HENRIQUE BARBOSA RIBEIRO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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search.filters.applied.f.dateIssued: 2016 × Assunto: Cardiac & Cardiovascular Systems ×

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  • article 38 Citação(ões) na Scopus
    Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation Insights From the Brazilian Transcatheter Aortic Valve Replacement Registry
    (2016) BERNARDI, Fernando L. M.; RIBEIRO, Henrique B.; CARVALHO, Luiz A.; SARMENTO-LEITE, Rogerio; MANGIONE, Jose A.; LEMOS, Pedro A.; ABIZAID, Alexandre; GRUBE, Eberhard; RODES-CABAU, Josep; BRITO JR., Fabio S. de
    Background-Direct transcatheter aortic valve replacement (TAVR) is regarded as having potential advantages over TAVR with balloon aortic valve predilatation (BAVP) in reducing procedural complications, but there are few data to support this approach. Methods and Results-Patients included in the Brazilian TAVR registry with CoreValve and Sapien-XT prosthesis were compared according to the implantation technique, with or without BAVP. Clinical and echocardiographic data were analyzed in overall population and after propensity score matching. A total of 761 consecutive patients (BAVP=372; direct-TAVR=389) were included. Direct-TAVR was possible in 99% of patients, whereas device success was similar between groups (BAVP=81.2% versus direct-TAVR=78.1%; P=0.3). No differences in clinical outcomes at 30 days and 1 year were observed, including all-cause mortality (7.6% versus 10%; P=0.25 and 18.1% versus 24.5%; P=0.07, respectively) and stroke (2.8% versus 3.8%; P=0.85 and 5.5% versus 6.8%; P=0.56, respectively). Nonetheless, TAVR with BAVP was associated with a higher rate of new onset persistent left bundle branch block with the CoreValve (47.7% versus 35.1%; P=0.01 at 1 year). Mean gradient and incidence of moderate/severe aortic regurgitation were similar in both groups at 1 year (11% versus 13.3%; P=0.57 and 9.8 +/- 5.5 versus 8.7 +/- 4.3; P=0.09, respectively). After propensity score matching analysis, all-cause mortality and stroke remained similar. By multivariable analysis, BAVP and the use of CoreValve were independent predictors of new onset persistent left bundle branch block. Conclusions-The 2 TAVR strategies, with or without BAVP, provided similar clinical and echocardiographic outcomes over a midterm follow-up although BAVP was associated with a higher rate of new onset persistent left bundle branch block, particularly in patients receiving a CoreValve.
  • article 4 Citação(ões) na Scopus
    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 da
    Dual 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.