Igor Tiago Correia Silva
@cardioin.com.br
IMIP - Instituto de Medicina Integral Prof. Fernando Figueira
Cardioin
RESEARCH, TEACHING, or OTHER INTERESTS
Cardiology and Cardiovascular Medicine
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Diogo Luiz de Magalhães Ferraz, Cristiano Berardo Carneiro da Cunha, Fernando Augusto Marinho dos Santos Figueira, Igor Tiago Correia Silva, Verônica Soares Monteiro, Rodrigo Moreno Dias Carneiro, Bruna Gomes de Castro, Mariana Barreto Requião, Victor de França Oliveira, Patrícia Jaqueline Xavier da Silva,et al.
Sociedade Brasileira de Cirurgia Cardiovascular
Introduction Heart transplantation is the gold standard for advanced heart failure treatment. This study examines the survival rates and risk factors for early mortality in adult heart transplant recipients at a Brazilian center. Methods This retrospective cohort study involved 255 adult heart transplant patients from a single center in Brazil. Data were collected from medical records and databases including three defined periods (2012-2015, 2016-2019, and 2020-2022). Statistical analysis employed Kaplan-Meier survival curves, Cox proportional hazards analysis for 30-day mortality risk factors, and Log-rank tests. Results The recipients were mostly male (74.9%), and the mean age was 46.6 years. Main causes of heart failure were idiopathic dilated cardiomyopathy (33.9%), Chagas cardiomyopathy (18%), and ischemic cardiomyopathy (14.3%). The study revealed an overall survival of 68.1% at one year, 58% at five years, and 40.8% at 10 years after heart transplantation. Survivalimproved significantly over time, combining the most recent periods (2016 to 2022) it was 73.2% in the first year and 63% in five years. The main risk factors for 30-day mortality were longer time on cardiopulmonary bypass, the initial period of transplants (2012 to 2015), older age of the donor, and nutritional status of the donor (overweight or obese). The main causes of death within 30 days post-transplant were infection and primary graft dysfunction. Conclusion The survival analysis by period demonstrated that the increased surgical volume, coupled with the team’s experience and modifications to the immunosuppression protocol, contributed to the improved early and mid-term outcomes.
Cristiano Berardo Carneiro da Cunha, Tiago Andrade Lima, Diogo Luiz de Magalhães Ferraz, Igor Tiago Correia Silva, Matheus Kennedy Dionisio Santiago, Gabrielle Ribeiro Sena, Verônica Soares Monteiro, and Lívia Barbosa Andrade
Sociedade Brasileira de Cirurgia Cardiovascular
Introduction Blood transfusion is a common practice in cardiac surgery, despite its well-known negative effects. To mitigate blood transfusion-associated risks, identifying patients who are at higher risk of needing this procedure is crucial. Widely used risk scores to predict the need for blood transfusions have yielded unsatisfactory results when validated for the Brazilian population. Methods In this retrospective study, machine learning (ML) algorithms were compared to predict the need for blood transfusions in a cohort of 495 cardiac surgery patients treated at a Brazilian reference service between 2019 and 2021. The performance of the models was evaluated using various metrics, including the area under the curve (AUC), and compared to the commonly used Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST) scoring systems. Results The study found that the model had the highest performance, achieving an AUC of 0.7350 (confidence interval [CI]: 0.7203 to 0.7497). Importantly, all ML algorithms performed significantly better than the commonly used TRACK and TRUST scoring systems. TRACK had an AUC of 0.6757 (CI: 0.6609 to 0.6906), while TRUST had an AUC of 0.6622 (CI: 0.6473 to 0.6906). Conclusion The findings of this study suggest that ML algorithms may offer a more accurate prediction of the need for blood transfusions than the traditional scoring systems and could enhance the accuracy of predicting blood transfusion requirements in cardiac surgery patients. Further research could focus on optimizing and refining ML algorithms to improve their accuracy and make them more suitable for clinical use.
Cristiano Berardo Carneiro da Cunha, Verônica Soares Monteiro, Diogo Luiz de Magalhães Ferraz, Rodrigo Mezzalira Tchaick, Jeú Delmondes de Carvalho Júnior, Igor Tiago Correia Silva, Fernando Augusto Marinho dos Santos Figueira, and Lívia Barbosa Andrade
Sociedade Brasileira de Cirurgia Cardiovascular
Introduction Transfusion of red blood cells is recurrent in cardiac surgery despite the well-established deleterious effects. Identifying patients with higher chances of requiring blood transfusion is essential to apply strategic preventive measures to reduce such chances, considering the restricted availability of this product. The most used risk scores to predict blood transfusion are the Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST). However, these scores were not validated for the Brazilian population. The objective of this study was to assess the accuracy of TRACK and TRUST scores in estimating the need for postoperative transfusion of red blood cell concentrates (TRBCC) after cardiac surgery. Methods A clinical retrospective study was conducted using the database of a Brazilian reference service composed of patients operated between November 2019 and September 2021. Scores were compared using Mann-Whitney U test. Hosmer-Lemeshow goodness of fit test assessed calibration of the scores. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC). All analyses considered a level of significance of 5%. The study was approved by the research ethics committee (CAAE 55577421.4.0000.5201). Results This study assessed 498 patients. Only the TRACK score presented good calibration (P=0.238; TRUST P=0.034). AUC of TRACK was 0.678 (95% confidence interval 0.63 to 0.73; P<0.001), showing a significant accuracy. Conclusion Between the scores analyzed, only the TRACK score showed a good calibration, but low accuracy, to predict postoperative TRBCC after cardiac surgery.
Diogo Luiz de Magalhães Ferraz, Karina Mascarenhas Bezerra Alves, Larissa Almeida Barp Santos, Girliney dos Santos Leandro, Cristiano Berardo Carneiro da Cunha, Rodrigo Mezzalira Tchaick, Igor Correia Silva, João Paulo Segundo de Paiva Oliveira, Jeú Delmondes de Carvalho Júnior, Felipe Ribeiro Walter,et al.
Sociedade Brasileira de Cardiologia
Background: Right valve diseases are not benign, the tricuspid regurgitation has a significant impact on morbidity and mortality of patients. Objectives: This study aimed to report the short-term results of tricuspid annuloplasty using the De Vega technique modified by Manuel Antunes. Methods: A descriptive-analytical study was performed to evaluate the results of the tricuspid valvuloplasty performed at the Instituto de Medicina Integral Professor Fernando Figueira between 2012 and 2017. Data were collected by reviewing charts and databases of the Department of Cardiology and Cardiovascular Surgery of the institution. Those with rheumatic diseases or infective endocarditis with tricuspid valve involvement, or reoperation of the tricuspid valve were excluded. Student's t-test and McNemar's were used for statistical analysis. A p-value < 0.05 was considered statistically significant. Results: A total of 87 patients were studied, most of them were women (56.3%). The most associated heart valve diseases were mitral regurgitation (27.6%) and aortic regurgitation (20.7%). There was a significant decrease in the degree of tricuspid regurgitation in the postoperative period, with 83.3% of patients with none or mild regurgitation and only 1.1% with severe regurgitation (p = 0.0077). Conclusions: In the current study, tricuspid valve annuloplasty using the modified De Vega technique was shown to be effective in the short term. Further studies are needed to evaluate the long-term results. (Int J Cardiovasc Sci. 2019; [online].ahead print, PP.0-0)
Isaac Newton Guimarães, Fernando Moraes, João Paulo Segundo, Igor Silva, Tamyris Guimarães Andrade, and Carlos R. Moraes
FapUNIFESP (SciELO)
FUNDAMENTO: Idade maior a 80 anos nao e, por si so, o unico fator de risco para a mortalidade em revascularizacao miocardica. OBJETIVO: Identificar fatores de risco para a mortalidade em pacientes octogenarios submetidos a revascularizacao miocardica. METODOS: Estudamos 164 pacientes, com idade igual ou maior a 80 anos. As variaveis estudadas foram: sexo, idade (em anos), fracao de ejecao do ventriculo esquerdo (FEVE), reoperacao, cirurgia de emergencia, numero de arterias revascularizadas, uso da arteria toracica interna esquerda (ATIE), uso de circulacao extracorporea (CEC), cirurgia associada, revascularizacao da arteria interventricular anterior (AIVA) e uso de balao intra-aortico (BIA). A analise estatistica foi feita por meio de analises descritiva, univariada e multivariada por regressao logistica. Foram considerados significância estatistica os valores de p < 0,05, e a analise multivariada foi realizada com variaveis cujo valor era p < 0,20. RESULTADOS: A mortalidade foi de 11%. Na analise univariada, evidenciou-se que baixa FEVE (p = 0,008), cirurgia de emergencia (p < 0,001) e uso de balao intra-aortico (p = 0,049) relacionaram-se a maior chance de mortalidade. Ao ajustar pela regressao logistica, revelou-se que a idade acima de 85 anos correlacionou-se com uma chance de mortalidade 6,31 vezes maior (p = 0,012) e que a cirurgia de emergencia esteve relacionada a uma chance de mortalidade 55,39 vezes maior (p < 0,001). CONCLUSAO: Em octogenarios submetidos a cirurgia de revascularizacao miocardica, idade superior a 85 anos e cirurgia de emergencia sao fatores preditivos importantes de maior mortalidade.
Isaac Newton Guimarães Andrade, Fernando Ribeiro de Moraes Neto, João Paulo Segundo de Paiva Oliveira, Igor Tiago Correia Silva, Tamyris Guimarães Andrade, and Carlos Roberto Ribeiro de Moraes
FapUNIFESP (SciELO)
OBJECTIVE
To assess the applicability of the European Risk System in Cardiac Operations (EuroSCORE) in patients undergoing cardiac valve surgery at the Heart Institute of Pernambuco.
METHOD
840 patients operated on between 2001 and 2009, who medical records contained all the informations to calculate the EuroSCORE were included in the study. Hospital death was the end-point of the study. In order to assess the applicability of the EuroSCORE it was used the non parametric test of Mann-Whitney. The calibration of the model was measured by comparing the morbidity observed with that expected, using the Hosmer-Lemeshow Test of Goodness of Fit. The accuracy of the model was evaluated by the ROC curve (receiver operating characteristic curve).
RESULTS
The comparison of expected and observed mortality, by Hosmer-Lemershow test, showed good predictive capacity (P = 0.767) as well as when compared to each value of addictive EuroSCORE (P = 0,455). The area of ROC curve was 0.731 (IC 95%, 0.660 - 0.793) with P < 0.001. The global predicted mortality was practically identical to that observed (7.9%). The low-risk group (EuroSCORE 0-2) comprised 345 patients with a mortality of 3.19%. The medium-risk group (EuroSCORE 3-5) comprised 364 patients, with a mortality of 7.69% and the high-risk group (EuroSCORE > 6) included 131 patients, with a mortality of 20.6%. The regression logistic analyses allowed to identify the following risk-factors for death: age > 60 years, gender female, previous operation, active endocarditis, associated surgery of the thoracic aorta and extra-cardiac arteriopathy.
CONCLUSION
The EuroSCORE, a simple and objective method, proved to be a satisfactory predictor of operative mortality and risk factors for death in patients submitted to valve cardiac operations in the Heart Institute of Pernambuco.