JOSE MARIANI JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- 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.
- Validation of coronary computed tomography angiography scores for non-invasive assessment of atherosclerotic burden through a comparison with multivessel intravascular ultrasound(2016) CAVALCANTE, Rafael; BITTENCOURT, Marcio S.; PINHEIRO, Thais L.; FALCAO, Breno A. A.; MORAIS, Gustavo R.; SOARES, Paulo; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.; LEMOS, Pedro A.Aims: While the atherosclerotic plaque volume can be manually quantified in coronary computed tomography angiography (CTA) it is impractical for clinical routine use. Several anatomical scores have been developed as surrogates for overall atherosclerotic burden in coronary CTA and even proven to be highly predictive for future adverse events. However, they have not been validated against the gold standard for atherosclerotic burden, intra-vascular ultrasound (IVUS). In the present study we have compared several coronary CTA scores with the coronary IVUS. Methods and results: A total of 62 patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 6 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). On average, 3.8 +/- 0.7 vessels, comprising 123.8 +/- 31.3 mm in length, were imaged with IVUS per patient. All but one previously described scoring systems showed a significant association with IVUS-derived PAV. Among them, the SSS score demonstrated the strongest correlation with IVUS-PAV (r = 0.61, p < 0.001) and the greatest area under the ROC curve (C-statistic = 0.87), to predict a high PAV. Conclusions: Most frequently used coronary CTA scores have a good correlation with global coronary atherosclerotic burden measured by multivessel IVUS derived atheroma volume. Among them, the SSS score shows the best performance being a good non-invasive alternative to IVUS for global coronary atherosclerotic burden assessment.
conferenceObject Quantifying Total Atherosclerotic Burden Non-Invasively Through Coronary Computed Tomography Angiography: A Comparison With Multivessel Intravascular Ultrasound Data(2014) SILVA, Rafael C.; LIMA, Thais P.; FALCAO, Breno A.; MORAIS, Gustavo R.; SPADARO, Andre G.; MARIANI, Jose; RIBEIRO, Expedito E.; KALIL, Roberto; ROCHITTE, Carlos E.; LEMOS, Pedro A.- Late clinical outcomes of myocardial hybrid revascularization versus coronary artery bypass grafting for complex triple-vessel disease: Long-term follow-up of the randomized MERGING clinical trial(2021) ESTEVES, Vinicius; OLIVEIRA, Marco A. P.; FEITOSA, Fernanda S.; MARIANI JR., Jose; CAMPOS, Carlos M.; HAJJAR, Ludhmila A.; LISBOA, Luiz A.; JATENE, Fabio B.; FILHO, Roberto K.; LEMOS NETO, Pedro A.Objectives This article aimed to compare the outcomes after hybrid revascularization with conventional coronary artery bypass grafting (CABG) surgery. Background The concept of hybrid coronary revascularization combines the advantages of CABG and percutaneous coronary intervention to improve the treatment of patients with complex multivessel disease. Methods The Myocardial hybrid revascularization versus coronary artERy bypass GraftING for complex triple-vessel disease-MERGING study is a pilot randomized trial that allocated 60 patients with complex triple-vessel disease to treatment with hybrid revascularization or conventional CABG (2:1 ratio). The primary outcome was the composite of all-cause death, myocardial infarction, stroke, or unplanned repeat revascularization at 2 years. Results Clinical and anatomical characteristics were similar between groups. After a mean follow-up of 802 +/- 500 days, the primary endpoint rate was 19.3% in the hybrid arm and 5.9% in the CABG arm (p = NS). The incidence of unplanned revascularization increased over time in both groups, reaching 14.5 versus 5.9% in the hybrid and in the CABG groups, respectively (p = .4). Of note, in the hybrid group, there were no reinterventions driven by the occurrence of stent restenosis. Conclusions Hybrid myocardial was feasible but associated with increasing rates of major adverse cardiovascular events during 2 years of clinical follow-up, while the control group treated with conventional surgery presented with low rates of complications during the same period. In conclusion, before more definitive data arise, hybrid revascularization should be applied with careful attention in practice, following a selective case-by-case indication.
- Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology(2019) BEZERRA, Cristiano G.; HIDEO-KAJITA, Alexandre; BULANT, Carlos A.; MASO-TALOU, Gonzalo D.; MARIANI JR., Jose; PINTON, Fabio A.; FALCAO, Breno A. A.; ESTEVES-FILHO, Antonio; FRANKEN, Marcelo; FEIJOO, Raul A.; KALIL-FILHO, Roberto; GARCIA-GARCIA, Hector M.; BLANCO, Pablo J.; LEMOS, Pedro A.Objectives: To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUSFR), compared to gold-standard invasive measurements (FFRINVAS). Background: IVUS provides accurate anatomical evaluation of the lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention. However, IVUS poorly represents the functional status (i.e., flow-related information) of the imaged vessel. Methods: Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFRINVAS measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Computation of IVUSFR was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFRINVAS measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions. Results: A total of 24 patients with 34 vessels were analyzed. IVUSFR significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFRINVAS, with a mean difference of -0.008 +/- 0.067 (P = 0.47). IVUSFR presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96%, respectively, to detect significant stenosis. Conclusion: The computational processing of IVUSFR is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of grayscale IVUS.
- A Novel Algorithm to Quantify Coronary Remodeling Using Inferred Normal Dimensions(2015) FALCAO, Breno A. A.; FALCAO, Joao Luiz A. A.; MORAIS, Gustavo R.; SILVA, Rafael C.; LOPES, Augusto C.; SOARES, Paulo R.; MARIANI JR., Jose; KALIL-FILHO, Roberto; EDELMAN, Elazer R.; LEMOS, Pedro A.Background: Vascular remodeling, the dynamic dimensional change in face of stress, can assume different directions as well as magnitudes in atherosclerotic disease. Classical measurements rely on reference to segments at a distance, risking inappropriate comparison between dislike vessel portions. Objective: to explore a new method for quantifying vessel remodeling, based on the comparison between a given target segment and its inferred normal dimensions. Methods: Geometric parameters and plaque composition were determined in 67 patients using three-vessel intravascular ultrasound with virtual histology (IVUS-VH). Coronary vessel remodeling at cross-section (n = 27.639) and lesion (n = 618) levels was assessed using classical metrics and a novel analytic algorithm based on the fractional vessel remodeling index (FVRI), which quantifies the total change in arterial wall dimensions related to the estimated normal dimension of the vessel. A prediction model was built to estimate the normal dimension of the vessel for calculation of FVRI. Results: According to the new algorithm, ""Ectatic"" remodeling pattern was least common, ""Complete compensatory"" remodeling was present in approximately half of the instances, and ""Negative"" and ""Incomplete compensatory"" remodeling types were detected in the remaining. Compared to a traditional diagnostic scheme, FVRI-based classification seemed to better discriminate plaque composition by IVUS-VH. Conclusions: Quantitative assessment of coronary remodeling using target segment dimensions offers a promising approach to evaluate the vessel response to plaque growth/regression.
conferenceObject Quantifying Total Atherosclerotic Burden Non-Invasively Through Coronary Computed Tomography Angiography: A Comparison With Multivessel Intravascular Ultrasound Data(2014) SILVA, Rafael C.; FALCAO, Breno A.; LIMA, Thais P.; MORAIS, Gustavo R.; ROCHITTE, Carlos E.; SPADARO, Andre G.; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; LEMOS, Pedro A.- Impacto da insuficiência renal aguda na evolução hospitalar após tratamento percutâneo do infarto agudo do miocárdio(2013) SANTOS, Luciano Nunes dos; CONEJO, Fabio; FEITOSA FILHO, Francisco Hedilberto; CAMPOS, Carlos Augusto Homem de Magalhães; MARIANI JUNIOR, J.; TAKIMURA, Celso Kiyochi; ESTEVES FILHO, Antônio; SILVA, Expedito Eustáquio Ribeiro da; KALIL FILHO, Roberto; LEMOS NETO, Pedro AlvesBACKGROUND: Acute renal failure (ARF) is a possible complication after percutaneous coronary intervention (PCI). The objective of this study was to evaluate the occurrence and prognostic impact of ARF after PCI in patients with ST segment elevation myocardial infarction (STEMI). METHODS: Single-center registry evaluating in-hospital outcomes of 501 patients admitted with STEMI undergoing primary, rescue or late PCI. The incidence and predictors of ARF after PCI were evaluated. RESULTS: Mean age was 60.7 ± 12.6 years and 67% were male. The population had high cardiovascular risk characteristics, with 30% of diabetics and 7.4% with preexisting chronic kidney disease (CKD). The left anterior descending artery was the culprit vessel in 49.4% of the cases and 15% of patients had Killip class III or IV. ARF was observed in 24.7% of patients, who were significantly older, had more diabetes, history of CKD or heart failure, had higher enzyme elevation and lower ejection fraction when compared to those without ARF. In-hospital mortality was higher in patients who developed ARF (29% vs. 4.8%; P < 0.01). Independent predictors of ARF were age > 76 years, previous CKD, Killip class III or IV, need of vascular surgery or blood transfusion. CONCLUSIONS: Acute renal failure after PCI in STEMI was a frequent complication and was associated with increased in-hospital mortality.
- Intravascular Ultrasound Guidance to Minimize the Use of Iodine Contrast in Percutaneous Coronary Intervention The MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) Randomized Controlled Trial(2014) MARIANI JR., Jose; GUEDES, Cristiano; SOARES, Paulo; ZALC, Silvio; CAMPOS, Carlos M.; LOPES, Augusto C.; SPADARO, Andre G.; PERIN, Marco A.; ESTEVES FILHO, Antonio; TAKIMURA, Celso K.; RIBEIRO, Expedito; KALIL-FILHO, Roberto; EDELMAN, Elazer R.; SERRUYS, Patrick W.; LEMOS, Pedro A.OBJECTIVES The aim of this study was to evaluate the impact of intravascular ultrasound (IVUS) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND To date, few approaches have been described to reduce the final dose of contrast agent in PCIs. We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of iodine contrast. METHODS A total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI; both groups were treated according to a pre-defined meticulous procedural strategy. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months. RESULTS The median total volume of contrast was 64.5 ml (interquartile range [IQR]: 42.8 to 97.0 ml; minimum, 19 ml; maximum, 170 ml) in the angiography-guided group versus 20.0 ml (IQR: 12.5 to 30.0 ml; minimum, 3 ml; maximum, 54 ml) in the IVUS-guided group (p < 0.001). Similarly, the median volume of contrast/ creatinine clearance ratio was significantly lower among patients treated with IVUS-guided PCI (1.0 [IQR: 0.6 to 1.9] vs. 0.4 [IQR: 0.2 to 0.6, respectively; p < 0.001). In-hospital and 4-month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI. CONCLUSIONS Thoughtful and extensive use of IVUS as the primary imaging tool to guide PCI is safe and markedly reduces the volume of iodine contrast compared with angiography-alone guidance. The use of IVUS should be considered for patients at high risk of contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty. (C) 2014 by the American College of Cardiology Foundation.
conferenceObject A New Thin-Strut, Low-Dose, Sirolimus-Eluting Stent With Abluminal-Only Biodegradable Polymeric Coating: Safety and Efficacy Clinical Performance of the Inspiron (TM) Stent in High-Risk Patients(2014) PRADO JR., Guy F. A.; MELO, Pedro Henrique Craveiro; TAKIMURA, Celso; ALVES, Gustavo M.; GUIMARAES, Welingson V.; MARIANI JR., Jose; KAJITA, Luiz J.; CAMPOS, Carlos M.; FALCAO, Breno A.; GAMA, Marcus N.; MARCHIORI, Gilberto; ESTEVES-FILHO, Antonio; HORTA, Pedro E.; GALON, Micheli Z.; SPADARO, Andre G.; ZALC, Silvio; SOARES, Paulo R.; PERIN, Marco A.; RIBEIRO, Expedito; KALIL-FILHO, Roberto; LEMOS, Pedro A.