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
13 resultados
Resultados de Busca
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- Continuous quality improvement programme in cardiovascular surgery: the Latin American perspective(2016) MEJIA, Omar A.; LISBOA, Luiz A.; JATENE, Fabio B.
- 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.
conferenceObject STS, EuroSCORE II or SYNTAX II: which is the best score to assess mortality risk for complex coronary artery disease after CABG?(2018) GONZALES-TAMAYO, L.; CAMPOS, C. M.; LISBOA, L.; OLIVEIRA, M.; DALLAN, L.; JATENE, F.; MEJIA, O.- 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.
conferenceObject Circulating miRNA-770-5p and miRNA-30d-5p as potential biomarkers in vasoplegic syndrome after on-pump coronary artery bypass surgery - PREVENT trial(2022) MEJIA, O. A. V.; SOUZA, R. C.; MENEGHINI, B.; SANTOS, A. S.; LISBOA, L. A. F.; DALIAN, L. A. O.; CUNHA-NETO, E.; FERREIRA, L. R. P.; JATENE, F. B.- 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.
conferenceObject The FRAGILE clinical trial: the impact of the coronary artery bypass graft in frailty(2023) MEJIA, O. A. V.; MENEGHINI, B.; FREITAS, F. L.; HOEFLINGER, L. C. F.; GUERRIERI, M. L. J.; HUEB, A. C.; COSENTINO, F.; SEGALOTE, R.; RIBAS, F. F.; OLIVEIRA, M. A. P.; DEININGER, M. O.; DALLAN, L. R.; LISBOA, L. A. F.; DALLAN, L. A. O.; JATENE, F. B.conferenceObject RISK ASSESSMENT IN CARDIAC SURGICAL PROCEDURES USING THE SP-SCORE (SAO PAULO RISK SCORE) - AN INDEPENDENT VALIDATION(2021) NAKAZONE, Marcelo Arruda; MACHADO, Mauricio N.; MACHADO, Laura O.; MACHADO, Julia O.; MEJIA, Omar A. V.; LISBOA, Luiz A. F.; MAIA, Lilia N.