Perspectivas da evolução clínica de pacientes com cardiomiopatia chagásica listados em prioridade para o transplante cardíaco

Abstract

RBCCV 44205-757Perspectivas da evolução clínica de pacientes com cardiomiopatia chagásica listados em prioridade para o transplante cardíaco Clinical perspectives of patients with Chagas cardiomyopathy listed as high priority for heart transplantation Abstract Introduction: Heart failure deterioration is responsible for elevated mortality rates in the heart transplantation waiting lists. In Chagas cardiomyopathy, the presence of biventricular dysfunction increases the severity of this complication.Method: We studied 141 patients with cardiogenic shock, listed in priority for heart transplantation. Forty six patients presented Chagas cardiomyopathy and 95 other cardiomyopathies. Heart failure deterioration was treated with intravenous inotropic drugs and intra-aortic balloon pump insertion. Five patients with Chagas disease underwent paracorporeal left ventricular assist device implantation.Results: During a mean follow-up of 2.8 months, 58 (41.1%) of the 141 patients were transplanted, while 73 (53.7%) died and 10 were removed from the waiting list. The mortality of chagasic and non chagasic patients were 45.6% and 54.7%, respectively. Otherwise, the median survival expectation of patients with Chagas disease, without the heart transplantation performance, was only 1.5 months, and these patients presented a relative risk of mortality of 1.6 in relation to patients with other cardiomyopathies (p<0.05). The five patients submitted to left ventricular assist device implantation were maintained under support for a mean of 22 days. Two of them were transplanted, two died due to multiple organ failure and one still under circulatory support. None of these patients presented right ventricular dysfunction and there were no device related complications.Conclusion: The evolution of heart failure deterioration seems to be rapid in patients with Chagas cardiomyopathy. Therefore, it is important the precocious indication of mechanical circulatory support as a bridge to heart transplantation in these patients.Descriptors: Chagas cardiomyopathy. Shock, cardiogenic. Heart transplantation. Heart assist devices. 262 MOREIRA, LFP ET AL -Clinical perspectives of patients with Chagas cardiomyopathy listed as high priority for heart transplantation

Perfil dos pacientes na Lista Única de Espera para transplante cardíaco no estado do Ceará

“…In another study, conducted in another period, idiopathic dilated cardiomyopathy (37.5%), ischemic cardiomyopathy (33.9%), Chagas' disease (17.5%) also prevailed 7 . Another more recent study found similar findings, with prevalence of idiopathic dilated cardiomyopathy (39%), Chagas' disease (26.5%), ischemic cardiomyopathy (24.2%) and other etiologies (10.3%) 11 . Dilated cardiomyopathy is characterized by a uni or biventricular dysfunction with a progressive character, with deficiency in contractility; the etiology is varied and may be caused by multiple factors, including genetic, immunological and infectious factors which are decisive for myocardial injury 12 .…”

Transplante cardíaco na doença de Chagas

“…Estudos multicêntricos com transplante cardíaco em portadores de cardiomiopatia chagásica têm mostrado, de maneira paradoxal, que, em comparação com as outras etiologias, a sobrevida destes pacientes tende a melhorar após a cirurgia, apesar de a enfermidade representar um fator de risco para os pacientes em lista de espera [29][30][31] . É possível que a baixa reatividade vascular pulmonar própria desta doença e a maior atenção dedicada no pós-operatório em função da possibilidade de reativação possam desempenhar um papel favorável no acompanhamento destes pacientes.…”

Caracterização dos cuidadores de candidatos a transplante do coração na UNIFESP

“…In hemodynamically unstable patients, hospitalization is sometimes necessary in order to optimize their clinical conditions. This optimization is undertaken by administrating inotropic drugs, using intraaortic balloon, or other circulatory support devices by varying time periods, thus, minimizing the perioperative risk, while still in the waiting transplant list [15,16].…”