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
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- EuroSCORE II and the importance of a local model, InsCor and the future SP-SCORE(2014) LISBOA, Luiz Augusto Ferreira; MEJIA, Omar Asdrubal Vilca; MOREIRA, Luiz Felipe Pinho; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; DALLAN, Luis Roberto Palma; MASSOTI, Maria Raquel B.; JATENE, Fabio B.Introduction: The most widely used model for predicting mortality in cardiac surgery was recently remodeled, but the doubts regarding its methodology and development have been reported. Objective: The aim of this study was to evaluate the performance of the EuroSCORE II to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution. Methods: One thousand consecutive patients operated on coronary artery bypass grafts or valve surgery, between October 2008 and July 2009, were analyzed. The outcome of interest was in-hospital mortality. Calibration was performed by correlation between observed and expected mortality by Hosmer Lemeshow. Discrimination was calculated by the area under the ROC curve. The performance of the EuroSCORE II was compared with the EuroSCORE and InsCor (local model). Results: In calibration, the Hosmer Lemeshow test was inappropriate for the EuroSCORE II (P=0.0003) and good for the EuroSCORE (P=0.593) and InsCor (P=0.184). However, the discrimination, the area under the ROC curve for EuroSCORE II was 0.81 [95% CI (0.76 to 0.85), P<0.001], for the EuroSCORE was 0.81 [95% CI (0.77 to 0.86), P<0.001] and for InsCor was 0.79 [95% CI (0.74-0.83), P<0.001] showing up properly for all. Conclusion: The EuroSCORE II became more complex and resemblance to the international literature poorly calibrated to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution. These data emphasize the importance of the local model.
- Estratificação de risco cirúrgico como instrumento de inovação em programas de cirurgia cardíaca no Sistema Único de Saúde do Estado de São Paulo: ESTUDO SP-SCORE-SUS(2013) MEJIA, Omar Asdrubal Vilca; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; TRINDADE, Evelinda Marramon; JATENE, Fabio Biscegli; KALIL FILHO, RobertoCardiovascular diseases represent the greatest burden of morbidity and mortality for the health system and cardiac surgery has an important impact on their resolutivity. The association and correlation of patients' demographic and clinical relevant information with the resources required for each stratum represent the possibility to adapt, improve and innovate into the healthcare programs. This project aims to remodel the ""InsCor"" risk score for the formulation of the SP-SCORE (Sao Paulo System for Cardiac Operative Risk Evaluation) in order to better reflects the complexity of cardiac surgical care. The participating hospitals include the Health Technology Assessment Centers in of the Health Secretariat' HTA Network of Sao Paulo State (HTA-NATSs / SES-SP). The SP-SCORE will use 10 variables of the InsCor model and others 8 variables with presumed influence in Brazil. The primary endpoints are morbidity and mortality. Bootstrap technique besides automated selection of variables (stepwise) will be used to develop a parsimonious model by multiple logistic regression. This project will contribute for the SUS-SP regionalized health-care (RRAS) sustainability and financing of the CABG and/or heart valve surgery programs promoting equitable allocation, increasing access and effectiveness, as well as characterizing the magnitude of available resources and its impact.
- Late outcome analysis of the Braile Biomedica (R) pericardial valve in the aortic position(2014) AZEREDO, Lisandro Goncalves; VERONESE, Elinthon Tavares; SANTIAGO, Jose Augusto Duncan; BRANDAO, Carlos Manuel de Almeida; POMERANTZEFF, Pablo Maria Alberto; JATENE, Fabio BiscegliObjective: Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de Sao Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomedica (R) aortic bioprosthesis in patients with aortic valve disease. Methods: We retrospectively evaluated 196 patients with aortic valve disease submitted to aortic valve replacement with Braile Biomedica (R) bovine pericardial prosthesis, between 2006 and 2010. Mean age was 59.41 +/- 16.34 years and 67.3% were male. Before surgery, 73.4% of patients were in NYHA functional class III or IV. Results: Hospital mortality was 8.16% (16 patients). Linearized rates of mortality, endocarditis, reintervention, and structural dysfunction were 1.065%, 0.91%, 0.68% and 0.075% patients/year, respectively. Actuarial survival was 90.59 +/- 2.56% in 88 months. Freedom from reintervention, endocarditis and structural dysfunction was respectively 91.38 +/- 2.79%, 89.84 +/- 2.92% and 98.57 +/- 0.72% in 88 months. Conclusion: The Braile Biomedica (R) pericardial aortic valve prosthesis demonstrated actuarial survival and durability similar to that described in the literature, but further follow up is required to assess the incidence of prosthetic valve endocarditis and structural dysfunction in the future.
article 5 Citação(ões) na Scopus Long term results of septal myectomy in the treatment of obstructive hypertrophic cardiomyopathy(2011) LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; OLIVEIRA, Sergio Almeida de; JATENE, Fabio Biscegli; STOLF, Noedir Antonio GroppoObjectives: This study analyzed the clinical and echocardiographic late outcomes of surgical septal myectomy in patients with obstructive hypertrophic cardiomyopathy (OHCM). Methods: We examined, retrospectively, 34 consecutive adult patients (age 55.7 +/- 15.2 years) with OHCM operated on in our institution from 1988 to 2008. Only four (11.8%) patients had family history of OHCM. Nine (26.5%) patients were in New York Heart Association (NYHA) funcional class IV. Thirty (88.2%) patients had solely OHCM, and four (11.8%) had OHCM associated with coronary insufficiency. The surgical technique used in all patients was septal myectomy performed through an aortotomy. Results: In 26 (76.5%) patients the mitral insufficiency due to systolic anterior motion, decreased after the myectomy. Eight (23.5%) patients had mitral valve procedures. There was one hospitalar death (2.9%). Two (5.9%) patients required permanent pacemaker for complete heart block after the myectomy. The mean peak preoperative left ventrilcular outflow tract (LVOT) obstruction gradient was 84.9 +/- 29.0 mmHg, and decreased to 27.8 +/- 12.9 mmHg in the early postoperative and it was 19.2 +/- 11.2 mmHg in the late postoperative period (49.0 +/- 33.0 months). The NYHA functional class improved from 3.1 +/- 0.8 to 1.4 +/- 0.5 in the postoperative period. Survival free from death was 87.9% and survival free from cardiovascular events was 77.7% with mean follow-up 9.6 +/- 8.4 years. Conclusions: Surgical septal myectomy can be performed safely, with excellent survival, improvement from symptoms and relief for LVOT obstruction in patients with OHCM. The early benefits were remained at long term.- Fatores de risco pré-operatórios para mediastinite após cirurgia cardíaca: análise de 2768 paciente(2012) TIVERON, Marcos Gradim; FIORELLI, Alfredo Inacio; MOTA, Eduardo Moeller; MEJIA, Omar Asdrubal Vilca; BRANDAO, Carlos Manuel de Almeida; DALLAN, Luis A. O.; POMERANTZEFF, Pablo A. M.; STOLF, Noedir A. G.Background: Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. Objective: The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. Methods: This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. Results: Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 +/- 13.5 years and the EuroSCORE of 4.5 +/- 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.861, P = 0.012) and extracardiac vascular intervention (OR 4.39,95% CI [1.64 to 11.761,P = 0.003). Conclusion: This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.
- Long-term evolution of mitral commissurotomy in rheumatic patients with low echocardiographic score(2011) SOUZA, Luciano Rapold; BRANDAO, Carlos Manuel de Almeida; POMERANTZEFF, Pablo Maria Alberto; LEITE FILHO, Osanam Amorim; CARDOSO, Luiz Francisco; STOLF, Noedir Antonio GroppoIntroduction: The good results of open mitral commissurotomy are well known and there is a hypothesis that it could provide better results in patients selected by echocardiographic score. Objective: The purpose of this study is to analyze the late results with open mitral commissurotomy in patients selected by score and to identify variables influencing these results. Methods: From January 1990 to August 1994,50 patients were submitted to open mitral commissurotomy due to rheumatic mitral stenosis in Heart Institute of University of Sao Paulo Medical School. Patients with age < 60 years, in functional class II, III or IV (New York Heart Association) and echocardiographic score 9 were included. The mean age was 32.7 8.3 years and 41 patients (82%) were female. The functional class was II in three patients (6%), III in 46 (92%) and IV in one (2%). Forty six patients (92%) were in sinus rhythm and four (8%) were in atrial fibrillation. The mean mitral valve area was 0.9 +/- 0.2 cm(2). Results: There was no hospital mortality. There were two late deaths, one related to valve disease. Actuarial survival was 95.5 +/- 3.1 %, freedom from reoperation was 62.3 +/- 11,8% and freedom from tromboembolism was 88,2 +/- 5,0% in 18 years. There was no endocarditis. The grade of the echocardiographic score had no significant influence on the reoperations in late evolution. Conclusion: Open mitral commissurotomy presented excelent long term results in rheumatic patients with low echocardiographic score.
article 14 Citação(ões) na Scopus Os escores 2000 Bernstein-Parsonnet e EuroSCORE são similares na predição da mortalidade no Instituto do Coração-USP(2011) MEJIA, Omar Asdrubal Vilca; LISBOA, Luiz A. Ferreira; PUIG, Luiz Boro; DIAS, Ricardo Ribeiro; DALLAN, Luis A.; POMERANTZEFF, Pablo M.; STOLF, Noedir A. G.Objective: To evaluate the performance of 2000 Bernstein-Parsonnet (2000BP) and additive EuroSCORE (ES) for predicting surgical mortality at the Heart Institute, University of Sao Paulo. Methods: A prospective observational design. Seven hundred and seventy four patients were operated for coronary artery bypass graft, valve or combined procedure between May and October, 2007, were analyzed. The mortality was estimated with the 2000BP and ES. The correlation between expected mortality and observed mortality was validated through calibration and discrimination test. Results: The patients were stratified into five groups for the 2000BP and three for the ES. The Hosmer-Lemeshow test for 2000BP (P = 0.70) and for ES (P = 0.39) indicate a good calibration. The ROC curve for the 2000BP = 0.84 and for the ES = 0.81 confirms that the models are good predictors (P < 0.001). Conclusion: Both models are similar and adequate in predicting surgical mortality at the InCor-USP.- Validação do 2000 Bernstein-Parsonnet e EuroSCORE no Instituto do Coração - USP(2012) MEJIA, Omar Asdrubal Vilca; LISBOA, Luiz Augusto Ferreira; DALLAN, Luis Alberto Oliveira; POMERANTZEFF, Pablo Maria Alberto; MOREIRA, Luiz Felipe Pinho; JATENE, Fabio Biscegli; STOLF, Noedir Antonio GroppoObjective: To validate the 2000 Bernstein Parsonnet (2000BP) and additive EuroSCORE (ES) to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the Heart Institute, University of Sao Paulo (InCor/HC-FMUSP). Methods:A prospective observational design. We analyzed 3000 consecutive patients who underwent coronary bypass surgery and/or heart valve surgery, between May 2007 and July 2009 at the InCor/HC-FMUSP. Mortality was calculated with the 2000BP and ES models. The correlation between estimated mortality and observed mortality was validated by calibration and discrimination tests. Results: There were significant differences in the prevalence of risk factors between the study population, 2000BP and ES. Patients were stratified into five groups for 2000BP and three for the ES. In the validation of models, the ES showed good calibration (P = 0396), however, the 2000BP (P = 0.047) proved inadequate. In discrimination, the area under the ROC curve proved to be good for models, ES (0.79) and 2000BP (0.80). Conclusion: In the validation, 2000BP proved questionable and ES appropriate to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the InCor/HC-FMUSP.
- Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair(2015) GUEDES, Marco Antonio Vieira; POMERANTZEFF, Pablo Maria Alberto; BRANDAO, Carlos Manuel de Almeida; VIEIRA, Marcelo Luiz Campos; TARASOUTCHI, Flavio; SPINOLA, Pablo da Cunha; JATENE, Fabio BiscegliIntroduction: Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce. Objective: To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. Methods: Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05. Results: There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study. Conclusion: Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.
- Experiência inicial com a técnica de Pomerantzeff para redução do tamanho do átrio esquerdo gigante(2012) SOUSA, Jocerlano Santos de; POMERANTZEFF, Pablo Maria Alberto; BRANDAO, Carlos Manuel de Almeida; GONCALVES, Lisandro Azeredo; TIVERON, Marcos Gradim; VIEIRA, Marcelo Luiz Campos; TARASOUTCHI, Flavio; STOLF, Noedir Antonio GroppoIntroduction: The most common indication for surgical correction of giant left atrium is associated with mitral valve insufficiency with or without atrial fibrillation. Several techniques for this purpose are already described with varying results. Objective: To present the initial experience with the tangential triangular resection technique (Pomerantzeff). Methods: From 2002 to 2010, four patients underwent mitral valve operation with reduction of left atrial volume by the technique of triangular resection tangential in our service. Three patients were female. The age ranged from 21 to 51 years old. The four patients presented with atrial fibrillation. Ejection fraction of left ventricle preoperatively ranged from 38% to 62%. The left atrial diameter ranged from 78mm to 140mm. After treatment of mitral dysfunction, the left atrium was reduced by resecting triangular tangential posterior wall between the pulmonary veins to avoid anatomic distortion of the mitral valve or pulmonary veins, reducing tension in the suture line. Results: Average hospital stay was 21.5 +/- 6.5 days. The mean cardiopulmonary bypass time was 130 +/- 30 minutes. There was no surgical bleeding or mortality in the postoperative period. All patients had sinus rhythm restored in the output of cardiopulmonary bypass, maintaining this rate postoperatively. The average diameter of the left atrium was reduced by 50.5% +/- 19.5%. The left ventricular ejection fraction improved in all patients. Conclusion: Initial results with this technique have shown effective reduction of the left atrium.