PABLO MARIA ALBERTO POMERANTZEFF
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
LIM/65, Hospital das Clínicas, Faculdade de Medicina
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
LIM/65, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
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conferenceObject Impact of interstitial myocardial fibrosis measured by T1-mapping cardiac magnetic resonance on post-operative cardiac remodeling in patients with classical low-flow, low-gradient aortic stenosis(2018) ROSA, V. Emer Egypto; RIBEIRO, H. B.; SAMPAIO, R. O.; MORAIS, T. C.; ROSA, M. E. E.; SANTIS, A. S. A. L. De; FERNANDES, J. R. C.; VIEIRA, M. L. C.; POMERANTZEFF, P. M. A.; ROCHITTE, C. E.; MATHIAS JR., W.; TARASOUTCHI, F.- 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.
- 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.
- Predictive performance of six mortality risk scores and the development of a novel model in a prospective cohort of patients undergoing valve surgery secondary to rheumatic fever(2018) MEJIA, Omar A. V.; ANTUNES, Manuel J.; GONCHAROV, Maxim; DALLAN, Luis R. P.; VERONESE, Elinthon; LAPENNA, Gisele A.; LISBOA, Luiz A. F.; DALLAN, Luis A. O.; BRANDAO, Carlos M. A.; ZUBELLI, Jorge; TARASOUTCHI, Flavio; POMERANTZEFF, Pablo M. A.; JATENE, Fabio B.Background Mortality prediction after cardiac procedures is an essential tool in clinical decision making. Although rheumatic cardiac disease remains a major cause of heart surgery in the world no previous study validated risk scores in a sample exclusively with this condition. Objectives Develop a novel predictive model focused on mortality prediction among patients undergoing cardiac surgery secondary to rheumatic valve conditions. Methods We conducted prospective consecutive all-comers patients with rheumatic heart disease (RHD) referred for surgical treatment of valve disease between May 2010 and July of 2015. Risk scores for hospital mortality were calculated using the 2000 Bernstein-Parsonnet, EuroSCORE II, InsCor, AmblerSCORE, GuaragnaSCORE, and the New York SCORE. In addition, we developed the rheumatic heart valve surgery score (RheSCORE). Results A total of 2,919 RHD patients underwent heart valve surgery. After evaluating 13 different models, the top performing areas under the curve were achieved using Random Forest (0.982) and Neural Network (0.952). Most influential predictors across all models included left atrium size, high creatinine values, a tricuspid procedure, reoperation and pulmonary hypertension. Areas under the curve for previously developed scores were all below the performance for the RheSCORE model: 2000 Bernstein-Parsonnet (0.876), EuroSCORE II (0.857), InsCor (0.835), Ambler (0.831), Guaragna (0.816) and the New York score (0.834). A web application is presented where researchers and providers can calculate predicted mortality based on the RheSCORE. Conclusions The RheSCORE model outperformed pre-existing scores in a sample of patients with rheumatic cardiac disease.
conferenceObject Predictors of 1-Year Mortality After Surgical Aortic Valve Replacement in Patients With Classical Low-Flow, Low-Gradient Aortic Stenosis.(2018) ROSA, Vitor E. E.; RIBEIRO, Henrique B.; SAMPAIO, Roney O.; MORAIS, Thamara C.; ROSA, Marcela E. E.; SANTIS, Antonio S. A. I Antonio de; FERNANDES, Joao Ricardo C.; VIEIRA, Marcelo L. C.; POMERANTZEFF, Pablo M. A.; ROCHITTE, Carlos E.; JR, Wilson Mathias; TARASOUTCHI, Flavio- Relation of mitral valve morphology to surgical repair results in patients with mitral valve prolapse: A three-dimensional transesophageal echocardiography study(2018) PARDI, Mirian M.; POMERANTZEFF, Pablo M. A.; SAMPAIO, Roney Orismar; ABDUCH, Maria C.; BRANDAO, Carlos M. A.; MATHIAS JR., Wilson; GRINBERG, Max; TARASOUTCHI, Flavio; VIEIRA, Marcelo L. C.BackgroundThe identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results. MethodsFifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, grade II MR). Morphological parameters related to the mitral ring, dimension of leaflets and prolapse, coaptation line, distance from papillary muscles to the leaflet border and valve angles were analyzed by 3D MV quantification. Cardiac remodeling and MR quantitative parameters were also evaluated. ResultsThere was no correlation between 3D MV quantification and surgical results; a multivariate analysis did not show an association between morphological parameters and surgical outcome. The distance from the posteromedial papillary muscle to the leaflet border was higher (P=.038) in patients with grade II postoperative MR. The left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic and end-systolic volumes were larger in patients with a significant residual MR (P<.05). ConclusionThree-dimensional MV quantification did not predict the postoperative MR grade; however, the distance from the posteromedial papillary muscles to the leaflet border may be related to suboptimal repair results. Furthermore, excessive cardiac remodeling was related to postoperative MRgrade II, what could suggest a potential benefit of early surgical treatment.
- Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery(2018) ARTHUR, Camila Perez de Souza; MEJIA, Omar Asdrubal Vilca; LAPENNA, Gisele Aparecida; BRANDAO, Carlos Manuel de Almeida; LISBOA, Luiz Augusto Ferreira; DIAS, Ricardo Ribeiro; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; JATENE, Fabio B.Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (<180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.