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
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
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 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- 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.
- 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.
conferenceObject Valve-in-valve procedure for bioprosthesis dysfunction in rheumatic patients: a new procedure for an old disease(2021) LOPES, M. P.; ROSA, V. Emer Egypto; PALMA, J. H.; FERNANDES, J. R. C.; SANTIS, A. S. A. L. De; SPINA, G. S.; ABIZAID, A. C.; BRITO JR., F. S. De; TARASOUTCHI, F.; SAMPAIO, R. O.; RIBEIRO, H. B.- Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study(2021) ABIZAID, Alexandre; CAMPOS, Carlos M.; GUIMARAES, Patricia O.; JR, Jose de Ribamar Costa; FALCAO, Breno A. A.; MANGIONE, Fernanda; CAIXETA, Adriano; LEMOS, Pedro A.; BRITO, Fabio S. de; CAVALCANTE, Ricardo; BEZERRA, Cristiano Guedes; CORTES, Leandro; RIBEIRO, Henrique B.; SOUZA, Francis R. de; HUEMER, Natassja; VAL, Renata M. do; CARAMELLI, Bruno; CALDERARO, Daniela; LIMA, Felipe G.; HAJJAR, Ludhmila A.; MEHRAN, Roxana; KALIL FILHO, RobertoObjectives We aimed to explore angiographic patterns and in-hospital outcomes of patients with concomitant coronavirus disease-19 (COVID-19) and myocardial infarction (MI). Background Patients with COVID-19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID-19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID-19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1-10) days. A total of 83 (54.6%) patients presented with ST-elevation MI. The median angiographic Syntax score was 16 (9.0-25.3) and 69.0% had multi-vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in-hospital mortality was 23.7%. ST-segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30-5.80 and HR 3.73, 95%CI 1.61-8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID-19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in-hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
conferenceObject Multimodality imaging and systemic biomarkers in classical low-flow low-gradient aortic stenosis: key findings for cardiac remodeling evaluation(2021) LOPES, M. A. A. A. M. L.; CAMPOS, C. M.; ROSA, V. E. E.; SAMPAIO, R. O.; MORAIS, T. C.; BRITO, F. S.; VIEIRA, M. L. C.; MATHIAS, W.; MEDEIROS, H. N. A. A.; SANTIS, A. S. A. L.; ROCHITTE, C. E.; RIBEIRO, M. H.; SANTOS, L. M.; ABIZAID, A.; TARASOUTCHI, F.- Balloon-Expandable versus Self-Expandable Valves in Transcatheter Aortic Valve Implantation: Complications and Outcomes from a Large International Patient Cohort(2021) NIEUWKERK, Astrid C. van; SANTOS, Raquel B.; ANDRAKA, Leire; TCHETCHE, Didier; BRITO, Fabio S. de; BARBANTI, Marco; KORNOWSKI, Ran; LATIB, Azeem; D'ONOFRIO, Augusto; RIBICHINI, Flavio; TEN, Francisco; DUMONTEIL, Nicolas; BAAN, Jan; PIEK, Jan J.; ABIZAID, Alexandre; SARTORI, Samantha; D'ERRIGO, Paola; TARANTINI, Giuseppe; LUNARDI, Mattia; ORVIN, Katia; PAGNESI, Matteo; NOGALES-ASENSIO, Juan Manuel; GHATTAS, Angie; DANGAS, George; MEHRAN, Roxana; DELEWI, RonakBackground: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. Results: In the matched population of n = 5410 patients, the mean age was 81 +/- 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0-12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02-1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86-1.37, p = 0.48). Conclusion: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves.