RESUMO
The quality of data in electronic healthcare databases is a critical component when used for research and health practice. The aim of the present study was to assess the data quality in the Paulista Cardiovascular Surgery Registry II (REPLICCAR II) using two different audit methods, direct and indirect. The REPLICCAR II database contains data from 9 hospitals in São Paulo State with over 700 variables for 2229 surgical patients. The data collection was performed in REDCap platform using trained data managers to abstract information. We directly audited a random sample (n = 107) of the data collected after 6 months and indirectly audited the entire sample after 1 year of data collection. The indirect audit was performed using the data management tools in REDCap platform. We computed a modified Aggregate Data Quality Score (ADQ) previously reported by Salati et al. (2015). The agreement between data elements was good for categorical data (Cohen κ = 0.7, 95%CI = 0.59-0.83). For continuous data, the intraclass coefficient (ICC) for only 2 out of 15 continuous variables had an ICC < 0.9. In the indirect audit, 77% of the selected variables (n = 23) had a good ADQ score for completeness and accuracy. Data entry in the REPLICCAR II database proved to be satisfactory and showed competence and reliable data for research in cardiovascular surgery in Brazil.
Assuntos
Bases de Dados Factuais , Brasil , Procedimentos Cirúrgicos Cardiovasculares , Confiabilidade dos Dados , Humanos , Sistema de RegistrosRESUMO
The quality of data in electronic healthcare databases is a critical component when used for research and health practice. The aim of the present study was to assess the data quality in the Paulista Cardiovascular Surgery Registry II (REPLICCAR II) using two different audit methods, direct and indirect. The REPLICCAR II database contains data from 9 hospitals in São Paulo State with over 700 variables for 2229 surgical patients. The data collection was performed in REDCap platform using trained data managers to abstract information. We directly audited a random sample (n = 107) of the data collected after 6 months and indirectly audited the entire sample after 1 year of data collection. The indirect audit was performed using the data management tools in REDCap platform. We computed a modified Aggregate Data Quality Score (ADQ) previously reported by Salati et al. (2015). The agreement between data elements was good for categorical data (Cohen κ = 0.7, 95%CI = 0.59-0.83). For continuous data, the intraclass coefficient (ICC) for only 2 out of 15 continuous variables had an ICC < 0.9. In the indirect audit, 77% of the selected variables (n = 23) had a good ADQ score for completeness and accuracy. Data entry in the REPLICCAR II database proved to be satisfactory and showed competence and reliable data for research in cardiovascular surgery in Brazil.
Assuntos
Humanos , Procedimentos Cirúrgicos Cardiovasculares , Confiabilidade dos Dados , Sistema de Registros , Bases de Dados FactuaisRESUMO
OBJECTIVE: The present study aimed the functional recovery evaluation after long term of cardiac arrest induced by Custodiol (crystalloid-based) versus del Nido (blood-based) solutions, both added lidocaine and pinacidil as cardioplegic agents. Experiments were performed in isolated rat heart perfusion models. METHODS: Male rat heart perfusions, according to Langendorff technique, were induced to cause 3 hours of cardiac arrest with a single dose. The hearts were assigned to one of the following three groups: (I) control; (II) Custodiol-LP; and (III) del Nido-LP. They were evaluated after ischemia throughout 90 minutes of reperfusion. Left ventricular contractility function was reported as percentage of recovery, expressed by developed pressure, maximum dP/dt, minimum dP/dt, and rate pressure product variables. In addition, coronary resistance and myocardial injury marker by alpha-fodrin degradation were also evaluated. RESULTS: At 90 minutes of reperfusion, both solutions had superior left ventricular contractile recovery function than the control group. Del Nido-LP was superior to Custodiol-LP in maximum dP/dt (46%±8 vs. 67%±7, P<0.05) and minimum dP/dt (31%±4 vs. 51%±9, P<0.05) variables. Coronary resistance was lower in del Nido-LP group than in Custodiol-LP (395%±50 vs. 307%±13, P<0.05), as well as alpha-fodrin degradation, with lower levels in del Nido-LP group (P<0.05). CONCLUSION: Del Nido-LP cardioplegia showed higher functional recovery after 3 hours of ischemia. The analysis of alpha-fodrin degradation showed del Nido-LP solution provided greater protection against myocardial ischemia and reperfusion (IR) in this experimental model.
Assuntos
Soluções Cardioplégicas/farmacologia , Parada Cardíaca Induzida/métodos , Lidocaína/farmacologia , Reperfusão Miocárdica/métodos , Pinacidil/farmacologia , Compostos de Potássio/farmacologia , Animais , Western Blotting , Soluções Cardioplégicas/química , Proteínas de Transporte/análise , Vasos Coronários/fisiopatologia , Glucose/química , Glucose/farmacologia , Coração/efeitos dos fármacos , Masculino , Manitol/química , Manitol/farmacologia , Proteínas dos Microfilamentos/análise , Traumatismo por Reperfusão Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Cloreto de Potássio/química , Cloreto de Potássio/farmacologia , Compostos de Potássio/química , Procaína/química , Procaína/farmacologia , Ratos Wistar , Reprodutibilidade dos Testes , Fatores de Tempo , Resistência Vascular/fisiologia , Função Ventricular Esquerda/fisiologiaRESUMO
Abstract Objective: The present study aimed the functional recovery evaluation after long term of cardiac arrest induced by Custodiol (crystalloid-based) versus del Nido (blood-based) solutions, both added lidocaine and pinacidil as cardioplegic agents. Experiments were performed in isolated rat heart perfusion models. Methods: Male rat heart perfusions, according to Langendorff technique, were induced to cause 3 hours of cardiac arrest with a single dose. The hearts were assigned to one of the following three groups: (I) control; (II) Custodiol-LP; and (III) del Nido-LP. They were evaluated after ischemia throughout 90 minutes of reperfusion. Left ventricular contractility function was reported as percentage of recovery, expressed by developed pressure, maximum dP/dt, minimum dP/dt, and rate pressure product variables. In addition, coronary resistance and myocardial injury marker by alpha-fodrin degradation were also evaluated. Results: At 90 minutes of reperfusion, both solutions had superior left ventricular contractile recovery function than the control group. Del Nido-LP was superior to Custodiol-LP in maximum dP/dt (46%±8 vs. 67%±7, P<0.05) and minimum dP/dt (31%±4 vs. 51%±9, P<0.05) variables. Coronary resistance was lower in del Nido-LP group than in Custodiol-LP (395%±50 vs. 307%±13, P<0.05), as well as alpha-fodrin degradation, with lower levels in del Nido-LP group (P<0.05). Conclusion: Del Nido-LP cardioplegia showed higher functional recovery after 3 hours of ischemia. The analysis of alpha-fodrin degradation showed del Nido-LP solution provided greater protection against myocardial ischemia and reperfusion (IR) in this experimental model.
Assuntos
Animais , Masculino , Soluções Cardioplégicas/farmacologia , Reperfusão Miocárdica/métodos , Compostos de Potássio/farmacologia , Pinacidil/farmacologia , Parada Cardíaca Induzida/métodos , Lidocaína/farmacologia , Fatores de Tempo , Resistência Vascular/fisiologia , Soluções Cardioplégicas/química , Proteínas de Transporte/análise , Western Blotting , Ratos Wistar , Vasos Coronários/fisiopatologia , Glucose/farmacologia , Glucose/química , Coração/efeitos dos fármacos , Manitol/farmacologia , Manitol/química , Proteínas dos Microfilamentos/análiseRESUMO
After orthotopic heart transplantation (OHT), the allograft undergoes characteristic alterations in myocardial structure, including hypertrophy, increased ventricular stiffness, ischemia, and inflammation, all of which may decrease overall graft survival. Methods to quantify these phenotypes may clarify the pathophysiology of progressive graft dysfunction post-OHT. We performed cardiac magnetic resonance (CMR) with T1 mapping in 26 OHT recipients (mean age 47 ± 7 years, 30 % female, median follow-up post-OHT 6 months) and 30 age-matched healthy volunteers (mean age 50.5 ± 15 years; LVEF 63.5 ± 7 %). OHT recipients had a normal left ventricular ejection fraction (LVEF 65.3 ± 11 %) with higher LV mass relative to age-matched healthy volunteers (114 ± 27 vs. 85.8 ± 18 g; p < 0.001). There was no late gadolinium enhancement in either group. Both myocardial extracellular volume fraction (ECV) and intracellular lifetime of water (τic), a measure of cardiomyocyte hypertrophy, were higher in patients post-OHT (ECV: 0.39 ± 0.06 vs. 0.28 ± 0.03, p < 0.0001; τic: 0.12 ± 0.08 vs. 0.08 ± 0.03, p < 0.001). ECV was associated with LV mass (r = 0.74, p < 0.001). In follow-up, OHT recipients with normal biopsies by pathology (ISHLT grade 0R) in the first year post-OHT exhibited a lower ECV relative to patients with any rejection ≥2R (0.35 ± 0.02 for 0R vs. 0.45 ± 0, p < 0.001). Higher ECV but not LVEF was significantly associated with a reduced rejection-free survival. After OHT, markers of tissue remodeling by CMR (ECV and τic) are elevated and associated with myocardial hypertrophy. Interstitial myocardial remodeling (by ECV) is associated with cellular rejection. Further research on the impact of graft preservation and early immunosuppression on tissue-level remodeling of the allograft is necessary to delineate the clinical implications of these findings.
Assuntos
Cardiomegalia/diagnóstico por imagem , Transplante de Coração , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Função Ventricular Esquerda , Remodelação Ventricular , Adulto , Idoso , Aloenxertos , Biópsia , Cardiomegalia/etiologia , Cardiomegalia/patologia , Cardiomegalia/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Fibrose , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Transplante de Coração/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do TratamentoRESUMO
Fundamento: Estimulação elétrica neuromuscular (EENM) utilizando protocolo de estimulação por 5 dias/semana durante 8 semanas tem sido usada como opção de tratamento para pacientes com insuficiência cardíaca congestiva (ICC) incapazes de tolerar exercícios aeróbicos. Objetivo: Nós avaliamos o impacto de um protocolo de EENM mais curto, utilizando uma corrente russa (CR) sobre a capacidade funcional, qualidade de vida (QV) e perfil inflamatório de pacientes com ICC em estágio final. Métodos: Vinte e oito pacientes com ICC grave (53 ± 11 anos) foram randomizados em grupo tratamento (EENM) e grupo placebo. O grupo EENM foi submetido a tratamento com CR aplicada por 50 minutos no quadríceps, bilateralmente, duas vezes por semana, por 7 semanas. No grupo EENM a estimulação foi aplicada promovendo contração muscular visível e para o grupo placebo a aplicação da corrente não promoveu contração muscular. A distância no teste de caminhada de 6 minutos (TC6) e a pontuação de QV pelo Questionário Minnesota Living with Cardiac Insufficiency foram avaliadas antes, imediatamente após e um mês após a conclusão do protocolo aplicado. Os leucócitos periféricos foram obtidos para medir os níveis de expressão gênica de citocinas inflamatórias. Resultados : O grupo EENM apresentou aumento na distância percorrida no TC6 (324 ± 117 vs 445 ± 100 m; p = 0,02) e QV (64 ± 22 versus 45 ± 17; p < 0,01) imediatamente após o programa de tratamento, mas não um mês após a conclusão do protocolo. Assim como, o aumento nos níveis de expressão de IL-1 ß , IL-6 e IL-8 após a conclusão do protocolo. Conclusão: O uso da EENM aplicada duas vezes por semana melhora a qualidade de vida e a capacidade funcional de pacientes com IC grave. Esta melhora clínica foi acompanhada pelo aumento da expressão gênica de algumas citocinas nos leucócitos periféricos. Este protocolo mais curto de EENM é capaz de produzir efeitos clínicos benéficos semelhantes a protocolos mais intensos e longos, bem como modular a resposta inflamatória. Este protocolo pode ser uma boa alternativa para pacientes com ICC grave e limitações na adesão ao protocolo
Background: Neuromuscular electrical stimulation (NMES) using a stimulation wave for 5 days/week over 8 weeks has been used as a treatment option for congestive heart failure (CHF) patients who are unable to tolerate aerobic exercise. Objective: We assessed the impact of a shorter NMES protocol using a Russian stimulation wave on the functional status, quality of life (QoL) and inflammatory profile of end-stage CHF patients. Methods: Twenty-eight patients with end-stage CHF (53 ± 11 years) were randomized to the NMES or control group. Treatment was an NMES training program with Russian stimulation wave, applied for 50 minutes to both quadriceps femoral muscles twice weekly over seven weeks. The stimulation intensity was chosen to elicit muscle contractions in the NMES group and current input up to sensory threshold in the control group. Distance in the 6-minute walk test (6MWD) and QoL score by the Minnesota Living with Heart Failure Questionnaire were evaluated before, immediately after and one month after NMES protocol completion. Peripheral leukocytes were obtained to measure the gene expression levels of inflammatory cytokines. Results: The NMES group showed increases in the 6MWD (324 ± 117 vs. 445 ± 100 m; p = 0.02) and QoL score (64 ± 22 vs. 45 ± 17; p < 0.01) immediately but not 1 month after protocol completion, as well as increased gene expression levels of IL-1ß, IL-6 and IL-8 after protocol completion. Conclusion: Using a shorter and fewer sessions NMES protocol improved the QoL score and functional class of severe CHF patients, and modulated the gene expression levels of some cytokines. This protocol might be a good alternative for patients with severe CHF and limitations in protocol adherence
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Terapia por Estimulação Elétrica/efeitos adversos , Exercício Físico , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/terapia , Reabilitação/métodos , Transplante de Coração/reabilitação , Guias como Assunto/métodos , Qualidade de Vida , Interpretação Estatística de Dados , Inquéritos e Questionários , Resultado do TratamentoRESUMO
PURPOSE: Therapeutic strategies that modulate ventricular remodeling can be useful after acute myocardial infarction (MI). In particular, statins may exert effects on molecular pathways involved in collagen metabolism. The aim of this study was to determine whether treatment with atorvastatin for 4 weeks would lead to changes in collagen metabolism and ventricular remodeling in a rat model of MI. METHODS: Male Wistar rats were used in this study. MI was induced in rats by ligation of the left anterior descending coronary artery (LAD). Animals were randomized into three groups, according to treatment: sham surgery without LAD ligation (sham group, n = 14), LAD ligation followed by 10mg atorvastatin/kg/day for 4 weeks (atorvastatin group, n = 24), or LAD ligation followed by saline solution for 4 weeks (control group, n = 27). After 4 weeks, hemodynamic characteristics were obtained by a pressure-volume catheter. Hearts were removed, and the left ventricles were subjected to histologic analysis of the extents of fibrosis and collagen deposition, as well as the myocyte cross-sectional area. Expression levels of mediators involved in collagen metabolism and inflammation were also assessed. RESULTS: End-diastolic volume, fibrotic content, and myocyte cross-sectional area were significantly reduced in the atorvastatin compared to the control group. Atorvastatin modulated expression levels of proteins related to collagen metabolism, including MMP1, TIMP1, COL I, PCPE, and SPARC, in remote infarct regions. Atorvastatin had anti-inflammatory effects, as indicated by lower expression levels of TLR4, IL-1, and NF-kB p50. CONCLUSION: Treatment with atorvastatin for 4 weeks was able to attenuate ventricular dysfunction, fibrosis, and left ventricular hypertrophy after MI in rats, perhaps in part through effects on collagen metabolism and inflammation. Atorvastatin may be useful for limiting ventricular remodeling after myocardial ischemic events.
Assuntos
Anticolesterolemiantes/farmacologia , Atorvastatina/farmacologia , Colágeno/metabolismo , Remodelação Ventricular/efeitos dos fármacos , Animais , Anticolesterolemiantes/uso terapêutico , Atorvastatina/uso terapêutico , Ablação por Cateter , Modelos Animais de Doenças , Fibrose , Expressão Gênica/efeitos dos fármacos , Ventrículos do Coração/patologia , Hemodinâmica/efeitos dos fármacos , Interleucina-1/genética , Interleucina-1/metabolismo , Masculino , Metaloproteinase 1 da Matriz/metabolismo , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/patologia , Infarto do Miocárdio/cirurgia , Miocárdio/metabolismo , Miocárdio/patologia , Subunidade p50 de NF-kappa B/genética , Subunidade p50 de NF-kappa B/metabolismo , Ratos , Ratos Wistar , Inibidor Tecidual de Metaloproteinase-1/metabolismoRESUMO
BACKGROUND: The inflammatory response has been implicated in the pathogenesis of left ventricular (LV) remodeling after myocardial infarction (MI). An anthraquinone compound with anti-inflammatory properties, diacerein inhibits the synthesis and activity of pro-inflammatory cytokines, such as tumor necrosis factor and interleukins 1 and 6. The purpose of this study was to investigate the effects of diacerein on ventricular remodeling in vivo. METHODS AND RESULTS: Ligation of the left anterior descending artery was used to induce MI in an experimental rat model. Rats were divided into two groups: a control group that received saline solution (n = 16) and a group that received diacerein (80 mg/kg) daily (n = 10). After 4 weeks, the LV volume, cellular signaling, caspase 3 activity, and nuclear factor kappa B (NF-κB) transcription were compared between the two groups. After 4 weeks, end-diastolic and end-systolic LV volumes were reduced in the treatment group compared to the control group (p < .01 and p < .01, respectively). Compared to control rats, diacerein-treated rats exhibited less fibrosis in the LV (14.65%± 7.27% vs. 22.57%± 8.94%; p < .01), lower levels of caspase-3 activity, and lower levels of NF-κB p65 transcription. CONCLUSIONS: Treatment with diacerein once a day for 4 weeks after MI improved ventricular remodeling by promoting lower end-systolic and end-diastolic LV volumes. Diacerein also reduced fibrosis in the LV. These effects might be associated with partial blockage of the NF-κB pathway.
Assuntos
Antraquinonas/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/patologia , Função Ventricular Esquerda/efeitos dos fármacos , Animais , Antraquinonas/farmacologia , Anti-Inflamatórios/farmacologia , Caspase 3/genética , Modelos Animais de Doenças , Regulação da Expressão Gênica/efeitos dos fármacos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/genética , Ratos , Ratos Wistar , Fator de Transcrição RelA/genética , Remodelação Ventricular/efeitos dos fármacosRESUMO
BACKGROUND: Adhesions may increase the incidence of lethal complications of cardiac reoperations, which account for up to 20% of all open-heart surgeries. Herein, we describe the use of a polyvinyl alcohol membrane (PVAM) as a pericardial alternative and describe its performance during reoperation in a relevant animal model. METHODS: The PVAM samples were reticulated by electron beam radiation and manipulated into a tube shape. After thoracotomy, the pericardium of Wistar rats was opened to expose the heart. Rats were treated by pushing the heart back into the thoracic cavity (Sham group), sprinkling the epicardium with talcum powder (Talc group), encircling the heart with PVAM (PVAM group), or sprinkling the epicardium with talcum powder before placing the PVAM to encircle the heart (PVAM + Talc group). Animals were recovered for 8 weeks and then euthanized. Macroscopic findings (ie, extent and severity of adhesions) were classified according to a 4-grade adhesion scale. The PVAM was tested for direct and indirect cytotoxicity with Vero cells. The water absorption capability and in vivo calcification after 8 weeks of subcutaneous implantation of the membrane were examined. Data were analyzed by analysis of variance and Bonferroni post hoc tests. RESULTS: The PVAM group had lower adhesion scores than the Talc and Sham groups, as well as reduced epicardium thickness and inflammatory cell results, compared with the Talc and PVAM + Talc groups. The PVAM exhibited no direct or indirect cytotoxicity, good water absorption capability (42.4% ± 0.9%), and negligible calcification after 8 weeks (4.42 × 10(-3) ± 2.56 × 10(-3) percentage of the total mass). CONCLUSIONS: The PVAM shows promising properties for its potential use as a novel pericardial substitute.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Inflamação/prevenção & controle , Membranas Artificiais , Pericárdio/cirurgia , Álcool de Polivinil , Aderências Teciduais/prevenção & controle , Animais , Masculino , Ratos , Ratos Wistar , ReoperaçãoRESUMO
INTRODUCTION: Myocardial preservation during open heart surgeries and harvesting for transplant are of great importance. The heart at the end of procedure has to resume its functions as soon as possible. All cardioplegic solutions are based on potassium for induction of cardioplegic arrest. OBJECTIVE: To assess a cardioplegic solution with no potassium addition to the formula with two other commercially available cardioplegic solutions. The comparative assessment was based on cytotoxicity, adenosine triphosphate myocardial preservation, and caspase 3 activity. The tested solution (LIRM) uses low doses of sodium channel blocker (lidocaine), potassium channel opener (cromakalin), and actin/myosin cross bridge inhibitor (2,3-butanedione monoxime). METHODS: Wistar rats underwent thoracotomy under mechanical ventilation and three different solutions were used for "in situ" perfusion for cardioplegic arrest induction: Custodiol (HTK), Braile (G/A), and LIRM solutions. After cardiac arrest, the hearts were excised and kept in cold storage for 4 hours. After this period, the hearts were assessed with optical light microscopy, myocardial ATP content and caspase 3 activity. All three solutions were evaluated for direct cytotoxicity with L929 and WEHI-164 cells. RESULTS: The ATP content was higher in the Custodiol group compared to two other solutions (P<0.05). The caspase activity was lower in the HTK group compared to LIRM and G/A solutions (P<0.01). The LIRM solution showed lower caspase activity compared to Braile solution (P<0.01). All solutions showed no cytotoxicity effect after 24 hours of cells exposure to cardioplegic solutions. CONCLUSION: Cardioplegia solutions without potassium are promised and aminoacid addition might be an interesting strategy. More evaluation is necessary for an optimal cardioplegic solution development.
INTRODUÇÃO: Preservação do miocárdio durante cirurgias cardíacas abertas e de colheita para transplante são de grande importância. O coração ao final do processo tem de retomar as suas funções, logo que possível. Todas as soluções cardioplégicas são baseadas em potássio, para indução de parada cardioplégica. OBJETIVO: Comparar a uma solução cardioplégica sem adição de potássio à sua fórmula com duas outras soluções cardioplégicas disponíveis comercialmente. A avaliação comparativa foi baseada na citotoxicidade, preservação miocárdica (adenosina trifosfato, ATP) e atividade da caspase 3. A solução testada (LIRM) utiliza baixas doses de bloqueador de canal de sódio (lidocaína), abridor do canal de potássio (cromacalina) e inibidor da ponte actina/miosina (2,3-butanodiona monoxima). MÉTODOS: Ratos Wistar foram submetidos à toracotomia sob ventilação mecânica e três soluções diferentes foram utilizadas para perfusão in situ para a indução de parada cardioplégica: soluções Custodiol (HTK) Braile (G/A) e LIRM. Após parada cardíaca, os corações foram retirados e mantidos em câmara fria por 4 horas. Após esse período, o coração foi avaliado com microscopia de luz ótica, o conteúdo de ATP miocárdico e atividade da caspase 3. Todas as três soluções foram avaliadas quanto à citotoxicidade direta com células L929 e WEHI-164. RESULTADOS: A quantidade de ATP foi maior no grupo Custodiol em comparação às com outras duas soluções (P<0,05). A atividade de caspase foi menor no grupo HTK quando comparado às soluções LIRM e G/A (P<0,01). A solução LIRM demonstrou menor atividade da caspase em comparação à solução Braile (P<0,01). Todas as soluções não mostraram qualquer efeito de citotoxicidade após 24 horas de exposição das células às soluções cardioplégicas. CONCLUSÃO: Soluções cardioplégicas sem potássio são uma perspectiva e a adição de aminoácido pode ser uma estratégia interessante. Mais avaliações são necessárias para o desenvolvimento ideal da solução cardioplégica.
Assuntos
Animais , Ratos , Soluções Cardioplégicas/farmacologia , Parada Cardíaca Induzida/métodos , Coração/efeitos dos fármacos , Preservação de Órgãos/métodos , Trifosfato de Adenosina/análise , Soluções Cardioplégicas/química , /análise , Sobrevivência Celular/efeitos dos fármacos , Glucose/química , Glucose/farmacologia , Modelos Animais , Manitol/química , Manitol/farmacologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Cloreto de Potássio/química , Cloreto de Potássio/farmacologia , Potássio/química , Potássio/farmacologia , Procaína/química , Procaína/farmacologia , Ratos Wistar , Reprodutibilidade dos Testes , Bloqueadores dos Canais de Sódio/química , Fatores de TempoRESUMO
AIMS: Although an increase in the ventricular pacing threshold (VPT) has been observed after administration of transthoracic shock for ventricular defibrillation, few studies have evaluated the phenomenon with respect to the defibrillation waveform energy. Therefore, this study examined the VPT behaviour after transthoracic shock with a monophasic or biphasic energy waveform. METHOD AND RESULTS: Domestic Landrace male piglets implanted with a permanent pacemaker stimulation system were divided into three groups: no ventricular fibrillation (VF) induction and transthoracic shock with monophasic or biphasic energy (group I); VF induction, 1 min of observation without intervention, 2 min of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group II); and VF induction, 2 min of observation without intervention, 4 min of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group III). After external shock, the VPT was evaluated every minute for 10 min. A total of 143 experiments were performed. At the end of the observation period, groups I and II showed steady VPT values. Group III showed an increase in VPT with monophasic or biphasic external energy, with no difference between the external energy sources. The monophasic but not the biphasic waveform was associated with higher VPT values when the VF was longer. CONCLUSION: Defibrillation does not have a significant impact on pacing threshold, but a longer VF period is related to a higher VPT after defibrillation with monophasic waveform.
Assuntos
Estimulação Cardíaca Artificial/métodos , Cardioversão Elétrica/métodos , Sistema de Condução Cardíaco/fisiologia , Coração/fisiologia , Contração Miocárdica/fisiologia , Fibrilação Ventricular/fisiopatologia , Animais , Masculino , Modelos Animais , Distribuição Aleatória , Sus scrofa , Fibrilação Ventricular/terapiaRESUMO
OBJECTIVES: The effect of erythropoietin (EPO) on neonatal hearts is not well understood. The current hypothesis is that EPO has protective effects against ischaemia-reperfusion when administered prior to ischaemia induction. METHODS: Systolic and diastolic indices, as well as the Akt and extracellular-regulated kinase (Erk) signalling pathways, were studied in vivo using a neonatal pig heart model. Regional ischaemia was induced for 45 min by the ligation of the left anterior descending artery, followed by 90 min of reperfusion. The treatment groups consisted of: (i) untreated controls, (ii) treatment with EPO 3 min prior to ischaemia and (iii) treatment with EPO 24 h before ischaemia. Sophisticated myocardial contractility indices were assessed by pressure/volume loops of the left ventricle. The Akt and Erk pathways were evaluated via a western blot. RESULTS: Elastance was found to be higher in the group receiving EPO 3 min prior to ischaemia. In addition, preload recruitable stroke work was higher for both groups receiving EPO prior to ischaemia when compared with controls. The time constant of the isovolumic relaxation and end-diastolic pressure-volume relationship did not differ between the three groups after 90 min of reperfusion. Furthermore, EPO treatment enhanced phosphorylation of Akt, but not Erk, and EPO-treated animals showed lower levels of apoptosis-related proteins. CONCLUSIONS: EPO had a protective effect on neonatal systolic function after ischaemia/reperfusion injury, but no effect on diastolic function. This cardioprotective effect might be mediated by the activation of the Akt pathway.
Assuntos
Cardiotônicos/farmacologia , Eritropoetina/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Análise de Variância , Animais , Animais Recém-Nascidos , Apoptose/efeitos dos fármacos , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Masculino , Contração Miocárdica/efeitos dos fármacos , Fosforilação/efeitos dos fármacos , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/fisiopatologia , Transdução de Sinais/efeitos dos fármacos , Suínos , Sístole/efeitos dos fármacosRESUMO
INTRODUCTION: Myocardial preservation during open heart surgeries and harvesting for transplant are of great importance. The heart at the end of procedure has to resume its functions as soon as possible. All cardioplegic solutions are based on potassium for induction of cardioplegic arrest. OBJECTIVE: To assess a cardioplegic solution with no potassium addition to the formula with two other commercially available cardioplegic solutions. The comparative assessment was based on cytotoxicity, adenosine triphosphate myocardial preservation, and caspase 3 activity. The tested solution (LIRM) uses low doses of sodium channel blocker (lidocaine), potassium channel opener (cromakalin), and actin/myosin cross bridge inhibitor (2,3-butanedione monoxime). METHODS: Wistar rats underwent thoracotomy under mechanical ventilation and three different solutions were used for "in situ" perfusion for cardioplegic arrest induction: Custodiol (HTK), Braile (G/A), and LIRM solutions. After cardiac arrest, the hearts were excised and kept in cold storage for 4 hours. After this period, the hearts were assessed with optical light microscopy, myocardial ATP content and caspase 3 activity. All three solutions were evaluated for direct cytotoxicity with L929 and WEHI-164 cells. RESULTS: The ATP content was higher in the Custodiol group compared to two other solutions (P<0.05). The caspase activity was lower in the HTK group compared to LIRM and G/A solutions (P<0.01). The LIRM solution showed lower caspase activity compared to Braile solution (P<0.01). All solutions showed no cytotoxicity effect after 24 hours of cells exposure to cardioplegic solutions. CONCLUSION: Cardioplegia solutions without potassium are promised and aminoacid addition might be an interesting strategy. More evaluation is necessary for an optimal cardioplegic solution development.
Assuntos
Soluções Cardioplégicas/farmacologia , Parada Cardíaca Induzida/métodos , Coração/efeitos dos fármacos , Preservação de Órgãos/métodos , Trifosfato de Adenosina/análise , Animais , Soluções Cardioplégicas/química , Caspase 3/análise , Sobrevivência Celular/efeitos dos fármacos , Glucose/química , Glucose/farmacologia , Manitol/química , Manitol/farmacologia , Modelos Animais , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Potássio/química , Potássio/farmacologia , Cloreto de Potássio/química , Cloreto de Potássio/farmacologia , Procaína/química , Procaína/farmacologia , Ratos , Ratos Wistar , Reprodutibilidade dos Testes , Bloqueadores dos Canais de Sódio/química , Fatores de TempoRESUMO
OBJECTIVE: To assess the quality of life in patients undergoing myocardial revascularization using the six-minute walk test. METHODS: Prospective observational study with patients who undergoing CABG. The clinical variables, the sixminute walk test, and the SF-36 test were recorded. The patients were assessed at the preoperative time and at 2 months of postoperative period. According their six-minute walk test results, the patients were divided into two groups: group walked more than 350 meters (> 350 meters Group) and the group walked less than 350 meters (< 350 meters Group) at the preoperative time. RESULTS: Eight-seven patients were included. Age was comparable in both groups (59 ± 9.5 years vs. 61 ± 9.3 years; respectively, P = 0.24). The group walked > 350 meters distance was higher than the < 350 meters group after 2 months of operation (436 ± 78 meters vs. 348 ± 87 meters; P <0.01). The quality of life was lower in the < 350 meters group compared to the > 350 meters group in the preoperative period in the following domains: functional capabilities, limitations due to physical aspects, overall health feelings, vitality, and social aspects. Quality of life improved after two months in both groups. CONCLUSIONS: The six-minute walk test at the preoperative time is associated with the quality of life after two months of coronary artery bypass grafting. In overall, quality of life has improved in all patients. The improvement in the quality of life was greater in those patients who walked distances lower than 350 meters at the preoperative time.
Assuntos
Ponte de Artéria Coronária/reabilitação , Teste de Esforço/métodos , Período Perioperatório , Qualidade de Vida , Caminhada , Idoso , Métodos Epidemiológicos , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Fatores Sexuais , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUÇÃO: Uma grande variedade de técnicas e soluções é utilizada na preservação do coração durante o transplante, o que demonstra a falta de método ideal na prática clínica. A administração da cardioplegia de forma retrógrada propicia perfusão contínua, o que pode conferir melhor recuperação inicial do coração transplantado. O objetivo deste trabalho é descrever a experiência de um único centro onde todos os pacientes receberam a mesma solução de conservação de órgão e foram submetidos a microcardioplegia sanguínea retrógrada contínua durante o implante do enxerto e avaliar fatores de mortalidade precoce e tardia com a utilização desta técnica. MÉTODOS: Este é um estudo retrospectivo, observacional e descritivo, realizado em um único centro. RESULTADOS: No período do estudo, foram realizados 35 transplantes cardíacos, sendo que 15 (42,9%) pacientes encontravam-se em choque cardiogênico. A probabilidade de sobrevida foi 74,8±7,8%, 60,4±11,3% e 15,1±13,4% ao final de 1 ano, 5 anos e 10 anos de seguimento, respectivamente. O tempo médio de sobrevida foi de 96,6 meses. CONCLUSÃO: A utilização da solução cardioplégica para proteção de órgãos e a estratégia de iniciar a perfusão com microcardioplegia sanguínea retrógrada contínua forneceu proteção adequada.
BACKGROUND: Several techniques and cardioplegic solutions have been used for heart preservation during transplant procedures. Unfortunately, there is a lack of ideal method for myocardial preservation in the clinical practice. The use of retrograde cardioplegia provides continuous infusion of cardioplegic solution during the graft implantation. This strategy may provide better initial recovery of the graft. The objective of this study is to describe the experience of a single center where all patients received the same solution for organ preservation and were subjected to continuous retrograde blood microcardioplegia during implantation of the graft and to evaluate factors associated to early and late mortality with this technique. METHODS: This is a retrospective, observational and descriptive study of a single center. RESULTS: During the study period were performed 35 heart transplants. Fifteen (42.9%) patients were in cardiogenic shock. The probability of survival was 74.8±7.8%, 60.4±11.3% and 15.1±13.4% at 1 year, 5 years and 10 years of follow-up, respectively. The median survival time was 96.6 months. CONCLUSION: The use of myocardial protection with retrograde cardioplegic solution may reduce the risks associated morbidity due to cold ischemia time during the heart transplant, and we suggest that this benefit may be even greater in cases of cold ischemia time longer ensuring protection to the myocardium.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Cardioplégicas , Coração , Parada Cardíaca Induzida/métodos , Transplante de Coração/mortalidade , Preservação de Órgãos/métodos , Brasil , Métodos Epidemiológicos , Transplante de Coração/métodos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJETIVO: Avaliar a utilidade do teste de caminhada de seis minutos como indicador prognóstico de qualidade de vida em pacientes submetidos a revascularização do miocárdio. MÉTODO: Estudo prospectivo observacional em pacientes submetidos a operação de revascularização do miocárdio. Foram avaliadas as características clínicas, teste de caminhada de seis minutos (TC6) e questionário para avaliação de qualidade de vida, o questionário SF-36. Os pacientes foram avaliados no pré-operatório e divididos em dois grupos, conforme a distância percorrida no TC6: grupo que caminhou mais de 350 metros e grupo que caminhou menos de 350 metros. RESULTADOS: Foram incluídos no estudo 87 pacientes. A idade média semelhante em ambos os grupos (59 ± 9,5 anos vs. 61 ± 9,3 anos; P = 0,24). Os pacientes do grupo > 350 metros caminharam mais no TC6 após dois meses de operação (436 ± 78 metros vs. 348 ± 87 metros; P<0,01) quando comparado ao grupo < 350 metros. Observamos que a qualidade de vida era inferior no grupo < 350 metros em relação ao grupo > 350 metros, no período pré-operatório, nos domínios: capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos sociais. A qualidade de vida melhorou após dois meses, em ambos os grupos. CONCLUSÕES: O TC6 no pré-operatório tem correlação com a qualidade de vida após dois meses de revascularização do miocárdio. A qualidade de vida melhorou de forma geral em todos pacientes, sendo maior a melhora da qualidade de vida naqueles que caminharam menos que 350 metros no pré-operatório.
OBJECTIVE: To assess the quality of life in patients undergoing myocardial revascularization using the six-minute walk test. METHODS: Prospective observational study with patients who undergoing CABG. The clinical variables, the sixminute walk test, and the SF-36 test were recorded. The patients were assessed at the preoperative time and at 2 months of postoperative period. According their six-minute walk test results, the patients were divided into two groups: group walked more than 350 meters (> 350 meters Group) and the group walked less than 350 meters (< 350 meters Group) at the preoperative time. RESULTS: Eight-seven patients were included. Age was comparable in both groups (59 ± 9.5 years vs. 61 ± 9.3 years; respectively, P = 0.24). The group walked > 350 meters distance was higher than the < 350 meters group after 2 months of operation (436 ± 78 meters vs. 348 ± 87 meters; P <0.01). The quality of life was lower in the < 350 meters group compared to the > 350 meters group in the preoperative period in the following domains: functional capabilities, limitations due to physical aspects, overall health feelings, vitality, and social aspects. Quality of life improved after two months in both groups. CONCLUSIONS: The six-minute walk test at the preoperative time is associated with the quality of life after two months of coronary artery bypass grafting. In overall, quality of life has improved in all patients. The improvement in the quality of life was greater in those patients who walked distances lower than 350 meters at the preoperative time.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária/reabilitação , Teste de Esforço/métodos , Período Perioperatório , Qualidade de Vida , Caminhada , Métodos Epidemiológicos , Terapia por Exercício , Complicações Pós-Operatórias , Prognóstico , Fatores Sexuais , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: Modified ultrafiltration (MUF) has been shown to decrease the postcardiac surgery inflammatory response and to improve respiratory function and cardiac performance in pediatric patients; however, this approach has not been well established in adults. The present study hypothesized that MUF could decrease the postsurgical inflammatory response, leading to improved respiratory and cardiac function in adults undergoing coronary artery bypass grafting. METHODS: Sixty patients undergoing coronary artery bypass grafting were randomized to the MUF or control group (n = 30 each). MUF was performed for 15 minutes at the end of bypass. The following data were recorded at the beginning of anesthesia, end of bypass, end of experimental treatment, and 24 and 48 hours after surgery: alveolar-arterial oxygen gradient, red blood cell units transfused, chest tube drainage, hemodynamic parameters, and cytokine levels (interleukin-6, P-selectin, intercellular adhesion molecule, and soluble tumor necrosis factor receptor). RESULTS: The MUF group displayed less chest tube drainage than the control group after 48 hours (598 ± 123 mL vs 848.0 ± 455 mL; P = .04) and less red blood cell transfusions (0.6 ± 0.6 units/patient vs 1.6 ± 1.1 units/patient; P = .03). Hematocrit level was higher in the MUF group than in the control group at the end of bypass (37.8% ± 1.1% vs 34.1% ± 1.1%; P < .05), but the levels were comparable at 48 hours. Similar values for interleukin-6 and P-selectin were observed at all stages. Plasma levels of intercellular adhesion molecule were higher in the MUF group than in the control group, particularly in the first sampling after experimental treatment (P = .01). Plasma levels of soluble tumor necrosis factor receptor were higher in the MUF group than in the control group at 48 hours. Hemodynamic and oxygen transport parameters were similar in both groups throughout the observation period. There were no differences in other clinical outcomes. CONCLUSIONS: Use of MUF was associated with increased inflammatory response, reduced blood loss, and less blood transfusions in adults undergoing coronary artery bypass grafting.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Hemofiltração/efeitos adversos , Inflamação/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Análise de Variância , Biomarcadores/sangue , Brasil , Ponte Cardiopulmonar/efeitos adversos , Tubos Torácicos , Drenagem/instrumentação , Transfusão de Eritrócitos , Feminino , Hemodinâmica , Humanos , Inflamação/sangue , Mediadores da Inflamação/sangue , Molécula 1 de Adesão Intercelular/sangue , Interleucina-6/sangue , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Selectina-P/sangue , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Receptores do Fator de Necrose Tumoral/sangue , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Several techniques and cardioplegic solutions have been used for heart preservation during transplant procedures. Unfortunately, there is a lack of ideal method for myocardial preservation in the clinical practice. The use of retrograde cardioplegia provides continuous infusion of cardioplegic solution during the graft implantation. This strategy may provide better initial recovery of the graft. The objective of this study is to describe the experience of a single center where all patients received the same solution for organ preservation and were subjected to continuous retrograde blood microcardioplegia during implantation of the graft and to evaluate factors associated to early and late mortality with this technique. METHODS: This is a retrospective, observational and descriptive study of a single center. RESULTS: During the study period were performed 35 heart transplants. Fifteen (42.9%) patients were in cardiogenic shock. The probability of survival was 74.8±7.8%, 60.4±11.3% and 15.1±13.4% at 1 year, 5 years and 10 years of follow-up, respectively. The median survival time was 96.6 months. CONCLUSION: The use of myocardial protection with retrograde cardioplegic solution may reduce the risks associated morbidity due to cold ischemia time during the heart transplant, and we suggest that this benefit may be even greater in cases of cold ischemia time longer ensuring protection to the myocardium.
Assuntos
Soluções Cardioplégicas , Parada Cardíaca Induzida/métodos , Transplante de Coração/mortalidade , Coração , Preservação de Órgãos/métodos , Adulto , Brasil , Métodos Epidemiológicos , Feminino , Transplante de Coração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUÇÃO: Os resultados tardios da plastia mitral em pacientes reumáticos são controversos na literatura. OBJETIVO: Estudo observacional e prospectivo que avalia os resultados tardios e identifica os fatores associados à reoperação e à mortalidade em pacientes reumáticos submetidos à plastia da valva mitral. MÉTODOS: Incluídos somente os pacientes com valvopatia mitral reumática submetidos a plastia, com insuficiência tricúspide associada ou não. Excluídos os pacientes com outros procedimentos associados. Um total de 104 pacientes foi estudado. Sobrevida e reoperação foram avaliadas pela analise de Kaplan-Meier e regressão logística de Cox. RESULTADOS: O tempo de seguimento foi de 63 ± 39 meses (IC 95 por cento 36 a 74 meses). A classe funcional III e IV estava presente em 65,4 por cento dos pacientes no pré-operatório. Foram realizadas 33 plastias do anel posterior, 21 comissurotomias, 50 comissurotomias e plastias do anel posterior. Não houve mortalidade operatória e a tardia foi de três (2,8 por cento) pacientes. A reoperação tardia esteve associada à insuficiência mitral residual no pós-operatório (P<0,001), presença de hipertensão pulmonar no pré-operatório (P< 0,01), idade (P<0,04) e classe funcional no pós-operatório (P<0,001). No seguimento, a probabilidade de estar livre de reoperação com 5 e 10 anos foi de 91,2 ± 3,4 por cento e 71,1 ± 9,2 por cento, respectivamente. CONCLUSÃO: Os resultados tardios do reparo da valva mitral em pacientes reumáticos têm fatores associados à reoperação. O reparo da valva mitral reumática é seguro e com ótima sobrevida a longo prazo.
INTRODUCTION AND AIMS: The long-term results after surgical repair of rheumatic mitral valve remain controversial in literature. Our aim was to determine the predictive factors which impact the long-term results after isolated rheumatic mitral valve repair and to evaluate the effect of those factors on reoperation and late mortality. METHODS: One hundred and four patients with rheumatic valve disease who had undergone mitral valve repair with or without tricuspid valve annuloplasty were included. All patients with associated procedures were excluded. The predictive variables for reoperation were assessed with Cox regression and Kaplan Meier survival curves. RESULTS: The mean follow-up time was 63 ± 39 months (CI 95 percent 36 to 74 months). The functional class III and IV was observed in 65.4 percent of all patients. The posterior ring annuloplasty was performed in 33 cases, comissutoromy in 21 cases, and comissurotomy with posterior ring annuloplasty in 50 patients. There was no operative mortality. The late mortality was 2.8 percent (three patients). The late reoperation was associated with residual mitral valve regurgitation after surgery (P<0.001), pulmonary hypertension at the pre-operative time (P<0.001), age (P<0.04) and functional class at the post-operative time (P<0.001). We observed freedom from reoperation rates at 5 and 10 years of 91.2 ± 3.4 percent and 71.1 ± 9.2 percent, respectively. CONCLUSION: Repair of mitral valve in rheumatic valve disease is feasible with good long-term outcomes. Preoperative pulmonary hypertension, residual mitral valve regurgitation after surgery, age and functional class are predictors of late reoperation.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hipertensão Pulmonar/complicações , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Cardiopatia Reumática/mortalidade , Métodos Epidemiológicos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Cuidados Pré-Operatórios , Fatores de Risco , Reoperação/estatística & dados numéricos , Cardiopatia Reumática/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Myocardial infarction might result in dilated left ventricle and numerous techniques have been described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to compare our experience with a modified Dor procedure using a rigid prosthesis to the septal anterior ventricular exclusion procedure (SAVE) for left ventricle restoration. The EuroScore index for prediction of late follow up survival was evaluated. METHODS: We evaluated 80 patients who underwent left ventricle restoration between 1999 to 2007 and eight patients were excluded with incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was performed on 53 patients and 19 underwent the septal anterior ventricular exclusion procedure (SAVE group). The patients were classified according their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analysis were performed to assess survival after both techniques and expected surgical mortality using EuroScore index ranking after 12 years of follow up. RESULTS: The operative mortality was comparable in both groups ranked by EuroScore index. The groups were comparable for all clinical data, except the MD group had more patients using intra-aortic balloon pumps before surgery, (5.7% vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape showed comparable survival for all patients, with slightly higher survival for type I. Kaplan Meier analysis of all death showed equivalent survival curves for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ± 20.5 years; P=0.08). Kaplan Meier analysis of EuroScore index for all patients showed a difference between the three ranked categories, i.e., 0 to 10%, 11 to 49% and higher than 50% expected surgical mortality after 12 years of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003). CONCLUSION: The MD procedure showed consistent ejection fraction improvements after long term follow up. Survival was comparable for all ventricular types and for the MD and SAVE procedures. The EuroScore index is a useful index for late survival assessment of ventricular restoration techniques.