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Doctoral Thesis
DOI
https://doi.org/10.11606/T.98.2022.tde-13072023-201032
Document
Author
Full name
Jenny Lourdes Rivas de Oliveira
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2022
Supervisor
Committee
Timerman, Ari (President)
Campagnucci, Valquiria Pelisser
Fonseca, José Honório de Almeida Palma da
Togna, Dorival Julio Della
Title in Portuguese
Avaliação da resposta inflamatória no pós-operatório de pacientes com anel aórtico pequeno após implante de prótese valvar Perceval e seu impacto na sobrevida no curto e médio prazo
Keywords in Portuguese
Estenose da Valva Aórtica
Implante de Prótese de Valva Cardíaca, Bioprótese
Interleucinas
Síndrome de Resposta Inflamatória Sistêmica
Vesículas Extracelulares
Abstract in Portuguese
A Síndrome de Resposta Inflamatória Sistêmica (Systemic Inflammatory Response Syndrome, SIRS) está relacionada com aumento de micropartículas endoteliais circulantes, como marcadores de comprometimento endotelial em pacientes com estenose aórtica e no pós-operatório de pacientes submetidos à troca valvar aórtica. O objetivo deste estudo foi avaliar o impacto da resposta inflamatória na sobrevida no curto e médio prazo e sua relação com os níveis de micropartículas endoteliais no pós-operatório entre pacientes com anel aórtico pequeno submetidos ao implante de prótese biológica de uso rotineiro e prótese Sutureless Perceval (LivaNova). O estudo foi prospectivo randomizado de 24 pacientes submetidos à Troca valvar aórtica isolada divididos em dois grupos: prótese valvar Perceval (Grupo P) e prótese valvar biológica convencional (Grupo C). Análise do perfil de liberação de micropartículas endoteliais e concentração plasmática de marcadores inflamatórios Interleucinas 6 e 8, Proteína C Reativa, Procalcitonina; realizados no pré e pós-operatório com 24 horas e 3 meses, e a sua relação com a resposta inflamatória; realização do ecocardiograma transtorácico no período pré-operatório e pós-operatório de 30 dias e 6 meses. 24 pacientes, com idade 69,92±5,17 anos, 83,33% do sexo feminino,12 pacientes em cada grupo, a incidência de SIRS foi igual em ambos os grupos, 11(91,7%) pacientes em ambos os grupos, na concentração plasmática de micropartículas endoteliais não houve interação estatisticamente significativa, os grupos se comportaram de maneira similar ao longo do tempo P=0,11, com aumento no pós-operatório de 24 horas e posterior diminuição no pós-operatório de 3 meses. Na Interleucina 8, a interação foi significativa P=0,006, maior aumento no grupo Convencional.
Title in English
Assessment of postoperative inflammatory response in patients with small aortic annulus after Perceval valve prosthesis implantation and its impact on short and medium term survival
Keywords in English
Aortic Valve Stenosis
Bioprosthesis Systemic Inflammatory Response Syndrome
Extracellular Vesicles
Heart Valve Prosthesis Implantation
Interleukins
Abstract in English
SIRS (Systemic Inflammatory Response Syndrome) is related to an increase in the number of circulating endothelial microparticles as markers of endothelial impairment in patients with aortic stenosis and/or patients in postoperative recovery after having undergone an aortic valve replacement surgery. The purpose of this study was to assess the impact of inflammatory responses on short- and medium term survival rates, and its relation to the levels of endothelial microparticles among patients with small aortic annulus having undergone implantation of a conventional biological prosthesis or a Perceval Sutureless prosthesis. A prospective, randomized study was conducted involving 24 patients who undergoing isolated aortic valve replacement surgery. The patients are divided into two groups: those with Perceval valves (P Group) and those with conventional bioprosthetic valves (C Group), with the evaluation of: the release profile of endothelial microparticles, and the plasma concentration of inflammatory markers; Interleukins-6 and -8; reactive C protein; the levels of procalcitonin (preoperative, and 24-hour and 3-month postoperative), and their relation to an inflammatory response and performing transthoracic echocardiogram during the postoperative (30-day and 6-month) follow-up period. 24 patients, aged 69.92±5.17 years, 83.33% female, 12 patients in each group, the incidence of SIRS was the same in both groups, 11 (91.7%) patients in both groups, in the plasma concentration of endothelial microparticles there was no statistically significant interaction, the groups behaved similarly over time P=0.11, with an increase in the 24-hour postoperative period and a subsequent decrease in the 3-month postoperative period. In Interleukin 8, the interaction was significant P=0.006, greater increase in the Conventional group.
 
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Publishing Date
2023-09-29
 
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