Cirurgia de revascularização do miocárdio no Brasil: análise crítica da realidade nacional através do registro Bypass

Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a registry database on surgical practice and results. Anticipating this recommendation, the BYPASS registry started in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: This is a cross-sectional study of 2292 patients undergoing CABG and included in the BYPASS Registry up to November, 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in the Registry were predominantly male (71%), with previous myocardial infarction in 41.1% of cases, diabetes in 42.5%, and left ventricular ejection fraction lower than 40% in 9.7%. Surgery was indicated by Heart Team in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), where the use of cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery (ITA) was used as graft in 91% of the cases; the right ATI, in 5.6%; and; the radial artery, in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of stroke was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS registry analysis is representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.Introdução: A cirurgia de revascularização do miocárdio (CRM) é a cirurgia cardíaca mais realizada no Brasil. Diretrizes internacionais recentes recomendaram que as sociedades nacionais estabeleçam base de dados sobre a prática e resultados da CRM. Antecipando a recomendação, a SBCCV iniciou em 2015 o projeto BYPASS, que constitui a base de dados institucional sobre a cirurgia cardíaca no Brasil. Objetivo: Analisar o perfil, fatores de risco, resultados e estratégia cirúrgica de pacientes submetidos a CRM no Brasil com base no registro BYPASS. Métodos: Este é um estudo transversal com 2292 pacientes submetidos a CRM catalogados no registro BYPASS até novembro de 2018. Dados demográficos, quadro clínico, variáveis operatórias e resultados hospitalares são analisados. Resultados: Os pacientes submetidos a CRM no registro foram predominantemente homens (71%), com infarto do miocárdio prévio em 41,1%, diabetes em 42,5%, e fração de ejeção menor de 40% em 9,7%. A cirurgia foi indicada por Heart Team em 32,9%. A maioria dos casos foi operada com uso de circulação extracorpórea (87%), onde a cardioplegia foi o método de proteção miocárdica escolhido em 95,2% dos casos. A mediana de vasos tratados foi 3 e o uso bilateral de enxertos da artéria torácica interna ocorreu em 6,9%. A mortalidade hospitalar foi 2,8% e a incidência de AVE 1.2%. Conclusão: Os dados fornecidos pelo Registro BYPASS são representativos da nossa realidade e prática e em concordância com as normas internacionais de qualidade de dados. Esse banco de dados constitui uma importante referência para indicações e comparações em procedimentos terapêuticos, assim como propor modelos subsequentes para melhorar a segurança do paciente e a qualidade da prática cirúrgica no país.Dados abertos - Sucupira - Teses e dissertações (2019

Cardiac transplantation and neoplasms: experiences at Escola Paulista de Medicina of the Federal University of São Paulo

OBJECTIVE: To study the occurrence and types of neoplasms developed by patients who underwent an orthotopic cardiac transplantation under the Program of Cardiac Transplantation of Escola Paulista de Medicina, Federal University of São Paulo. METHODS: This is an observational study of 106 patients who underwent orthotopic cardiac transplantation from November 1986 to September 2002 and survived at least thirty days following the procedure. The triple immunosuppressive regimen given included cyclosporin A, azathioprine and a corticosteroid agent. Only two patients received OKT3 in addition to the regimen established. Mean follow-up was 61.4 months (ranging from two months to 192 months). RESULTS: Twenty-three patients (21.3%) developed neoplasms - 56.5% of these were skin neoplasm, 30.1%, solid tumors, and 13.4% of post-transplant lymphoproliferative disease (PTLD). Mean interval between transplantation and diagnosis of neoplasm was: 54.9 months for skin neoplasm; 24.8 months for solid tumors and 70.3 months for PTLD. CONCLUSION: Malignant neoplasms are relatively common in the population studied. Skin cancer was the most common type compared to the other types of neoplasms. Solid tumors were more frequently diagnosed than the lymphoproliferative diseases in the population examined.OBJETIVOS: Analisar ocorrência e tipos de neoplasias que se desenvolveram em pacientes submetidos a transplante cardíaco ortotópico, no Programa de Transplante Cardíaco da Escola de Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP). MÉTODOS: O presente estudo apresenta uma análise observacional de 106 pacientes submetidos a transplante cardíaco ortotópico, no período de novembro de 1986 a setembro de 2002, que sobreviveram por período superior a trinta dias após o procedimento. O regime de imunossupressão consistiu de terapia tríplice com ciclosporina A, azatioprina e corticosteróide. Apenas dois pacientes receberam, além da terapia tríplice, a adição de ortoclone OKT-3. O período médio de acompanhamento foi de 61,4 meses. (variação de dois meses a 192 meses). RESULTADOS: Vinte e três pacientes (21,3%) desenvolveram neoplasias, dos quais 56,5% apresentaram neoplasia de pele, 30,1% apresentaram tumores sólidos e 13,4%, doença linfoproliferativa pós-transplante (DLPT). O intervalo médio entre o transplante e o diagnóstico de neoplasia foi: pele - 54,9 meses, tumores sólidos - 24,8 meses e DLPT - 70,3 meses. CONCLUSÕES: A ocorrência de neoplasias malignas foi relativamente comum na população analisada. O câncer de pele prevaleceu em relação às demais neoplasias e os tumores sólidos foram mais diagnosticados do que as doenças linfoproliferativas nessa série de pacientes.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Sildenafil improves right ventricular function in a cardiac transplant recipient

We report the case of a male patient who underwent orthotopic cardiac transplantation. A marginal donor was used, because the recipient's clinical condition was critical. He experienced cardiogenic shock due to right ventricular dysfunction secondary to pulmonary hypertension associated with vasoplegia. After the introduction of sildenafil, the patient recovered hemodynamically, his pulmonary vascular resistance decreased, the vasoactive drugs were withdrawn, and his right ventricular function improved.Relatamos caso de um paciente submetido a transplante cardíaco ortotópico, onde se utilizou um doador marginal pela piora clínica do receptor, que apresentava choque cardiogênico por disfunção de ventrículo direito secundária a hipertensão pulmonar associado à vasoplegia. Obtivemos recuperação hemodinâmica do paciente, com redução da resistência vascular pulmonar, retirada de drogas vasoativas e recuperação da função do ventrículo direito após a introdução de sildenafil.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients

Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systemsand 7.3% from private (out-of-pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.Univ Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilHosp Caridade Sao Vicente Paulo, Jundiai, SP, BrazilInst Med Integral Prof Fernando Figueira IMIP, Recife, PE, BrazilHosp Base FUNFARME & FAMERP, Sao Jose Do Rio Preto, SP, BrazilIMC, Sao Jose Do Rio Preto, SP, BrazilIrmandade Santa Casa Sao Paulo INCT HPV, Fac Ciencias Med Santa Casa Sao Paulo, Sao Paulo, SP, BrazilFundacao Univ Cardiol, Inst Cardiol Rio Grande do Sul, Porto Alegre, RS, BrazilInst Coracao Natal, Natal, RN, BrazilInst Cardiol Dist Fed, Brasilia, DF, BrazilUniv Fed Maranhao HU UFMA, Univ Hosp, Sao Luis, MA, BrazilHosp Evangelico, Cachoeiro De Itapemirim, ES, BrazilHosp Coracao Sergipe, Aracaju, SE, BrazilHosp Nossa Senhora Salete, Inst Cirurgia Cardiovasc ICCV, Cascavel, PR, BrazilHosp Wilson Rosado, Mossoro, RN, BrazilHosp Bosque Saude, Sao Paulo, SP, BrazilHosp Univ Santa Maria, Santa Maria, RS, BrazilHosp Coracao HCor, Sao Paulo, SP, BrazilHosp Coracao IP HCor, Ins Pesquisa, Sao Paulo, SP, BrazilInst Coracao InCor, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilWeb of Scienc

Synthesis, photophysical and electrochemical properties of novel and highly fluorescent difluoroboron flavanone beta-diketonate complexes

Difluoroboron β-diketonates complexes are highly luminescent with extensive properties such as their fluorescence both in solution and in solid state and their high molar extinction coefficients. Due to their rich optical properties, these compounds have been studied for their applications in organic electronics such as in self-assembly and applications in biosensors, bio-imaging and optoelectronic devices. The easy and fast synthesis of difluoroboron β-diketonate (BF2dbm) complexes makes their applications even more attractive. Although many different types of difluoroboron β-diketonates complexes have been studied, the cyclic flavanone analogues of these compounds have never been reported in the literature. Therefore, the present work aims to synthesize difluouroboron flavanone β-diketonate complexes, study their photophysical and electrochemical properties and assess their suitability for applications in optoelectronic devices. The synthesis was based on a Baker-Venkataraman reaction which initially provided substituted diketones, which were subsequently reacted with aldehydes to afford the proposed flavanones. The complexation was achieved by reacting flavanones and BF3·Et2O and in total 9 novel compounds were obtained. A representative difluoroboron flavanone complex was subjected to single crystal X-ray diffraction to unequivocally confirm the chemical structure. A stability study indicated only partial degradation of these compounds over a few days in a protic solvent at elevated temperatures. Photophysical studies revealed that the substituent groups and the solvent media significantly influence the electrochemical and photophysical properties of the final compounds, especially the molar absorption coefficient, fluorescence quantum yields, and the band gap. Moreover, the compounds exhibited a single excited-state lifetime in all studied solvents. Computational studies were employed to evaluate ground and excited state properties and carry out DFT and TDDFT level analysis. These studies clarify the role of each state in the experimental absorption spectra as well as the effect of the solvent

CCDC 1996094: Experimental Crystal Structure Determination

Related Article: Elida Betania Ariza Paez, Sergio Curcio, Natália P. Neme, Matheus J. S. Matos, Rodrigo S. Correa, Fabio Junio Pereira, Flaviane Francisco Hilário, Thiago Cazati, Jason Guy Taylor|2020|New J.Chem.|44|14615|doi:10.1039/D0NJ03525