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
9 resultados
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- European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)(2020) BLOMSTROM-LUNDQVIST, Carina; TRAYKOV, Vassil; ERBA, Paola Anna; BURRI, Haran; NIELSEN, Jens Cosedis; BONGIORNI, Maria Grazia; POOLE, Jeanne; BORIANI, Giuseppe; COSTA, Roberto; DEHARO, Jean-Claude; EPSTEIN, Laurence M.; SAGHY, Laszlo; SNYGG-MARTIN, Ulrika; STARCK, Christoph; TASCINI, Carlo; STRATHMORE, NeilPacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
- 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.
- Pacemaker-related infection detected by F-18-fluorodeoxyglucose positron emission tomography-computed tomography(2014) PEIXOTO, Giselle de Lima; SICILIANO, Rinaldo Focaccia; CAMARGO, Raphael Abegao; BUENO, Fabiana Lucas; SOARES JUNIOR, Jose; COSTA, Roberto; STRABELLI, Tania Mara Varejao; MARTINELLI FILHO, MartinoLead endocarditis (LE) is one of the most feared complications and remains a challenging diagnosis in cardiology due to the possibility of an obscure clinical course and symptoms, leading to a delayed diagnosis, or even no diagnosis. F-18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) appears to be a valuable imaging technique and has been shown to have advantages in the diagnosis of patients with fever of unknown origin. We present the case of a 52-year-old man with a 3-year history of intermittent fever, chills, anemia, and weight loss (13 kg). He was submitted to an extensive investigation to clarify his symptoms and all results were negative. LE was finally diagnosed by FDG PET/CT. This examination could become a useful noninvasive method for the detection of LE at an earlier stage, thus avoiding repeated tests and reducing the length of hospital stay.
- 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
- Predictors of death in chronic Chagas cardiomyopathy patients with pacemaker(2018) PEIXOTO, Giselle de Lima; MARTINELLI FILHO, Martino; SIQUEIRA, Sergio Freitas de; NISHIOKA, Silvana Angelina D'Orio; PEDROSA, Anisio Alexandre Andrade; TEIXEIRA, Ricardo Alkmim; COSTA, Roberto; KALIL FILHO, Roberto; RAMIRES, Jose Antonio FranchiniBackground: Chronic Chagas cardiomyopathy (CCC) is the most serious and frequent manifestation of Chagas disease. Conduction abnormalities and bradycardia requiring pacemaker are common. The aim of this study was to determine the rate and predictors of death in CCC patients with pacemaker. Methods: In this single-center prospective cohort study we assessed the outcome of 396 CCC patients with pacemaker, followed-up for at least 24 months. All patients underwent a clinical and device assessment, 12-lead electrocardiography and echocardiography. Results: During the median follow-up of 1.9 years (Interquartile range 1.6-2.4), there were 65 (16.4%) deaths, yielding an annual mortality rate of 8.6%. The major cause was sudden death (33.8%), followed by heart failure (HF), 32.3%. All the investigated variables were examined as potential predictors of death. The final multivariate logistic regression model included five independent variables: advanced HF functional class (OR [odds ratio] 6.71; 95% confidence interval [95% CI] 1.95-23.2; P = 0.003), renal disease (OR 5.71; 95% CI 1.80-18.0; P = 0.003), QRS >= 150 ms (OR 2.80; 95% CI 1.08-7.27; P = 0.034), left atrial enlargement (OR 2.75; 95% CI 1.09-6.95; P = 0.032) and left ventricular ejection fraction = 43% (OR 2.31; 95% CI 1.07-4.97; P = 0.032). Themodel had good discrimination, confirmed by bootstrap validation (optimism-adjusted c-statistic of 0.78) and the calibration curve showed a proper calibration (slope = 0.972). Conclusions: CCC patients with pacemaker have a high annual mortality rate despite that the pacemaker related variables were not predictors of death. The independent predictors of death can help us to identify the poor prognosis patients.
- Efficacy, Safety, and Performance of Isolated Left vs. Right Ventricular Pacing in Patients with Bradyarrhythmias: A Randomized Controlled Trial(2019) CREVELARI, Elizabeth Sartori; SILVA, Katia Regina da; ALBERTINI, Caio Marcos de Moraes; VIEIRA, Marcelo Luiz Campos; MARTINELLI FILHO, Martino; COSTA, RobertoBackground: Considering the potential deleterious effects of right ventricular (RV) pacing, the hypothesis of this study is that isolated left ventricular (LV) pacing through the coronary sinus is safe and may provide better clinical and echocardiographic benefits to patients with bradyarrhythmias and normal ventricular function requiring heart rate correction alone. Objective: To assess the safety, efficacy, and effects of LV pacing using an active-fixation coronary sinus lead in comparison with RV pacing, in patients eligible for conventional pacemaker (PM) implantation. Methods: Randomized, controlled, and single-blinded clinical trial in adult patients submitted to PM implantation due to bradyarrhythmias and systolic ventricular function >= 0.40. Randomization (RV vs. LV) occurred before PM implantation. The main results of the study were procedural success, safety, and efficacy. Secondary results were clinical and echocardiographic changes. Chi-squared test, Fisher's exact test and Student's t-test were used, considering a significance level of 5%. Results: From June 2012 to January 2014, 91 patients were included, 36 in the RV Group and 55 in the LV Group. Baseline characteristics of patients in both groups were similar. PM implantation was performed successfully and without any complications in all patients in the RV group. Of the 55 patients initially allocated into the LV group, active-fixation coronary sinus lead implantation was not possible in 20 (36.4%) patients. The most frequent complication was phrenic nerve stimulation, detected in 9 (25.7%) patients in the LV group. During the follow-up period, there were no hospitalizations due to heart failure. Reductions of more than 10% in left ventricular ejection fraction were observed in 23.5% of patients in the RV group and 20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed that 91.2% of subjects in the RV group and 68.8% of those in the LV group had interventricular dyssynchrony (p = 0.022). Conclusion: The procedural success rate of LV implant was low, and the safety of the procedure was influenced mainly by the high rate of phrenic nerve stimulation in the postoperative period.
- 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS(2018) BONGIORNI, Maria G.; BURRI, Haran; DEHARO, Jean C.; STARCK, Christoph; KENNERGREN, Charles; SAGHY, Laszlo; RAO, Archana; TASCINI, Carlo; LEVER, Nigel; KUTARSKI, Andrzej; LOZANO, Ignacio Fernandez; STRATHMORE, Neil; COSTA, Roberto; EPSTEIN, Laurence; LOVE, Charles; BLOMSTROM-LUNDQVIST, Carina; FAUCHIER, Laurent; DEFAYE, Pascal; ARNAR, David O.; KLUG, Didier; BOVEDA, Serge; NIELSEN, Jens Cosedis; BORIANI, Giuseppe; ZHANG, Shu; MARTIN, Andrew Paul; PRUTKIN, Jordan M.; ZULOAGA, Claudio de
- Usefulness of Preoperative Venography in Patients with Cardiac Implantable Electronic Devices Submitted to Lead Replacement or Device Upgrade Procedures(2018) ALBERTINI, Caio Marcos de Moraes; SILVA, Katia Regina da; LEAL FILHO, Joaquim Maurfcio da Motta; CREVELARI, Elizabeth Sartori; MARTINELLI FILHO, Martino; CAMEVALE, Francisco Cesar; COSTA, RobertoBackground: Venous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation. Objectives: We aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures. Methods: From April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level. Results: Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan. Conclusions: The prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.
- The impact of data quality monitoring of a multicenter prospective registry of cardiac implantable electronic devices(2023) SAUCEDO, Sarah Caroline Martins; SILVA, Katia Regina; SILVA, Laisa de Arruda; CRIVELARI, Jessica Moretto; COSTA, RobertoData quality monitoring plays a crucial role in multicenter prospective registries. By maintaining high data accuracy, completeness, and consistency, researchers can improve the overall quality and reliability of the registry data, enabling meaningful conclusions and supporting evidencebased decisions. The purpose of the present study was to evaluate data quality metrics (completeness, accuracy, and temporal plausibility) of a Multicenter Registry of Cardiac Implantable Electronic Devices (CIEDs) and to perform a direct data audit of a random sample of records to assess the agreement levels with the source documents. The CIED Registry was a prospective, multicenter, real-world observational study carried out from January 2020 to December 2022 in five designated centers across Sao Paulo, Brazil. We assessed the data quality of the CIED Registry by using two distinct approaches: center dot Dynamic data monitoring using features of the REDCap (Research Electronic Data Capture) software, including data reports and data quality rules center dot Direct data audit in which information from a random sample of 10 % of cases from the coordinating center was compared with original source documents Our findings suggest that the methodological approach applied to the CIED Registry resulted in high data completeness, accuracy, temporal plausibility, and excellent agreement levels with the source documents.