LEONARDO AUGUSTO MIANA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
39 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 39
- Suporte Circulatório como Ponte para Transplante Cardíaco Pediátrico(2016) CANEO, Luiz Fernando; MIANA, Leonardo A.; JATENE, Marcelo B.
- Surgical Correction of Ascending Aortic Aneurysm Without Coronary Dilatation After Kawasaki Disease in a 3-Year-Old Child(2022) SANTOS, Romullo M.; MASSOTI, Maria Raquel B.; CORONEL, Monica Raquel Gonzalez; MAIA, Frederico Faria; MIANA, Leonardo Augusto; JATENE, Marcelo BiscegliKawasaki disease (KD) is an inflammatory condition that may affect genetically predisposed individuals in pediatric ages after infectious/ environmental triggering. An infrequent finding associated with KD is ascending aortic aneurysm during or after the acute phase of the disease. In this Multimedia presentation, we describe a three-year-old girl submitted to surgical treatment.
- New and available biomarker to predict acute kidney injury after pediatric cardiac surgery(2022) MANUEL, Valdano; MIANA, Leonardo A.
- Where is the new beginning for Latin America?(2022) MIANA, Leonardo A.; DARODA, Larissa L.
- Heart Retransplantation for Coronary Allograft Vasculopathy in Children: 25 Years of Single -Center Experience(2020) AZEKA, Estela; WALKER, Thomas; SIQUEIRA, Adailson Wagner da Silva; PENHA, Juliano; MIANA, Leonardo; CANEO, Luiz Fernando; MASSOTI, Maria Raquel; TANAMATI, Carla; MIURA, Nana; JATENE, Marcelo Biscegli
- Lessons Learned From a Critical Analysis of the Fontan Operation Over Three Decades in a Single Institution(2017) CANEO, Luiz Fernando; TURQUETTO, Aida L. R.; NEIROTTI, Rodolfo A.; BINOTTO, Maria A.; MIANA, Leonardo A.; TANAMATI, Carla; PENHA, Juliano G.; SILVEIRA, Joao B. D.; SILVA, Thais M. Alexandre e; JATENE, Fabio B.; JATENE, Marcelo B.Background: The Fontan operation (FO) has evolved and many centers have demonstrated improved results relative to those from earlier eras. We report a single-institution experience over three decades, describing the outcomes and evaluating risk factors. Methods: Successive patients undergoing primary FO were divided into era I (1984-1994), era II (1995-2004), and era III (2005-2014). Clinical and operative notes were reviewed for demographic, anatomic, and procedure details. End points included early and late mortality and a composite of death, heart transplantation (HTX), or Fontan takedown. Results: A total of 420 patients underwent 18 atriopulmonary connections, 82 lateral tunnels (LT), and 320 extracardiac conduit (EC) Fontan procedures. Forty-six (11%) patients died; early and late mortality were 7.9% and 3.1%, respectively. Eight (1.9%) patients underwent HTX, 11 (2.6%) underwent Fontan conversion to EC, and 1 (0.2%) takedown of EC to bidirectional Glenn shunt. Prevalence of concomitant valve surgery (P < .001) and pulmonary artery reconstruction (P < .001) differed over the eras. Preoperative valve regurgitation was associated with likelihood of early mortality (odds ratio [OR] = 3.5, P = .002). Embolic events (OR = 1.9, P = .047), preoperative valve regurgitation (OR = 2.3, P = .029), diagnosis of unbalanced atrioventricular canal defect (OR = 1.14, P = .03), and concomitant valve replacement (OR = 6.9, P = .001) during the FO were associated with increased risk of the composite end point (death, HTX, or takedown). Conclusion: Technical modifications did not result in improved results across eras, due in part to more liberal indications for surgery in the recent years. Valve regurgitation, unbalanced atrioventricular canal, embolic events, or concomitant valve replacement were associated with FO failure.
- Translation and Validation of the Boston Technical Performance Score in a Developing Country(2021) MIANA, Leonardo A.; NATHAN, Meena; TENORIO, Davi Freitas; MANUEL, Valdano; GUERREIRO, Gustavo; FERNANDES, Natalia; CAMPOS, Carolina Vieira de; V, Paula Gaiolla; CASSAR, Renata Sa; TURQUETTO, Aida; AMATO, Luciana; CANEO, Luiz Fernando; DARODA, Larissa Leitao; JATENE, Marcelo Biscegli; JATENE, Fabio B.Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.
- Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation(2015) CANEO, Luiz Fernando; MIANA, Leonardo Augusto; TANAMATI, Carla; PENHA, Juliano Gomes; SHIMODA, Monica Satsuki; AZEKA, Estela; MIURA, Nana; GALAS, Filomena Regina Barbosa Gomes; GUIMARAES, Vanessa Alves; JATENE, Marcelo BiscegliBackground: Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure. Objective: To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy. Methods: Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy. Results: We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n = 10), eight died waiting and 2 patients (20%) were transplanted, but none was discharged. In group B (n = 9), 6 patients (66.7%) were transplanted and three were discharged. The mean support time was 21,8 days (6 to 984h). The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B. Conclusion: Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.
article Cardiac Arrhythmias Guideline in Children and Congenital Cardiomyopathies SOBRAC and DCC - CP(2016) MAGALHAES, L. P.; GUIMARAES, I. C. B.; MELO, S. L.; MATEO, E. I. P.; ANDALAFT, R. B.; XAVIER, L. F. R.; LORGA FILHO, A. M.; FAGUNDES, A. A.; MOREIRA, D. A. R.; HACHUL, D. T.; STERNICK, E. B.; ANDREA, E. M.; CANNAVAN, F. P. S.; OLIVEIRA, F. J. B.; DARRIEUX, F. C. C.; LIMA, G. G.; ATIE, J.; ELIAS NETO, J.; ZIMERMAN, L. I.; MIANA, L.; PELLANDA, L. C.; SACILOTTO, L.; JATENE, M. B.; SOARES, M. M.; BINOTTO, M. A.; SCANAVACCA, M. I.; OLIVEIRA JUNIOR, N. A.; ZIELINSKY, P.; SALERNO, P. R.; TEIXEIRA, R. A.; KUNIYOSHI, R. R.; COSTA, R.; SCHAMES NETO, S.; PEDRA, S. R. F. F.; GIMENEZ, S. C.; WU, T. C.; AIELLO, V. D.- Neutrophil-Lymphocyte Ratio in Congenital Heart Surgery: What Is Known and What Is New?(2022) MANUEL, Valdano; MIANA, Leonardo A.; JATENE, Marcelo B.Operative mortality after repair of congenital heart disease has improved dramatically over the past few decades. Nevertheless, there is always room for the additional mitigation of complications and mortality. Being able to anticipate adverse outcomes is clearly important, especially when using low-cost and easily accessible resources. The neutrophil-lymphocyte ratio (NLR) is defined as the ratio of the absolute neutrophil to lymphocyte count, which can be easily measured using a regular white blood cell count. Recently, preoperative NLR has been shown to be a predictor of outcomes in patients undergoing congenital heart surgery. Although it presented promising results, there are still many gaps to be filled like the normal value for children, the ideal cutoff value to predict adverse outcomes, the wide variation and its correlation with other biomarkers, and if it is a modifiable risk factor. The aim of this review is to understand the prognostic value of preoperative NLR as a biomarker predictor of outcomes in patients undergoing congenital heart surgery based on previous clinical studies and to propose future directions in order to solve the above-mentioned questions.