HENRIQUE BARBOSA RIBEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
24 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 24
- Myocardial Injury After Transcatheter Mitral Valve Replacement Versus Surgical Reoperation(2024) MARCHI, Mauricio Felippi de Sa; ROSA, Vitor Emer Egypto; NICZ, Pedro Felipe Gomes; FONSECA, Jose Honorio de Almeida Palma da; CALOMENI, Pedro; CHIODINI, Fernando; SAMPAIO, Roney Orismar; POMERANTZEFF, Pablo Maria Alberto; VIEIRA, Marcelo de Campos; TARASOUTCHI, Flavio; MIEGHEM, Nicolas M. Van; BRITO, Fabio Sandoli de; ABIZAID, Alexandre; RIBEIRO, Henrique BarbosaThis study aimed to evaluate the incidence and clinical implications of myocardial injury, as determined by cardiac biomarker increase, in patients who underwent mitral bioprosthesis dysfunction treatment with transcatheter mitral valve replacement (TMVR) versus surgical mitral valve replacement reoperation (SMVR-REDO). Between 2014 and 2023, 310 patients with mitral bioprosthesis failure were included (90 and 220 patients for TMVR and SMVR-REDO, respectively). Multivariable analysis and propensity score matching were performed to adjust for the intergroup differences in baseline characteristics. Creatinine kinase-MB (CK-MB) and cardiac troponin I (cTn) were collected at baseline and 6 to 12, 24, 48, and 72 hours after intervention. The cardiac biomarkers values were evaluated in relation to their reference values. The outcomes were determined according to the Mitral Valve Academic Research Consortium criteria. CK-MB and cTn increased above the reference level in almost all patients after SMVR-REDO and TMVR (100% vs 94%, respectively), with the peak occurring within 6 to 12 hours. SMVR-REDO was associated with a two- to threefold higher increase in cardiac biomarkers. After 30 days, the mortality rates were 13.3% in the TMVR and 16.8% in the SMVR-REDO groups. At a median follow-up of 19 months, the mortality rates were 21.1% in the TMVR and 17.7% in the SMVR-REDO groups. Left ventricular ejection fraction, estimated glomerular filtration rate, CK-MB, and cTn were predictors of mortality. In conclusion, some degree of myocardial injury occurred systematically after the treatment of mitral bioprosthetic degeneration, especially after SMVR, and higher CK-MB and cTn levels were associated with increased cumulative late mortality, regardless of the approach.
- 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- Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation(2022) COSTA, Giuliano; PILGRIM, Thomas; SANTOS, Ignacio J. Amat; BACKER, Ole De; KIM, Won-Keun; RIBEIRO, Henrique Barbosa; SAIA, Francesco; BUNC, Matjaz; TCHETCHE, Didier; GAROT, Philippe; RIBICHINI, Flavio Luciano; MYLOTTE, Darren; BURZOTTA, Francesco; WATANABE, Yusuke; MARCO, Federico De; TESORIO, Tullio; RHEUDE, Tobias; TOCCI, Marco; FRANZONE, Anna; VALVO, Roberto; SAVONTAUS, Mikko; WIENEMANN, Hendrik; PORTO, Italo; GANDOLFO, Caterina; IADANZA, Alessandro; BORTONE, Alessandro Santo; 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; JONER, Michael; 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; KARGOLI, Faraj; TAMBURINO, Corrado; BARBANTI, MarcoBackground:The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. Methods:The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. Results:Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio, 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio, 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). Conclusions:The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
- 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.
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