LUDHMILA ABRAHAO HAJJAR

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Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: FABIO BISCEGLI JATENE ×

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Agora exibindo 1 - 10 de 21
  • conferenceObject
    Economic analysis of platelet aggregability-guided surgical revascularization compared with standard of care in ACS patients: subanalysis from PLAT-CABG randomized clinical trial
    (2020) NAKASHIMA, C. A. K.; DALIAN, L. A. O.; LISBOA, L. A. F.; JATENE, F. B.; SOEIRO, A. M.; NAJJAR, L. A.; SILVA, B. A.; DORNAS, C. J. C. B.; DALCOQUIO, T. F.; FURTADO, R. H. M.; BARACIOLI, L. M.; FUKUSHIMA, J. T.; GURBEL, P. A.; GIUGLIANO, R. P.; NICOLAU, J. C.
  • article 19 Citação(ões) na Scopus
    Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial
    (2018) FERREIRA, Graziela Santos Rocha; ALMEIDA, Juliano Pinheiro de; LANDONI, Giovanni; VINCENT, Jean Louis; FOMINSKIY, Evgeny; GALAS, Filomena Regina Barbosa Gomes; GAIOTTO, Fabio A.; DALLAN, Luis Oliveira; FRANCO, Rafael Alves; LISBOA, Luiz Augusto; DALLAN, Luis Roberto Palma; FUKUSHIMA, Julia Tizue; RIZK, Stephanie Itala; PARK, Clarice Lee; STRABELLI, Tania Mara; LAGE, Silvia Helena Gelas; CAMARA, Ligia; ZEFERINO, Suely; JARDIM, Jaquelline; ARITA, Elisandra Cristina Trevisan Calvo; RIBEIRO, Juliana Caldas; AYUB-FERREIRA, Silvia Moreira; AULER JR., Jose Otavio Costa; KALIL FILHO, Roberto; JATENE, Fabio Biscegli; HAJJAR, Ludhmila Abrahao
    Objectives: The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. Design: A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. Setting: Heart Institute of SAo Paulo University. Patients: High-risk patients undergoing elective coronary artery bypass surgery. Intervention: Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use. Measurements and Main Results: The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [sd] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51hr [interquartile range, 32-94 hr] vs 39hr [interquartile range, 25-66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4 d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use. Conclusions: In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.
  • article 3 Citação(ões) na Scopus
    Chronic thromboembolic pulmonary hypertension: the impact of advances in perioperative techniques in patient outcomes
    (2021) SCUDELLER, Paula Gobi; TERRA-FILHO, Mario; FILHO, Orival Freitas; GALAS, Filomena Regina Barbosa Gomes; ANDRADE, Tiago Dutra de; NICOTARI, Daniela Odnicki; GOBBO, Laura Michelin; GAIOTTO, Fabio Antonio; HAJJAR, Ludhmila Abrahao; JATENE, Fabio Biscegli
    Objectives: Pulmonary endarterectomy (PEA) is the gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed at reporting outcomes of CTEPH patients undergoing PEA within 10 years, focusing on advances in anesthetic and surgical techniques. Methods: We evaluated 102 patients who underwent PEA between January 2007 and May 2016 at the Instituto do Coracao do Hospital das Clinicas da Universidade de Sao Paulo. Changes in techniques included longer cardiopulmonary bypass, heating, and cooling times and mean time of deep hypothermic circulatory arrest and shortened reperfusion time. Patients were stratified according to temporal changes in anesthetic and surgical techniques: group 1 (January 2007December 2012), group 2 (January 2013-March 2015), and group 3 (April 2015-May 2016). Clinical outcomes were any occurrence of complications during hospitalization. Results: Groups 1, 2, and 3 included 38, 35, and 29 patients, respectively. Overall, 62.8% were women (mean age, 49.1 years), and 65.7% were in New York Heart Association functional class III-IV. Postoperative complications were less frequent in group 3 than in groups 1 and 2: surgical complications (10.3% vs. 34.2% vs. 31.4%, p=0.035), bleeding (10.3% vs. 31.5% vs. 25.7%, p=0.047), and stroke (0 vs. 13.2% vs. 0, p=0.01). Between 3 and 6 months post-discharge, 85% were in NYHA class I-II. Conclusion: Improvements in anesthetic and surgical procedures were associated with better outcomes in CTEPH patients undergoing PEA during the 10-year period.
  • article 4 Citação(ões) na Scopus
    Cerebral hemodynamics with intra-aortic balloon pump: business as usual?
    (2017) CALDAS, J. R.; PANERAI, R. B.; BOR-SENG-SHU, E.; ALMEIDA, J. P.; FERREIRA, G. S. R.; CAMARA, L.; NOGUEIRA, R. C.; OLIVEIRA, M. L.; JATENE, F. B.; ROBINSON, T. G.; HAJJAR, L. A.
    Objective: Intra-aortic balloon pump (IABP) is commonly used as mechanical support after cardiac surgery or cardiac shock. Although its benefits for cardiac function have been well documented, its effects on cerebral circulation are still controversial. We hypothesized that transfer function analysis (TFA) and continuous estimates of dynamic cerebral autoregulation (CA) provide consistent results in the assessment of cerebral autoregulation in patients with IABP. Approach: Continuous recordings of blood pressure (BP, intra-arterial line), end-tidal CO2, heart rate and cerebral blood flow velocity (CBFV, transcranial Doppler) were obtained (i) 5 min with IABP ratio 1: 3, (ii) 5 min, starting 1 min with the IABP-ON, and continuing for another 4 min without pump assistance (IABP-OFF). Autoregulation index (ARI) was estimated from the CBFV response to a step change in BP derived by TFA and as a function of time using an autoregressive moving-average model during removal of the device (ARI(t)). Critical closing pressure and resistance area-product were also obtained. Main results: ARI with IABP-ON (4.3 +/- 1.2) were not different from corresponding values at IABP-OFF (4.7 +/- 1.4, p = 0.42). Removal of the balloon had no effect on ARIt, CBFV, BP, cerebral critical closing pressure or resistance area-product. Significance: IABP does not disturb cerebral hemodynamics. TFA and continuous estimates of dynamic CA can be used to assess cerebral hemodynamics in patients with IABP. These findings have important implications for the design of studies of critically ill patients requiring the use of different invasive support devices.
  • article 3 Citação(ões) na Scopus
    Respiratory failure after lung transplantation: extracorporeal membrane oxygenation as a rescue treatment
    (2012) PEGO-FERNANDES, Paulo Manuel; HAJJAR, Ludhmila Abrahao; GALAS, Filomena Regina Barbosa Gomes; SAMANO, Marcos Naoyuki; RIBEIRO, Alexandre Kazantzi Fonseca; PARK, Marcelo; SOARES, Rodolfo; OSAWA, Eduardo; JATENE, Fabio Biscegli
  • article 11 Citação(ões) na Scopus
    Diretriz de Assistência Circulatória Mecânica da Sociedade Brasileira de Cardiologia
    (2016) AYUB-FERREIRA, Silvia Moreira; SOUZA NETO, Joao David de; ALMEIDA, Dirceu Rodrigues; BISELLI, Bruno; AVILA, Monica Samuel; COLAFRANCESCHI, Alexandre Siciliano; STEFANELLO, Bianca; CARVALHO, Braulio Matias de; POLANCZYK, Carisi Anne; GALANTINI, Danilo Ribeiro; BOCCHI, Edimar Alcides; CHAMLIAN, Eduardo Gregorio; HOJAIJ, Elaine Marques; GAIOTTO, Fabio Antonio; PINTON, Fabio Augusto; JATENE, Fabio Biscegli; RAMIRES, Felix Jose Alvarez; ATIK, Fernando Antibas; FIGUEIRA, Fernando; BACAL, Fernando; GALAS, Filomena Regina Barbosa Gomes; BRITO, Flavio de Souza; CONCEICAO-SOUZA, Germano Emilio; RIBEIRO, Gustavo Calado de Aguiar; PINHEIRO JUNIOR, Jairo Alves; SOUZA, Januario Manoel de; ROSSI NETO, Joao Manoel; LIMA, Jose Lindemberg da Costa; MEJIA, Juan Cosquillo; FERNANDES, Juliana Rolim; BAUMWORCEL, Leonardo; MOURA, Lidia Ana Zytynski; HAJJAR, Ludhmila Abrahao; BECK-DA-SILVA, Luis; ROHDE, Luis Eduardo Paim; SEGURO, Luis Fernando Bernal da Costa; PINHEIRO, Mabel Leite; PARK, Marcelo; FERNANDES, Marcelo Ramalho; MONTERA, Marcelo Westerlund; ALVES, Marco Stephan Lofrano; WANDERLEY JUNIOR, Mauro Rogerio de Barros; HOSSNE, Nelson; FERNANDES, Paulo Manuel Pego; LEMOS, Pedro; SCHNEIDEWIND, Rafael Otto; UCHOA, Ricardo Barreira; HONORATO, Ronaldo; MANGINI, Sandrigo; FALCAO, Sandra Nivea dos Reis Saraiva; LOPES, Sergio Augusto Veiga; STRABELLI, Tania Mara Varejao; GUIMARAES, Tereza Cristina Felippe; CAMPANILI, Ticiane Carolina Goncalves Faustino; ISSA, Victor Sarli
  • article 23 Citação(ões) na Scopus
    Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management
    (2012) TEDDE, Miguel L.; VASCONCELOS FILHO, Paulo; HAJJAR, Ludhmila Abrahao; ALMEIDA, Juliano Pinheiro de; FLORA, Gustavo Fagundes; OKUMURA, Erica Mie; OSAWA, Eduardo A.; FUKUSHIMA, Julia Tizue; TEIXEIRA, Manoel Jacobsen; GALAS, Filomena Regina Barbosa Gomes; JATENE, Fabio Biscegli; AULER JR., Jose Otavio Costa
    OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov:NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.
  • article 11 Citação(ões) na Scopus
    Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
    (2021) FRANCO, Rafael Alves; ALMEIDA, Juliano Pinheiro de; LANDONI, Giovanni; SCHEEREN, Thomas W. L.; GALAS, Filomena Regina Barbosa Gomes; FUKUSHIMA, Julia Tizue; ZEFFERINO, Suely; NARDELLI, Pasquale; PICCIONI, Marilde de Albuquerque; ARITA, Elisandra Cristina Trevisan Calvo; PARK, Clarice Hyesuk Lee; CUNHA, Ligia Cristina Camara; OLIVEIRA, Gisele Queiroz de; COSTA, Isabela Bispo Santos da Silva; KALIL FILHO, Roberto; JATENE, Fabio Biscegli; HAJJAR, Ludhmila Abrahao
    BackgroundThe detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine).ResultsA total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p=0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay.DiscussionAlthough it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery.Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801
  • conferenceObject
    VASOPRESSIN OR NOREPINEPHRINE IN VASOPLEGIC AFTER CARDIAC SURGERY (YANCS STUDY): A RANDOMIZED, DOUBLE-BLIND AND CONTROLLED STUDY
    (2014) HAJJAR, L. A.; VINCENT, J. L.; RHODES, A.; GALAS, F.; FUKUSHIMA, J. T.; OSAWA, E. A.; GRANDE, S. M.; ALMEIDA, J. P.; ZEFFERINO, S.; CAMARA, L.; JATENE, F. B.; FILHO, R. K.
  • article 10 Citação(ões) na Scopus
    Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization
    (2021) NAKASHIMA, Carlos A. K.; DALLAN, Luis A. O.; LISBOA, Luiz A. F.; JATENE, Fabio B.; HAJJAR, Ludhmila A.; SOEIRO, Alexandre M.; FURTADO, Remo H. M.; DALCOQUIO, Talia F.; BARACIOLI, Luciano M.; LIMA, Felipe G.; V, Roberto R. C. Giraldez; SILVA, Bianca A.; COSTA, Mateus S. S.; STRUNZ, Celia M. C.; DALLAN, Luis R. P.; BARBOSA, Carlos J. D. G.; BRITTO, Flavia A. B.; FARKOUH, Michael E.; GURBEL, Paul A.; NICOLAU, Jose C.
    BACKGROUND Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications. OBJECTIVES This study aimed to evaluate if a platelet reactivity-based strategy is noninferior to standard of care for 24-h post-CABG bleeding. METHODS In this randomized, open label noninferiority trial, 190 patients admitted with ACS with indications for CABG and on aspirin and P2Y(12) receptor inhibitors, were assigned to either control group, P2Y(12) receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day after platelet reactivity normalization (predefined as >= 46 aggregation units). RESULTS Within the first 24 h of CABG, the median chest tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and 350 ml (IQR: 255 to 500 ml) in the intervention and control groups, respectively (p for noninferiority <0.001). The median waiting period between the decision to undergo CABG and the procedure was 112 h (IQR: 66 to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the intention-to-treat analysis, a 6.4% decrease in the median in-hospital expenses was observed in the intervention group (p = 0.014), with 11.2% decrease in the analysis per protocol (p = 0.003). CONCLUSIONS A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with ACS awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses. (C) 2021 by the American College of Cardiology Foundation.