with Chagas heart disease to either renal denervation or conservative treatment (2:1 ratio). The primary endpoint was the incidence of major adverse events at 9 months, defined as a composite of all-cause death, myocardial infarction, stroke, need for renal artery invasive treatment, or worsening renal function. Results A total of 17 patients were allocated for renal denervation (n = 11) or conservative treatment (n = 6). Included patients had severe symptomatic heart disease, with markedly depressed left ventricular function (average ejection fraction 26.7 +/- 4.9%). For patients randomized to renal denervation, the procedure was performed successfully and uneventfully. After 9 months, the primary endpoint occurred in 36.4% of patients in the renal denervation group and 50.0% in the control arm (p = .6). After 9 months, clinical, laboratory, functional, echocardiographic, and quality of life parameters were similar between groups. Conclusions This pilot study suggests that renal denervation is safe and feasible in patients with Chagas cardiomyopathy, warranting future studies to better evaluate the clinical efficacy of the interventional strategy in improving the prognosis of this high-risk population.
- Type 4 Dual Left Anterior Descending Artery: A Very Rare Coronary Anomaly Circulation(2015) OLIVEIRA, Marcos Danillo Peixoto; MELO, Pedro H. M. Craveiro de; ESTEVES FILHO, Antonio; KAJITA, Luiz J.; RIBEIRO, Expedito E.; LEMOS, Pedro AlvesCoronary artery anomalies are congenital changes in their origin, course, and/or structure. They are the second most frequent cause of sudden death in young athletes. Dual LAD artery is a rare coronary anomaly. We present the case of a 44-year-old man with recent onset exertional angina and documented ischemia whose coronary angiogramand computed tomography (CT) showed type 4 dual LAD artery, the rarest and most interesting variant.
- Denervação simpática renal percutânea(2013) BERNARDI, Fernando Luiz de Melo; GOMES, Wilton Francisco; SPADARO, André Gasparini; ESTEVES FILHO, Antônio; BORTOLOTTO, Luiz Aparecido; SCANAVACCA, Maurício Ibrahim; LEMOS, Pedro AlvesArterial hypertension is a highly prevalent disease and is associated with increased cardiovascular risk. Despite great advances in drug therapy, a considerable number of patients do not have an effective control of the disease, despite the use of multiple drugs, usually in high doses. Renal sympathetic denervation (RSD) has proved to be a promising therapy, with high safety and efficacy in preliminary studies in patients with resistant hypertension. The role of sympathetic nervous system in the physiopathology of hypertension is well known and is the rationale for the ablation of sympathetic fibers by transluminal delivery of radiofrequency in the renal arteries. In the last few years, results from case series, non-controlled studies and one multicenter randomized trial with a limited number of patients have shown a significant decrease in short and mid-term blood pressure levels. The objective of this review was to gather evidence on the use of RSD in the control of resistant hypertension and describe technical aspects and perspectives of the procedure.
- Valvuloplastia aórtica por cateter balão na estenose aórtica degenerativa: impacto terapêutico em pacientes em condição clínica in extremis(2013) VAHLE, Vitor de Andrade; PINTON, Fábio Augusto; MELO, Eduardo França Pessoa de; BEZERRA, Cristiano Guedes; PERIN, Marco Antônio; ARRIETA, Santiago Raul; KAJITA, Luiz Junya; MARIANI JUNIOR, José; ESTEVES FILHO, Antônio; SILVA, Expedito Eustáquio Ribeiro da; TARASOUTCHI, Flávio; GRINBERG, Max; LEMOS NETO, Pedro AlvesBACKGROUND: Balloon aortic valvuloplasty (BAV) is used as a palliative strategy in patients who are not eligible for valve replacement surgery, transcatheter aortic valve implantation, or as a bridge to these treatment modalities. The impact of BAV as a salvage procedure for patients in extreme clinical conditions (in extremis) is unknown. METHODS: Patients with severe degenerative aortic stenosis undergoing BAV between July 2008 and January 2013 were evaluated. Patients were divided into the in-extremis group (defined by the presence of two or more of the following organ dysfunctions: mechanical ventilation, hemodynamic instability, dialysis, coagulopathy or severe hepatic dysfunction) and the control group, which included the remaining patients. RESULTS: A total of 19 patients underwent BAV. The clinical condition in-extremis was present in 42.1% of them. Patients from the in-extremis group had a higher EUROSCORE II (41.1 ± 24.7 vs. 15.9 ± 14.0; P = 0.001) and LV ejection fraction lower than the control group (33.9 ± 17.3% vs. 49.0 ± 12.5; P = 0.04). None of the patients in the in-extremis group survived past the hospitalization period, whereas the control group mortality was 27.3% (P < 0.01). CONCLUSIONS: BAV has an unfavorable result in patients with severe degenerative aortic stenosis with two or more organ dysfunctions, that is, patients in extremis.
- Injeção de trombina guiada por ultrassom no tratamento de pseudoaneurisma da artéria femoral após procedimento percutâneo em pacientes com síndrome coronária aguda(2013) PINTON, Fábio Augusto; SPÓSITO, Alexandre Russo; VAHLE, Vitor de Andrade; SOARES, Paulo Rogério; ZALC, Silvio; PERIN, Marco Antonio; SILVA, Expedito Eustáquio Ribeiro da; ESTEVES FILHO, Antonio; LEMOS NETO, Pedro AlvesBACKGROUND: Ultrasound-guided thrombin injection (TI) is an option for the treatment of femoral artery pseudoaneurysm. Nevertheless, the result of this technique in patients with acute coronary syndrome (ACS) may be compromised by the use of antithrombotic drugs. In addition, thrombin extravasation to systemic circulation could potentially cause an increase in thromboembolic events. METHODS: Patients admitted with ACS who developed femoral artery pseudoaneurysm after a percutaneous procedure and treated by TI between January 2007 and July 2011 were included. Clinical and laboratory characteristics, treatment results and complications were evaluated. RESULTS: We evaluated 23 patients with mean age of 67.1 ± 14.2 years, 60.9% were women, with body mass index of 28.4 ± 4.7 kg/m² and 52.2% were diabetics. At presentation, 87% had non-ST elevation ACS and the remaining had ST elevation myocardial infarction. Of the evaluated patients, 70% were submitted to percutaneous coronary intervention. All patients were receiving aspirin, 78.3% used P2Y12 inhibitors and 39.1% used glycoprotein IIb/IIIa inhibitors. TI was successful in occluding the pseudoaneurysm in 100% of cases (96.7% after the first injection), without distal embolization, local infection or need of surgical correction. There were no cases of myocardial infarction, stroke or unscheduled revascularization. There was one death due to cardiogenic shock 22 days after TI, on the second post-operative day after an elective coronary artery bypass graft surgery. CONCLUSIONS: Treatment of femoral artery pseudoaneurysm by TI is a safe and effective procedure in patients with ACS.
- Residual aortic regurgitation is a major determinant of late mortality after transcatheter aortic valve implantation(2012) LEMOS, Pedro A.; SAIA, Francesco; MARIANI JR., Jose; MARROZZINI, Cinzia; ESTEVES FILHO, Antonio; KAJITA, Luiz J.; CIUCA, Cristina; TAGLIERI, Nevio; BORDONI, Barbara; MORETTI, Carolina; PALMERINI, Tullio; DRACOULAKIS, Marianna D. A.; JATENE, Fabio B.; KALIL-FILHO, Roberto; MARZOCCHI, Antonio
- Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? Analysis of 568 Patients(2015) TRUFFA, Marcio A. M.; ALVES, Gustavo M. P.; BERNARDI, Fernando; ESTEVES FILHO, Antonio; RIBEIRO, Expedito; GALON, Micheli Z.; SPADARO, Andre; KAJITA, Luiz J.; ARRIETA, Raul; LEMOS, Pedro A.Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective: To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure. Methods: The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results: A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 +/- 70.7 Gycm(2), while the staged group, to 139.2 +/- 75.3 Gycm(2) (p < 0.001). Conclusion: Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.
conferenceObject Coronary computed tomography angiography (CCTA) blood flow model, how we can improve it? Insights based on comparison with intravascular ultrasound (IVUS) tridimensional model.(2016) BEZERRA, Cristiano G.; BULANT, Carlos A.; TALOU, Gonzalo Maso; MARIANI JR., Jose; FALCAO, Breno A. A.; PINTON, Fabio A.; FEIJOO, Raul A.; FILHO, Antonio E.; BLANCO, Pablo J.; LEMOS, Pedro A.