FABIO BISCEGLI JATENE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder
36 resultados
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- Autologous blood salvage in cardiac surgery: clinical evaluation, efficacy and levels of residual heparin(2021) VIEIRA, Sergio Domingos; PERINI, Fernanda da Cunha Vieira; SOUSA, Luiz Carlos Bento de; BUFFOLO, Enio; CHACCUR, Paulo; ARRAIS, Magaly; JATENE, Fabio BiscegliObjective: Intraoperative blood salvage (cell saver technique) in cardiac surgery is universally used in surgical procedures with a marked risk of blood loss. The primary objectives of this study were to determine the concentration of residual heparin in the final product that is reinfused into the patient in the operating room and to evaluate the efficacy and safety of the cell saver technique. Method: Twelve patients undergoing elective cardiac surgery were enrolled in this study. Using the XTRA Autotransfusion System, blood samples were collected from the cardiotomy reservoir, both prior to blood processing (pre-sample) and after it, directly from the bag with processed product (post-sample). Hematocrit and hemoglobin levels, the protein, albumin and residual heparin concentrations, hemolysis index, and the platelet, erythrocyte and leukocyte counts were measured. Results: Hematocrit and hemoglobin levels and red blood cell counts were higher in post-processing samples, with a mean variation of 54.78%, 19.81 g/dl and 6.84 x 10(6)/mm(3), respectively (p < 0.001). The mean hematocrit of the processed bag was 63.49 g/dl (range: 57.2-67.5). The residual heparin levels were <= 0.1 IU/ml in all post-treatment analyses (p = 0.003). No related adverse events were observed. Conclusion: The reduced residual heparin values (<= 0.1 IU/ml) in processed blood found in this study are extremely important, as they are consistent with the American Association of Blood Banks guidelines, which establish target values below 0.5 IU/ml. The procedure was effective, safe and compliant with legal requirements and the available international literature. (C) 2019 Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular.
- Multivessel Woven Coronary Artery Disease(2021) DALLAN, Luis Roberto Palma; DALLAN, Luis Alberto Oliveira; MORETTI, Miguel; MORAGAS, Ana Beatriz Camerlengo; DALLAN, Luis Augusto Palma; JATENE, Fabio B.Woven coronary disease is a rare pathology with unknown etiology. Although initially considered benign, recent publications report myocardial ischemia caused by the affected vessel. Since most patients are asymptomatic, long-term follow-up to understand its behavior is mandatory. We report a multivessel woven disease case with documented ischemia that was submitted to coronary artery bypass grafting and remained asymptomatic for two years of follow-up.
- Chronic thromboembolic pulmonary hypertension: the impact of advances in perioperative techniques in patient outcomes(2021) SCUDELLER, Paula Gobi; TERRA-FILHO, Mario; FILHO, Orival Freitas; GALAS, Filomena Regina Barbosa Gomes; ANDRADE, Tiago Dutra de; NICOTARI, Daniela Odnicki; GOBBO, Laura Michelin; GAIOTTO, Fabio Antonio; HAJJAR, Ludhmila Abrahao; JATENE, Fabio BiscegliObjectives: Pulmonary endarterectomy (PEA) is the gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed at reporting outcomes of CTEPH patients undergoing PEA within 10 years, focusing on advances in anesthetic and surgical techniques. Methods: We evaluated 102 patients who underwent PEA between January 2007 and May 2016 at the Instituto do Coracao do Hospital das Clinicas da Universidade de Sao Paulo. Changes in techniques included longer cardiopulmonary bypass, heating, and cooling times and mean time of deep hypothermic circulatory arrest and shortened reperfusion time. Patients were stratified according to temporal changes in anesthetic and surgical techniques: group 1 (January 2007December 2012), group 2 (January 2013-March 2015), and group 3 (April 2015-May 2016). Clinical outcomes were any occurrence of complications during hospitalization. Results: Groups 1, 2, and 3 included 38, 35, and 29 patients, respectively. Overall, 62.8% were women (mean age, 49.1 years), and 65.7% were in New York Heart Association functional class III-IV. Postoperative complications were less frequent in group 3 than in groups 1 and 2: surgical complications (10.3% vs. 34.2% vs. 31.4%, p=0.035), bleeding (10.3% vs. 31.5% vs. 25.7%, p=0.047), and stroke (0 vs. 13.2% vs. 0, p=0.01). Between 3 and 6 months post-discharge, 85% were in NYHA class I-II. Conclusion: Improvements in anesthetic and surgical procedures were associated with better outcomes in CTEPH patients undergoing PEA during the 10-year period.
- Improving the heart team: An interdisciplinary team and integrated practice unit(2021) VERONESE, Elinthon Tavares; POMERANTZEFF, Pablo Maria Alberto; JATENE, Fabio BiscegliHeart Team emerged as an important tool in the cardiovascular care, improving the efficiency of decision-making process. In addition to the benefits in patient care, it symbolizes a new culture and mindset. However, beyond the clinical condition, in low/middle-income countries other concerns arise regarding patient's background and these demands are, usually, as challenging as the medical treatment. New models have been proposed face these demands and to assure a holistic care by Integrated Practice Units. Optimization and reorganization of already existing resources and promotion of interdisciplinary and holistic care may be an effective manner to improve outcomes despite socioeconomic barriers.
- Translation and Validation of the Boston Technical Performance Score in a Developing Country(2021) MIANA, Leonardo A.; NATHAN, Meena; TENORIO, Davi Freitas; MANUEL, Valdano; GUERREIRO, Gustavo; FERNANDES, Natalia; CAMPOS, Carolina Vieira de; V, Paula Gaiolla; CASSAR, Renata Sa; TURQUETTO, Aida; AMATO, Luciana; CANEO, Luiz Fernando; DARODA, Larissa Leitao; JATENE, Marcelo Biscegli; JATENE, Fabio B.Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.
bookPart Tratamento cirúrgico do tromboembolismo pulmonar crônico(2021) FREITAS FILHO, Orival de; PêGO-FERNANDES, Paulo Manuel; JATENE, Fábio Biscegli- Treatment and Chest Reconstruction for Mediastinitis Following Sternotomy for Cardiac Surgery at the Heart Institute of the University of Sao Paulo Medical School(2021) PAGOTTO, Vitor Penteado Figueiredo; GALLAFRIO, Samuel Terra; CARNEIRO, Igor Castro; GEMPERLI, Rolf; JATENE, Fabio B.This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of Sao Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.
- Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial(2021) FRANCO, Rafael Alves; ALMEIDA, Juliano Pinheiro de; LANDONI, Giovanni; SCHEEREN, Thomas W. L.; GALAS, Filomena Regina Barbosa Gomes; FUKUSHIMA, Julia Tizue; ZEFFERINO, Suely; NARDELLI, Pasquale; PICCIONI, Marilde de Albuquerque; ARITA, Elisandra Cristina Trevisan Calvo; PARK, Clarice Hyesuk Lee; CUNHA, Ligia Cristina Camara; OLIVEIRA, Gisele Queiroz de; COSTA, Isabela Bispo Santos da Silva; KALIL FILHO, Roberto; JATENE, Fabio Biscegli; HAJJAR, Ludhmila AbrahaoBackgroundThe detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine).ResultsA total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p=0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay.DiscussionAlthough it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery.Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801
- Mortality risk prediction in high-risk patients undergoing coronary artery bypass grafting: Are traditional risk scores accurate? (vol 16, e0255662, 2021)(2021) GONCHAROV, Maxim; MEJIA, Omar Asdrubal Vilca; ARTHUR, Camila Perez de Souza; ORLANDI, Bianca Maria Maglia; SOUSA, Alexandre; OLIVEIRA, Marco Antonio Praca; ATIK, Fernando Antibas; SEGALOTE, Rodrigo Coelho; TIVERON, Marcos Gradim; SILVA, Pedro Gabriel Melo de Barros e; NAKAZONE, Marcelo Arruda; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; ZHENG, Zhe; HU, Shengshou; JATENE, Fabio Biscegli
- Impact ofCOVID-19oncoronary artery surgery: Hardlessons learned(2021) DALLAN, Luis Alberto O.; LISBOA, Luiz Augusto F.; DALLAN, Luis Roberto P.; JATENE, Fabio B.