AIDA LUIZA RIBEIRO TURQUETTO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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bookPart Exercício físico na criança e no adolescente(2019) AGOSTINHO, Daniela Regina; TURQUETTO, Aída Luiza Ribeiro- Development of an international standard set of patient-centred outcome measures for overall paediatric health: a consensus process(2021) ALGUREN, Beatrix; RAMIREZ, Jessily P.; SALT, Matthew; SILLETT, Nick; MYERS, Stacie N.; ALVAREZ-COTE, Albie; BUTCHER, Nancy J.; CANEO, Luiz F.; CESPEDES, Jaime A.; CHAPLIN, John E.; NG, Kee Chong; GARCIA-GARCIA, Juan J.; HAZELZET, Jan A.; KLASSEN, Anne F.; TURQUETTO, Aida Luiza R.; MEW, Emma J.; MORRIS, Michael; OFFRINGA, Martin; O'MEARA, Matthew; PAPP, James M.; RODRIGO, Carlos; SWITAJ, Timothy L.; MAYER, Catalina Valencia; JENKINS, Kathy J.Objective To develop an Overall Pediatric Health Standard Set (OPH-SS) of outcome measures that captures what matters to young people and their families and recognising the biopsychosocial aspects of health for all children and adolescents regardless of health condition. Design A modified Delphi process. Setting The International Consortium for Health Outcomes Measurement convened an international Working Group (WG) comprised of 23 international experts from 12 countries in the field of paediatrics, family medicine, psychometrics as well as patient advisors. The WG participated in 11 video-conferences, through a modified Delphi process and 9 surveys between March 2018 and January 2020 consensus was reached on a final recommended health outcome standard set. By a literature review conducted in March 2018, 1136 articles were screened for clinician and patient-reported or proxy-reported outcomes. Further, 4315 clinical trials and 12 paediatric health surveys were scanned. Between November 2019 and January 2020, the final standard set was endorsed by a patient validation (n=270) and a health professional (n=51) survey. Results From a total of 63 identified outcomes, consensus was formed on a standard set of outcome measures that comprises 10 patient-reported outcomes, 5 clinician-reported measures, and 6 case-mix variables. The four developmental age-specific packages (ie, 0-5, 6-12, 13-17, 18-24 years) include either five or six measures with an average time for completion of 20 min. Conclusions The OPH-SS is a starting point to drive value-based paediatric healthcare delivery from a global perspective for enhancing child and adolescent physical health and psychosocial well-being.
- Blunted peripheral blood supply and underdeveloped skeletal muscle in Fontan patients: The impact on functional capacity(2018) TURQUETTO, Aida Luiza Ribeiro; SANTOS, Marcelo Rodrigues dos; SAYEGH, Ana Luiza Carrari; SOUZA, Francis Ribeiro de; AGOSTINHO, Daniela Regina; OLIVEIRA, Patricia Alves de; SANTOS, Yarla Alves dos; LIBERATO, Gabriela; BINOTTO, Maria Angelica; OTADUY, Maria Concepcion Garcia; NEGRAO, Carlos Eduardo; CANEO, Luiz Fernando; JATENE, Fabio Biscegli; JATENE, Marcelo BiscegliBackground: Changes in circulatory physiology are common in Fontan patients due to suboptimal cardiac output, which may reduce the peripheral blood flow and impair the skeletal muscle. The objective of this study was to investigate the forearm blood flow (FBF), cross-sectional area (CSA) of the thigh and functional capacity in asymptomatic clinically stable patients undergoing Fontan surgery. Methods: Thirty Fontan patients and 27 healthy subjects underwent venous occlusion plethysmography, magnetic resonance imaging of the thigh musculature and maximal cardiopulmonary exercise testing. Muscle sympathetic nerve activity (MSNA), norepinephrine measures, cardiovascular magnetic resonance, handgrip strength and 6-minute walk test were also performed. Results: Fontan patients have blunted FBF (1.59 +/- 0.33 vs 2.17 +/- 0.52 mL/min/100 mL p < 0.001) and forearm vascular conductance (FVC) (1.69 +/- 0.04 vs 2.34 +/- 0.62 units p < 0.001), reduced CSA of the thigh (81.2 +/- 18.6 vs 116.3 +/- 26.4 cm(2) p < 0.001), lower peak VO2 (29.3 +/- 6 vs 41.5 +/- 9mL/kg/min p < 0.001), walked distance (607 +/- 60 vs 701 +/- 58m p < 0.001) and handgrip strength (21 +/- 9 vs 30 +/- 8 kgf p < 0.001). The MSNA (30 +/- 4 vs 22 +/- 3 bursts/min p < 0.001) and norepinephrine concentration [265 (236-344) vs 222 (147-262) pg/mL p = 0.006] were also higher in Fontan patients. Multivariate linear regression showed FVC (beta = 0.653; CI = 0.102-1.205; p = 0.022) and stroke volume (beta = 0.018; CI = 0.007-0.029; p = 0.002) to be independently associated with reduced CSA of the thigh adjusted for body mass index. The CSA of the thigh adjusted for body mass index (beta = 5.283; CI = 2.254-8.312; p = 0.001) was independently associated with reduced peak VO2. Conclusion: Patients with Fontan operation have underdeveloped skeletal muscle with reduced strengh that is associated with suboptimal peripheral blood supply and diminished exercise capacity.
- Lessons Learned From a Critical Analysis of the Fontan Operation Over Three Decades in a Single Institution(2017) CANEO, Luiz Fernando; TURQUETTO, Aida L. R.; NEIROTTI, Rodolfo A.; BINOTTO, Maria A.; MIANA, Leonardo A.; TANAMATI, Carla; PENHA, Juliano G.; SILVEIRA, Joao B. D.; SILVA, Thais M. Alexandre e; JATENE, Fabio B.; JATENE, Marcelo B.Background: The Fontan operation (FO) has evolved and many centers have demonstrated improved results relative to those from earlier eras. We report a single-institution experience over three decades, describing the outcomes and evaluating risk factors. Methods: Successive patients undergoing primary FO were divided into era I (1984-1994), era II (1995-2004), and era III (2005-2014). Clinical and operative notes were reviewed for demographic, anatomic, and procedure details. End points included early and late mortality and a composite of death, heart transplantation (HTX), or Fontan takedown. Results: A total of 420 patients underwent 18 atriopulmonary connections, 82 lateral tunnels (LT), and 320 extracardiac conduit (EC) Fontan procedures. Forty-six (11%) patients died; early and late mortality were 7.9% and 3.1%, respectively. Eight (1.9%) patients underwent HTX, 11 (2.6%) underwent Fontan conversion to EC, and 1 (0.2%) takedown of EC to bidirectional Glenn shunt. Prevalence of concomitant valve surgery (P < .001) and pulmonary artery reconstruction (P < .001) differed over the eras. Preoperative valve regurgitation was associated with likelihood of early mortality (odds ratio [OR] = 3.5, P = .002). Embolic events (OR = 1.9, P = .047), preoperative valve regurgitation (OR = 2.3, P = .029), diagnosis of unbalanced atrioventricular canal defect (OR = 1.14, P = .03), and concomitant valve replacement (OR = 6.9, P = .001) during the FO were associated with increased risk of the composite end point (death, HTX, or takedown). Conclusion: Technical modifications did not result in improved results across eras, due in part to more liberal indications for surgery in the recent years. Valve regurgitation, unbalanced atrioventricular canal, embolic events, or concomitant valve replacement were associated with FO failure.
- Impaired Pulmonary Function is an Additional Potential Mechanism for the Reduction of Functional Capacity in Clinically Stable Fontan Patients(2017) TURQUETTO, Aida L. R.; CANEO, Luiz F.; AGOSTINHO, Daniela R.; OLIVEIRA, Patricia A.; LOPES, Maria Isabel C. S.; TREVIZAN, Patricia F.; FERNANDES, Frederico L. A.; BINOTTO, Maria A.; LIBERATO, Gabriela; TAVARES, Glaucia M. P.; NEIROTTI, Rodolfo A.; JATENE, Marcelo B.Central factors negatively affect the functional capacity of Fontan patients (FP), but ""non-cardiac"" factors, such as pulmonary function, may contribute to their exercise intolerance. We studied the pulmonary function in asymptomatic FP and its correlations with their functional capacity. Pulmonary function and cardiopulmonary exercise tests were performed in a prospective study of 27 FP and 27 healthy controls (HC). Cardiovascular magnetic resonance was used to evaluate the Fontan circulation. The mean age at tests, the mean age at surgery, and the median follow-up time of FP were 20(+/- 6), 8(+/- 3), and 11(8-17) years, respectively. Dominant ventricle ejection fraction was within normal range. The mean of peak VO2 expressed in absolute values (L/min), the relative values to body weight (mL/kg/min), and their predicted values were lower in FP compared with HC: 1.69 (+/- 0.56) vs 2.81 (+/- 0.77) L/min; 29.9 (+/- 6.1) vs 41.5 (+/- 9.3) mL/kg/min p < 0.001 and predicted VO2 Peak [71% (+/- 14) vs 100% (+/- 20) p < 0.001]. The absolute and predicted values of the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), inspiratory capacity (IC), total lung capacity (TLC), diffusion capacity of carbon monoxide of the lung (DLCO), maximum inspiratory pressure (MIP), and sniff nasal inspiratory pressure (SNIP) were also significantly lower in the Fontan population compared to HC. An increased risk of restrictive ventilatory pattern was found in patients with postural deviations (OD:10.0, IC:1.02-97.5, p = 0.042). There was a strong correlation between pulmonary function and absolute peak VO2 [FVC (r = 0.86, p < 0.001); FEV1 (r = 0.83, p < 0.001); IC (r = 0.84, p < 0.001); TLC (r = 0.79, p < 0.001); and DLCO (r = 0.72, p < 0.001). The strength of the inspiratory muscles in absolute and predicted values was also reduced in FP [-79(+/- 28) vs -109(+/- 44) cmH(2)O (p = 0.004) and 67(+/- 26) vs 89(+/- 36) % (p = 0.016)]. Thus, we concluded that the pulmonary function was impaired in clinically stable Fontan patients and the static and dynamic lung volumes were significantly reduced compared with HC. We also demonstrated a strong correlation between absolute Peak VO2 with the FVC, FEV1, TLC, and DLCO measured by complete pulmonary test.
- Effect Of Supervised Physical Training In Patients With Univentricular Physiology After Fontan Operation(2019) AGOSTINHO, Daniela Regina; TURQUETTO, Aida Luiza Ribeiro; AMATO, Luciana Patrick; OLIVEIRA, Patricia Alves de; SILVEIRA, Joao Bruno Dias; BARNABE, Milena Schiezari Ru; HODAS, Fabiana Padilla; CANEO, Luiz Fernando; NEGRAO, Carlos Eduardo; JATENE, Marcelo Bisegli
- Risk factors for death or mechanical ventilation time after bidirectional cavopulmonary anastomosis in a developing country(2022) JONAS, Marina C.; CARMONA, Fabio; CANEO, Luiz F.; TURQUETTO, Aida L. R.; JATENE, Marcelo B.; MANSO, Paulo H.Background: Glenn procedure is performed for patients with cyanotic CHD and univentricular physiology and has a survival rate above 90%. Aim: To evaluate the risk factors associated with a poor outcome after Glenn procedure. Methods: The data for this retrospective analysis were collected from a regional Brazilian registry of congenital heart surgeries (ASSIST initiative) from 2014 to 2019. Data from 97 patients who underwent the Glenn procedure were considered. The primary outcomes were prolonged mechanical ventilation (>24 hours post-operatively) or in-hospital death, alone and combined. Results: The overall in-hospital mortality was 13.4% (n = 13). Prolonged mechanical ventilation occurred in 52% (n = 51) of the patients. Our analysis found that risk factors for death or prolonged post-operative mechanical ventilation were cardiopulmonary bypass duration and post-operative lactate, whereas weight-for-age z-score and age at surgery were risk factors for prolonged mechanical ventilation. Cardiopulmonary bypass duration increased (adjusted odds ratio: 1.02; 95 % CI: 1.01, 1.03) and age at surgery decreased (adjusted odds ratio: 0.96; 95 % CI: 0.93, 0.99) the odds of the combined outcome. Conclusions: Age at surgery, post-operative lactate, and low-weight-for-age z-score are associated with prolonged mechanical ventilation and death following the Glenn procedure.
- Initial experience with del Nido cardioplegia solution at a Pediatric and Congenital Cardiac Surgery Program in Brazil(2022) CANEO, Luiz Fernando; MATTE, Gregory S.; TURQUETTO, Aida Luiza R.; PEGOLLO, Luana Marques de Carvalho; MIGLIOLI, Maria Clara Amato; SOUZA, Gisele T. de; AMATO, Luciana Patrick; MIANA, Leonardo A.; MASSOTI, Maria Raquel B.; PENHA, Juliano G.; TANAMATI, Carla; JATENE, Marcelo B.; JATENE, Fabio B.Objective: The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients. Methods: Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas' solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality. Results: Both groups were comparable demographically. Statistically significant differences (p <= 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance. Conclusion: In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas' solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.
- Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?(2019) MANUEL, Valdano; MORAIS, Humberto; TURQUETTO, Aida L. R.; MIGUEL, Gade; MIANA, Leonardo A.; PEDRO, Albino; NUNES, Maria A. S.; LEON, Gilberto; MAGALHAES, Manuel Pedro; MARTINS, Telmo; JUNIOR, Antonio P. F.Introduction: Single ventricle physiology management is challenging, especially in low-income countries Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock-Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.
- The role of the neutrophil-lymphocyte ratio for pre-operative risk stratification of acute kidney injury after tetralogy of Fallot repair(2021) MANUEL, Valdano; MIANA, Leonardo A.; TURQUETTO, Aida; GUERREIRO, Gustavo Pampolha; FERNANDES, Natalia; JATENE, Marcelo BiscegliIntroduction: Acute kidney injury is a risk factor for chronic kidney disease and mortality after congenital heart surgery under cardiopulmonary bypass. The neutrophil-lymphocyte ratio is an inexpensive and easy to measure biomarker for predicting outcomes in children with congenital heart disease undergoing surgical correction. Objective: To identify children at high risk of acute kidney injury after tetralogy of Fallot repair using the neutrophil-lymphocyte ratio. Methods: This single-centre retrospective analysis included consecutive patients aged < 18 years who underwent tetralogy of Fallot repair between January 2014 and December 2018. The pre-operative neutrophil-lymphocyte ratio was measured using the last pre-operative complete blood count test. We used the Acute Kidney Injury Network definition. Results: A total of 116 patients were included, of whom 39 (33.6%) presented with acute kidney injury: 20 (51.3%) had grade I acute kidney injury, nine had grade II acute kidney injury (23.1%), and 10 (25.6%) had grade III acute kidney injury. A high pre-operative neutrophil-lymphocyte ratio was associated with grade III acute kidney injury in the post-operative period (p = 0.04). Patients with acute kidney injury had longer mechanical ventilation time (p = 0.023), intensive care unit stay (p < 0.001), and hospital length of stay (p = 0.002). Conclusion: Our results suggest that the pre-operative neutrophil-lymphocyte ratio can be used to identify patients at risk of developing grade III acute kidney injury after tetralogy of Fallot repair.