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
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- 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.
- Impact of the COVID-19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective(2021) KHALIL, Kalil Hussein; SA, Michel Pompeu B. O.; VERVOORT, Dominique; ROEVER, Leonardo; PIRES, Marcos Alfredo de Andrade; LIMA, Jaqueline Maria de Oliveira; SALLES, Felipe Borsu de; KHALIL, Giovana Munhoz; GOMES, Pedro Felipe; MEJIA, Omar Asdrubal Vilca; OKINO, Arnaldo Akio; LIMA, Ricardo de CarvaihoIntroduction The coronavirus disease 2019 (COVID-19) pandemic has been a worldwide challenge, and efforts to ""flatten the curve,"" including restrictions imposed by policymakers and medical societies, have forced a reduction in the number of procedures performed in the Brazilian Health Care System. The aim of this study is to evaluate the outcomes of coronary artery bypass graft (CABG) from 2008 to 2020 in the SUS and to assess the impacts of the COVID-19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS. Methods This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures and death rates. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. Results We identified 281,760 CABG procedures performed from January 2008 to December 2020. The average number of procedures until the end of 2019 was of 22,104. During 2020 there was a 25% reduction CABG procedures, to 16,501. There was an increase in the national death rate caused by a statistical significant increase in death rates in Brazil's Southeast and Central-west regions. Conclusion The COVID-19 pandemic remains a global challenge for Brazil's health care system. During the year of 2020 there was a reduction in access to CABG related to an increase in the number of COVID-19 cases. There was also an increase in the national CABG death rate.
- Transit-time flow measurement parameters after protamine infusion in CABG surgeries(2022) DALLAN, Luis Roberto P.; DALLAN, Luis Alberto O.; LISBOA, Luiz Augusto F.; V, Omar A. Mejia; PLATANIA, Fernando; RODRIGUES, Renan de Carvalho; DALLAN, Luis Augusto P.; JATENE, Fabio B.Objective The objective of this study is to evaluate protamine sulfate effects on graft's blood flow by comparing transit-time flow measurement (TTFM) values before and after protamine administration. Methods This is an observational study with data collected between years 2018 and 2020. Immediate graft patency was evaluated using TTFM. Only patients with TTFM parameters registered before and after protamine infusion were included. The main three parameters studied were: mean graft flow (MGF), pulsatility index (PI), and diastolic flow (DF). In the first analysis, all conduits were evaluated regardless of the surgical technique used. In a second analysis, on-pump and off-pump groups were compared. Evaluated grafts were left internal thoracic artery, saphenous vein graft (SVG), radial artery, and right internal thoracic artery. Since SVG was numerically the most used graft, an exclusive analysis was created. Results Our study included 575 patients, resulting in a total of 1686 grafts, mean 2.93 grafts/patient. Off-pump surgery was performed in 158 patients. Before protamine infusion, inadequate TTFM parameters were observed in 3.8% of grafts. Overall, after protamine administration, MGF decreased in all grafts, but its reduction was not statistically significant. PI values increased in the SVG and DF values reduced in LIMA grafts. SVG group analysis showed that after protamine PI values were higher in OM1 and RCA. DF values increased in RCA. The comparison between off and on-pump surgeries, showed that in off-pump cases TTFM measures did not present statistically significant differences. Conclusion Significant variations were observed in TTFM values before and after protamine administration. Although different, those values remained within the normal reference ranges. We recommend that flow measurement should be performed before protamine infusion.
- Coronary artery bypass graft surgery in Brazil from 2008 to 2017(2021) KHALIL, Kalil Hussein; SA, Michel Pompeu B. O.; VERVOORT, Dominique; ROEVER, Leonardo; PIRES, Marcos Alfredo de Andrade; LIMA, Jaqueline Maria de Oliveira; SALLES, Felipe Borsu de; KHALIL, Giovana Munhoz; NICZ, Pedro Felipe Gomes; MEJIA, Omar Asdrubal Vilca; OKINO, Arnaldo Akio; LIMA, Ricardo de CarvalhoBackground: Brazil is an upper middle-income country in South America with the world's sixth largest population. Despite great advances in health-care services and cardiac surgical care in both its public and private health systems, little is known on the volume, outcomes, and trends of coronary artery bypass grafting (CABG) in Brazil's public health system. Objective: The aim of this study was to evaluate the outcome of CABG on the public health system from January 2008 to December 2017 through the database DATASUS. Methods: This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures, death rates, length of stay, and costs. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. The chi(2) test was used to compare death rates. A p < .05 was considered statistically significant. Results: We identified 226,697 CABG procedures performed from January 2008 to December 2017. The overall in-hospital mortality over the 10-year period was 5.7%. We observed statistically significant differences in death rates between the five Brazilian macro-regions. Death rates by state ranged from 2.6% to 13.1%. The national average mortality rate remained stable over the course of time. Conclusion: Over 10 years, a high volume of CABG was performed in the Brazilian Public Health System, with significant differences in mortality, number of procedures, and distribution of surgeries by region. Future databases involving all centers that perform CABG and carry out risk-adjusted analysis will help improve Brazilian results and enable policymakers to adopt appropriate health-care policies for greater transparency and accountability.
- Increased number of ventricular septal rupture cases after acute myocardial infarction in 2020(2021) DALLAN, Luis R. P.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; MEJIA, Omar A. V.; VERONESE, Elinthon T.; CAMILO, Juliana P. M.; NASCIMENTO, Polyanna C. M.; JATENE, Fabio B.Introduction Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI) such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution. Methods From a retrospective database analysis in our institution between the years 2004 and 2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality. Results Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intra-aortic balloon pump were associated with significantly increased mortality using logistic regression. Conclusion We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.