Navegando por Palavras-chave "Heart transplantation"

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    Avaliação e seguimento em médio prazo em candidatos a transplante cardíaco submetidos a exercício de baixa intensidade
    (Sociedade Brasileira de Cirurgia Cardiovascular, 2010-09-01) Yoshimori, Darlene Yuri [UNIFESP]; Cipriano Junior, Gerson [UNIFESP]; Mair, Vanessa [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Brasília
    OBJECTIVE: To study cardiovascular behavior and safety regarding a low-intensity exercise program for heart transplant candidates with severe heart failure. METHODS: Twenty-one patients with severe heart failure on the transplant list of the UNIFESP university hospital (Brazil) were studied. Following evaluation, the patients were monitored during an exercise program with six progressive phases (1 - upper limbs; 2 - lower limbs; 3 - walking; 4 - ½ flight of stairs; 5 - walking 200 m; and 6 - whole flight of stairs), with the intensity estimated at two to six metabolic equivalents (1 MET = 3.5 ml of O2/kg/min.). The patients were prospectively followed up for approximately 17 months for the occurrence of clinical complications and death. RESULTS: Three patients were unable to perform the complete program; BMI, maximal respiratory pressure (Pimax and Pemax, cmH2O) and number of previous hospitalizations were considered predictors for this subgroup. Heart rate (HR, bpm), double product (DP, bpm x mmHg) and Borg perceived exertion scale (PE) underwent the greatest oscillation during exercise, especially in phase 5 (HMETS), and are considered the best markers related to exertion. Blood pressure (BP, mmHg) oscillated little. There was no increase in the incidence of arrhythmia (Kappa=0.552) during exercise. There was a moderate positive correlation between PE and BP (r=0.4; P=0.02) in phase 5 (walking 200 m). The patients who died had low Pimax values upon the initial evaluation. During the exercise program, there was a reduction in BP response and an increase in HR response. CONCLUSION: Regarding cardiovascular behavior, the exercise program proved safe and well tolerated, but there is a need for monitoring. Information obtained upon the initial evaluation and during exercise program is associated to decompensation and death. Such information could assist in determining the stage of the disease.
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    Caracterização dos cuidadores de candidatos a transplante do coração na UNIFESP
    (Sociedade Brasileira de Cirurgia Cardiovascular, 2007-12-01) Machado, Regimar Carla [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Michel, Jeanne Liliane Marlene [UNIFESP]; Gabriel, Edmo Atique [UNIFESP]; Locali, Rafael Fagionato [UNIFESP]; Helito, Renata Almeida Barros [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVES: To identify and describe the main caregiver of the patients on the heart transplant waiting list; to compare relevant information provided by patients and caregivers, and to classify the caregivers according to their dedication and efficiency in assisting the patient by correlating them to sociodemographic data. METHODS: Descriptive study performed from October 2004 to October 2005 at UNIFESP outpatient clinics. The study sample consisted of 21 patients and their caregivers. Data were collected through a structured interview. RESULTS: The main caregiver was a family member (95%), usually the spouse. There were 13 women (81%) and three men (19%). Patient age ranged from 24 to 65 years (mean 44.3). Patients were married (56%); catholic (43.8%); 29% have finished elementary school; 24% have finished high school; 14% have higher education; 68.8% have a regular job; and 81.4% had their own income. All caregivers lived in the same house as the patient. Once a score was established, the caregivers were classified as: good - 8 (50%); regular - 7 (43.7%); and bad 1 - (6.3%). The scores were correlated with education, professional activity, and income without any significant statistical correlation. CONCLUSION: It is important to determine the instruments to recognize and describe the caregivers. The caregiver is usually a family member (spouse), female, mean age of 44.3 years; has his/her own income and, most of the time, he/she is classified as good or regular, and no correlation was found with education, professional activity and income. Further studies with a larger sample should establish the relationship between the caregiver's role and the heart transplant outcomes.
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    Construção e validação de protocolo clínico para assistência ao paciente no pós-operatório de transplante cardíaco em unidade de terapia intensiva
    (Universidade Federal de São Paulo, 2022-01-28) Sant’Anna, Ana Lúcia Gargione Galvão de [UNIFESP]; Machado, Regimar Carla [UNIFESP]; http://lattes.cnpq.br/1310723429860987; http://lattes.cnpq.br/8430563252181123
    Objetivos: Construir e validar um protocolo para assistência ao paciente no pós-operatório de transplante cardíaco na unidade de terapia intensiva. Métodos: Estudo metodológico baseado no referencial de Spínola, referente à validação de conteúdo de um protocolo clínico que seguiu três etapas. Na etapa 1 (proposta do protocolo) construiu-se o instrumento de coleta de dados delineado em evidências da literatura científica e na experiência profissional dos pesquisadores, contendo 03 categorias, 09 tópicos, 31 itens e 106 subitens assistenciais. Na etapa 2 (validação de conteúdo) realizou-se a apreciação das variáveis da proposta do protocolo (primeira rodada de Delphi) por meio de ajuizamento com comitê de especialistas na temática. Posteriormente, realizou-se uma revisão integrativa da literatura referente as complicações no pós-operatório de transplante cardíaco composta por seis etapas e estratégia PICOT. A busca foi realizada em oito bases de dados (LILACS, MEDLINE®/PubMed®, Embase®, CINAHL, Cochrane Library®, Scopus®, Web of Science e Ovid) e para seleção dos artigos utilizou-se o programa Rayyan QCRI. Em seguida procedeu-se ao ajuizamento das variáveis do protocolo (segunda rodada de Delphi) com a avaliação por experts brasileiros e estrangeiros. Na etapa 3 realizou-se a construção das variáveis do protocolo clínico (constructo final). Este estudo foi aprovado pelo CEP UNIFESP CAAE: 18298919.6.0000.5505. Resultados: Na primeira rodada de Delphi realizou-se, por videoconferência, a análise das variáveis propostas no instrumento de coleta de dados pelo comitê de especialistas na temática, composto por 02 médicos e 02 enfermeiras, assim compôs-se de 03 categorias, 09 tópicos, 31 itens e 119 subitens. Na revisão integrativa da literatura foram incluídos 05 artigos referentes ao período pós-operatório imediato. Na segunda rodada de Delphi participaram 04 (44,4%) experts do Brasil, 04 (44,4%) da Espanha e 01 (11,1%) do Equador com prática clínica em pós-operatório de transplante cardíaco entre 2 e 30 anos. Os resultados computaram 105 (88,2%) subitens com índice de validade de conteúdo total (IVC-T) de 01 (100,0%) e demostrou que a maioria obteve o IVC > 0,80 (80,0%) estipulado para este estudo. Conclusão: O protocolo (constructo final) foi estruturado com 03 categorias, 09 tópicos, 31 itens e 119 subitens, visando ser um instrumento para garantir a segurança do paciente e a qualidade da assistência prestada articulada aos avanços tecnológicos.
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    A elevação da pressão arterial sistólica durante o teste ergométrico após transplante cardíaco: correlação com o quadro clínico e a função ventricular avaliada pela ecocardiografia sob estresse com dobutamina
    (Sociedade Brasileira de Cardiologia - SBC, 2006-11-01) Salles, Ana Fátima [UNIFESP]; Machado, Cristiano Vieira [UNIFESP]; Cordovil, Adriana [UNIFESP]; Leite, Wagner Aparecido [UNIFESP]; Moisés, Valdir Ambrósio [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Oliveira Filho, Japy Angelini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: Patients who underwent heart transplantation (HTX) experience a reduction in the elevation that is usual in systolic blood pressure during exercise testing. Of unknown origin, this phenomenon varies in frequency and intensity. The aim of this study was to analyze the relationship between systolic blood pressure increase (delta SBP) and clinical aspects, as well as variables measured during exercise testing (ET) and dobutamine stress echocardiography (DSE) in patients in the late post-transplantation course. METHODS: Forty-five men, mean age 49.04 ± 10.19, underwent clinical assessment, ET and DSE 40.91 ± 27.46 months after heart transplantation. Left ventricular wall motion score index and ejection fraction were assessed. Delta SBP < 35mmHg during ET was considered abnormal (SBC,1995). RESULTS: No significant correlation was found between delta SBP and post-transplantation time, graft ischemic time, history of rejection, diltiazem dosage, oxygen uptake, ejection fraction, and wall motion score index (WMSI). Delta SBP was normal in 17 patients (Group I) and abnormal in 28 (Group II). Patients of both groups did not differ significantly in regard to clinical features and ET and DSE results. CONCLUSION: Unlike other populations, no correlation was found between delta SBP during exercise testing and clinical condition or left ventricular function in heart transplant patients. Pathophysiological factors associated with delta SBP reduction during exercise testing remain unknown.
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    Mensuração da adesão aos medicamentos imunossupressores em pacientes do pós-transplante cardíaco
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-20) Poltronieri, Nadja Van Geen [UNIFESP]; Roza, Bartira de Aguiar [UNIFESP]; Moreira, Rita Simone Lopes [UNIFESP]; http://lattes.cnpq.br/9682287639705372; http://lattes.cnpq.br/9255434835123749; http://lattes.cnpq.br/4188804767803899; Universidade Federal de São Paulo (UNIFESP)
    Introdução e Objetivos:Evidencia-se que além de ser universal a dificuldade dos pacientes em aderir ao tratamento, outros fatores interferem, como o profissional de saúde, o tratamento, a patologia e o paciente. A não adesão é hoje reconhecida como um fator determinante para o aumento da morbidade e mortalidade, redução da qualidade de vida, aumento dos custos médicos e excesso da utilização dos serviços de saúde. Em Transplantados, este estudo teve como objetivos a de mensurar a adesão medicamentosa nos pacientes pós-transplante cardíaco medianteo uso da Escala Basel Para Avaliação de Aderência a Medicamentos Imunossupressores (BAASIS)®, identificar as comorbidades prevalentes e a sobrevida. Metodologia:O método estudado foi de coorte histórica de abordagem quantitativa, realizado no ambulatório de transplante cardíaco do Instituto Dante Pazzanese de Cardiologia (IDPC). A população foi composta pelos pacientes submetidos a transplante no período de 2009 a 2016, totalizando 60 casos. A coleta de dados foi realizada, seja por meio de análise do instrumento BAASIS ou, pela escala analógica visual (VAS). Resultados:A mensuração da adesão utilizando as variáveis da pesquisa nos mostrou que com a aplicação do instrumento BAASIS, 53,3% dos pacientes aderiram à medicação, o grupo de não adesão foi de 25% que relatou atraso de até 2 horas do prescrito, porém, sem interrupção dos remédios. Embora os valores de adesão do VAS foram maiores ao do instrumento BAASIS (93,3% vs 83,3%), ambos valores não foram significativamente diferentes entre eles (p=0,950). As comorbidades estudadas foram hipertensão arterial sistêmica (HAS), diabetes mellitus (DM), dislipidemias (DLP) e insuficiência renal crônica. Observou-se que HAS e DLP permaneceram com resultados similares; 38,3% e 30% no pré-transplante e 48,3% e 30% no período pós-transplante. A sobrevida dos pacientes obteve como média 7 anos (85,1meses) pós-transplante, independente do grupo com adesão e sem adesão.Considerações finais: Diante da complexidade do tratamento ao transplante cardíaco, com possíveis eventos adversos e comorbidades, podemos de fato considerar a extrema importância à adesão medicamentosa no pós-transplante e mensurá-las para que todo trabalho empenhado pelos profissionais envolvidos, familiares destes receptores e principalmente do próprio paciente, em questão, não seja em vão. Nisto consiste o trabalho de vários profissionais e estudos sobre adesão para que mostremos sua importância e relevância no resultado final que é a sobrevida destes pacientes com qualidade e sem complicações ou as controláveis com tratamento.
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    Qualidade de vida dos candidatos a transplante de coração
    (Sociedade Brasileira de Cirurgia Cardiovascular, 2009-03-01) Helito, Renata Almeida Barros [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; D'Innocenzo, Maria [UNIFESP]; Machado, Regimar Carla [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade do Vale do Paraíba Curso de Enfermagem
    OBJECTIVE: To assess the quality of life of patients with refractory heart failure disease as candidates for heart transplant. METHODS: A transversal, descriptive and prospective study with 18 adult patients, with mean age of 52 years under pre-transplantation outpatient follow-up at educational and public hospital in São Paulo town. The quality of life was assessed by reference to The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) generic questionnaire in order to assess the aspects in relation to the function, dysfunction, physical and emotional uneasiness. RESULTS: According to this group, 14 (77.8%) of these patients were male and four (22.2%) female; 14 (77.8%) of them were classified as functional class IV and four (22.2%) as functional class III (New York Heart Association); 17 (94.4%) of them were at stage D and one (5.6%) at stage C (American Heart Association/American College of Cardiology). The mean results obtained from the assessment of SF-36 scales were: functional capacity 38%, pain 49%, health general condition 49%, vitality 39%, social aspects 53%, emotional aspects 43% and mental health 54%. CONCLUSION: The quality of life of patients presenting terminal heart failure is considered to be very bad; it is likely to be worse than in many other more common morbid entities. Both mental and social aspects are least affected, on the other hand the vitality and functional capacity are the most affected.
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    Transplante cardíaco e infecção
    (Sociedade Brasileira de Cirurgia Cardiovascular, 2001-06-01) Couto, Wilson José [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Vick, Rodrigo [UNIFESP]; Teles, Carlos Alberto [UNIFESP]; Aguiar, Luciano F. [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the incidence of infection, the etiological agents, to present the clinical aspects and the surgical morbi-mortality in patients who underwent cardiac transplant at Federal University of São Paulo. Material and Methods: From November 1966 to June 1998, a total of 97 patients were operated by the UNIFESP Cardiovascular Surgery team and survived longer than 1 week after the transplantation and were studied retrospectively as far as infections. The age of the patients ranged from 3 to 63 years (average 44.4 ± 13 years). Most of the patients had dilated myocardiopathy (46), or Chagas (24) or ischemis (23). The follow up ranged from 0.33 to 119 months (36 ± 30.7 months) Results: Of the 97 patients, 16 (16.4%) had infection as the main cause of death, followed by rejection in 10 (10.3%). The causes of infection were: bacterial sepsis in 6 patients, pneumonia in 6, intra-abdominal infection in 2, toxoplasmosis in 1 and cytomegalovirus infection in 1. There were 142 infection episodes, bacterial 76 (52.5%), viral 34 (28.8%), fungi 20 (17.5%) and protozoa 12 (12.4%). There were 8 episodes of the reactivation were treated successfully with alopurinol. Conclusions: Our data showed the predominance of bacterial infections as the cause of most mortality. In transplanted patients suffering from Chagas´disease, the reactivation of the disease may be adequately controlled by means of alopurinol. Such data serve as orientation in our community for our programs of transplants, since they show particular aspects of our enviroment.
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    Transplante cardíaco em amiloidose primária
    (Sociedade Brasileira de Cirurgia Cardiovascular, 2009-09-01) Baumgratz, José Francisco; Vila, José Henrique Andrade [UNIFESP]; Guilhen, Claudia Jesus; Fonseca, Luciana Da [UNIFESP]; Leite, Weverton Ferreira; D'andretta, Carlos; Tângari Junior, Américo; Silva, José Pedro Da; Hospital Beneficência Portuguesa; Universidade Federal de São Paulo (UNIFESP); Hospital Beneficência Portuguesa UTI cardiológica
    Cardiac amyloidosis is a disease with a gloom life expectance after the beginning of the symptomatic phase, usually with sudden death as the final event. The aggression to other organs, although, can make heart transplantation a disputable form of treatment taking into consideration the shortage of donor organs. The aim is to report the evolution with a survival of seven years after heart transplantation and in very fair condition of a patient with amyloidosis. One year after the heart transplantation, there was indication of renal transplantation also from the aggression from the disease. This patient compares' favorable with three other patients also from our service, who died early after de diagnosis. Even considering the multi systemic nature of amyloidosis, we can accept that in peculiar patients justified the heart transplantation, taking in the consideration the very bad prognosis of the disease
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    Transplante cardíaco ortotópico: experiência na Universidade Federal de São Paulo (UNIFESP)
    (Sociedade Brasileira de Cirurgia Cardiovascular, 1998-10-01) Branco, João Nelson Rodrigues [UNIFESP]; Teles, Carlos Alberto [UNIFESP]; Aguiar, Luciano de Figueiredo [UNIFESP]; Vargas, Guilherme Flora [UNIFESP]; Hossne Junior, Nelson Americo [UNIFESP]; Andrade, José Carlos S. [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    From November, 1986 to April, 1997; 92 orthotopic heart transplants were performed, with recipient mean age of 44,9 years (range 3 to 63 years). Recipient diagnoses included dilated cardiomyopathy in 42 (44.6%) ischemic cardiomyopathy in 23 (25%), Chagas disease in 21 (22.8%), valve disease in 3 (3.2%) patients. The surgical technique used (described by Lower e Shumway, in 1960, with minor modification) was satisfactory and without complication. Graft ischemic time - Longer in heart transported from other institutions compared to side-by-side transplantation - was always less than 4 hours. The most common chronic complications of immunosuppressive therapy were: arterial hyperthension (84.6%), hyperuricemia (75.4%) and hypercholesterolemia (63%). Regarding infections, viral were the most common ones with 92 (45.6%) followed by bacterial with 35 (38.0%), and protozoal with 15 (16.3%) cases. Among bacterial infections, 7 occurred in the surgical wound, with good evolution. Among those infections caused by protozoal, 7 (46.6%) were due to Trypanossoma cruzi. The overall mortality rate within 30 days of transplantation was 17.3%, with infection, neurologic complications and rejection as major causes. From 30 days to 1 year of transplantation, the mortality rate was 10.3%, with infection and rejection as primary causes. And after one year post-transplantation, the mortality rate was 14%, with several different causes: sudden death, infection, rejection and others. The actuarial survival estimates at 1, 2, 3, 4, 5, and 6 years were 71.6%, 66.5%, 60.5%, 54.4%, 54.4% and 54.4%, respectively. There were no follow-up losses, and all the surviving patients are in functional type I of the NYHA. Cardiac transplantation procedure is possible in our community with accetable survival and post-operative complication rates acceptable, even though different from international statistics.