ROBERTO COSTA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder
14 resultados
Resultados de Busca
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- Effectiveness and Safety of Transvenous Removal of Cardiac Pacing and Implantable Cardioverter-defibrillator Leads in the Real Clinical Scenario(2020) COSTA, Roberto; SILVA, Katia Regina da; CREVELARI, Elizabeth Sartori; NASCIMENTO, Wagner Tadeu Jurevicius; NAGUMO, Marcia Mitie; MARTINELLI FILHO, Martino; JATENE, Fabio BiscegliBackground: Transvenous lead extraction (TLE) of cardiac implantable electronic devices (CIED) is an uncommon procedure and requires specialized personnel and adequate facilities. Objectives: To evaluate the effectiveness and safety of the removal of CIED leads and to determine risk factors for surgical complications and mortality in 30 days. Methods: Prospective study with data derived from clinical practice. From January 2014 to April 2020, we included 365 consecutive patients who underwent TLE, regardless of the indication and surgical technique used. The primary outcomes were: success rate of the procedure, combined rate of major complications and intraoperative death. Secondary outcomes were: risk factors for major intraoperative complications and death within 30 days. Univariate and multivariate analysis were used, with a significance level of 5%. Results: Procedure success rate was 96.7%, with 90.1% of complete success and 6.6% of clinical success. Major intraoperative complications occurred in 15 (4.1%) patients. Predictors of major complications were: lead dwelling time >= 7 years (OR = 3.78, p = 0.046) and change in surgical strategy (OR = 5.30, p = 0.023). Functional class III-IV (OR = 6.98, p <0.001), renal failure (OR = 5.75, p = 0.001), CIED infection (OR = 13.30, p <0.001), number of procedures performed (OR = 77.32, p <0.001) and major intraoperative complications (OR = 38.84, p <0.001) were predictors of 30-day mortality. Conclusions: The results of this study, which is the largest prospective registry of consecutive TLE procedures in Latin America, confirm the safety and effectiveness of this procedure in the context of real clinical practice.
- Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry(2016) SILVA, Katia Regina da; ALBERTINI, Caio Marcos de Moraes; CREVELARI, Elizabeth Sartori; CARVALHO, Eduardo Infante Januzzi de; FIORELLI, Alfredo Inacio; MARTINELLI FILHO, Martino; COSTA, RobertoBackground: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III--IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease.
- Functional Capacity of Patients with Pacemaker Due to Isolated Congenital Atrioventricular Block(2015) OLIVEIRA JUNIOR, Roberto Marcio de; SILVA, Katia Regina da; KAWAUCHI, Tatiana Satie; ALVES, Lucas Bassolli de Oliveira; CREVELARI, Elizabeth Sartori; MARTINELLI FILHO, Martino; COSTA, RobertoBackground: Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation. Objectives: To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling. Methods: This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%. Results: A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 +/- 6.3 years. The percentage of ventricular pacing was 97.9 +/- 4.1%, and the duration of the paced QRS complex was 153.7 +/- 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 +/- 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. Conclusions: The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling.
- Minimally Invasive Epicardial Pacemaker Implantation in Neonates with Congenital Heart Block(2017) COSTA, Roberto; SILVA, Katia Regina da; MARTINELLI FILHO, Martino; CARRILLO, RogerBackground: Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). Objective: This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Methods: Between July 2002 and February 2015,16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 +/- 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. Results: All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 +/- 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 +/- 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Conclusion: Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.
article Cardiac Arrhythmias Guideline in Children and Congenital Cardiomyopathies SOBRAC and DCC - CP(2016) MAGALHAES, L. P.; GUIMARAES, I. C. B.; MELO, S. L.; MATEO, E. I. P.; ANDALAFT, R. B.; XAVIER, L. F. R.; LORGA FILHO, A. M.; FAGUNDES, A. A.; MOREIRA, D. A. R.; HACHUL, D. T.; STERNICK, E. B.; ANDREA, E. M.; CANNAVAN, F. P. S.; OLIVEIRA, F. J. B.; DARRIEUX, F. C. C.; LIMA, G. G.; ATIE, J.; ELIAS NETO, J.; ZIMERMAN, L. I.; MIANA, L.; PELLANDA, L. C.; SACILOTTO, L.; JATENE, M. B.; SOARES, M. M.; BINOTTO, M. A.; SCANAVACCA, M. I.; OLIVEIRA JUNIOR, N. A.; ZIELINSKY, P.; SALERNO, P. R.; TEIXEIRA, R. A.; KUNIYOSHI, R. R.; COSTA, R.; SCHAMES NETO, S.; PEDRA, S. R. F. F.; GIMENEZ, S. C.; WU, T. C.; AIELLO, V. D.- Diretriz Brasileira de Dispositivos Cardiacos Eletronicos Implantaveis-2023(2023) TEIXEIRA, Ricardo Alkmim; FAGUNDES, Alexsandro Alves; JR, Jose Mario Baggio; OLIVEIRA, Julio Cesar de; MEDEIROS, Paulo de Tarso Jorge; VALDIGEM, Bruno Pereira; TENO, Luiz Antonio Castilho; SILVA, Rodrigo Tavares; MELO, Celso Salgado de; ELIAS NETO, Jorge; JR, Antonio Vitor Moraes; PEDROSA, Anisio Alexandre Andrade; PORTO, Fernando Mello; JR, Helio Lima de Brito; SOUZA, Thiago Goncalves Schroder e; MATEOS, Jose Carlos Pachon; MORAES, Luis Gustavo Belo de; FORNO, Alexander Romeno Janner Dal; D'AVILA, Andre Luiz Buchele; CAVACO, Diogo Alberto de Magalhaes; KUNIYOSHI, Ricardo Ryoshim; PIMENTEL, Mauricio; CAMANHO, Luiz Eduardo Montenegro; SAAD, Eduardo Benchimol; ZIMERMAN, Leandro Ioschpe; OLIVEIRA, Eduardo Bartholomay; SCANAVACCA, Mauricio Ibrahim; MARTINELLI FILHO, Martino; LIMA, Carlos Eduardo Batista de; PEIXOTO, Giselle de Lima; DARRIEUX, Francisco Carlos da Costa; DUARTE, Jussara de Oliveira Pinheiro; GALVAO FILHO, Silas dos Santos; COSTA, Eduardo Rodrigues Bento; MATEO, Enrique Indalecio Pachon; MELO, Sissy Lara De; RODRIGUES, Thiago da Rocha; ROCHA, Eduardo Arrais; HACHUL, Denise Tessariol; LORGA FILHO, Adalberto Menezes; NISHIOKA, Silvana Angelina D'Orio; GADELHA, Eduardo Barreto; COSTA, Roberto; ANDRADE, Veridiana Silva de; TORRES, Gustavo Gomes; OLIVEIRA NETO, Nestor Rodrigues de; LUCCHESE, Fernando Antonio; MURAD, Henrique; WANDERLEY NETO, Jose; BROFMAN, Paulo Roberto Slud; ALMEIDA, Rui M. S.; LEAL, Joao Carlos Ferreira
- Impact of the COVID-19 Pandemic on Cardiac Implantable Electronic Devices Procedures in a Tertiary Referral Center(2021) COSTA, Roberto; SILVA, Katia Regina da; SAUCEDO, Sarah Caroline Martins; SILVA, Laisa Arruda; CREVELARI, Elizabeth Sartori; NASCIMENTO, Wagner Tadeu Jurevicius; SILVEIRA, Thiago Goncalves; FIORELLI, Alfredo; MARTINELLI FILHO, Martino; JATENE, Fabio Biscegli
- Prognosis Determinants after Cardioverter-Defibrillators Implantation in Brazil Reply(2017) SILVA, Katia Regina da; ALBERTINI, Caio Marcos de Moraes; CREVELARI, Elizabeth Sartori; CARVALHO, Eduardo Infante Januzzi de; FIORELLI, Alfredo Inacio; MARTINELLI FILHO, Martino; COSTA, Roberto
- Analysis of > 100,000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes(2020) V, Omar A. Mejia; LISBOA, Luiz Augusto Ferreira; CANEO, Luiz Fernando; ARITA, Elisandra Trevisan; BRANDAO, Carlos Manuel de Almeida; DIAS, Ricardo Ribeiro; COSTA, Roberto; JATENE, Marcelo Biscegli; POMERANTZEFF, Pablo Maria Alberto; DALLAN, Luis Alberto Oliveira; JATENE, Fabio BiscegliBackground: 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 Clinicas Heart Institute of the University of Sao 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.
- Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates(2015) SILVA, Rodrigo Tavares; MARTINELLI FILHO, Martino; PEIXOTO, Giselle de Lima; LIMA, Jose Jayme Galvao de; SIQUEIRA, Sergio Freitas de; COSTA, Roberto; GOWDAK, Luis Henrique Wolff; PAULA, Flavio Jota de; KALIL FILHO, Roberto; RAMIRES, Jose Antonio FranchiniBackground: The recording of arrhythmic events (AE) in renal transplant candidates (RTCs) undergoing dialysis is limited by conventional electrocardiography. However, continuous cardiac rhythm monitoring seems to be more appropriate due to automatic detection of arrhythmia, but this method has not been used. Objective: We aimed to investigate the incidence and predictors of AE in RTCs using an implantable loop recorder (ILR). Methods: A prospective observational study conducted from June 2009 to January 2011 included 100 consecutive ambulatory RTCs who underwent ILR and were followed-up for at least 1 year. Multivariate logistic regression was applied to define predictors of AE. Results: During a mean follow-up of 424 +/- 127 days, AE could be detected in 98% of patients, and 92% had more than one type of arrhythmia, with most considered potentially not serious. Sustained atrial tachycardia and atrial fibrillation occurred in 7% and 13% of patients, respectively, and bradyarrhythmia and non-sustained or sustained ventricular tachycardia (VT) occurred in 25% and 57%, respectively. There were 18 deaths, of which 7 were sudden cardiac events: 3 bradyarrhythmias, 1 ventricular fibrillation, 1 myocardial infarction, and 2 undetermined. The presence of a long QTc (odds ratio [OR] = 7.28; 95% confidence interval [CI], 2.01-26.35; p = 0.002), and the duration of the PR interval (OR = 1.05; 95% CI, 1.02-1.08; p < 0.001) were independently associated with bradyarrhythmias. Left ventricular dilatation (LVD) was independently associated with non-sustained VT (OR = 2.83; 95% CI, 1.01-7.96; p = 0.041). Conclusions: In medium-term follow-up of RTCs, ILR helped detect a high incidence of AE, most of which did not have clinical relevance. The PR interval and presence of long QTc were predictive of bradyarrhythmias, whereas LVD was predictive of non-sustained VT.