HENRIQUE BARBOSA RIBEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
20 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 20
- Risk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical intervention(2023) TESSARI, Fernanda Castiglioni; LOPES, Maria Antonieta Albanez A. de M.; CAMPOS, Carlos M. M.; ROSA, Vitor Emer Egypto; SAMPAIO, Roney Orismar; SOARES, Frederico Jose Mendes Mendonca; LOPES, Rener Romulo Souza; NAZZETTA, Daniella Cian; JR, Fabio Sandoli de Brito; RIBEIRO, Henrique Barbosa; VIEIRA, Marcelo L. C.; JR, Wilson Mathias; FERNANDES, Joao Ricardo Cordeiro; LOPES, Mariana Pezzute; ROCHITTE, Carlos E. E.; POMERANTZEFF, Pablo M. A.; ABIZAID, Alexandre; TARASOUTCHI, FlavioIntroductionClassical low-flow, low-gradient aortic stenosis (LFLG-AS) is an advanced stage of aortic stenosis, which has a poor prognosis with medical treatment and a high operative mortality after surgical aortic valve replacement (SAVR). There is currently a paucity of information regarding the current prognosis of classical LFLG-AS patients undergoing SAVR and the lack of a reliable risk assessment tool for this particular subset of AS patients. The present study aims to assess mortality predictors in a population of classical LFLG-AS patients undergoing SAVR.MethodsThis is a prospective study including 41 consecutive classical LFLG-AS patients (aortic valve area & LE;1.0 cm(2), mean transaortic gradient <40 mmHg, left ventricular ejection fraction <50%). All patients underwent dobutamine stress echocardiography (DSE), 3D echocardiography, and T1 mapping cardiac magnetic resonance (CMR). Patients with pseudo-severe aortic stenosis were excluded. Patients were divided into groups according to the median value of the mean transaortic gradient (& LE;25 and >25 mmHg). All-cause, intraprocedural, 30-day, and 1-year mortality rates were evaluated.ResultsAll of the patients had degenerative aortic stenosis, with a median age of 66 (60-73) years; most of the patients were men (83%). The median EuroSCORE II was 2.19% (1.5%-4.78%), and the median STS was 2.19% (1.6%-3.99%). On DSE, 73.2% had flow reserve (FR), i.e., an increase in stroke volume & GE;20% during DSE, with no significant differences between groups. On CMR, late gadolinium enhancement mass was lower in the group with mean transaortic gradient >25 mmHg [2.0 (0.0-8.9) g vs. 8.5 (2.3-15.0) g; p = 0.034), and myocardium extracellular volume (ECV) and indexed ECV were similar between groups. The 30-day and 1-year mortality rates were 14.6% and 43.8%, respectively. The median follow-up was 4.1 (0.3-5.1) years. By multivariate analysis adjusted for FR, only the mean transaortic gradient was an independent predictor of mortality (hazard ratio: 0.923, 95% confidence interval: 0.864-0.986, p = 0.019). A mean transaortic gradient & LE;25 mmHg was associated with higher all-cause mortality rates (log-rank p = 0.038), while there was no difference in mortality regarding FR status (log-rank p = 0.114).ConclusionsIn patients with classical LFLG-AS undergoing SAVR, the mean transaortic gradient was the only independent mortality predictor in patients with LFLG-AS, especially if & LE;25 mmHg. The absence of left ventricular FR had no prognostic impact on long-term outcomes.
- Angiotensin Receptor-Neprilysin Inhibitor Effects on Atherosclerotic Cardiovascular Disease Events: A Meta-Analysis of Randomized Controlled Trials(2023) RAVANI, Lis Victoria; GEWEHR, Douglas Mesadri; CALOMENI, Pedro; GAUZA, Mateus de Miranda; PEREIRA, Jussara; CARDOSO, Rhanderson; RIBEIRO, Henrique Barbosa; BOCCHI, EdimarSacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the associaangiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;205:259-268)
- Late Bleeding Events in Patients Undergoing Percutaneous Coronary Intervention in the Workup Pre-TAVR(2023) AVVEDIMENTO, Marisa; CAMPELO-PARADA, Francisco; MUNOZ-GARCIA, Erika; NOMBELA-FRANCO, Luis; FISCHER, Quentin; DONAINT, Pierre; SERRA, Vicenc; VEIGA, Gabriela; GUTIERREZ, Enrique; ESPOSITO, Giovanni; VILALTA, Victoria; ALPERI, Alberto; REGUEIRO, Ander; ASMARATS, Lluis; RIBEIRO, Henrique B.; MATTA, Anthony; MUNOZ-GARCIA, Antonio; TIRADO-CONTE, Gabriela; URENA, Marina; METZ, Damien; RODENAS-ALESINA, Eduard; HERNANDEZ, Jose Maria de la Torre; FERNANDEZ-NOFRERIAS, Eduard; PASCUAL, Isaac; VIDAL-CALES, Pablo; ARZAMENDI, Dabit; CAMPANHA-BORGES, Diego Carter; TRINH, Kim Hoang; COTE, Melanie; FAROUX, Laurent; RODES-CABAU, JosepBACKGROUND In patients undergoing percutaneous coronary intervention (PCI) in the work-up pre-transcatheter aortic valve replacement (TAVR), the incidence and clinical impact of late bleeding events (LBEs) remain largely unknown.OBJECTIVES This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of LBEs in patients undergoing PCI in the work-up pre-TAVR.METHODS This was a multicenter study including 1,457 consecutive patients (mean age 81 +/- 7 years; 41.5% women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium-2 criteria.RESULTS LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (IQR: 12-40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (P <= 0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (43.9% vs 36.0; P = 0.034). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05-1.83; P = 0.020).CONCLUSIONS In TAVR candidates with concomitant significant coronary artery disease requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients.
conferenceObject Impact of Coronary Atherosclerotic Burden on the Long-Term Prognosis of Patients With Chronic Kidney Disease Undergoing Renal Replacement Therapy(2023) GODINHO, Roger; CAMPOS, Carlos; ABIZAID, Alexandre; LIMA, Jose Jayme de; RIBEIRO, Henrique; LOPES, Neuza; MOTA, Gabriel; SANTOS, Luciano; GOWDAK, Luis; KALIL FILHO, Roberto; RIBEIRO, Expedito- Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation(2023) RHEUDE, Tobias; COSTA, Giuliano; RIBICHINI, Flavio Luciano; PILGRIM, Thomas; AMAT-SANTOS, Ignacio J.; BACKER, Ole De; KIM, Won-Keun; RIBEIRO, Henrique Barbosa; SAIA, Francesco; BUNC, Matjaz; TCHETCHE, Didier; GAROT, Philippe; MYLOTTE, Darren; BURZOTTA, Francesco; WATANABE, Yusuke; BEDOGNI, Francesco; TESORIO, Tullio; TOCCI, Marco; FRANZONE, Anna; VALVO, Roberto; SAVONTAUS, Mikko; WIENEMANN, Hendrik; PORTO, Italo; GANDOLFO, Caterina; IADANZA, Alessandro; BORTONE, Alessandro S.; MACH, Markus; LATIB, Azeem; BIASCO, Luigi; TARAMASSO, Maurizio; ZIMARINO, Marco; TOMII, Daijiro; NUYENS, Philippe; SONDERGAARD, Lars; CAMARA, Sergio F.; PALMERINI, Tullio; ORZALKIEWICZ, Mateusz; STEBLOVNIK, Klemen; DEGRELLE, Bastien; GAUTIER, Alexandre; SOLE, Paolo Alberto Del; MAINARDI, Andrea; PIGHI, Michele; LUNARDI, Mattia; KAWASHIMA, Hideyuki; CRISCIONE, Enrico; CESARIO, Vincenzo; BIANCARI, Fausto; ZANIN, Federico; ESPOSITO, Giovanni; ADAM, Matti; GRUBE, Eberhard; BALDUS, Stephan; MARZO, Vincenzo De; PIREDDA, Elisa; CANNATA, Stefano; IACOVELLI, Fortunato; ANDREAS, Martin; FRITTITTA, Valentina; DIPIETRO, Elena; REDDAVID, Claudia; STRAZZIERI, Orazio; MOTTA, Silvia; ANGELLOTTI, Domenico; SGROI, Carmelo; XHEPA, Erion; KARGOLI, Faraj; TAMBURINO, Corrado; JONER, Michael; BARBANTI, MarcoBackground: The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. Aims: We sought to compare different PCI timing strategies in TAVI patients. Methods: The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. Results: A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. Conclusions: In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.
conferenceObject Percutaneous Tricuspid Valve-in- Valve Implantation in Failed Surgical Bioprosthetic Valves: Brazilian Single Center Registry(2023) FILIPPINI, Filippe; BRATZ, Guilherme; SESSA, Bruno; MOREIRA, Cauyna Gurgel; HATTORI, Mario; COIMBRA, Germana; CASSAR, Renata; FREIRE, Antonio Fernando; RIBEIRO, Henrique; ABIZAID, Alexandre; BRITO JR., Fabio; ARRIETA, RaulconferenceObject Noncontrast Transcatheter Aortic Valve Implantation for Patients With Aortic Stenosis and Chronic Kidney Disease: Long-Term Follow-Up of The Pilot Study(2023) FILIPPINI, Filippe; FREIRE, Antonio Fernando; NICZ, Pedro; BRATZ, Guilherme; SESSA, Bruno; RIBEIRO, Henrique; ACCORSI, Tarso; LIBERATO, Gabriela; NOMURA, Cesar Higa; CASSAR, Renata; VIEIRA, Marcelo; BIHAN, David Le; BARRETTO, Rodrigo; MATHIAS, Wilson; POMERANTZEFF, Pablo; TARASOUTCHI, Flavio; ABIZAID, Alexandre; BRITO JR., Fabio- The Forgotten Valve is not to be Forgiven: Tricuspid Regurgitation Impact on Clinical Outcomes after Transcatheter Aortic Valve Implantation(2023) KANHOUCHE, Gabriel; RIBEIRO, Henrique B.
conferenceObject PACLITAXEL-COATED DEVICES DO NOT IMPACT LONG-TERM MORTALITY: A META-ANALYSIS OF KAPLAN-MEIER-DERIVED INDIVIDUAL PATIENT DATA(2023) CARVALHO, Lis Victoria Ravani; CALOMENI, Pedro Abi-Kair Borges; MELO, Pedro; GAUZA, Mateus De Miranda; RIBEIRO, Henrique B.- Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment The VIVID Registry(2023) SIMONATO, Matheus; WHISENANT, Brian K.; UNBEHAUN, Axel; KEMPFERT, Joerg; RIBEIRO, Henrique B.; KORNOWSKI, Ran; ERLEBACH, Magdalena; BLEIZIFFER, Sabine; WINDECKER, Stephan; PILGRIM, Thomas; TOMII, Daijiro; GUERRERO, Mayra; AHMAD, Yousif; FORREST, John K.; MONTORFANO, Matteo; ANCONA, Marco; ADAM, Matti; WIENEMANN, Hendrik; FINKELSTEIN, Ariel; VILLABLANCA, Pedro; CODNER, Pablo; HILDICK-SMITH, David; FERRARI, Enrico; PETRONIO, Anna Sonia; SHAMEKHI, Jasmin; PRESBITERO, Patrizia; BRUSCHI, Giuseppe; RUDOLPH, Tanja; CERILLO, Alfredo; ATTIAS, David; NEJJARI, Mohammed; ABIZAID, Alexandre; MARCHI, Mauricio Felippi de Sa; HORLICK, Eric; WIJEYSUNDERA, Harindra; ANDREAS, Martin; THUKKANI, Arun; AGRIFOGLIO, Marco; IADANZA, Alessandro; BAER, L. Matthew; NANNA, Michael G.; DVIR, DannyBACKGROUND Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction. OBJECTIVES This study aimed to determine whether device position and asymmetry are associated with these outcomes. METHODS Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve In-ternational Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient $5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated. RESULTS A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 +/- 11.6 years; 61.9% female; STS score = 8.3 +/- 7.1). Mean asymmetry was 6.2% +/- 4.4%. Mean depth of implantation was 19.0% +/- 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 +/- 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027). CONCLUSIONS Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered. (J Am Coll Cardiol Intv 2023;16:2615-2627) (c) 2023 by the American College of Cardiology Foundation.