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
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- Post-Operative Prognostic Prediction of Different Myocardial Fibrosis Measures in Severe Aortic Valvular Heart Disease(2020) PIRES, Lucas J.; ROSA, Vitor E.; MORAIS, Thamara C.; SANTIS, Antonio S. de; FERNANDES, Joao Ricardo C.; BOER, Berta P.; ROSSI, Eduardo; LAVITOLA, Paulo D.; ROCHITTE, Carlos E.; NOMURA, Cesar H.; POMERANTZEFF, Pablo M.; TARASOUTCHI, Flavio
- 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.
article Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020 (vol 14, pg 849, 2020)(2020) AVILA, Walkiria Samuel; ALEXANDRE, Elizabeth Regina Giunco; CASTRO, Marildes Luiza de; LUCENA, Alexandre Jorge Gomes de; MARQUES-SANTOS, Celi; FREIRE, Claudia Maria Vilas; ROSSI, Eduardo Giusti; CAMPANHARO, Felipe Favorette; RIVERA, Ivan Romero; COSTA, Maria Elizabeth Navegantes Caetano; RIVERA, Maria Alayde Mendonca; CARVALHO, Regina Coeli Marques de; ABZAID, Alexandre; MORON, Antonio Fernandes; RAMOS, Auristela Isabel de Oliveira; ALBUQUERQUE, Carlos Japhet da Mata; FEIO, Claudine Maia Alves; BORN, Daniel; SILVA, Fabio Bruno da; NANI, Fernando Souza; TARASOUTCHI, Flavio; COSTA JUNIOR, Jose de Ribamar; MELO FILHO, Jose Xavier de; KATZ, Leila; ALMEIDA, Maria Cristina Costa; GRINBERG, Max; AMORIM, Melania Maria Ramos de; MELO, Nilson Roberto de; MEDEIROS, Orlando Otavio de; POMERANTZEFF, Pablo Maria Alberto; BRAGA, Sergio Luiz Navarro; CRISTINO, Sonia Conde; MARTINEZ, Tania Leme da Rocha; LEAL, Tatiana de Carvalho Andreuci Torres- Update of the Brazilian Guidelines for Valvular Heart Disease-2020(2020) TARASOUTCHI, Flavio; MONTERA, Marcelo Westerlund; RAMOS, Auristela Isabel de Oliveira; SAMPAIO, Roney Orismar; ROSA, Vitor Emer Egypto; ACCORSI, Tarso Augusto Duenhas; SANTIS, Antonio de; FERNANDES, Joao Ricardo Cordeiro; PIRES, Lucas Jose Tachotti; SPINA, Guilherme S.; VIEIRA, Marcelo Luiz Campos; LAVITOLA, Paulo de Lara; AVILA, Walkiria Samuel; PAIXAO, Milena Ribeiro; BIGNOTO, Tiago; TOGNA, Dorival Julio Della; MESQUITA, Evandro Tinoco; ESTEVES, William Antonio de Magalhaes; ATIK, Fernando; COLAFRANCESCHI, Alexandre Siciliano; MOISES, Valdir Ambrosio; KIYOSE, Alberto Takeshi; POMERANTZEFF, Pablo M. A.; LEMOS, Pedro A.; BRITO JUNIOR, Fabio Sandoli de; WEKSLER, Clara; BRANDAO, Carlos Manuel de Almeida; POFFO, Robinson; SIMOES, Ricardo; RASSI, Salvador; LEAES, Paulo Ernesto; MOURILHE-ROCHA, Ricardo; PENA, Jose Luiz Barros; JATENE, Fabio Biscegli; BARBOSA, Marcia de Melo; ABIZAID, Alexandre; RIBEIRO, Henrique Barbosa; BACAL, Fernando; ROCHITTE, Carlos Eduardo; FONSECA, Jose Honorio de Almeida Palma; GHORAYEB, Samira Kaissar Nasr; LOPES, Marcelo Antonio Cartaxo Queiroga; SPINA, Salvador Vicente; PIGNATELLI, Ricardo H.; SARAIVA, Jose Francisco Kerr
conferenceObject Relationship Between Biomarkers and Different Types of Myocardial Fibrosis in Severe Aortic Valvular Heart Disease(2020) PIRES, Lucas J.; ROSA, Vitor E.; MORAIS, Thamara C.; SANTIS, Antonio S. de; FERNANDES, Joao Ricardo C.; BOER, Berta P.; ROSSI, Eduardo; LAVITOLA, Paulo D.; ROCHITTE, Carlos E.; NOMURA, Cesar H.; POMERANTZEFF, Pablo M.; TARASOUTCHI, Flavio- 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.
- Derivation and validation of an early diagnostic score for mediastinitis after cardiothoracic surgery(2020) SICILIANO, Rinaldo Focaccia; MEDINA, Andrea Carolina Rodas; BITTENCOURT, Marcio Sommer; GUALANDRO, Danielle; UEZUMI, Kiyomi Kato; SANTOS, Marcus Vinicius Barbosa; POMERANTZEFF, Pablo Maria Alberto; SCARPA, Bruna; LEAL, Tatiana de Carvalho Andreuci Torres; STRABELLI, Tania Mara VarejaoObjectives: The aim of this study was to elaborate on and validate a score for the early diagnosis of mediastinitis after cardiothoracic surgery. Methods: Between 2007 and 2017, patients who experienced thoracic surgical-site infection after cardiothoracic surgery were enrolled. Laboratory, clinical, and chest CT findings were retrospectively analyzed. Patients were followed up until hospital discharge or intra-hospital death. Univariate and multivariate regression analyses were performed. Results: 950 surgical-site infections were found and analyzed (131 mediastinitis, 819 superficial/deep infections). Of the 131 mediastinitis episodes, 88% required surgical thoracic debridement,Staphylococcus aureus was identified in 43%, and overall mortality was 42%. The following variables were related to mediastinitis diagnosis: sternal diastasis (OR = 2.5; 95% confidence interval [95%CI]: 1.2-5.3; P = 0.012), bilateral pleural effusion (OR = 1.9; 95%CI: 1.0-3.6; P = 0.04), leukocyte count >= 14,000cells/mm(3) (OR = 2.5; 95%CI: 1.3-4.7; P = 0.006), male sex (OR = 2; 95%CI: 1.11-4; P = 0.022), and positive blood culture (OR = 3.0; 95%CI: 1.6-5.6; P = 0.001). The score predicted with reasonable accuracy mediastinitis in the derivation cohort (AUC-ROC, 0.7476) and the validation cohort (AUC-ROC, 0.7149). Groups with high (31%) and low (5%) risk of mediastinitis were identified. Conclusions: An early diagnostic score in patients with surgical-site infection after cardiothoracic surgery identified groups with a low and high risk for mediastinitis. (C) 2019 The Authors.
- Validation and quality measurements for STS, EuroSCORE II and a regional risk model in Brazilian patients(2020) MEJIA, Omar Asdrubal Vilca; BORGOMONI, Gabrielle Barbosa; ZUBELLI, Jorge Passamani; DALLAN, Luis Roberto Palma; POMERANTZEFF, Pablo Maria Alberto; OLIVEIRA, Marco Antonio Praca; PETRUCCI JUNIOR, Orlando; TIVERON, Marcos Gradim; NAKAZONE, Marcelo Arruda; TINELI, Rafael Angelo; CAMPAGNUCCI, Valquiria Pelisser; SILVA, Roberto Rocha e; RODRIGUES, Alfredo Jose; GOMES, Walter Jose; LISBOA, Luiz Augusto Ferreira; JATENE, Fabio BiscegliObjectives The objectives of this study were to describe a novel statewide registry for cardiac surgery in Brazil (REPLICCAR), to compare a regional risk model (SPScore) with EuroSCORE II and STS, and to understand where quality improvement and safety initiatives can be implemented. Methods A total of 11 sites in the state of Sao Paulo, Brazil, formed an online registry platform to capture information on risk factors and outcomes after cardiac surgery procedures for all consecutive patients. EuroSCORE II and STS values were calculated for each patient. An SPScore model was designed and compared with EuroSCORE II and STS to predict 30-day outcomes: death, reoperation, readmission, and any morbidity. Results A total of 5222 patients were enrolled in this study between November 2013 and December 2017. The observed 30-day mortality rate was 7.6%. Most patients were older, overweight, and classified as New York Heart Association (NYHA) functional class III; 14.5% of the patient population had a positive diagnosis of rheumatic heart disease, 10.9% had insulin-dependent diabetes, and 19 individuals had a positive diagnosis of Chagas disease. When evaluating the prediction performance, we found that SPScore outperformed EuroSCORE II and STS in the prediction of mortality (0.90 vs. 0.76 and 0.77), reoperation (0.84 vs. 0.60 and 0.56), readmission (0.84 vs. 0.55 and 0.51), and any morbidity (0.80 vs. 0.65 and 0.64), respectively (p<0.001). Conclusions The REPLICCAR registry might stimulate the creation of other cardiac surgery registries in developing countries, ultimately improving the regional quality of care provided to patients.
- Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease-2020(2020) AVILA, Walkiria Samuel; ALEXANDRE, Elizabeth Regina Giunco; CASTRO, Marildes Luiza de; LUCENA, Alexandre Jorge Gomes de; MARQUES-SANTOS, Celi; FREIRE, Claudia Maria Vilas; ROSSI, Eduardo Giusti; CAMPANHARO, Felipe Favorette; RIVERA, Ivan Romero; COSTA, Maria Elizabeth Navegantes Caetano; RIVERA, Maria Alayde Mendonca; CARVALHO, Regina Coeli Marques de; ABZAID, Alexandre; MORON, Antonio Fernandes; RAMOS, Auristela Isabel de Oliveira; ALBUQUERQUE, Carlos Japhet da Mata; FEIO, Claudine Maia Alves; BORN, Daniel; SILVA, Fabio Bruno da; NANI, Fernando Souza; TARASOUTCHI, Flavio; COSTA JUNIOR, Jose de Ribamar; MELO FILHO, Jose Xavier de; KATZ, Leila; ALMEIDA, Maria Cristina Costa; GRINBERG, Max; AMORIM, Melania Maria Ramos de; MELO, Nilson Roberto de; MEDEIROS, Orlando Otavio de; POMERANTZEFF, Pablo Maria Alberto; BRAGA, Sergio Luiz Navarro; CRISTINO, Sonia Conde; MARTINEZ, Tania Leme Rocha; LEAL, Tatiana de Carvalho Andreuci Torres
- Transcatheter mitral valve-in-valve implantation: reports of the first 50 cases from a Latin American Centre(2020) COSTA, Leonardo Paim Nicolau da; PALMA, Jose Honorio; RIBEIRO, Henrique Barbosa; SAMPAIO, Roney Orismar; VIOTTO, Guilherme; SANTOS, Romullo Medeiros; TENORIO, Davi Freitas; SAITO, Victor Tadami; ROSA, Vitor Emer Egypto; MOREIRA, Luiz Felipe Pinho; TARASOUTCHI, Flavio; POMERANTZEFF, Pablo Maria; JATENE, Fabio BiscegliOBJECTIVES: Our goal was to analyse the initial results of the first 50 transapical transcatheter mitral valve-in-valve procedures performed in a single Latin American centre. METHODS: A prospective, single centre, database analysis was conducted to evaluate immediate, 30-day and 1-year postoperative results of 50 consecutive patients who had a transcatheter mitral valve-in-valve procedure from May 2015 to June 2018. All patients were operated on in a hybrid operating room and received a balloon-expandable valve via the transapical approach. Preoperative and postoperative characteristics were analysed and compared between the first 25 and the second 25 patients to evaluate the impact of the learning curve. Twenty patients had a follow-up examination at 1 year. RESULTS: There was a 98% device success rate. The patients had a mean age of 64.8 years; 72% were women; 80% were in New York Heart Association functional class >= III preoperatively; and 36% of the procedures were urgent. The mean Society of Thoracic Surgeons scores and EuroSCORE II were 8.3% and 12.4%, respectively. Patients had a median of 2 previous operations; valve durability was 12.1 years; and 64% mitral valve disease of rheumatic fever aetiology. Echocardiography showed decreases in the maximum and mean mitral gradients from 23.5 to 14.6 and 11.5 to 6.4mmHg postoperatively; the overall mean hospitalization period was 15 days. The overall mortality rate at 30 days was 14%, with 1 intraprocedural death. Further subanalyses between the first and the second half of the cases showed a drop in the mortality rate from 20% to 8% (P < 0.01). CONCLUSION: The transcatheter mitral valve-in-valve procedure was shown to be a safe and effective procedure to treat bioprosthetic dysfunction, with potential benefits in patients with rheumatic disease.