Transplante cardíaco ortotópico: experiência na Universidade Federal de São Paulo (UNIFESP)

• Autor(a) principal: Branco, João Nelson Rodrigues [UNIFESP]
• Data de Publicação: 1998
• Outros Autores: Teles, Carlos Alberto [UNIFESP], Aguiar, Luciano de Figueiredo [UNIFESP], Vargas, Guilherme Flora [UNIFESP], Hossne Junior, Nelson Americo [UNIFESP], Andrade, José Carlos S. [UNIFESP], Carvalho, Antonio Carlos [UNIFESP], Buffolo, Enio [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• dARK ID: ark:/48912/0013000012b3s
• DOI: 10.1590/S0102-76381998000400002
• Texto Completo: http://dx.doi.org/10.1590/S0102-76381998000400002; http://repositorio.unifesp.br/handle/11600/678
• topic: Heart transplantation; Graft rejection; Transplante de coração; Rejeição de enxerto

From November, 1986 to April, 1997; 92 orthotopic heart transplants were performed, with recipient mean age of 44,9 years (range 3 to 63 years). Recipient diagnoses included dilated cardiomyopathy in 42 (44.6%) ischemic cardiomyopathy in 23 (25%), Chagas disease in 21 (22.8%), valve disease in 3 (3.2%) patients. The surgical technique used (described by Lower e Shumway, in 1960, with minor modification) was satisfactory and without complication. Graft ischemic time - Longer in heart transported from other institutions compared to side-by-side transplantation - was always less than 4 hours. The most common chronic complications of immunosuppressive therapy were: arterial hyperthension (84.6%), hyperuricemia (75.4%) and hypercholesterolemia (63%). Regarding infections, viral were the most common ones with 92 (45.6%) followed by bacterial with 35 (38.0%), and protozoal with 15 (16.3%) cases. Among bacterial infections, 7 occurred in the surgical wound, with good evolution. Among those infections caused by protozoal, 7 (46.6%) were due to Trypanossoma cruzi. The overall mortality rate within 30 days of transplantation was 17.3%, with infection, neurologic complications and rejection as major causes. From 30 days to 1 year of transplantation, the mortality rate was 10.3%, with infection and rejection as primary causes. And after one year post-transplantation, the mortality rate was 14%, with several different causes: sudden death, infection, rejection and others. The actuarial survival estimates at 1, 2, 3, 4, 5, and 6 years were 71.6%, 66.5%, 60.5%, 54.4%, 54.4% and 54.4%, respectively. There were no follow-up losses, and all the surviving patients are in functional type I of the NYHA. Cardiac transplantation procedure is possible in our community with accetable survival and post-operative complication rates acceptable, even though different from international statistics.