OMAR ASDRUBAL VILCA MEJIA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
10 resultados
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- Current Impact of Cardiopulmonary Bypass in Coronary Artery Bypass Grafting in Sao Paulo State(2020) BORGOMONI, Gabrielle Barbosa; MEJIA, Omar Asdrubal Vilca; ORLANDI, Bianca Maria Maglia; GONCHAROV, Maxim; LISBOA, Luiz Augusto Ferreira; CONTE, Pedro Henrique; OLIVEIRA, Marco Antonio Praca; FIORELLI, Alfredo Inacio; JUNIOR, Orlando Petrucci; TIVERON, Marcos Grandim; DALLAN, Luis Alberto de Oliveira; JATENE, Fabio BiscegliBackground: Previous results on the use of cardiopulmonary bypass (CPB) have generated difficulties in choosing the best treatment for each patient undergoing myocardial revascularization surgery (CABG) in the current context. Objective: Evaluate the current impact of CPB in CABG in Sao Paulo State. Methods: A total of 2905 patients who underwent CABG were consecutively analyzed in 11 Sao Paulo State centers belonging to the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) I. Perioperative and follow-up data were included online by trained specialists in each hospital. Associations of the perioperative variables with the type of procedure and with the outcomes were analyzed. The study outcomes were morbidity and operative mortality. The expected mortality was calculated using EuroSCORE II (ESII). The values of p <5% were considered significant. Results: There were no significant differences concerning the patients' age between the groups (p=0.081). 72.9% of the patients were males. Of the patients, 542 underwent surgery without CPB (18.7%). Of the preoperative characteristics, patients with previous myocardial infarction (p=0.005) and ventricular dysfunction (p=0.031) underwent surgery with CPB. However, emergency or New York Heart Association (NYHA) class IV patients underwent surgery without CPB (p<0.001). The ESII value was similar in both groups (p=0.427). In CABG without CPB, the radial graft was preferred (p<0.001), and in CABG with CPB the right mammary artery was the preferred one (p<0.001). In the postoperative period, CPB use was associated with reoperation for bleeding (p=0.012). Conclusion: Currently in the REPLICCAR, reoperation for bleeding was the only outcome associated with the use of CPB in CABG.
- Quality improvement program in Latin America decreases mortality after cardiac surgery: a before-after intervention study(2022) MEJIA, Omar Asdrubal Vilca; BORGOMONI, Gabrielle Barbosa; DALLAN, Luis Roberto Palma; MIOTO, Bruno Mahler; ACCORSI, Tarso Augusto Duenhas; LIMA, Eduardo Gomes; SOEIRO, Alexandre de Matos; LIMA, Felipe Gallego; BRANDAO, Carlos Manuel de Almeida; POMERANTZEFF, Pablo Maria Alberto; DALLAN, Luis Alberto Oliveira; LISBOA, Luiz Augusto FerreiraBackground: The current challenge of cardiac surgery (CS) is to improve outcomes in adverse scenarios. The aim of this study was to assess the impact of a quality improvement program (QIP) on hospital mortality in the largest CS center in Latin America.Methods: Patients were divided into two groups: before (Jan 2013-Dec 2015, n = 3534) and after establishment of the QIP (Jan 2017-Dec 2019, n = 3544). The QIP consisted of the implementation of 10 central initiatives during 2016. The procedures evaluated were isolated coronary artery bypass grafting surgery (CABG), mitral valve surgery, aortic valve surgery, combined mitral and aortic valve surgery, and CABG associated with heart valve surgery. Propensity Score Matching (PSM) was used to adjust for inequality in patients' preoperative characteristics before and after the implementation of QIP. A multivariate logistic regression model was built to predict hospital mortality and validated using discrimination and calibration metrics.Results: The PMS paired two groups using 5 variables, obtaining 858 patients operated before (non-QIP) and 858 patients operated after the implementation of the QIP. When comparing the QIP versus Non-QIP group, there was a shorter length of stay in all phases of hospitalization. In addition, the patients evolved with less anemia (P = 0.001), use of intra-aortic balloon pump (P = 0.003), atrial fibrillation (P = 0.001), acute kidney injury (P < 0.001), cardiogenic shock (P = 0.011), sepsis (P = 0.046), and hospital mortality (P = 0.001). In the multiple model, among the predictors of hospital mortality, the lack of QIP increased the chances of mortality by 2.09 times.Conclusion: The implementation of a first CS QIP in Latin America was associated with a reduction in length of hospital stay, complications and mortality after the cardiac surgeries analyzed.
- REPLICCAR II Study: Data quality audit in the Paulista Cardiovascular Surgery Registry(2020) ORLANDI, Bianca Maria Maglia; MEJIA, Omar Asdrubal Vilca; BORGOMONI, Gabrielle Barbosa; GONCHAROV, Maxim; ROCHA, Kenji Nakahara; BASSOLLI, Lucas; SILVA, Pedro Gabriel Melo de Barros e; NAKAZONE, Marcelo Arruda; SOUSA, Alexandre; CAMPAGNUCCI, Valquiria Pelisser; VILARINHO, Karlos Alexandre de Sousa; KATZ, Marcelo; TIVERON, Marcos Gradim; SANTOS, Magaly Arrais dos; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto de Oliveira; JATENE, Fabio BiscegliThe quality of data in electronic healthcare databases is a critical component when used for research and health practice. The aim of the present study was to assess the data quality in the Paulista Cardiovascular Surgery Registry II (REPLICCAR II) using two different audit methods, direct and indirect. The REPLICCAR II database contains data from 9 hospitals in SAo Paulo State with over 700 variables for 2229 surgical patients. The data collection was performed in REDCap platform using trained data managers to abstract information. We directly audited a random sample (n = 107) of the data collected after 6 months and indirectly audited the entire sample after 1 year of data collection. The indirect audit was performed using the data management tools in REDCap platform. We computed a modified Aggregate Data Quality Score (ADQ) previously reported by Salati et al. (2015). The agreement between data elements was good for categorical data (Cohen kappa = 0.7, 95%CI = 0.59-0.83). For continuous data, the intraclass coefficient (ICC) for only 2 out of 15 continuous variables had an ICC < 0.9. In the indirect audit, 77% of the selected variables (n = 23) had a good ADQ score for completeness and accuracy. Data entry in the REPLICCAR II database proved to be satisfactory and showed competence and reliable data for research in cardiovascular surgery in Brazil.
- Teams, Rapid Recovery Protocols and Technology to Resume Cardiac Surgery in the COVID-19 Era(2021) LIMA, Mariana Kabakura do Amaral; BORGOMONI, Gabrielle Barbosa; MEJIA, Omar Asdrubal VilcaThe coronavirus disease 2019 (COVID-19) pandemic brings numerous challenges to the health ecosystem, including the safe resumption of elective cardiac surgery. In the pre-pandemic period, rapid recovery protocols demonstrated, through strategies focused on the multidisciplinary approach, reduction of hospital length of stay, infection rates and, consequently, costs. Even with several studies proving the benefits of these protocols, their acceptance and implementation have been slow. It is believed that the resumption of surgeries in the current context requires the use of rapid recovery protocols combined with the use of a mobile application promoting greater engagement between patients, caregivers and care teams.
- The arrival of COVID-19 in Brazil and the impact on coronary artery bypass surgery(2021) MEJIA, Omar A. V.; BORGOMONI, Gabrielle B.; SILVEIRA, Lucas M. V.; GUERREIRO, Gustavo P.; FALCAO FILHO, Alexandre. T. G.; GONCHAROV, Maxim; DALLAN, Luis R. P.; OLIVEIRA, Marco A. P.; SOUSA, Alexandre G. de; NAKAZONE, Marcelo A.; TIVERON, Marcos G.; CAMPAGNUCCI, Valquiria P.; SILVA, Pedro G. M.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; JATENE, Fabio B.Background and Aim of the Study This study analyzed the arrival of coronavirus disease 2019 (COVID-19) in Brazil and its impact on coronary artery bypass grafting (CABG) surgery. Methods Patients undergoing isolated CABG in six hospitals in Brazil were divided into two periods: pre-COVID-19 (March-May 2019, N = 468) and COVID-19 era (March-May 2020, N = 182). Perioperative data were included on a dedicated REDCap platform. Patients with clinical and tomographic criteria and/or PCR (+) for severe acute respiratory syndrome coronavirus 2 infection were considered COVID-19 (+). Logistic regression analysis was performed to create a multiple predictive model for mortality after CABG in COVID-19 era. Results Compared to 2019, in 2020, CABG surgeries had a 2.8-fold increased mortality risk (95% confidence interval [CI]: 1-7.6, p = .041), patients who evolved with COVID-19 had a 11-fold increased mortality risk (95% CI: 2.2-54.9, p < .003), rates of morbidities and readmission to the intensive care unit. The surgical volume was decreased by 60%. The model to predict mortality after CABG in the COVID-19 era was validated with good calibration (Hosmer-Lemeshow = 1.43) and discrimination (receiver operating characteristic = 0.78). Conclusion The COVID-19 pandemic had an adverse impact on mortality, morbidity and volume of patients undergoing CABG.
- Safe and effective protocol for discharge 3 days after cardiac surgery(2021) MEJIA, Omar Asdrubal Vilca; BORGOMONI, Gabrielle Barbosa; LASTA, Nilza; OKADA, Mariana Yumi; GOMES, Mariana Silva Biason; FOZ, Mary Lee Norris Nelsen; BISCHOFF, Helga Priscila Giugno; SARUHASHI, Tatiana; MELRO, Livia Maria Garcia; SAMPAIO, Marcio Campos; SILVA, Pedro Gabriel Melo de Barros e; GARCIA, Jose Carlos Teixeira; FURLAN, ValterThe Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the ""TotalCor protocol"". After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P<0.025), postoperative stay (P0.001) and length of hospital stay (P <= 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had>70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay>5 days.
- Most deaths in low-risk cardiac surgery could be avoidable(2021) MEJIA, Omar Asdrubal Vilca; BORGOMONI, Gabrielle Barbosa; LIMA, Eduardo Gomes; GUERREIRO, Gustavo Pampolha; DALLAN, Luis Roberto; SILVA, Pedro de Barros e; NAKAZONE, Marcelo Arruda; PETRUCCI JUNIOR, Orlando; GOMES, Walter Jose; OLIVEIRA, Marco Antonio Praca de; SOUSA, Alexandre; CAMPAGNUCCI, Valquiria Pelisser; TIVERON, Marcos Gradim; RODRIGUES, Alfredo Jose; TINELI, Rafael Angelo; SILVA, Roberto Rocha e; LISBOA, Luiz Augusto Ferreira; JATENE, Fabio BiscegliIt is observed that death rates in cardiac surgery has decreased, however, root causes that behave like triggers of potentially avoidable deaths (AD), especially in low-risk patients (less bias) are often unknown and underexplored, Phase of Care Mortality Analysis (POCMA) can be a valuable tool to identify seminal events (SE), providing valuable information where it is possible to make improvements in the quality and safety of future procedures. Our results show that in SAo Paul State, only one third of AD in low-risk cardiac surgery was related to specific surgical problems. After a revisited analysis, 75% of deaths could have been avoided, which in the pre-operative phase, the SE was related judgment, patient evaluation and preparation. In the intra-operative phase, most occurrences could have been avoided if other surgical technique had been used. Sepsis was responsible for 75% of AD in the intensive care unit. In the ward phase, the recognition/management of clinical decompensations and sepsis were the contributing factors. Logistic regression model identified age, previous coronary stent implantation, coronary artery bypass grafting+heart valve surgery,>= 2 combined heart valve surgery and hospital-acquired infection as independent predictors of AD.
- Immediate Results after Multiple Arterial Grafts in Coronary Artery Bypass Graft Surgery in the S?o Paulo State: Cross Cohort Study(2023) MICALAY, Raul Armando; BORGOMONI, Gabrielle Barbosa; MICALAY, Anny Katia Puchalski; CAMACHO, Jose Carlos Arteaga; DALLAN, Luis Roberto Palma; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto de Oliveira; MEJIA, Omar Asdrubal Vilca; Grp Estudos REPLICCARBackground: The short-term results after using arterial grafts still raise questions and doubts for medical society. Objective: To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery.Methods: Cross-sectional cohort study in the Sao Paulo Registry of Cardiovascular Surgery II. Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk.Results: After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048).Conclusion: Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin >= 6.40%, had a greater influence on the infectious outcome than the choice of grafts.
- Preparing Patients And Optimizing Processes In The Perioperative Period Of Cardiac Surgery: How To Redesign The Flow Of Care After COVID-19(2022) MEJIA, Omar Asdrubal Vilca; MIOTO, Bruno Mahler; BORGOMONI, Gabrielle Barbosa; CAMILO, Juliana Mendanha; WATANABE, Danielle Misumi; NUNES, Sirlei Pereira; SALLAI, Vanessa Santos; LIMA, Maraina Pegorini Liborio de; PALOMO, Jurema da Silva Herbas; COSTA, Helenice Moreira da; ARITA, Elisandra Trevisan; FELTRIM, Maria Ignez Zanetti; COIMBRA, Vera; DIAS, Roger Daglius; GALAS, Filomena Regina Barbosa Gomes; AULER JUNIOR, Jose Otavio Costa; JATENE, Fabio Biscegli
- Validation and quality measurements for STS, EuroSCORE II and a regional risk model in Brazilian patients(2020) MEJIA, Omar Asdrubal Vilca; BORGOMONI, Gabrielle Barbosa; ZUBELLI, Jorge Passamani; DALLAN, Luis Roberto Palma; POMERANTZEFF, Pablo Maria Alberto; OLIVEIRA, Marco Antonio Praca; PETRUCCI JUNIOR, Orlando; TIVERON, Marcos Gradim; NAKAZONE, Marcelo Arruda; TINELI, Rafael Angelo; CAMPAGNUCCI, Valquiria Pelisser; SILVA, Roberto Rocha e; RODRIGUES, Alfredo Jose; GOMES, Walter Jose; LISBOA, Luiz Augusto Ferreira; JATENE, Fabio BiscegliObjectives The objectives of this study were to describe a novel statewide registry for cardiac surgery in Brazil (REPLICCAR), to compare a regional risk model (SPScore) with EuroSCORE II and STS, and to understand where quality improvement and safety initiatives can be implemented. Methods A total of 11 sites in the state of Sao Paulo, Brazil, formed an online registry platform to capture information on risk factors and outcomes after cardiac surgery procedures for all consecutive patients. EuroSCORE II and STS values were calculated for each patient. An SPScore model was designed and compared with EuroSCORE II and STS to predict 30-day outcomes: death, reoperation, readmission, and any morbidity. Results A total of 5222 patients were enrolled in this study between November 2013 and December 2017. The observed 30-day mortality rate was 7.6%. Most patients were older, overweight, and classified as New York Heart Association (NYHA) functional class III; 14.5% of the patient population had a positive diagnosis of rheumatic heart disease, 10.9% had insulin-dependent diabetes, and 19 individuals had a positive diagnosis of Chagas disease. When evaluating the prediction performance, we found that SPScore outperformed EuroSCORE II and STS in the prediction of mortality (0.90 vs. 0.76 and 0.77), reoperation (0.84 vs. 0.60 and 0.56), readmission (0.84 vs. 0.55 and 0.51), and any morbidity (0.80 vs. 0.65 and 0.64), respectively (p<0.001). Conclusions The REPLICCAR registry might stimulate the creation of other cardiac surgery registries in developing countries, ultimately improving the regional quality of care provided to patients.