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1.
Arq Bras Cardiol ; 121(5): e20230699, 2024.
Article in Portuguese, English | MEDLINE | ID: mdl-38922272

ABSTRACT

BACKGROUND: Heart failure (HF) contributes to a high burden of hospitalization, and its form of presentation is associated with disease prognosis. OBJECTIVES: To describe the association of hemodynamic profile of acute HF patients at hospital admission, based on congestion (wet/dry) and perfusion (cold/warm), with mortality, hospital length of stay and risk of readmission. METHODS: Cohort study, with patients participating in the "Best Practice in Cardiology" program, admitted for acute HF in Brazilian public hospitals between March 2016 and December 2019, with a six-month follow-up. Characteristics of the population and hemodynamic profile at admission were analyzed, in addition to survival analysis using Cox proportional hazard model for associations between hemodynamic profile at admission and mortality, and logistic regression for the risk of rehospitalization, using a statistical significance level of 5%. RESULTS: A total of 1,978 patients were assessed, with mean age of 60.2 (±14.8) years and mean left ventricular ejection fraction of 39.8% (±17.3%). A high six-month mortality rate (22%) was observed, with an association of cold hemodynamic profiles with in-hospital mortality (HR=1.72, 95%CI 1.27-2.31; p < 0.001) and six-month mortality (HR= 1.61, 95%CI 1.29-2.02). Six-month rehospitalization rate was 22%, and higher among patients with wet profiles (OR 2.30; 95%CI 1.45-3.65; p < 0.001). CONCLUSIONS: Acute HF is associated with high mortality and rehospitalization rates. Patient hemodynamic profile at admission is a good prognostic marker of this condition.


FUNDAMENTO: A insuficiência cardíaca (IC) é responsável por alta carga de internações hospitalares. A sua forma de apresentação está relacionada ao prognóstico da doença. OBJETIVOS: Descrever a associação entre o perfil hemodinâmico de admissão hospitalar na IC aguda, baseado em congestão (úmido ou seco) e perfusão (frio ou quente), e desfechos de mortalidade, tempo de internação e chance de reinternação. MÉTODOS: Estudo de coorte, envolvendo pacientes do projeto "Boas Práticas Clínicas em Cardiologia", internados por IC aguda em hospitais públicos brasileiros, entre março de 2016 a dezembro de 2019, com seguimento de seis meses. Foram realizadas análises das características populacionais e do perfil hemodinâmico de admissão, além de análises de sobrevivência pelos modelos de Cox para associação entre o perfil de admissão e mortalidade, e regressão logística para chance de reinternação, considerando nível de significância estatística de 5%. RESULTADOS: Foram avaliados 1978 pacientes, com idade média foi 60,2 (±14,8) anos e fração de ejeção média do ventrículo esquerdo de 39,8% (±17,3%). Houve altas taxas de mortalidade no seguimento de seis meses (22%), com associação entre os perfis hemodinâmicos frios e a mortalidade hospitalar (HR=1,72; IC95% 1,27-2,31; p < 0,001) e em 6 meses (HR= 1,61, IC 95% 1,29-2,02). A taxa de reinternação em 6 meses foi de 22%, sendo maior para os pacientes admitidos em perfis úmidos (OR 2,30; IC95% 1,45-3,65; p < 0,001). CONCLUSÕES: A IC aguda no Brasil apresenta altas taxas de mortalidade e reinternações e os perfis hemodinâmicos de admissão hospitalar são bons marcadores prognósticos dessa evolução.


Subject(s)
Heart Failure , Hemodynamics , Hospital Mortality , Patient Readmission , Humans , Heart Failure/mortality , Heart Failure/physiopathology , Heart Failure/therapy , Male , Female , Middle Aged , Brazil/epidemiology , Hemodynamics/physiology , Aged , Acute Disease , Patient Readmission/statistics & numerical data , Length of Stay/statistics & numerical data , Prognosis , Hospitalization/statistics & numerical data , Risk Factors , Cohort Studies , Patient Admission/statistics & numerical data
2.
Arq Bras Cardiol ; 120(10): e20230375, 2023 Nov.
Article in Portuguese, English | MEDLINE | ID: mdl-38055374

ABSTRACT

BACKGROUND: A Nationwide Initiative to Improve Cardiology Quality: The Best Practice in Cardiology Program in Brazil ACEI/ARB: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; LVEF: left ventricular ejection fraction; LVSD: left ventricular systolic dysfunction; AF: atrial fibrillation; PT/INR: prothrombin time/international normalized ratio. BACKGROUND: Despite significant progress in improving the quality of cardiovascular care, persistent gaps remain in terms of inconsistent adherence to guideline recommendations. OBJECTIVE: This study evaluates the effects of implementing a quality improvement program adapted from the American Heart Association's Get with the Guidelines™ initiative on adherence to guideline-directed medical therapy for acute coronary syndrome (ACS), atrial fibrillation (AF), and heart failure (HF). METHODS: We examined demographics, quality measures, and short-term outcomes in patients hospitalized with ACS, AF, and HF enrolled in the Best Practice in Cardiology (BPC) Program from 2016 to 2022. RESULTS: This study included 12,167 patients in 19 hospitals in Brazil. Mean age was 62.5 [53.8-71] y/o; 61.1% were male, 68.7% had hypertension, 32.0% diabetes mellitus, and 24.1% had dyslipidemia. Composite score had a sustainable performance in the period from baseline to the last quarter: 65.8±36.2% to 73± 31.2% for AF (p=0.024), 81.0± 23.6% to 89.9 ± 19.3% for HF (p<0.001), and from 88.0 ± 19.1 to 91.2 ±14.9 for ACS (p<0.001). CONCLUSIONS: The BPC program is a quality improvement program in Brazil in which real-time data, obtained using cardiology guideline metrics, were implemented in a quality improvement program resulting in an overall sustained improvement in AF, HF, and ACS management.


Subject(s)
Acute Coronary Syndrome , Atrial Fibrillation , Cardiology , Heart Failure , Humans , Male , United States , Middle Aged , Female , Angiotensin-Converting Enzyme Inhibitors , Angiotensin Receptor Antagonists , Brazil , Stroke Volume , Guideline Adherence , Ventricular Function, Left , Acute Coronary Syndrome/therapy
5.
Arq. bras. cardiol ; 115(1): 92-99, jul. 2020. tab, graf
Article in Portuguese | LILACS, Sec. Est. Saúde SP | ID: biblio-1131254

ABSTRACT

Resumo Fundamento Existem grandes oportunidades de melhoria da qualidade do cuidado cardiovascular em países em desenvolvimento por meio da implementação de um programa de qualidade. Objetivo Avaliar o efeito de um programa de Boas Práticas em Cardiologia (BPC) nos indicadores de desempenho e desfechos clínicos dos pacientes relacionados à insuficiência cardíaca, fibrilação atrial e síndromes coronarianas agudas em um subconjunto de hospitais públicos brasileiros. Métodos O programa Boas Práticas em Cardiologia (BPC) foi adaptado do programa Get With The Guidelines (GWTG) da American Heart Association (AHA) para ser utilizado no Brasil. O programa está sendo iniciado em três domínios de cuidado simultaneamente (síndrome coronariana aguda, fibrilação atrial e insuficiência cardíaca), o que consiste em uma abordagem nunca testada no GWTG. Existem seis eixos de intervenções utilizadas pela literatura sobre tradução do conhecimento que abordará barreiras locais identificadas por meio de entrevistas estruturadas e reuniões regulares para auditoria e feedback. Planeja-se incluir no mínimo 10 hospitais e 1500 pacientes por doença cardíaca. O desfecho primário inclui as taxas de adesão às medidas de cuidado recomendadas pelas diretrizes. Desfechos secundários incluem o efeito do programa sobre o tempo de internação, mortalidade global e específica, taxas de readmissão, qualidade de vida, percepção do paciente sobre saúde e adesão dos pacientes às intervenções prescritas. Resultados Espera-se, nos hospitais participantes, uma melhoria e a manutenção das taxas de adesão as recomendações baseadas em evidência e dos desfechos dos pacientes. Este é o primeiro programa em melhoria da qualidade a ser realizado na América do Sul, que fornecerá informações importantes de como programas de sucesso originados em países desenvolvidos como os Estados Unidos podem ser adaptados às necessidades de países com economias em desenvolvimento como o Brasil. Um programa bem sucedido dará informações valiosas para o desenvolvimento de programas de melhoria da qualidade em outros países em desenvolvimento. Conclusões Este estudo de mundo real proverá informações para a avaliação e aumento da adesão às diretrizes de cardiologia no Brasil, bem como a melhora dos processos assistenciais. (Arq Bras Cardiol. 2020; 115(1):92-99)


Abstract Background There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods The Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association's (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients' health perception and patients' adherence to prescribed interventions. Results It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Quality of Life , Cardiology , United States , Brazil , Guideline Adherence , Hospitals, Public
6.
Arq Bras Cardiol ; 115(1): 92-99, 2020 07.
Article in English, Portuguese | MEDLINE | ID: mdl-32187286

ABSTRACT

Background There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods The Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association's (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients' health perception and patients' adherence to prescribed interventions. Results It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).


Subject(s)
Cardiology , Quality of Life , Brazil , Guideline Adherence , Hospitals, Public , Humans , United States
7.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(suppl2): 79-89, 2017. tab
Article in Portuguese | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1066832

ABSTRACT

Introdução: A lesão renal aguda (LRA) é uma importante complicação em cirurgias cardíacas. Pacientes que desenvolvem LRA implicam aumento do tempo de hospitalização,diminuição da qualidade de vida e da sobrevida. Objetivo: Avaliar a sobrevida de pacientes que desenvolvem LRA no pós-operatório de cirurgia cardíaca, bem como as variáveis associadasa ela. Método: Revisão integrativa da literatura realizada a partir da seleção de artigos publicados entre 2009 e 2014, indexados por Medline/PUBMED, nos idiomas português, inglês e espanhol. Foram identificados inicialmente 597 artigos com a utilização dos descritorescontrolados. Após aplicação dos critérios de inclusão e exclusão, 17 artigos foram selecionados para análise por dois pesquisadores independentes. Resultados: Os pacientesque desenvolvem LRA após cirurgia cardíaca podem apresentar fatores de risco pré, intra e pós-operatórios que interferem na taxa de sobrevida, e evoluem com uma sobrevida médiade cinco anos. Conclusão: A sobrevida foi gradativamente reduzida nos primeiros cinco anos após a cirurgia e os principais fatores apontados como preditores de mortalidade foram,entre outros, idade avançada, gravidade da disfunção renal e tipo de cirurgia.


Subject(s)
Survival Analysis , Renal Dialysis , Renal Insufficiency , Cardiovascular Surgical Procedures
8.
Rev. SOBECC ; 21(3): 125-131, jul.-set. 2016.
Article in English, Portuguese | LILACS, BDENF - Nursing | ID: biblio-827195

ABSTRACT

Objetivo: Avaliar itens de segurança na cirurgia cardíaca em pacientes de um hospital público. Método: Estudo descritivo e transversal. A coleta de dados, desenvolvida em 2012, foi realizada em uma instituição hospitalar pública estadual, onde foram observadas 30 cirurgias cardíacas por meio de um roteiro embasado nas 3 fases do checklist de cirurgia segura da Organização Mundial da Saúde (OMS), com alternativas descritas como "em conformidade" e "em não conformidade". Resultados: Os resultados de não conformidade corresponderam a 56% dos casos antes da indução anestésica, 57% antes do procedimento e 75% na saída da sala de cirurgia. Conclusão: O checklist da OMS se faz necessário, porém, o treinamento profissional e a educação permanente constituem a linha mestra para a formação de uma equipe de saúde crítica e consciente do seu papel na segurança dos pacientes.


Objective: Evaluation of security items in cardiac surgery at a public hospital. Methods: Cross-sectional descriptive study. Data collection was performed in 2012 at a public state-owned hospital, where 30 cardiac surgeries were observed and evaluated through a script based on the 3 steps of the World Health Organization (WHO) surgical safety checklist. Procedures were categorized as "in conformance" or "in non-conformance." Results: Non-conformance results made up 56% of cases before anesthetic induction, 57% prior to the procedure, and 75% of cases before leaving the operating room. Conclusions: Though the WHO checklist is indispensable, professional training and continuing education remain crucial for training a critical health care team that is aware of its role in securing patient safety.


Objetivo: Evaluar ítems de seguridad en la cirugía cardíaca en pacientes de un hospital público. Método: Estudio descriptivo y transversal. La colecta de datos, desarrollada en 2012, fue realizada en una institución hospitalaria pública estadual, donde fueron observadas 30 cirugías cardíacas por medio de un itinerario basado en las 3 fases del checklist de cirugía segura de la Organización Mundial de la Salud (OMS), con alternativas descritas como "en conformidad" y "en no conformidad". Resultados: Los resultados de no conformidad correspondieron al 56% de los casos antes de la inducción anestésica, un 57% antes del procedimiento y un 75% en la salida del quirófano. Conclusión: El checklist de la OMS se hace necesario, sin embargo, la capacitación profesional y la educación permanente constituyen la línea maestra para la formación de un equipo de salud crítico y consciente de su papel en la seguridad de los pacientes.


Subject(s)
Humans , Operating Room Nursing , Thoracic Surgery , Patient Safety , Time Out, Healthcare , Safety , General Surgery , World Health Organization , Hospitals, Public
9.
Rev. bras. cir. cardiovasc ; 27(4): 592-599, out.-dez. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-668121

ABSTRACT

OBJETIVO: Para melhorar as propriedades mecânicas e imunogênicas, o glutaraldeído é utilizado no tratamento do pericárdio bovino que é utilizado em biopróteses. A liofilização do pericárdio bovino tratado com glutaraldeído diminui os radicais aldeído, com provável redução do potencial para calcificação. O objetivo deste estudo é avaliar os efeitos da liofilização em biopróteses valvares de pericárdio bovino como mecanismo protetor na diminuição da disfunção estrutural valvar. MÉTODOS: Foi realizado o implante de biopróteses de pericárdio bovino tratado com glutaraldeído, liofilizadas ou não, em carneiros de 6 meses de idade, sendo os animais eutanasiados com 3 meses de seguimento. As biopróteses foram implantadas em posição pulmonar, com auxílio de circulação extracorpórea. Um grupo controle e outro grupo liofilizado foram avaliados quanto ao gradiente ventrículo direito/artéria pulmonar (VD/AP) no implante e explante; análise quantitativa de cálcio; inflamação; trombose e pannus. O nível de significância estabelecido foi de 5%. RESULTADOS: O gradiente médio VD/AP, no grupo controle, no implante, foi 2,04 ± 1,56 mmHg e, no grupo de liofilização, foi 6,61 ± 4,03 mmHg. No explante, esse gradiente aumentou para 7,71 ± 3,92 mmHg e 8,24 ± 6,2 mmHg, respectivamente, nos grupos controle e liofilização. O teor de cálcio médio, após 3 meses, nas biopróteses do grupo controle foi 21,6 ± 39,12 µg Ca+2/mg de peso seco, em comparação com um teor médio de 41,19 ± 46,85 µg Ca+2/mg de peso seco no grupo liofilizado (P = 0,662). CONCLUSÃO: A liofilização de próteses valvares com pericárdio bovino tratado com glutaraldeído não demonstrou diminuição da calcificação neste experimento.


OBJECTIVE: Glutaraldehyde is currently used in bovine pericardium bioprosthesis to improve mechanical and immunogenic properties. Lyophilization is a process that may decrease aldehyde residues in the glutaraldehyde treated pericardium decreasing cytotoxicity and enhancing resistance to calcification. The aim of this study is to evaluate bioprosthetic heart valves calcification in adolescent sheep and to study the potential of lyophilization as a mechanism to protect calcification. METHODS: Two groups were evaluated: a control group in which a bovine pericardium prosthetic valve was implanted in pulmonary position and a lyophilized group in which the bovine pericardium prosthetic valve was lyophilized and further implanted. Sixteen sheeps 6 months old were submitted to the operation procedure. After 3 months the sheeps were euthanized under full anesthesia. RESULTS: Six animals of the control group reached 95.16 ± 3.55 days and six animals in the lyophilized group reached 91.66 ± 0.81 days of postoperative evolution. Two animals had endocarditis. Right ventricle/pulmonary artery (RV/PA) mean gradient, in the control group, at the implantation was 2.04 ± 1.56 mmHg, in the lyophilization group, the RV/PA mean gradient, at the implantation was 6.61 ± 4.03 mmHg. At the explantation it increased to 7.71 ± 3.92 mmHg and 8.24 ± 6.25 mmHg, respectively, in control and lyophilization group. The average calcium content, after 3 months, in the control group was 21.6 ± 39.12 µg Ca+2/mg dry weight, compared with an average content of 41.19 ± 46.85 µg Ca+2/mg dry weight in the lyophilization group (P=0.662). CONCLUSION: Freeze drying of the bovine pericardium prosthesis in the pulmonary position could not demonstrate calcification mitigation over a 3 month period although decreased inflammatory infiltration over the tissue.


Subject(s)
Animals , Cattle , Bioprosthesis/adverse effects , Calcinosis/prevention & control , Heart Valve Prosthesis/adverse effects , Materials Testing/methods , Pericardium/chemistry , Pulmonary Artery/surgery , Calcinosis/pathology , Fixatives/pharmacology , Freeze Drying/methods , Glutaral/pharmacology , Models, Animal , Pericardium/ultrastructure , Random Allocation , Sheep , Statistics, Nonparametric
10.
Rev. bras. cir. cardiovasc ; 27(3): 405-410, jul.-set. 2012. tab
Article in English | LILACS | ID: lil-660812

ABSTRACT

OBJECTIVE: Kidney dysfunction is a major complication in the postoperative cardiac surgery setting. Operative risk factors for its development are cardiopulmonary bypass, anemia, antifibrinolytic drugs and blood transfusion. The objective of this study was to identify the risk factors for developing kidney dysfunction in patients undergoing cardiac surgery. METHODS: Ninety-seven patients were studied and 84 were analyzed. The sample was stratified into two groups. A serum creatinine higher than 30% compared to the preoperative period was considered for the kidney dysfunction group (n=9; 10.71%). There also was a control group when the increase in serum creatinine remained lower than 30% (n=75; 89.28%). RESULTS: It was observed that intraoperative transfusion of fresh frozen plasma in the control group was 2.05 ± 0.78 units and 3.80 ± 2.16 units in the kidney dysfunction group with P= 0.032. CONCLUSION: It was possible to associate that fresh frozen plasma transfusion is a risk factor for postoperative kidney dysfunction after cardiovascular surgery.


OBJETIVO: A disfunção renal é uma complicação importante no cenário de pós-operatório de cirurgia cardiovascular. Como fatores de risco conhecidos no intraoperatório para o seu desenvolvimento destacam-se a circulação extracorpórea, a hemodiluição, drogas antifibrinolíticos e a transfusão sanguínea. O objetivo deste estudo é identificar os fatores de risco na transfusão de sangue e derivados para o desenvolvimento de disfunção renal em pacientes submetidos à cirurgia cardiovascular. MÉTODOS: Noventa e sete pacientes foram estudados e 84 foram analisados. A amostra foi estratificada em dois grupos, sendo que o incremento de 30% na creatinina sérica no pós-operatório foi considerado para o grupo com disfunção renal (n = 9; 10,71%). O grupo não disfunção renal foi caracterizado pela creatinina sérica, que permaneceu inferior a aumento de 30% no pós-operatório (n = 75; 89,28%). RESULTADOS: Foi observado que a transfusão de plasma fresco congelado no grupo não disfunção renal foi de 2,05 ± 0,78 unidades e 3,80 ± 2,16 unidades no grupo disfunção renal com P= 0,032. CONCLUSÃO: Foi possível associar, nesta série de pacientes, que a transfusão de plasma fresco congelado foi um fator de risco para disfunção renal pós-operatório de cirurgia cardiovascular.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Blood Transfusion/adverse effects , Cardiovascular Surgical Procedures/adverse effects , Plasma , Renal Insufficiency/etiology , Chi-Square Distribution , Creatinine/blood , Postoperative Period , Postoperative Complications/etiology , Risk Factors , Renal Insufficiency/blood , Statistics, Nonparametric
11.
Rev Bras Cir Cardiovasc ; 27(4): 592-9, 2012 Dec.
Article in English, Portuguese | MEDLINE | ID: mdl-23515732

ABSTRACT

OBJECTIVE: Glutaraldehyde is currently used in bovine pericardium bioprosthesis to improve mechanical and immunogenic properties. Lyophilization is a process that may decrease aldehyde residues in the glutaraldehyde treated pericardium decreasing cytotoxicity and enhancing resistance to calcification. The aim of this study is to evaluate bioprosthetic heart valves calcification in adolescent sheep and to study the potential of lyophilization as a mechanism to protect calcification. METHODS: Two groups were evaluated: a control group in which a bovine pericardium prosthetic valve was implanted in pulmonary position and a lyophilized group in which the bovine pericardium prosthetic valve was lyophilized and further implanted. Sixteen sheep 6 months old were submitted to the operation procedure. After 3 months the sheep were euthanized under full anesthesia. RESULTS: Six animals of the control group reached 95.16 ± 3.55 days and six animals in the lyophilized group reached 91.66 ± 0.81 days of postoperative evolution. Two animals had endocarditis. Right ventricle/pulmonary artery (RV/PA) mean gradient, in the control group, at the implantation was 2.04 ± 1.56 mmHg, in the lyophilization group, the RV/PA mean gradient, at the implantation was 6.61 ± 4.03 mmHg. At the explantation it increased to 7.71 ± 3.92 mmHg and 8.24 ± 6.25 mmHg, respectively, in control and lyophilization group. The average calcium content, after 3 months, in the control group was 21.6 ± 39.12 µg Ca+2/mg dry weight, compared with an average content of 41.19 ± 46.85 µg Ca+2/mg dry weight in the lyophilization group (P=0.662). CONCLUSION: Freeze drying of the bovine pericardium prosthesis in the pulmonary position could not demonstrate calcification mitigation over a 3 month period although decreased inflammatory infiltration over the tissue.


Subject(s)
Bioprosthesis/adverse effects , Calcinosis/prevention & control , Heart Valve Prosthesis/adverse effects , Materials Testing/methods , Pericardium/chemistry , Pulmonary Artery/surgery , Animals , Calcinosis/pathology , Cattle , Fixatives/pharmacology , Freeze Drying/methods , Glutaral/pharmacology , Models, Animal , Pericardium/ultrastructure , Random Allocation , Sheep , Statistics, Nonparametric
12.
Rev Bras Cir Cardiovasc ; 27(3): 405-10, 2012.
Article in English | MEDLINE | ID: mdl-23288182

ABSTRACT

OBJECTIVE: Kidney dysfunction is a major complication in the postoperative cardiac surgery setting. Operative risk factors for its development are cardiopulmonary bypass, anemia, antifibrinolytic drugs and blood transfusion. The objective of this study was to identify the risk factors for developing kidney dysfunction in patients undergoing cardiac surgery. METHODS: Ninety-seven patients were studied and 84 were analyzed. The sample was stratified into two groups. A serum creatinine higher than 30% compared to the preoperative period was considered for the kidney dysfunction group (n=9; 10.71%). There also was a control group when the increase in serum creatinine remained lower than 30% (n=75; 89.28%). RESULTS: It was observed that intraoperative transfusion of fresh frozen plasma in the control group was 2.05 ± 0.78 units and 3.80 ± 2.16 units in the kidney dysfunction group with P= 0.032. CONCLUSION: It was possible to associate that fresh frozen plasma transfusion is a risk factor for postoperative kidney dysfunction after cardiovascular surgery.


Subject(s)
Cardiovascular Surgical Procedures/adverse effects , Plasma , Renal Insufficiency/etiology , Transfusion Reaction , Aged , Chi-Square Distribution , Creatinine/blood , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Period , Renal Insufficiency/blood , Risk Factors , Statistics, Nonparametric
13.
Rev Bras Cir Cardiovasc ; 22(2): 201-5, 2007.
Article in English, Portuguese | MEDLINE | ID: mdl-17992325

ABSTRACT

OBJECTIVE: Acute renal failure following heart surgery is a major complication. The aim of this study was to evaluate if duration of cardiopulmonary bypass (CPB) is an important factor that influences kidney dysfunction. METHODS: One hundred and sixteen patients from a single center referred for heart surgery were evaluated. Demographic factors, clinical data, operative and postoperative variables were evaluated. Serum creatinine and creatinine clearance were calculated until the fifth postoperative day. Acute renal failure was defined as the requirement of dialysis therapy. Patients were divided into two groups, the CPB<70min Group, patients with CPB duration equal to or less than 70 minutes and the CPB<90min Group, patients with CPB duration equal to or more than 90 minutes. RESULTS: The median increases in serum creatinine were 0.18 + 0.41(CPB<70min) and 0.42 + 0.44 (CPB>90min p=0.005). Dialysis was indicated in 1.3% (CPB<70min) and 12.5% 90min - p = 0.018). The odds ratio for dialysis was 1.12 (95% CI; 1.00-1.20) for CPB>90min. There was no significant difference in mortality (5.2 versus 7.5%, p = 0.631). CONCLUSION: The greatest likelihood of developing kidney failure after heart surgery is observed when CPB is at least 90 minutes, although creatinine clearance was not significantly altered between the groups studied.


Subject(s)
Acute Kidney Injury/etiology , Cardiopulmonary Bypass/adverse effects , Coronary Artery Bypass , Creatinine/blood , Epidemiologic Methods , Female , Humans , Male , Middle Aged , Postoperative Period , Renal Dialysis , Time Factors
14.
Rev. bras. cir. cardiovasc ; 22(2): 201-205, abr.-jun. 2007. tab, graf
Article in Portuguese | LILACS | ID: lil-461760

ABSTRACT

OBJETIVO: A insuficiência renal aguda (IRA) no pósoperatório (PO) de cirurgia cardíaca é complicação grave. O objetivo deste trabalho é avaliar o tempo de circulação extracorpórea (CEC) como fator de risco para IRA. MÉTODO: Foram avaliados 116 pacientes de um único centro, submetidos a cirurgia cardíaca com CEC. Foram avaliados os dados demográficos, características clínicas, variáveis intra e pós-operatórias. A creatinina sérica e o clearance de creatinina foram avaliados até o 5°PO. IRA foi definida como necessidade de diálise. Os pacientes foram estratificados em dois grupos: grupo CEC< 70 min e grupo CEC> 90min. RESULTADOS: O aumento médio da creatinina sérica no PO foi 0,18+0,41 no grupo CEC<70min e 0,42+0,44 no grupo CEC>90min (p=0,005). Diálise foi necessária em 1,3 por cento dos pacientes do grupo CEC<70min, e em 12,5 por cento do grupo CEC> 90min (p=0,018). O risco relativo para diálise foi 1,12 (IC 95 por cento, 1,00-1,20) para CEC>90min. Não houve diferença para mortalidade (5,2 versus 7,5 por cento, p=0,631). CONSLUSÃO: O desenvolvimento de IRA no pós-operatório de cirurgia cardíaca foi observado em pacientes com tempo de CEC superior a 90 minutos, embora o clearance de creatinina não tenha demonstrado alteração entre os grupos.


OBJECTIVE: Acute renal failure following heart surgery is a major complication. The aim of this study was to evaluate if duration of cardiopulmonary bypass (CPB) is an important factor that influences kidney dysfunction. METHODS: One hundred and sixteen patients from a single center referred for heart surgery were evaluated. Demographic factors, clinical data, operative and postoperative variables were evaluated. Serum creatinine and creatinine clearance were calculated until the fifth postoperative day. Acute renal failure was defined as the requirement of dialysis therapy. Patients were divided into two groups, the CPB<70min Group, patients with CPB duration equal to or less than 70 minutes and the CPB<90min Group, patients with CPB duration equal to or more than 90 minutes. RESULTS: The median increases in serum creatinine were 0.18 + 0.41(CPB<70min) and 0.42 + 0.44 (CPB>90min p=0.005). Dialysis was indicated in 1.3 percent (CPB<70min) and 12.5 percent 90min - p = 0.018). The odds ratio for dialysis was 1.12 (95 percent CI; 1.00-1.20) for CPB>90min. There was no significant difference in mortality (5.2 versus 7.5 percent, p = 0.631). CONCLUSION: The greatest likelihood of developing kidney failure after heart surgery is observed when CPB is at least 90 minutes, although creatinine clearance was not significantly altered between the groups studied.


Subject(s)
Humans , Female , Adult , Middle Aged , Dialysis , Extracorporeal Circulation , Renal Insufficiency , Acute Disease , Midazolam/administration & dosage
15.
Botucatu; s.n; 2006. 112 p. tab, graf.
Thesis in Portuguese | LILACS | ID: lil-478332

ABSTRACT

A insuficiência renal aguda (IRA) é complicação frequente no pós-operatório de cirurgia cardiovascular. Apresenta incidência de 7 a 31 %. O menor hematócito (MNHT) durante a circulação extracorpórea foi identificado como fator de risco para disfunção renal em cirurgia cardíaca. O objetivo deste estudo é determinar se diferentes níveis de MNHT durante a CEC são relacionados à disfunção renal no pós-operatorío de cirurgia cardiovascular. Material e Métodos: Estudo prospectivo, observacional realizado em pacientes adultos consecutivos submetidos a revascularização do miocárdio. A função renal pré-operatório foi determinada pelo creatinina sérica pré-operatória (CrPré). A creatinina pico pós­-operatória (CrPós) foi determinada como sendo o maior valor de creatinina sérica no pós-operatório. A diferença em percentual da creatinina (%deltaCr) foi definida como a diferença da CrPré e CrPós representada em porcentagem da CrPré. O MNHT durante a CEC foi definindo como o menor valor de hematócrito durante a CEC. Os pacientes foram divididos em grupos de MNHT durante a CEC. Os grupos determinados foram: 1 menor que 23%,2 entre 23,1 a 28% e 3 maior que 28,1 %.


Subject(s)
Humans , Male , Female , Adult , Acute Kidney Injury , Extracorporeal Circulation , Hemodilution , Myocardial Revascularization , Thoracic Surgery
16.
Acta cir. bras ; 14(3): 136-9, jul.-set. 1999.
Article in Portuguese | LILACS | ID: lil-254242

ABSTRACT

O presente estudo teve por objetivo padronizar modelo experimental de estimulação cardíaca artificial atrial em coelhos. Foram utilizados 20 coelhos raça Norfolk-2000 de ambos os sexos com peso mínimo de 2200g. Após anestesia endovenosa com pentobarbital(30mg/Kg), foi dissecada a veia jugular externa esquerda e introduzido eletrodo EthiconÒ especialmente preparado, até átrio direito via veia cava esquerda. Foram realizadas leituras dos parâmetros elétricos(ondaP, resistência e limiar de comando) no ato cirúrgico e com 7, 14 e 21 dias denominados M1,M2, M3 e M4 respectivamente. Observamos diferença significativa em todos as variáveis analisadas entre M1 e demais momentos. Os resultados são compatíveis com o que se conhece de estimulação cardíaca artificial em outras espécies animais e no homem. O presente modelo mostrou ser viável para estudos de estimulação cardíaca artificial


Subject(s)
Animals , Rabbits , Male , Female , Cardiac Pacing, Artificial , Disease Models, Animal , Electric Stimulation
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