GUILHERME VIOTTO RODRIGUES DA SILVA
Índice h a partir de 2011
4
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
7 resultados
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- Thrombocytopenia After Transcatheter Valve-in-Valve Implantation: Prognostic Marker or Mere Finding?(2018) SOUZA, Renato C. de; PAIM, Leonardo; VIOTTO, Guilherme; APRIGIO, Joaquim; ARAUJO, Lucas L.; RIBEIRO, Henrique; SAMPAIO, Roney O.; TARASOUTCHI, Flavio; POMERANTZEFF, Pablo M. A.; PALMA, Jose Honorio; JATENE, Fabio B.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/mu L), 54% moderate (<100.000/mu L) and 21% severe (<50.000/mu L) 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-invalve 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.
- Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits(2018) CANEO, Luiz Fernando; MATTE, Gregory S.; GUIMARAES, Daniel Peres; VIOTTO, Guilherme; MAZZETO, Marcelo; CESTARI, Idagene; NEIROTTI, Rodolfo A.; JATENE, Marcelo B.; WANG, Shigang; UNDAR, Akif; CHANG JUNIOR, Joao; JATENE, Fabio B.Objective: Hemodilution is a concern in cardiopulmonary bypass (CPB). Using a smaller dual tubing rather than a single larger inner diameter (ID) tubing in the venous limb to decrease prime volume has been a standard practice. The purpose of this study is to evaluate these tubing options. Methods: Four different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16"" ID venous limbs (Circuit A) or to a single 1/4"" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4"" ID venous limbs (Circuit C) or a single 3/8"" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36 degrees C and 28 degrees C. Results: Circuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively. Conclusion: A single 1/4"" venous limb is better than dual 3/16"" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8"" venous limb is better than dual 1/4"" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB.
- Rational Use of Mechanical Circulatory Support as a Bridge to Pediatric and Congenital Heart Transplantation(2018) MIANA, Leonardo A.; SILVA, Guilherme Viotto Rodrigues da; CANEO, Luiz Fernando; TURQUETTO, Aida Luisa; TANAMATI, Carla; FORONDA, Gustavo; MASSOTI, Maria Raquel; PENHA, Juliano G.; AZEKA, Estela; GALAS, Filomena R. B. G.; JATENE, Fabio B.; JATENE, Marcelo B.Introduction: Donor shortage and organ allocation is the main problem in pediatric heart transplant. Mechanical circulatory support is known to increase waiting list survival, but it is not routinely used in pediatric programs in Latin America. Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital. Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor (R). Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4-26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04). Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience.
- Early and Long-Term Outcomes of Surgical Treatment of Ebstein's Anomaly(2019) SILVA, Guilherme Viotto Rodrigues da; MIANA, Leonardo Augusto; CANEO, Luiz Fernando; TURQUETTO, Aida Luiza Ribeiro; TANAMATI, Carla; PENHA, Juliano G.; JATENE, Fabio B.; JATENE, Marcelo B.Objective: This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. Methods: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. Results: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5 +/- 14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8 +/- 6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1 +/- 4.9 years after the first procedure. Conclusion: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.
- Outcomes of the Conversion of the Fontan-Kreutzer Operation to a Total Cavopulmonary Connection for the Failing Univentricular Circulation(2019) FERNANDES, Gabriel Carmona; SILVA, Guilherme Viotto Rodrigues da; CANEO, Luiz Fernando; TANAMATI, Carla; TURQUETTO, Aida Luiza Ribeiro; JATENE, Marcelo BiscegliBackground: The Fontan-Kreutzer procedure (FK) was widely performed in the past, but in the long-term generated many complications resulting in univentricular circulation failure. The conversion to total cavopulmonary connection (TCPC) is one of the options for treatment. Objective: To evaluate the results of conversion from FK to TCPC. Methods: A retrospective review of medical records for patients who underwent the conversion of FK to TCPC in the period of 1985 to 2016. Significance p < 0,05. Results: Fontan-type operations were performed in 420 patients during this period: TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten cases from the FK group were elected to conversion to TCPC. All patients submitted to Fontan Conversion were included in this study. In nine patients the indication was due to uncontrolled arrhythmia and in one, due to protein-losing enteropathy. Death was observed in the first two cases. The average intensive care unit (ICU) length of stay (LOS) was 13 days, and the average hospital LOS was 37 days. A functional class by New York Heart Association (NYHA) improvement was observed in 80% of the patients in NYHA I or II. Fifty-seven percent of conversions due to arrhythmias had improvement of arrhythmias; four cases are cured. Conclusions: The conversion is a complex procedure and requires an experienced tertiary hospital to be performed. The conversion has improved the NYHA functional class despite an unsatisfactory resolution of the arrhythmia.
- Early outcomes of transcatheter tricuspid valve-in-valve implantation: a case series(2019) VIOTTO, Guilherme; PAIM, Leonardo; SOUZA, Renato; APRIGIO, Joaquim; LACERDA, Lucas; POMERANTZEFF, Pablo; JATENE, Marcelo B.; PALMA, Jose Honorio; JATENE, Fabio B.OBJECTIVES: In this study, we sought to evaluate early outcomes of transcatheter valve-in-valve implantation in patients with a degenerated bioprosthesis in the tricuspid position. METHODS: We used a prospective study, which included patients with a degenerated bioprosthesis in the tricuspid position who were considered high-risk by our heart team and who underwent a valve-in-valve implantation. The procedures were performed via transjugular venous access and were done with the patient under general anaesthesia with transoesophageal echocardiographic and fluoroscopic guidance. Perioperative data were analysed, and the patients were followed prospectively. RESULTS: Seven patients were included. The baseline diagnoses were 3 patients with Ebstein's anomaly, 1 patient with tetralogy of Fallot, 1 patient with neonatal endocarditis, 1 patient with ventricular septal defect with a double tricuspid lesion and 1 patient with rheumatic mitral and tricuspid valve who underwent a combined transapical mitral and transjugular tricuspid valve-in-valve implantation. age was 33 +/- 10.8 years and 57.1% of the patients were men. The mean number of previous thoracotomies was 3 +/- 2 (range 1-5) procedures. The mean follow-up was 1.24 years. The implant was successful in all cases, and there was no need for conversion to open surgery. There were no deaths during the study period, and all patients are currently in the New York Heart Association functional class I/II. There was a statistically significant difference when the mean transvalvular gradients preimplantation and postimplantation were compared (P < 0.001). CONCLUSIONS: Percutaneous tricuspid valve implantation should be considered a safe and effective therapy and stands as a viable, reliable alternative for the treatment of a degenerated bioprosthesis in high-surgical-risk/inoperable patients.
- Transcatheter mitral valve-in-valve implantation: reports of the first 50 cases from a Latin American Centre(2020) COSTA, Leonardo Paim Nicolau da; PALMA, Jose Honorio; RIBEIRO, Henrique Barbosa; SAMPAIO, Roney Orismar; VIOTTO, Guilherme; SANTOS, Romullo Medeiros; TENORIO, Davi Freitas; SAITO, Victor Tadami; ROSA, Vitor Emer Egypto; MOREIRA, Luiz Felipe Pinho; TARASOUTCHI, Flavio; POMERANTZEFF, Pablo Maria; JATENE, Fabio BiscegliOBJECTIVES: Our goal was to analyse the initial results of the first 50 transapical transcatheter mitral valve-in-valve procedures performed in a single Latin American centre. METHODS: A prospective, single centre, database analysis was conducted to evaluate immediate, 30-day and 1-year postoperative results of 50 consecutive patients who had a transcatheter mitral valve-in-valve procedure from May 2015 to June 2018. All patients were operated on in a hybrid operating room and received a balloon-expandable valve via the transapical approach. Preoperative and postoperative characteristics were analysed and compared between the first 25 and the second 25 patients to evaluate the impact of the learning curve. Twenty patients had a follow-up examination at 1 year. RESULTS: There was a 98% device success rate. The patients had a mean age of 64.8 years; 72% were women; 80% were in New York Heart Association functional class >= III preoperatively; and 36% of the procedures were urgent. The mean Society of Thoracic Surgeons scores and EuroSCORE II were 8.3% and 12.4%, respectively. Patients had a median of 2 previous operations; valve durability was 12.1 years; and 64% mitral valve disease of rheumatic fever aetiology. Echocardiography showed decreases in the maximum and mean mitral gradients from 23.5 to 14.6 and 11.5 to 6.4mmHg postoperatively; the overall mean hospitalization period was 15 days. The overall mortality rate at 30 days was 14%, with 1 intraprocedural death. Further subanalyses between the first and the second half of the cases showed a drop in the mortality rate from 20% to 8% (P < 0.01). CONCLUSION: The transcatheter mitral valve-in-valve procedure was shown to be a safe and effective procedure to treat bioprosthetic dysfunction, with potential benefits in patients with rheumatic disease.