LUIS ALBERTO OLIVEIRA DALLAN
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
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 - Líder
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 - Líder
12 resultados
Resultados de Busca
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- Current Impact of Cardiopulmonary Bypass in Coronary Artery Bypass Grafting in Sao Paulo State(2020) BORGOMONI, Gabrielle Barbosa; MEJIA, Omar Asdrubal Vilca; ORLANDI, Bianca Maria Maglia; GONCHAROV, Maxim; LISBOA, Luiz Augusto Ferreira; CONTE, Pedro Henrique; OLIVEIRA, Marco Antonio Praca; FIORELLI, Alfredo Inacio; JUNIOR, Orlando Petrucci; TIVERON, Marcos Grandim; DALLAN, Luis Alberto de Oliveira; JATENE, Fabio BiscegliBackground: Previous results on the use of cardiopulmonary bypass (CPB) have generated difficulties in choosing the best treatment for each patient undergoing myocardial revascularization surgery (CABG) in the current context. Objective: Evaluate the current impact of CPB in CABG in Sao Paulo State. Methods: A total of 2905 patients who underwent CABG were consecutively analyzed in 11 Sao Paulo State centers belonging to the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) I. Perioperative and follow-up data were included online by trained specialists in each hospital. Associations of the perioperative variables with the type of procedure and with the outcomes were analyzed. The study outcomes were morbidity and operative mortality. The expected mortality was calculated using EuroSCORE II (ESII). The values of p <5% were considered significant. Results: There were no significant differences concerning the patients' age between the groups (p=0.081). 72.9% of the patients were males. Of the patients, 542 underwent surgery without CPB (18.7%). Of the preoperative characteristics, patients with previous myocardial infarction (p=0.005) and ventricular dysfunction (p=0.031) underwent surgery with CPB. However, emergency or New York Heart Association (NYHA) class IV patients underwent surgery without CPB (p<0.001). The ESII value was similar in both groups (p=0.427). In CABG without CPB, the radial graft was preferred (p<0.001), and in CABG with CPB the right mammary artery was the preferred one (p<0.001). In the postoperative period, CPB use was associated with reoperation for bleeding (p=0.012). Conclusion: Currently in the REPLICCAR, reoperation for bleeding was the only outcome associated with the use of CPB in CABG.
- Age, Creatinine and Ejection Fraction Score in Brazil: Comparison with InsCor and the EuroSCORE(2015) MEJIA, Omar Asdrubal Vilca; MATRANGOLO, Bruna La Regina; TITINGER, David Provenzale; FARIA, Leandro Batisti de; DALLAN, Luis Roberto Palma; GALAS, Filomena Regina Barbosa; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; JATENE, Fabio BiscegliBackground: Risk scores for cardiac surgery cannot continue to be neglected. Objective: To assess the performance of ""Age, Creatinine and Ejection Fraction Score"" (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores. Methods: A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor's and EuroSCORE's performance through correlation, calibration and discrimination tests. Results: Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763). Conclusion: Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center.
- Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST (II Edição, 2007) - Atualização 2013/2014(2014) NICOLAU, JC; TIMERMAN, A; MARIN-NETO, JA; PIEGAS, LS; BARBOSA, CJDG; FRANCI, A; AVEZUM JR., A; CARVALHO, ACC; MARKMAN FILHO, B; POLANCZYK, CA; ROCHITTE, CE; SERRANO JÚNIOR, CV; PRECOMA, DB; SILVA JUNIOR, DG; ALBUQUERQUE, DC; STEFANINI, E; KNOBEL, E; JATENE, FB; FERES, F; MORCERF, FAP; GANEM, F; LIMA FILHO, FA; FEITOSA FILHO, GS; FERREIRA, JFM; MENEGHETTI, JC; SARAIVA, JFK; SILVA, LS; MAIA, LN; BARACIOLI, LM; LISBOA, LAF; DALLAN, LAO; BODANESE, LC; ANDRADE, MD; OLIVEIRA JÚNIOR, M; DUTRA, OP; COELHO, OR; LEÃES, PE; ALBUQUERQUE, PF; LEMOS, P; KALIL, R; COSTA, RVC; ESPORCATE, R; MARINO, RL; BOTELLHO, RV; MENEGHELO, RS; SPROVIERI, SR; TIMERMAN, S; MATHIAS JÚNIOR, W
- Impact of the First Wave of the COVID-19 Pandemic on Cardiovascular Surgery in Brazil: Analysis of a Tertiary Reference Center(2022) LISBOA, Luiz Augusto; MEJIA, Omar Asdrubal Vilca; ARITA, Elisandra Trevisan; GUERREIRO, Gustavo Pampolha; SILVEIRA, Lucas Molinari Veloso Da; BRANDAO, Carlos Manuel De Almeida; DIAS, Ricardo Ribeiro; DALLAN, Luis Roberto Palma; MIANA, Leonardo; CANEO, Luiz F.; JATENE, Marcelo Biscegli; DALLAN, Luis Alberto Oliveira; JATENE, Fabio Biscegli
- R Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System(2015) TITINGER, David Provenzale; LISBOA, Luiz Augusto Ferreira; MATRANGOLO, Bruna La Regina; DALLAN, Luis Roberto Palma; DALLAN, Luis Alberto Oliveira; TRINDADE, Evelinda Marramon; ECKL, Ivone; KALIL FILHO, Roberto; MEJIA, Omar Asdrubal Vilca; JATENE, Fabio BiscegliBackground: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001),as well as occurrence of any postoperative complication (EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 +/- R$ 13.928,00 versus R$ 34.854,00 +/- R$ 27.814,00 versus R$ 43.234,00 +/- R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 +/- R$ 4.571,00 versus R$ 16.217,00 +/- R$ 7.298,00 versus R$ 19.548,00 +/- R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
- InsCor: um método simples e acurado para avaliação do risco em cirurgia cardíaca(2013) MEJA, Omar A. V.; LISBOA, Luiz A. F.; PUIG, Luiz B.; MOREIRA, Luiz Felipe P.; DALLAN, Luis A. O.; POMERANTZEFF, Pablo M. A.; JATENE, Fabio B.; STOLF, Noedir A. G.Background: Risk scores show difficulties to attain the same performance in different populations. Objective: To create a simple and accurate risk assessment model for patients submitted to surgery due to coronary and/or valvular disease at Instituto do Coracao da Universidade de Sao Paulo (InCor-HCFMUSP). Methods: Between 2007 and 2009, 3,000 patients were submitted to surgical procedure due to coronary artery and/or valvular disease at InCor-HCFMUSP. From this record, data of 2/3 of the patients were used for model development (bootstrap technique), and 1/3 for internal validation of the model. The performance of the model (InsCor) was compared to the 2000 Bernstein-Parsonnet (2000BP) and EuroSCORE (ES) complexes. Results: Only 10 variables were selected: age > 70 years, female sex; coronary revascularization + valve, myocardial infarction < 90 days; reoperation; surgical treatment of aortic valve; surgical treatment of tricuspid valve; creatinine < 2mg/dL; ejection fraction < 30%, and events. The Hosmer Lemeshow test for the InsCor was 0.184, indicating excellent calibration. The area under the ROC curve was 0.79 for the InsCor, 0.81 for the ES and 0.82 for 2000BP, confirming that the models are good and have similar discrimination. Conclusions: The InsCor and ES performed better than 2000BP at all stages of validation, but the new model, in addition to showing identification with the local risk factors, is simpler and more objective for mortality prediction in patients undergoing surgery due to coronary and/or valvular disease at InCor-HCFMUSP (Arq Bras Cardiol. 2013;100(3):246-254).
- Analysis of > 100,000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes(2020) V, Omar A. Mejia; LISBOA, Luiz Augusto Ferreira; CANEO, Luiz Fernando; ARITA, Elisandra Trevisan; BRANDAO, Carlos Manuel de Almeida; DIAS, Ricardo Ribeiro; COSTA, Roberto; JATENE, Marcelo Biscegli; POMERANTZEFF, Pablo Maria Alberto; DALLAN, Luis Alberto Oliveira; JATENE, Fabio BiscegliBackground: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clinicas Heart Institute of the University of Sao Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.
- Intervenção Coronariana Percutânea Prévia como Fator de Risco para Revascularização Miocárdica(2012) LISBOA, Luiz Augusto Ferreira; MEJIA, Omar Asdrubal Vilca; DALLAN, Luis Alberto Oliveira; MOREIRA, Luiz Felipe Pinho; PUIG, Luiz Boro; JATENE, Fabio Biscegli; STOLF, Noedir Antonio GroppoBackground: Percutaneous coronary intervention (PCI) has increased as the initial revascularization strategy in chronic coronary artery disease. Consequently, more patients undergoing coronary artery bypass grafting (CABG) have history of coronary stent. Objective: Evaluate the impact of previous PCI on in-hospital mortality after CABG in patients with multivessel coronary artery disease. Methods: Between May/2007 and June/2009, 1099 consecutive patients underwent CABG on cardiopulmonary bypass. Patients with no PCI (n=938, 85.3%) were compared with patients with previous PCI (n=161, 14.6%). Logistic regression models and propensity score matching analysis were used to assess the risk-adjusted impact of previous PCI on in-hospital mortality. Results: Both groups were similar, except for the fact that patients with previous PCI were more likely to have unstable angina (16.1% x 9.9%, p=0.019). In-hospital mortality after CABG was higher in patients with previous PCI (9.3% x 5.1%, p=0.034) and it was comparable with EuroSCORE and 2000 Bernstein-Parsonnet risk score. Using multivariate logistic regression analysis, previous PCI emerged as an independent predictor of postoperative in-hospital mortality (odds ratio 1.94, 95% CI 1.02-3.68, p=0.044) as strong as diabetes (odds ratio 1.86, 95% CI 1.07-3.24, p=0.028). After computed propensity score matching based on preoperative risk factors, in-hospital mortality remained higher among patients with previous PCI (odds ratio 3.46, 95% CI 1.10-10.93, p=0.034). Conclusions: Previous PCI in patients with multivessel coronary artery disease is an independent risk factor for in-hospital mortality after CABG. This fact must be considered when PCI is indicated as initial alternative in patients with more severe coronary artery disease. (Arq Bras Cardiol 2012;99(1):586-595)
- Immediate Results after Multiple Arterial Grafts in Coronary Artery Bypass Graft Surgery in the S?o Paulo State: Cross Cohort Study(2023) MICALAY, Raul Armando; BORGOMONI, Gabrielle Barbosa; MICALAY, Anny Katia Puchalski; CAMACHO, Jose Carlos Arteaga; DALLAN, Luis Roberto Palma; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto de Oliveira; MEJIA, Omar Asdrubal Vilca; Grp Estudos REPLICCARBackground: The short-term results after using arterial grafts still raise questions and doubts for medical society. Objective: To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery.Methods: Cross-sectional cohort study in the Sao Paulo Registry of Cardiovascular Surgery II. Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk.Results: After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048).Conclusion: Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin >= 6.40%, had a greater influence on the infectious outcome than the choice of grafts.
- Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation-2021(2021) NICOLAU, Jose Carlos; FEITOSA FILHO, Gilson Soares; PETRIZ, Joao Luiz; FURTADO, Remo Holanda de Mendonca; PRECOMA, Dalton Bertolim; LEMKE, Walmor; LOPES, Renato Delascio; TIMERMAN, Ari; MARIN-NETO, Jose A.; NETO, Luiz Bezerra; GOMES, Bruno Ferraz de Oliveira; SANTOS, Eduardo Cavalcanti Lapa; PIEGAS, Leopoldo Soares; SOEIRO, Alexandre de Matos; NEGRI, Alexandre Jorge de Andrade; FRANCI, Andre; MARKMAN FILHO, Brivaldo; BACCARO, Bruno Mendonca; MONTENEGRO, Carlos Eduardo Lucena; ROCHITTE, Carlos Eduardo; BARBOSA, Carlos Jose Dornas Goncalves; VIRGENS, Claudio Marcelo Bittencourt das; STEFANINI, Edson; MANENTI, Euler Roberto Fernandes; LIMA, Felipe Gallego; MONTEIRO JUNIOR, Francisco das Chagas; CORREA FILHO, Harry; PENA, Henrique Patrus Mundim; PINTO, Ibraim Masciarelli Francisco; FALCAO, Joao Luiz de Alencar Araripe; SENA, Joberto Pinheiro; PEIXOTO, Jose Maria; SOUZA, Juliana Ascencao de; SILVA, Leonardo Sara da; MAIA, Lilia Nigro; OHE, Louis Nakayama; BARACIOLI, Luciano Moreira; DALLAN, Luis Alberto de Oliveira; DALLAN, Luis Augusto Palma; MATTOS, Luiz Alberto Piva e; BODANESE, Luiz Carlos; RITT, Luiz Eduardo Fonteles; CANESIN, Manoel Fernandes; RIVAS, Marcelo Bueno da Silva; FRANKEN, Marcelo; MAGALHAES, Marcos Jose Gomes; OLIVEIRA JUNIOR, Mucio Tavares de; FILGUEIRAS FILHO, Nivaldo Menezes; DUTRA, Oscar Pereira; COELHO, Otavio Rizzi; LEAES, Paulo Ernesto; ROSSI, Paulo Roberto Ferreira; SOARES, Paulo Rogerio; LEMOS NETO, Pedro Alves; FARSKY, Pedro Silvio; CAVALCANTI, Rafael Rebelo C.; ALVES, Renato Jorge; KALIL, Renato Abdala Karam; ESPORCATTE, Roberto; MARINO, Roberto Luiz; GIRALDEZ, Roberto Rocha Correa Veiga; MENEGHELO, Romeu Sergio; LIMA, Ronaldo de Souza Leao; RAMOS, Rui Fernando; FALCAO, Sandra Nivea dos Reis Saraiva; DALCOQUIO, Talia Falcao; LEMKE, Viviana de Mello Guzzo; CHALELA, William Azem; MATHIAS JUNIOR, Wilson