FERNANDO LUIZ DE MELO BERNARDI
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- 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.
- Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry(2015) BERNARDI, Fernando L. M.; GOMES, Wilton F.; BRITO JR., Fabio S. de; MANGIONE, Jose A.; SARMENTO-LEITE, Rogerio; SIQUEIRA, Dimitry; CARVALHO, Luiz A.; TUMELERO, Rogerio; GUERIOS, Enio E.; LEMOS, Pedro A.ObjectiveTo compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among real-world patients from the multi-center Brazilian TAVI registry. BackgroundVascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described. MethodsThe study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a real-world, nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year. ResultsA total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P=0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P=0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year. ConclusionTotal percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI. (c) 2015 Wiley Periodicals, Inc.
conferenceObject Transcatheter aortic valve implantation in degenerated aortic bioprosthesis: an analysis from the Brazilian TAVI Registry(2015) BERNARDI, Guilherme; BERNARDI, Fernando L. de Melo; PRATES, Paulo R.; LEMOS, Pedro A.; SIQUEIRA, Dimytri A.; MANGIONE, Jose A.; DOURADO, Adriano; CARVALHO, Luiz Antonio; THIAGO, Luiz Eduardo Sao; LIMA, Valter; ANDREA, Julio; BRITO JR., Fabio; SARMENTO-LEITE, Rogerio Rogerio- Recent Developments and Current Status of Transcatheter Aortic Valve Replacement Practice in Latin America - the WRITTEN LATAM Study(2022) BERNARDI, Fernando Luiz de Melo; RIBEIRO, Henrique Barbosa; NOMBELA-FRANCO, Luis; CERRATO, Enrico; MALUENDA, Gabriel; NAZIF, Tamim; LEMOS, Pedro Alves; SZTEJFMAN, Matias; LAMELAS, Pablo; ECHEVERRI, Dario; LOPES, Marcelo Antonio Cartaxo Queiroga; BRITO, Fabio Sandoli de; ABIZAID, Alexandre A.; MANGIONE, Jose A.; ELTCHANINOFF, Helene; SONDERGAARD, Lars; RODES-CABAU, JosepBackground: Transcatheter aortic valve replacement (TAVR) is a worldwide adopted procedure with rapidly evolving practices. Regional and temporal variations are expected to be found. Objective: To compare TAVR practice in Latin America with that around the world and to assess its changes in Latin America from 2015 to 2020. Methods: A survey was applied to global TAVR centers between March and September 2015, and again to Latin-American centers between July 2019 and January 2020. The survey consisted of questions addressing: i) center's general information; ii) pre-TAVR evaluation; iii) procedural techniques; iv) post-TAVR management; v) follow-up. Answers from the 2015 survey of Latin-American centers (LATAM15) were compared with those of other centers around the world (WORLD15) and with the 2020 updated Latin-American survey (LATAM20). A 5% level of significance was adopted for statistical analysis. Results: 250 centers participated in the 2015 survey (LATAM15=29; WORLD15=221) and 46 in the LATAM20. Combined centers experience accounted for 73 707 procedures, with WORLD15 centers performing, on average, 6- and 3-times more procedures than LATAM15 and LATAM20 centers, respectively. LATAM centers performed less minimalistic TAVR than WORLD15 centers, but there was a significant increase in less invasive procedures after 5 years in Latin-American centers. For postprocedural care, a lower period of telemetry and maintenance of temporary pacing wire, along with less utilization of dual antiplatelet therapy was observed in LATAM20 centers. Conclusion: Despite still having a much lower volume of procedures, many aspects of TAVR practice in Latin-American centers have evolved in recent years, following the trend observed in developed country centers.
- Incidence, Predictor, and Clinical Outcomes of Multiple Resheathing With Self-Expanding Valves During Transcatheter Aortic Valve Replacement(2021) BERNARDI, Fernando L. M.; RODES-CABAU, Josep; TIRADO-CONTE, Gabriela; SANTOS, Ignacio J. Amat; PLACHTZIK, Claudia; CURA, Fernando; SZTEJFMAN, Matias; MANGIONE, Fernanda M.; TUMELEIRO, Rogerio; ESTEVES, Vinicius Borges Cardozo; MELO, Eduardo Franca Pessoa de; CHAUVET, Alejandro Alcocer; FUCHS, Felipe; SARMENTO-LEITE, Rogerio; MARTINS, Estevao Carvalho de Campos; NOMBELA-FRANCO, Luis; DELGADO-ARANA, Jose Raul; BOCKSCH, Wolfgang; LAMELAS, Pablo; GIULIANI, Carlos; CAMPANHA-BORGES, Diego Carter; MANGIONE, Jose A.; JR, Fabio Sandoli de Brito; ABIZAID, Alexandre C.; RIBEIRO, Henrique B.Background No study has evaluated the impact of the additional manipulation demanded by multiple resheathing (MR) in patients undergoing transcatheter aortic valve replacement with repositionable self-expanding valves. Methods and Results This study included a real-world, multicenter registry involving 16 centers from Canada, Germany, Latin America, and Spain. All consecutive patients who underwent transcatheter aortic valve replacement with the Evolut R, Evolut PRO, and Portico valves were included. Patients were divided according to the number of resheathing: no resheathing, single resheathing (SR), and MR. The primary end point was device success. Secondary outcomes included procedural complications, early safety events, and 1-year mortality. In 1026 patients, the proportion who required SR and MR was 23.9% and 9.3%, respectively. MR was predicted by the use of Portico and moderate/severe aortic regurgitation at baseline (both with P<0.01). Patients undergoing MR had less device success (no resheathing=89.9%, SR=89.8%, and MR=80%; P=0.01), driven by more need for a second prosthesis and device embolization. At 30 days, there were no differences in safety events. At 1 year, more deaths occurred with MR (no resheathing=10.5%, SR=8.0%, and MR=18.8%; P=0.014). After adjusting for baseline differences and center experience by annual volume, MR associated with less device success (odds ratio, 0.42; P=0.003) and increased 1-year mortality (hazard ratio, 2.06; P=0.01). When including only the Evolut R/PRO cases (N=837), MR continued to have less device success (P<0.001) and a trend toward increased mortality (P=0.05). Conclusions Repositioning a self-expanding valve is used in a third of patients, being multiple in approximate to 10%. MR, but not SR, was associated with more device failure and higher 1-year mortality, regardless of the type of valve implanted.
- Denervação simpática renal percutânea(2013) BERNARDI, Fernando Luiz de Melo; GOMES, Wilton Francisco; SPADARO, André Gasparini; ESTEVES FILHO, Antônio; BORTOLOTTO, Luiz Aparecido; SCANAVACCA, Maurício Ibrahim; LEMOS, Pedro AlvesArterial hypertension is a highly prevalent disease and is associated with increased cardiovascular risk. Despite great advances in drug therapy, a considerable number of patients do not have an effective control of the disease, despite the use of multiple drugs, usually in high doses. Renal sympathetic denervation (RSD) has proved to be a promising therapy, with high safety and efficacy in preliminary studies in patients with resistant hypertension. The role of sympathetic nervous system in the physiopathology of hypertension is well known and is the rationale for the ablation of sympathetic fibers by transluminal delivery of radiofrequency in the renal arteries. In the last few years, results from case series, non-controlled studies and one multicenter randomized trial with a limited number of patients have shown a significant decrease in short and mid-term blood pressure levels. The objective of this review was to gather evidence on the use of RSD in the control of resistant hypertension and describe technical aspects and perspectives of the procedure.
- 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. deBackground-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.
- Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? Analysis of 568 Patients(2015) TRUFFA, Marcio A. M.; ALVES, Gustavo M. P.; BERNARDI, Fernando; ESTEVES FILHO, Antonio; RIBEIRO, Expedito; GALON, Micheli Z.; SPADARO, Andre; KAJITA, Luiz J.; ARRIETA, Raul; LEMOS, Pedro A.Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective: To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure. Methods: The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results: A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 +/- 70.7 Gycm(2), while the staged group, to 139.2 +/- 75.3 Gycm(2) (p < 0.001). Conclusion: Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.
- Case 03/12-A 41-Year-Old Female Patient with Hypertrophic Cardiomyopathy and Congestive Heart Failure(2012) BERNARDI, Fernando Luiz de Melo; BENVENUTI, Luiz Alberto
conferenceObject Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: insights from the brazilian TAVI registry(2014) BERNARDI, F. L.; BRITO JR., F. S.; MANGIONE, J. A.; SARMENTO-LEITE, R.; SIQUEIRA, D. A.; CARVALHO, L. A.; SICILIANO, A.; DIAS, J. C.; ABIZAID, A.; LEMOS, P. A.