FLAVIO TARASOUTCHI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder
60 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 60
- Is Heart Team Fundamental to Aortic Stenosis Transcatheter Treatment?(2014) ROSA, Vitor Emer Egypto; LOPES, Antnio Sergio de Santis Andrade; ACCORSI, Tarso Augusto Duenhas; LEMOS NETO, Pedro Alves; POMERANTZEFF, Pablo Maria Alberto; TARASOUTCHI, Flavio
- 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.
- Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease(2021) SILVA, Michel V. Lemes da; NUNES FILHO, Antonio C. B.; ROSA, Vitor E. E.; CAIXETA, Adriano; LEMOS NETO, Pedro A.; RIBEIRO, Henrique B.; ALMEIDA, Breno O.; MARIANI JR., Jose; CAMPOS, Carlos M.; ABIZAID, Alexandre A. C.; MANGIONE, Jose A.; SAMPAIO, Roney O.; CARAMORI, Paulo; SARMENTO-LEITE, Rogerio; TARASOUTCHI, Flavio; FRANKEN, Marcelo; BRITO JR., Fabio S. deBackground Chronic kidney disease is commonly found in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and has marked impact in their prognosis. It has been shown however that TAVR may improve renal function by alleviating the hemodynamic barrier imposed by AS. Nevertheless, the predictors of and clinical consequences of renal function improvement are not well established. Our aim was to assess the predictors of improvement of renal function after TAVR. Methods The present work is an analysis of the Brazilian Registry of TAVR, a national non-randomized prospective study with 22 Brazilian centers. Patients with baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m(2)) were stratified according to renal function after TAVR: increase >10% in eGFR were classified as TAVR induced renal function improvement (TIRFI); decrease > 10% in eGFR were classified as acute kidney injury (AKI) and stable renal function (neither criteria). Results A total of 819 consecutive patients with symptomatic severe AS were included. Of these, baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m(2)) was present in 577 (70%) patients. Considering variance in renal function between baseline and at discharge after TAVR procedure, TIRFI was seen in 197 (34.1%) patients, AKI in 203 (35.2%), and stable renal function in 177 (30.7%). The independent predictors of TIRFI were: absence of coronary artery disease (OR: 0.69; 95% CI 0.48-0.98; P = 0.039) and lower baseline eGFR (OR: 0.98; 95% CI 0.97-1.00; P = 0.039). There was no significant difference in 30-day and 1-year all-cause mortality between patients with stable renal function or TIRFI. Nonetheless, individuals that had AKI after TAVR presented higher mortality compared with TIRFI and stable renal function groups (29.3% vs. 15.4% vs. 9.5%, respectively; p < 0.001). Conclusions TIRFI was frequently found among baseline impaired renal function individuals but was not associated with improved 1-year outcomes.
- Longitudinal Shortening of the Left Ventricle by Cine-CMR for Assessment of Diastolic Function in Patients with Aortic Valve Disease(2020) RIBEIRO, Sergio Marrone; AZEVEDO FILHO, Clerio Francisco de; SAMPAIO, Roney; TARASOUTCHI, Flavio; GRINBERG, Max; KALIL-FILHO, Roberto; ROCHITTE, Carlos EduardoBackground: Diastolic dysfunction, commonly evaluated by echocardiography, is an important early finding in many cardiomyopathies. Cardiac magnetic resonance (CMR) often requires specialized sequences that extends the test time. Recently, feature-tracking imaging has been made available, but still requires expensive software and lacks clinical validation. Objective: To assess diastolic function in patients with aortic valve disease (AVD) and compare it with normal controls by evaluating left ventricular (LV) longitudinal displacement by CMR. Methods: We compared 26 AVD patients with 19 normal controls. Diastolic function was evaluated as LV longitudinal displacement in 4-chamber view cine-CMR images using steady state free precession (SSFP) sequence during the entire cardiac cycle with temporal resolution < 50 ms. The resulting plot of atrioventricular junction (AVJ) position versus time generated variables of AVJ motion. Significance level of p < 0.05 was used. Results: Maximum longitudinal displacement (0.12 vs. 0.17 cm), maximum velocity during early diastole (MVED, 0.6 vs. 1.4s(-1)), slope of the best-fit line of displacement in diastasis (VDS, 0.22 vs. 0.03s(-1)), and VDS/MVED ratio (0.35 vs. 0.02) were significantly reduced in AVD patients compared with controls, respectively. Aortic regurgitation showed significantly worse longitudinal LV shortening compared with aortic stenosis. Higher LV mass indicated worse diastolic dysfunction. Conclusions: A simple linear measurement detected significant differences on LV diastolic function between AVD patients and controls. LV mass was the only independent predictor of diastolic dysfunction in these patients. This method can help in the evaluation of diastolic dysfunction, improving cardiomyopathy detection by CMR, without prolonging exam time or depending on expensive software.
- Thrombocytopenia After Transcatheter Valve-in-Valve Implantation: Prognostic Marker or Mere Finding?(2018) SOUZA, Renato C. de; PAIM, Leonardo; VIOTTO, Guilherme; APRIGIO, Joaquim; ARAUJO, Lucas L.; RIBEIRO, Henrique; SAMPAIO, Roney O.; TARASOUTCHI, Flavio; POMERANTZEFF, Pablo M. A.; PALMA, Jose Honorio; JATENE, Fabio B.Objective: To analyze the behavior of platelets after transcatheter valve-in-valve implantation for the treatment of degenerated bioprosthesis and how they correlate with adverse events upon follow-up. Methods: Retrospective analysis of 28 patients who received a valve-in-valve implant, 5 in aortic, 18 in mitral and 5 in tricuspid positions. Data were compared with 74 patients submitted to conventional redo valvular replacements during the same period, and both groups' platelet curves were analyzed. Statistical analysis was conducted using the IBM SPSS Statistics (R) 20 for Windows. Results: All patients in the valve-in-valve group developed thrombocytopenia, 25% presenting mild (<150.000/mu L), 54% moderate (<100.000/mu L) and 21% severe (<50.000/mu L) thrombocytopenia. The platelet nadir was on the 4th postoperative day for aortic ViV, 2nd for mitral and 3rd for tricuspid patients, with the majority of patients recovering regular platelet count. However, the aortic subgroup comparison between valve-invalve and conventional surgery showed a statistically significant difference from the 7th day onwards, where valve-in-valve patients had more severe and longer lasting thrombocytopenia. This, however, did not translate into a higher postoperative risk. In our study population, postoperative thrombocytopenia did not correlate with greater occurrence of adverse outcomes and only normal preoperative platelet count could significantly predict a postoperative drop >50%. Conclusion: Although thrombocytopenia is an extremely common finding after valve-in-valve procedures, the degree of platelet count drop did not correlate with greater incidence of postoperative adverse outcomes in our study population.
- Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease(2021) LOPES, Mariana Pezzute; ROSA, Vitor Emer Egypto; PALMA, Jose Honorio; VIEIRA, Marcelo Luiz Campos; FERNANDES, Joao Ricardo Cordeiro; SANTIS, Antonio de; SPINA, Guilherme Sobreira; FONSECA, Rafael de Jesus; MARCHI, Mauricio F. de Sa; ABIZAID, Alexandre; BRITO, Fabio Sandoli de; TARASOUTCHI, Flavio; SAMPAIO, Roney Orismar; RIBEIRO, Henrique BarbosaBackground: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median followup of 20.7 [5.1-30.4] months, cumulative mortality was similar between both groups (p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30 day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.
- Cardiac Magnetic Resonance Analysis of Mitral Annular Dynamics after Mitral Valve Repair(2020) ABDOUNI, Ahmad A.; BRANDAO, Carlos M. A.; ROCHITTE, Carlos E.; POMERANTZEFF, Pablo M. A.; VERONESE, Elinthon T.; PACHECO, Ariane B.; SANTIS, Antonio S.; TARASOUTCHI, Flavio; JATENE, Fabio B.OBJECTIVES: The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR). METHODS: Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively. RESULTS: We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28 +/- 1.95 cm to 11.50 +/- 1.59 cm, and the diastolic circumference was reduced from 12.51 +/- 2.01 cm to 10.66 +/- 2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p < 0.001). The mean maximum area of the MA was significantly reduced from 14.34 +/- 4.03 to 10.45 +/- 3.17 cm(2) when comparing the immediate postoperative period and the 2 year follow-up (p <0.001). The same occurred with the mean minimum area of the MA, which was reduced from 12.53 +/- 3.68 cm(2) to 9.23 +/- 2.84 cm(2) in the same period, and this reduction was greater in the antero-posterior diameter than in the mid-lateral diameter. The mobility of the MA was preserved after surgery, ranging between 19.6% and 25.7% at 2-year follow-up. CONCLUSION: We observed a significant reduction in the MA size after MVR, with preservation of the MA mobility at the 2-year follow-up.
- Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review(2018) SICILIANO, Rinaldo Focaccia; RANDI, Bruno Azevedo; GUALANDRO, Danielle Menosi; SAMPAIO, Roney Orismar; BITTENCOURT, Marcio Sommer; PELAES, Christian Emmanuel da Silva; MANSUR, Alfredo Jose; POMERANTZEFF, Pablo Maria Alberto; TARASOUTCHI, Flavio; STRABELLI, Tania Mara VarejaoObjective: To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles. Methods: Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997-2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded. Results: One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings. Conclusions: Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited. (C) 2017 The Authors.
- Endothelial, platelet, and macrophage microparticle levels do not change acutely following transcatheter aortic valve replacement(2016) MARCHINI, Julio F.; MIYAKAWA, Ayumi Aurea; TARASOUTCHI, Flavio; KRIEGER, Jose Eduardo; LEMOS, Pedro; CROCE, KevinBackground: Patients with severe aortic stenosis have increased levels of prothrombotic and proinflammatory microparticles (MP), and MPs actively regulate pathological processes that lead to atherothrombotic cardiovascular events. Shear stress is a validated stimulus of MP production, and abnormal shear stress in aortic stenosis increases MP release in ex-vivo studies. We hypothesized that in patients with severe aortic stenosis, percutaneous replacement of the aortic valve (TAVR) would reduce abnormal shear stress and would decrease levels of circulating MPs. Findings: The experimental protocol utilized flow cytometry (FC) and nanoparticle tracking analysis (NTA) to quantify circulating plasma MP levels in aortic stenosis patients at baseline and 5 days after TAVR. The baseline and 5 day MP counts measured by FC were 6.10.10(5) +/- 1.21.10(5) MP/mu L and 5.74.10(5) +/- 9.54.10(4) MP/mu L, respectively (p = 0.91). The baseline and 5 day MP counts measured by NTA were 9.29.10(13) +/- 1.66.10(13) MP/mu L and 3.95.10(14) +/- 3.11.10(14) MP/mu L, respectively (p = 0.91). When MPs were stratified by cell source, there was no difference in pre/post TAVR endothelial, platelet, or leukocyte MP levels. Conclusion: Levels of circulating MPs do not change acutely following TAVR therapy for aortic stenosis. Trial registered at clinicaltrials. gov NCT02193035 on July 11, 2014.
- Percutaneous Treatment of Mitral Paraprosthetic Regurgitation: an Alternative to Surgery(2015) SAMPAIO, Roney Orismar; OLIVEIRA, Alessandra Gomes de; MIRANDA, George Barreto; LEMOS NETO, Pedro Alves; VIEIRA, Marcelo Luiz Campos; TARASOUTCHI, Flavio