FABIO SANDOLI DE BRITO JUNIOR
Índice h a partir de 2011
11
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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- 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.
conferenceObject Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation Is Associated With Increased Mortality(2021) NIEUWKERK, Astrid van; BLANCO, Roberto; TCHETCHE, Didier; BRITO JR., Fabio; BARBANTI, Marco; KORNOWSKI, Ran; LATIB, Azeem; D'ONOFRIO, Augusto; RIBICHINI, Flavio; DOMINGUEZ, Juan Francisco Oteo; DUMONTEIL, Nicolas; ABIZAID, Alexandre; BAAN, Jan; SARTORI, Samantha; D'ERRIGO, Paola; TARANTINI, Giuseppe; LUNARDI, Mattia; ORVIN, Katia; GHATTAS, Angie; PAGNESI, Matteo; DANGAS, George; MEHRAN, Roxana; DELEWI, Ronak- Seattle Angina Pectoris Questionnaire and Canadian Cardiovascular Society Angina Categories in the Assessment of Total Coronary Atherosclerotic Burden(2021) GUIMARAES, Welingson Vanucci Negreiros; NICZ, Pedro Felipe Gomes; GARCIA-GARCIA, Hector M.; ABIZAID, Alexandre; SANTOS, Luciano de Moura; ROSA, Vitor E.; RIBEIRO, Marcelo Harada; MEHTA, Sameer; RIBEIRO, Expedito; LEMOS, Pedro A.; BRITO JR., Fabio S.; HAJJAR, Ludhmila; KALIL FILHO, Roberto; CAMPOS, Carlos M.The patient reported angina measurement with the Seattle Angina Questionnaire (SAQ) has shown to have prognostic implications and became an endpoint in clinical trials. Our objective was to study physician-reported and SAQ severity with the total coronary atherosclerotic burden as assessed by 4 angiographic scores. We prospectively analyzed data of consecutive patients scheduled for coronary angiography or percutaneous coronary intervention. The Canadian Cardiovascular Society (CCS) angina categories was used as physician-reported angina. SAQ domains were categorized as severe (0 to 24), moderate 25 to 75 and mild angina (>75). All angina assessments were done before coronary angiography. Gensini, Syntax, Friesinger, and Sullivan angiographic scores were used for total atherosclerotic burden quantification: 261 patients were included in the present analysis. The median age was 66.0 (59.0 to 71.8) years, 53.6% were male and 43.7% had diabetes. The median SYNTAX score was 6.0 (0 to 18.0). The worse the symptoms of CCS categories, the more severe was the atherosclerotic burden in all angiographic scores: SYNTAX (p = 0.01); Gensini (p<0.01); Friesinger (p = 0.02) and Sullivan (p = 0.03). Conversely, SAQ domains were not able to discriminate the severity of CAD in any of the scores. The only exception was the severe SAQ quality of life that had worse Gensini score than the mild SAQ quality of life (p = 0.04). In conclusion, CCS angina categories are related to the total atherosclerotic burden in coronary angiography, by all angiographic scores. SAQ domains should be used as a measure of patient functionality and quality of life but not as a measure of CAD severity. (C) 2021 Published by Elsevier Inc.
conferenceObject Patients With Previous Cerebrovascular Events Undergoing Transcatheter Aortic Valve Implantation Have More Periprocedural Strokes(2023) NIEUWKERK, Astrid van; AARTS, Hugo; HEMELRIJK, Kimberley; CARRILLO, Cristobal A. Urbano; TCHETCHE, Didier; BRITO JR., Fabio; BARBANTI, Marco; KORNOWSKI, Ran; LATIB, Azeem; D'ONOFRIO, Augusto; RIBICHINI, Flavio; GARCIA-BLAS, Sergio; DUMONTEIL, Nicolas; ABIZAID, Alexandre; SARTORI, Samantha; D'ERRIGO, Paola; TARANTINI, Giuseppe; LUNARDI, Mattia; ORVIN, Katia; PAGNESI, Matteo; DANGAS, George; MEHRAN, Roxana; DELEWI, RonakconferenceObject Balloon-Expandable or Self-Expandable Valves in Valve-in-Valve Transcatheter Aortic Valve Implantation?(2021) NIEUWKERK, Astrid Van; FERNANDEZ-NOFRERIAS, Eduard; TCHETCHE, Didier; BRITO JR., Fabio; BARBANTI, Marco; KORNOWSKI, Ran; LATIB, Azeem; D'ONOFRIO, Augusto; RIBICHINI, Flavio; TELLO, Vicente Mainar; DUMONTEIL, Nicolas; BAAN, Jan; ABIZAID, Alexandre; SARTORI, Samantha; D'ERRIGO, Paola; TARANTINI, Giuseppe; LUNARDI, Mattia; ORVIN, Katia; PAGNESI, Matteo; GHATTAS, Angie; DANGAS, George; MEHRAN, Roxana; DELEWI, Ronak- Quantitative aortography assessment of aortic regurgitation(2020) MODOLO, Rodrigo; CHANG, Chun Chin; ONUMA, Yoshinobu; SCHULTZ, Carl J.; TATEISHI, Hiroki; ABDELGHANI, Mohammad; MIYAZAKI, Yosuke; ABEN, Jean-Paul; RUTTEN, Marcel C. M.; PIGHI, Michele; BOUZIANI, Abdelhak El; MOURIK, Martijn van; LEMOS, Pedro A.; WYKRZYKOWSKA, Joanna; BRITO JR., Fabio Sandoli de; SAHYOUN, Cherif; PIAZZA, Nicolo; ELTCHANINOFF, Helene; SOLIMAN, Osama; ABDEL-WAHAB, Mohamed; MIEGHEM, Nicolas M. Van; WINTER, Robbert de; SERRUYS, Patrick W.
conferenceObject EFFECTIVE NEOINTIMAL REDUCTION WITH TWO NOVEL DRUG-ELUTING STENTS COATED WITH BIODEGRADABLE POLYMER - AN INTRAVASCULAR ULTRASOUND ANALYSIS FROM THE PAINT RANDOMIZED TRIAL(2012) MEDEIROS, Cesar; MOULIN, Bruno; ARRUDA, Airton; PERIN, Marco; OLIVEIRA, Ludmilla; LIMA, Valter; LIMA, Antonio Augusto; CARAMORI, Paulo; BARBOSA, Mauricio; BRITO, Fabio; RIBEIRO, Expedito; MARTINEZ, Eulogio; LEMOS, PedroBackground: Sirolimus and Paclitaxel are well known anti-restenosis agents; they have been tested in different stents with different platforms and polymers. Methods: We aim to compare the neointimal inhibition efficacy of two drug eluting stents with identical platforms and biodegradable polymers, but with different drugs (Sirolimus or Paclitaxel) against bare metal stents (BMS) by intravascular ultrasound (IVUS). From the 274 patient (pts) randomized in the PAINT trial, who had a stent implanted in a de novo lesion in a native vessel, a pre-defined subset of 110 patients underwent 9-month IVUS follow-up. Patients were randomly allocated at a 2:2:1 ratio for sirolimus-eluting stent (SES; n=45), paclitaxel-eluting stent (PES; n=45), or BMS (n=20). All IVUS analyses were performed by a technician blinded to the study group. Results: There were no differences in the stent length or stent area among the three groups. Incomplete apposition was found in 2 pts (1 in the BMS and 1 in the SES group). The average neointimal hyperplasia (NIH) area was 0.8 ± 0.9 mm2, 1.0 ± 1,2 mm2, and 1.8 ± 1.3 mm2, for the SES, PES, and BMS groups respectively (p = 0,004 for the overall comparison). Also, the NIH obstruction was 12.0 ± 11.9%, 12.9 ± 13.3%, and 24.9 ± 15.8% respectively (p = 0,002). There were no differences in the NIH parameters for the comparison of SES vs. PES. There were no differences in the analysis of the stent edge portions. Conclusions: Both sirolimus- and paclitaxel-eluting stents coated with a novel biodegradable polymer carrier were effective in inhibiting neointimal hyperplasia, in comparison to bare stents. The efficacy of both formulations of drug-eluting stents, releasing either sirolimus or paclitaxel, did not appear to be different when compared in a head-to-head analysis by IVUS.- 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.
- 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.