Navegando por Palavras-chave "Cardiopulmonary bypass"
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- ItemAcesso aberto (Open Access)Alterações da hemostasia em crianças submetidas a cirurgia cardíaca com circulação extracorpórea(Sociedade Brasileira de Cardiologia - SBC, 1998-01-01) Silveira, Fernanda Maria Rebouças da Costa [UNIFESP]; Lourenco, Dayse Maria [UNIFESP]; Maluf, Miguel Angel [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Buffolo, Enio [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: We evaluated hemostasic changes in children undergoing open heart surgery with cardiopulmonary bypass (CPB). METHODS: We studied 17 children before, during surgery, in the immediate, first and between the 4th and 7th postoperative days, measuring hematocrit, prothrombin time, activated partial thromboplastin time, fibrinogen, platelet count, factor V and euglobulin lysis time. Children were divided in those with and without excessive bleeding in the postoperative period. RESULTS: We observed significant prolongation of prothrombin time and activated partial thromboplastin time, reduction of fibrinogen and factor V, and shortening of euglobulin lysis time. Six (35%) children bled excessively. Platelet count reduction was greater in the intra operative period in these cases and the duration of CPB was longer in this group. CONCLUSION: Changes in hemostasis during open heart surgery are due to coagulation cascade disorders as well as fibrinolysis. The incidence of excessive bleeding is higher in the pediatric group. Prolonged CPB time and greater reduction in platelet count differentiated both groups.
- ItemAcesso aberto (Open Access)Cardiac muscle apoptosis: a comparison of myocardium revascularization with and without cardiopulmonary bypass(Sociedade Brasileira de Cirurgia Cardiovascular, 2003-09-01) Gaia, Diego Felipe [UNIFESP]; Moreira, Rafael Saviolo [UNIFESP]; Arrais, Magaly [UNIFESP]; Vinhola, Nivia Cristina Tot [UNIFESP]; Buffolo, Enio [UNIFESP]; Smith, Ricardo Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Inflammatory response and metabolic disturbances in coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and without (OFF-PUMP) have been researched. Apoptosis in ischemic reperfusion and chronic disease models has been shown in recent studies. The objective of this study is to compare the apoptosis intensity detected in cardiac myocytes before and after CABG with and without cardiopulmonary bypass. METHOD: Eighteen patients undergoing elective CABG were divided in two groups: the first group underwent cardiopulmonary bypasses and the second group did not. Auricle myocardial samples were obtained at the beginning and at the end of the surgery. Specimens were examined for apoptosis using the TUNEL method. RESULTS: There was no significant difference between the two groups in the surgical, demographic and postoperative data. The number of grafts was statistically different. There was no significant difference between the numbers of cells undergoing apoptosis in the two groups at the beginning of the procedure. There was no significant difference in the number of cells undergoing apoptosis from the beginning to the end of CABG in the OFF-PUMP group. There was a significant difference between the number of cells undergoing apoptosis at the beginning and the end of the CABG in the CPB group (p<0.01). CONCLUSION: The smaller number of cells undergoing apoptosis in the OFF-PUMP group is in accordance with published data that suggest CPB is capable of promoting cell lesion. Having shown that, another favorable argument can be added to the indication of the CABG without CPB.
- ItemAcesso aberto (Open Access)Experiência inicial da Universidade Federal de São Paulo no desenvolvimento e aplicação do implante valvar aórtico transcateter(Universidade Federal de São Paulo (UNIFESP), 2009-11-25) Santos, Diego Felipe Gaia dos [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for aortic position implant. METHOD: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median age was 75,5 years. Median Logistic EuroSCORE was 43,7%. Four patients presented with disfunctional bioprosthesis, remainig ones presented calcified aortic stenosis (peak transvalvular gradient 79,7 mmHg). After minithoracotomy and under echocardiograph and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiograph and angiograph controls were performed and the patients were referred to ICU. RESULTS: Implant was feasible in 13 cases. There were no intra-operative deaths. Mortality was 42%. Median peak transvalvular aortic gradient reduced to 25,0 mmHg, and left ventricular function improved in the first 7 post operative days. Paravalvular aortic regurgitation was mild and present in most cases. Platelet count significantly decreased after procedure, but returned to normal values after 30 days. CONCLUSION: The transapical implantation of catheter-mounted bioprosthesis was a feasible procedure. Technical details and learning curve require further discussion.
- ItemAcesso aberto (Open Access)Implante transapical de endoprótese valvada balão-expansível em posição aórtica sem circulação extracorpórea(Sociedade Brasileira de Cirurgia Cardiovascular, 2009-06-01) Gaia, Diego Felipe [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Souza, José Augusto Marcondes de [UNIFESP]; Guilhen, José Cícero Stocco [UNIFESP]; Telis, Andre [UNIFESP]; Fischer, Claudio Henrique [UNIFESP]; Ferreira, Carolina Baeta Neves Duarte [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation without cardiopulmonary bypass (CPB) has been shown to be viable, with lower morbidity and mortality. The aim of this study was to develop a catheter-mounted aortic bioprosthesis for implantation without CPB. METHODS: After developing in animals, three patients with high EuroSCORE underwent implantation. Case 1: patients with bioprosthesis dysfunction; Case 2: severe aortic stenosis; Case 3: dysfunction of aortic bioprosthesis. After minithoracotomy and under echocardiographic and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiographic and angiographic controls were performed and the patients were referred to ICU. RESULTS: In the first case, implantation without CPB was possible with appropriate results. The patient evolved with improvement of ventricular function. After, this patient developed bronchopneumonia, tracheoesophageal fistula and died due to mediastinitis. Autopsy confirmed proper valve positioning and leaflets preservation. The second case showed the device migration after inflation of the balloon, with the need for urgent median sternotomy, CPB and conventional valve replacement. This patient evolved well and was discharged from the ICU on the 14th postoperative day without complications. This patient developed respiratory infection, septic shock and died on the 60th postoperative day. The patient from the third case underwent successful implantation. CONCLUSION: The off-pump transapical implantation of catheter-mounted bioprosthesis was shown to be a feasible procedure. Technical details and learning curve require further discussion.
- ItemAcesso aberto (Open Access)Implante transcateter de valva aórtica: resultados atuais do desenvolvimento e implante de um nova prótese brasileira(Sociedade Brasileira de Cirurgia Cardiovascular, 2011-09-01) Gaia, Diego Felipe [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Ferreira, Carolina Baeta Neves Duarte [UNIFESP]; Souza, José Augusto Marcondes de [UNIFESP]; Gimenes, Marcus Vinícius [UNIFESP]; Macedo, Murilo Teixeira [UNIFESP]; Martins, Márcio Rodrigo [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment. METHODS: Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed. RESULTS: Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%. CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival
- ItemAcesso aberto (Open Access)Implante valve-in-valve transcateter em posição aórtica: uma mudança de seleção?(Sociedade Brasileira de Cirurgia Cardiovascular, 2012-09-01) Gaia, Diego Felipe [UNIFESP]; Couto, Aline [UNIFESP]; Breda, João Roberto [UNIFESP]; Ferreira, Carolina Baeta Neves Duarte [UNIFESP]; Macedo, Murilo Teixeira [UNIFESP]; Gimenes, Marcus Vinicius [UNIFESP]; Buffolo, Enio [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Aortic valve replacement for bioprosthesis dysfunction is a procedure involving considerable risk. In some cases, mortality is high and may contraindicate the procedure. Minimally invasive transcatheter aortic valve-in-valve implant appears to be an alternative, reducing morbidity and mortality. The objective is to evaluate aortic valve-in-valve procedure using Braile Inovare prosthesis. METHODS: The Braile Inovare prosthesis, transcatheter, expandable balloon, was used in 14 cases. Average EuroSCORE was 42.9%. All patients had double aortic bioprosthesis dysfunction. Procedures were performed in a surgical hybrid environment under echocardiographic and fluoroscopic guidance. Using left minithoracotomy prostheses were implanted through the ventricular apex under high-frequency ventricular pacing. Serial clinical and echocardiographic controls were performed. Follow-up ranged 1-30 months. RESULTS: Correct prosthetic deployment was obtained in all cases. There was no conversion. There was no operative mortality. The 30-day mortality was 14.3% (two cases). Ejection fraction increased significantly after the 7th postoperative day. Aortic gradient significantly reduced. The residual aortic regurgitation was not present. There were no vascular complications or complete atrioventricular block. CONCLUSION: The transcatheter valve-in-valve procedure for bioprosthesis dysfunction is safe with low morbidity. This possibility may change prosthesis choice during the first aortic valve replacement, favoring bioprostheses.
- ItemSomente MetadadadosMitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures(Oxford Univ Press, 2017) Gaia, Diego Felipe [UNIFESP]; Braz, Ademir Massarico [UNIFESP]; Simonato, Matheus [UNIFESP]; Dvir, Danny; Breda, Joao Roberto [UNIFESP]; Ribeiro, Gustavo Calado; Ferreira, Carolina Baeta [UNIFESP]; Marcondes Souza, Jose Augusto [UNIFESP]; Buffolo, Enio [UNIFESP]; Palma, Jose Honorio [UNIFESP]OBJECTIVES: Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper was to evaluate the mitral ViV approach using the Braile Inovare prosthesis. METHODS: The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operating room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex. Serial echocardiographic and clinical examinations were performed. Follow-up varied from 1 to 30 months. RESULTS: A total of 12 transapical mitral ViV procedures were performed. Patients had a mean age of 61.6 +/- 9.9 years and 92% were women. Mean logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. Thirty-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%
- ItemAcesso aberto (Open Access)Perfusão da artéria pulmonar não melhora os índices de fator natriurético cerebral (BNP) em estudo experimental em suínos(Sociedade Brasileira de Cirurgia Cardiovascular, 2010-12-01) Gabriel, Edmo Atique [UNIFESP]; Locali, Rafael Fagionato; Matsuoka, Priscila Katsumi; Almeida, Ludmila Santiago; Silva, Paulo Sérgio Venerando; Ishigai, Marcia Marcelino de Souza [UNIFESP]; Salerno, Tomas; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Miami Divisão de Cirurgia CardiotorácicaOBJECTIVE: Assess if the main pulmonary artery controlled perfusion over cardiopulmonary bypass (CPB) modifies BNP levels expressed by the ventricular myocardium. METHODS: Experimental research involving 32 pigs, divided into two groups according to CPB strategy - group I (cardioplegia) and group II (beating heart). Both groups were allocated into three subgroups according to lung perfusion strategy - subgroup A (control: no lung perfusion), subgroup B (lung perfusion with arterial blood) and subgroup C (lung perfusion with venous blood). In subgroups B and C, lung was perfused for 30 minutes, using preoperative mean pulmonary artery pressure (MPAP) as perfusion pressure, which was monitored through manometer. MPAP and pulmonary vascular resistance (PVR) were measured after coming off CPB using Swan-Ganz catheter. At preoperative time and 30 minutes after lung perfusion, specimens were taken from the right ventricular myocardium aiming to assess brain natriuretic peptide (BNP) and histologic pattern. Immunohistochemical and hematoxylin-eosin techniques were used to determine, respectively, BNP expression and inflammatory myocardial lesions. RESULTS: In animals submitted to controlled lung perfusion, there was a postoperative reduction of MPAP (P=0.03) and PVR (P=0.005).There was no differences among subgroups within the group, I (P=0.228) and subgroups within group II (P=0.325) as to postoperative BNP expression. There were no differences among subgroups with and without lung perfusion as to postoperative inflammatory lesions (P>0.05). CONCLUSION: Main pulmonary artery controlled perfusion for 30 minutes did not yield substantial modifications in BNP expression and histologic pattern of the right ventricular myocardium.
- ItemSomente MetadadadosRecovery of linear and nonlinear heart rate dynamics after coronary artery bypass grafting surgery(Wiley-Blackwell, 2014-11-01) Pantoni, Camila Bianca Falasco; Mendes, Renata Gonçalves; Di Thommazo-Luporini, Luciana; Simões, Rodrigo Polaquini; Amaral-Neto, Othon; Arena, Ross; Guizilini, Solange [UNIFESP]; Gomes, Walter José [UNIFESP]; Catai, Aparecida Maria; Borghi-Silva, Audrey; Universidade Federal de São Carlos (UFSCar); Irmandade Santa Casa Misericordia Hosp; Univ Illinois; Universidade Federal de São Paulo (UNIFESP)Background: Conventional coronary artery bypass grafting (C-CABG) and off-pump CABG (OPCAB) surgery may produce different patients' outcomes, including the extent of cardiac autonomic (CA) imbalance. the beneficial effects of an exercise-based inpatient programme on heart rate variability (HRV) for C-CABG patients have already been demonstrated by our group. However, there are no studies about the impact of a cardiac rehabilitation (CR) on HRV behaviour after OPCAB. the aim of this study is to compare the influence of both operative techniques on HRV pattern following CR in the postoperative (PO) period.Methods: Cardiac autonomic function was evaluated by HRV indices pre- and post-CR in patients undergoing C-CABG (n = 15) and OPCAB (n = 13). All patients participated in a short-term(approximately 5 days) supervised CR programme of early mobilization, consisting of progressive exercises, from active-assistive movements at PO day 1 to climbing flights of stairs at PO day 5.Results: Both groups demonstrated a reduction in HRV following surgery. the CR programme promoted improvements in HRV indices at discharge for both groups. the OPCAB group presented with higher HRV values at discharge, compared to the C-CABG group, indicating a better recovery of CA function.Conclusion: Our data suggest that patients submitted to OPCAB and an inpatient CR programme present with greater improvement in CA function compared to C-CABG.