HENRIQUE BARBOSA RIBEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Novel device-based therapies to improve outcome in ST-segment elevation myocardial infarction(2021) MARIA, Giovanni Luigi De; GARCIA-GARCIA, Hector M.; SCARSINI, Roberto; FINN, Aloke; SATO, Yu; VIRMANI, Renu; BHINDI, Ravinay; CIOFANI, Jonathan L.; NUCHE, Jorge; RIBEIRO, Henrique B.; MATHIAS JR., Wilson; YERASI, Charan; FISCHELL, Tim A.; OTTERSPOOR, Luuk; RIBICHINI, Flavio; IBANEZ, Borja; PIJLS, Nico H. J.; SCHWARTZ, Robert S.; KAPUR, Navin K.; STONE, Gregg W.; BANNING, Adrian P.Primary percutaneous coronary intervention (PPCI) has dramatically changed the outcome of patients with ST-elevation myocardial infarction (STEMI). However, despite improvements in interventional technology, registry data show little recent change in the prognosis of patients who survive STEMI, with a significant incidence of cardiogenic shock, heart failure, and cardiac death. Despite a technically successful PPCI procedure, a variable proportion of patients experience suboptimal myocardial reperfusion. Large infarct size and coronary microvascular injury, as the consequence of ischaemia-reperfusion injury and distal embolization of atherothrombotic debris, account for suboptimal long-term prognosis of STEMI patients. In order to address this unmet therapeutic need, a broad-range of device-based treatments has been developed. These device-based therapies can be categorized according to the pathophysiological pathways they target: (i) techniques to prevent distal atherothrombotic embolization, (ii) techniques to prevent or mitigate ischaemia/reperfusion injury, and (iii) techniques to enhance coronary microvascular function/integrity. This review is an overview of these novel technologies with a focus on their pathophysiological background, procedural details, available evidence, and with a critical perspective about their potential future implementation in the clinical care of STEMI patients.
- Valve-in-Valve Challenges: How to Avoid Coronary Obstruction(2019) BERNARDI, Fernando L. M.; DVIR, Danny; RODES-CABAU, Josep; RIBEIRO, Henrique B.Coronary obstruction is a rare but life-threatening complication in patients undergoing transcatheter aortic valve replacement (TAVR). Aortic valve-in-valve (VIV) procedures to treat failed surgical bioprosthesis is associated with similar to 6-fold higher risk for coronary obstruction in certain situations. The primary mechanism consists in the occlusion of the coronary ostium by the dislodged leaflet from the bioprosthesis after deployment of the transcatheter heart valve (THV), which most commonly occurs during the index procedure, but in up to 1/3 of cases a delayed presentation ensues. The clinical presentation consists of severe hypotension and ECG changes in most of the patients, with very high mortality rates. Therefore, pre-procedural multi-slice computed tomography is crucial for identifying high-risk features, such as low coronary heights, shallow sinuses of Valsalva, and short virtual THV to coronary ostial distance (VTC). Also, some models of surgical bioprosthesis present an increased risk for this dreadful complication. Preemptive protective strategies with coronary wiring, with or without placement of an undeployed stent, could mitigate the risks associated with this complication in high-risk patients, even though studies are lacking. This review aims to take a clinical perspective on the challenges in avoiding this complication during VIV procedures.
- Novel strategies in aortic valve-in-valve therapy including bioprosthetic valve fracture and BASILICA(2018) DVIR, Danny; KHAN, Jaffar; KORNOWSKI, Ran; KOMATSU, Ikki; CHHATRIWALLA, Adnan; MACKENSEN, G. Burkhard; SIMONATO, Matheus; RIBEIRO, Henrique; WOOD, David; LEIPSIC, Jonathon; WEBB, John; MYLOTTE, DarrenAn ageing population and increased utilisation of tissue valves in younger patients imply that the number of patients receiving transcatheter aortic valve implantation within failed bioprostheses will continue to increase. There are two major adverse events associated with aortic valve-in-valve procedures that may temper the enthusiasm for these appealing interventions. Residual stenosis is the ""Achilles' heel"" of aortic valve-in-valve, while coronary obstruction is an uncommon but life-threatening adverse event. Prevention of these adverse events is essential. Emerging tools and techniques enable operators to manipulate existing devices and to implant new ones inside them safely. Considering the available evidence, it seems that bioprosthetic valve ring fracture and bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) may enable some solution. Until we have prosthetic valves that are both very durable and non-thrombogenic, we can expect that techniques and tools chosen to treat failed bioprosthetic valves effectively will continue to be designed and utilised.
- Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure(2023) FILIPPINI, Filippe Barcellos; RIBEIRO, Henrique Barbosa; BOCCHI, Edimar; BACAL, Fernando; MARCONDES-BRAGA, Fabiana G.; AVILA, Monica S.; STURMER, Janine Daiana; MARCHI, Mauricio Felippi de Sa; KANHOUCHE, Gabriel; FERNANDO, Antonio; CASSAR, Renata; JR, Fabio Sandoli de Brito; ABIZAID, Alexandre A.Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
- When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?(2016) SILVA, Pedro Gabriel Melo de Barros e; RIBEIRO, Henrique Barbosa; BARUZZI, Antonio Claudio do Amaral; SILVA, Expedito Eustaquio Ribeiro daDual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.
- Impact of periprocedural myocardial injury after transcatheter aortic valve implantation on long-term mortality: a meta-analysis of Kaplan-Meier derived individual patient data(2023) MARCHI, Mauricio Felippi de Sa; CALOMENI, Pedro; GAUZA, Mateus de Miranda; KANHOUCHE, Gabriel; RAVANI, Lis Victoria; RODRIGUES, Caio Vinicius Fernandes; TARASOUTCHI, Flavio; JR, Fabio Sandoli de Brito; RODES-CABAU, Josep; MIEGHEM, Nicolas M. Van; ABIZAID, Alexandre; RIBEIRO, Henrique BarbosaBackground: Periprocedural myocardial injury (PPMI) frequently occurs after transcatheter aortic valve implantation (TAVI), although its impact on long-term mortality is uncertain.Methods: We performed a pooled analysis of Kaplan-Meier-derived individual patient data to compare survival in patients with and without PPMI after TAVI. Flexible parametric models with B-splines and landmark analyses were used to determine PPMI prognostic value. Subgroup analyses for VARC-2, troponin, and creatine kinase-MB (CK-MB)-defined PPMI were also performed.Results: Eighteen observational studies comprising 10,094 subjects were included. PPMI was associated with lower overall survival (OS) after two years (HR = 1.46, 95% CI 1.30-1.65, p < 0.01). This was also observed when restricting the analysis to overall VARC-2-defined PPMI (HR = 1.23, 95% CI 1.07-1.40, p < 0.01). For VARC-2 PPMI criteria and VARC-2 troponin-only, higher mortality was restricted to the first 2 months after TAVI (HR = 1.64, 95% CI 1.31-2.07, p < 0.01; and HR = 1.32, 95% CI 1.05-1.67, p = 0.02, respectively), while for VARC-2 defined CK-MB-only the increase in mortality was confined to the first 30 days (HR = 7.44, 95% CI 4.76-11.66, p < 0.01).Conclusion: PPMI following TAVI was associated with lower overall survival compared with patients without PPMI. PPMI prognostic impact is restricted to the initial months after the procedure. The analyses were consistent for VARC-2 criteria and for both biomarkers, yet CK-MB was a stronger prognostic marker of mortality than troponin.