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Álvaro M. Perazzo

Maastricht University

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Michel Pompeu Sá

Massachusetts General Hospital

Luiz Rafael P. Cavalcanti

Universidade de Pernambuco

Alexander Weymann

Medizinische Hochschule Hannover

Konstantin Zhigalov

Perm State University

Ricardo Carvalho Lima

Universidade de Pernambuco

Arjang Ruhparwar

Medizinische Hochschule Hannover

Samuel Padovani Steffen

Universidade de São Paulo

Fábio Biscegli Jatene

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Ricardo C. Lima

Universidade de Pernambuco

Fernando Bacal

Universidade de São Paulo

Cooperative Institutions

Universidade de Pernambuco

Universidade de São Paulo

Maastricht University

Erasmus University Rotterdam

Erasmus MC

Maastricht University Medical Centre

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Istituti di Ricovero e Cura a Carattere Scientifico

Universidade Federal de Pernambuco

Instituto do Coração

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Coronary Artery Bypass Graft Surgery Improves Survival Without Increasing the Risk of Stroke in Patients with Ischemic Heart Failure in Comparison to Percutaneous Coronary Intervention: A Meta- Analysis With 54,173 Patients

Brazilian Journal of Cardiovascular Surgery (2019)

Michel Pompeu Sá Álvaro M. Perazzo Felipe Augusto Santos Saragiotto Luiz Rafael P. Cavalcanti Antônio Carlos Escorel Almeida Neto

To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF).

Stroke

10.21470/1678-9741-2019-0170

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Citations (10)

A Milestone in Cardiac Care: The Intra-Aortic Balloon Pump in Cardiac Surgery and Transplantation

Brazilian Journal of Cardiovascular Surgery (2024)

Álvaro M. Perazzo Samuel Padovani Steffen Fábio Antônio Gaiotto Ronaldo Honorato Barros Santos Fábio Biscegli Jatene

Intra-aortic balloon pump

Milestone

Aortic surgery

10.21470/1678-9741-2024-0991

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Citations (0)

Management of Acute Type A Aortic Dissection at a Public Cardiac Center in the Northeast Region of Brazil

Brazilian Journal of Cardiovascular Surgery (2021)

Pablo César Lustosa Barros Bezerra Ricardo de Carvalho Lima Pedro R Salerno A. Martins Geovanna Menezes de Medeiros Lustosa

Introduction: Aortic diseases are among the most serious cardiovascular diseases; the overall mortality rate due to diseases such as aneurysms and aortic dissections has been estimated at 2.78 per 100,000 persons in 2010, with a higher mortality rate in men than women.Our objective was to evaluate the epidemiological profile of patients with acute type A aortic dissection at a cardiology referral center.Methods: A retrospective cross-sectional study was performed at a public cardiac center with 24 patients hospitalized from 1/1/2016 to 12/31/2017 with a confirmed diagnosis of acute type A aortic dissection.Results: Twenty (83.3%) out of 24 patients underwent surgery and four (16.7%) did not undergo surgery.Among those who underwent surgery, 10 (50%) died and 10 (50%) were discharged, and all non-operated patients died (P=0.114)(Fisher's exact test).The male gender predominated (n=19, 79.2%), 86.7% (n=13) of the patients presented body mass index > 25 kg/m 2 , chest pain was found in 91.7% (n=22), and renal failure was present in 45.8% (n=11) of the cases.Hypertension predominated in 91.7% (n=22) and the main exam was aortic angiotomography in 79.2% (n=19) of the cases. Conclusion:The study presented a small sample size, making it impossible to associate the factors, although the service was considered a high-volume referral center.It is possible that the delay in arriving at the service and the accomplishment of invasive imaging with the use of contrast agents have aggravated the patients' condition and have been decisive for the increase in lethality, which requires further studies.

Center (category theory)

10.21470/1678-9741-2020-0169

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German Aortic Valve Score in Risk Assessment for Surgical Aortic Valve Replacement in a Brazilian Center

Brazilian Journal of Cardiovascular Surgery (2020)

Sérgio C. Rayol Michel Pompeu Sá Luiz Rafael P. Cavalcanti Roberto Gouvea Silva Diniz Álvaro M. Perazzo

To test the German Aortic Valve (GAV) score at our university hospital in patients undergoing isolated aortic valve replacement (AVR).A total of 224 patients who underwent isolated conventional AVR between January 2015 and December 2018 were included. Patients with concomitant procedures and transcatheter aortic valve implantation were excluded. Patients' data were collected and analyzed retrospectively. Patients' risk scores were calculated according to criteria described by GAV score. Sensitivity, specificity, and accuracy (area under the ROC curve [AUC]) were also calculated. The calibration of the model was tested by the Hosmer-Lemeshow method.The mortality rate was 8.04% (18 patients). The patients' mean age was 58.2±19.3 years and 25% of them were female (56 patients). Mean GAV score was 1.73±5.86 (min: 0.0; max: 3.53). The GAV score showed excellent discriminative capacity (AUC 0.925, 95% confidence interval 0.882-0.956; P<0.001). The cutoff "1.8" turned out to be the best discriminatory point with the best combination of sensitivity (88.9%) and specificity (75.7%) to predict operative death. Hosmer-Lemeshow method revealed a P-value of 0.687, confirming a good calibration of the model.The GAV score applies to our population with high predictive accuracy.

10.21470/1678-9741-2019-0373

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A rare adverse reaction to ethambutol: drug-induced haemolytic anaemia

The International Journal of Tuberculosis and Lung Disease (2016)

Andrea Nicolini Álvaro M. Perazzo P Gatto Ines Maria Grazia Piroddi Cornelius Barlascini

Anti-tuberculosis drugs seldom cause serious haematological side effects. However, among these drugs, isoniazid and rifampicin, especially when administered intermittently, may very rarely be linked to acute autoimmune haemolytic anaemia. Ethambutol (EMB) can cause dose-related retrobulbar neuritis. In this paper, we present the first reported case of acute fatal autoimmune haemolytic anaemia due to EMB.

Neuritis

Adverse drug reaction

10.5588/ijtld.15.0742

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Bioprosthetic valve fracture for valve‐in‐valve transcatheter aortic valve implantation in patients with structural valve degeneration: Systematic review with meta‐analysis

Journal of Cardiac Surgery (2021)

Michel Pompeu Sá Sérgio C. Rayol Jef Van den Eynde Luiz Rafael P. Cavalcanti Antônio C. Escorel Neto

Objectives To determine the outcomes of bioprosthetic valve fracture (BVF) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for patients with structural valve degeneration (SVD) of bioprosthetic surgical valves (BSV) implanted during surgical aortic valve replacement (SAVR). Methods A systematic review was conducted including studies published by May 2021. The primary endpoints of the study were 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation, and coronary obstruction. The secondary endpoints were mean valve gradients (mmHg) and aortic valve area (AVA—cm2). A meta-analysis was conducted using the software R, version 3.6.3 (R Foundation for Statistical Computing). Results Four studies including 242 patients met our eligibility criteria. The overall proportions for 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation and coronary obstruction were 2.1%, <1.0%, <1.5%, <1.0%, <1.0%, and <1.5%, respectively. After ViV-TAVI with BVF, the difference in means for mean valve gradients showed a significant reduction (random-effects model: −26.7; −28.8 to −24.7; p < .001), whereas the difference in means for AVA showed a significant increase (random-effects model: 0.55 cm2; 0.13–0.97; p = .029). Despite the improvement in AVA means, these remain too low after the procedure highly likely due to the small size of the bioprosthetic valves implanted during the index SAVR. Conclusion ViV-TAVI with BVF has proven to be a promising option but data are still too scarce to enable us to draw definitive conclusions. Despite the decrease in gradients, postprocedural AVA remains worrisome. Studies with better designs and larger sample sizes are needed to advance this treatment option.

Stroke

10.1111/jocs.16032

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Citations (8)

Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Figshare (2019)

Michel Pompeu Sá Luiz Rafael P. Cavalcanti Felipe Augusto Santos Sarargiotto Álvaro M. Perazzo Sérgio da Costa Rayol

Abstract Objectives: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). Methods: Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. Results: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). Conclusion: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.

10.6084/m9.figshare.8988254

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Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications

Current Atherosclerosis Reports (2020)

Luiz Rafael P. Cavalcanti Michel Pompeu Sá Álvaro M. Perazzo Antônio C. Escorel Neto Rafael Alessandro Ferreira Gomes

This review summarizes the pathophysiology of mitral annular calcification (MAC) with recent findings and current strategies for diagnosis and treatment. Major factors in MAC development seem to be shear stress of the flow past the mitral valve, local inflammation, and dysregulation in regulators of mineral metabolism. MAC itself poses daunting technical challenges. Implanting a valve on top of the calcium bar might lead to paravalvular leak (PVL) that is less likely to heal. Annular decalcification allows for better valve seating and potentially better healing and less PVL. This, however, comes with the risk for catastrophic atrioventricular groove disruption. MAC can be sharply dissected with the scalpel; the annulus can be reconstructed with the autologous pericardium. Transcatheter mitral valve replacement is a promising approach in the treatment of patients who are deemed high-risk surgical candidates with severe MAC. MAC is a multifactorial disease that has some commonalities with atherosclerosis, mainly regarding lipid accumulation and calcium deposition. It is of great clinical importance, being a risk marker of cardiovascular events (including sudden death) and, with its progression, can have a negative impact on patients' lives.

Angiology

10.1007/s11883-020-0825-3

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Acute Aortic Dissection: an Update

Current Emergency and Hospital Medicine Reports (2020)

Luiz Rafael P. Cavalcanti Michel Pompeu Sá Jéssica Cordeiro Siqueira Campos Paulo Guilherme Bezerra Braga Álvaro M. Perazzo

10.1007/s40138-020-00216-3

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Citations (2)

Early Aortic Valve Replacement versus Watchful Waiting in Asymptomatic Severe Aortic Stenosis: A Study-Level Meta-Analysis

Structural Heart (2019)

Michel Pompeu Sá Luiz Rafael P. Cavalcanti Antônio Capone Neto Álvaro M. Perazzo Matheus Simonato

BackgroundThe management of patients with asymptomatic, severe aortic stenosis (AS) is controversial. We performed a meta-analysis to examine the impact on outcomes of early aortic valve replacement (AVR) in patients with severe asymptomatic AS versus a watchful-waiting (WW) approach.MethodsDatabases were searched for studies published until April 2019. Main outcome of interest was death during follow-up.ResultsThe search yielded 1,889 studies for inclusion. Of these, seven articles were analyzed and their data extracted. The total number of patients included was 3,839. The overall HR (95% CI) for death showed a statistically significant difference between the groups, with lower risk in the “early AVR” group (random effect model: HR 0.280; 95% CI 0.159–0.494, P < 0.001). There was evidence of significant statistical heterogeneity of treatment effect among the studies for death. Funnel plot analysis disclosed no asymmetry around the axis for the outcome of interest, which means that we have low risk of publication bias related to this outcome. Sensitivity analysis showed that none of the studies had a particular impact on the results. The meta-regression coefficients for the modulating factors age, male sex, presence of hypertension and presence of diabetes were significant for mortality, showing that the early intervention becomes even more protective in comparison with the conservative approach when we take these factors into consideration.ConclusionEarly AVR seems to be a better approach than WW in the treatment of asymptomatic patients with severe AS, but we would still advocate a case-by-case decision-making process.

Watchful waiting

Funnel plot

10.1080/24748706.2019.1652946

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Citations (5)