MONICA SAMUEL AVILA GRINBERG
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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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- Survival of Heart Transplant Patients with Chagas' Disease Under Different Antiproliferative Immunosuppressive Regimens(2023) FURQUIM, Silas Ramos; GALBIATI, Luana Campoli; AVILA, Monica S.; MARCONDES-BRAGA, Fabiana G.; FUKUSHIMA, Julia; MANGINI, Sandrigo; SEGURO, Luis Fernando Bernal da Costa; CAMPOS, Iascara Wozniak de; STRABELLI, Tania Mara Varejao; BARONE, Fernanda; PAULO, Audrey Rose da Silveira Amancio de; OHE, Luciana Akutsu; GALANTE, Mariana Cappelletti; GAIOTTO, Fabio Antonio; BACAL, FernandoBackground: Chagas' disease (CD) is an important cause of heart transplantation (HT). The main obstacle is Chagas' disease reactivation (CDR), usually associated to high doses of immunosuppressants. Previous studies have suggested an association of mycophenolate mofetil with increased CDR. However, mortality predictors are unknown.Objectives: To identify mortality risk factors in heart transplant patients with CD and the impact of antiproliferative regimen on survival.Methods: Retrospective study with CD patients who underwent HT between January 2004 and September 2020, under immunosuppression protocol that prioritized azathioprine and change to mycophenolate mofetil in case of rejection. We performed univariate regression to identify mortality predictors; and compared survival, rejection and evidence of CDR between who received azathioprine, mycophenolate mofetil and those who changed from azathioprine to mycophenolate mofetil after discharge (""Change"" group). A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included, 54.1% men, median age 49 (39-57) years, and 91.8% were given priority in waiting list. Nineteen (22.4%) used azathioprine, 37 (43.5%) mycophenolate mofetil and 29 (34.1%) switched therapy; survival was not different between groups, 2.9 (1.6-5.0) x 2.9 (1.8-4.8) x 4.2 (2.0-5.0) years, respectively; p=0.4. There was no difference in rejection (42%, 73% and 59% respectively; p=0.08) or in CDR (T. cruzi positive by endomyocardial biopsy 5% x 11% x 7%; p=0.7; benznidazole use 58% x 65% x 69%; p=0.8; positive PCR for T. cruzi 20% x 68% x 42% respectively; p=0.1) rates.Conclusions: This retrospective study did not show difference in survival in heart transplant patients with CD receiving different antiproliferative regimens. Mycophenolate mofetil was not associated with statistically higher rates of CDR or graft rejection in this cohort. New randomized clinical trials are necessary to address this issue.
- 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
- 3rd Brazilian Directive on Cardiac Transplantation(2018) BACAL, Lemando; MARCONDES-BRAGA, Fabiana C.; ROHDE, Luis Eduardo Paim; XAVIER JUNIOR, Jose Leudo; BRITO, Flavio de Souza; MOURA, Lidia Ana Zytynski; COLAFRANCESCHI, Alexandre Siciliano; LAVAGNOLI, Carlos Fernando Ramos; GELAPE, Claudio Leo; ALMEIDA, Dirceu Rodrigues; GAIOTTO, Fabio Antonio; ATIK, Fernando Antibas; FIGUEIRA, Fernando Augusto M. S.; SOUZA, Germano Emilio Conceicao; RODRIGUES, Helcio; CAMPOS, Iascara Wozniak; SOUZA NETO, Joao David de; ROSSI NETO, Joao Manoel; GASPARETTO, Juliano; GOLDRAICH, Livia Adams; BENVENUTI, Luiz Alberto; SEGURO, Luis Fernando B. C.; ULHOA JUNIOR, Marcelo Boteiho; V, Maria da Consolacao Moreira; AVILA, Monica Samuel; CARNEIRO, Rodrigo; MANGINI, Sandrigo; FERREIRA, Silvia Moreira Ayub; STRABELLI, Tania Mara
- Bone Metabolism Impairment in Heart Transplant: Results From a Prospective Cohort Study(2020) SEGURO, Luis F. B. C.; PEREIRA, Rosa M. R.; SEGURO, Luciana P. C.; CAPARBO, Valeria F.; AVILA, Monica S.; MANGINI, Sandrigo; CAMPOS, Iascara W.; GAIOTTO, Fabio A.; MARCONDES-BRAGA, Fabiana G.; BACAL, FernandoBackground. Data on the prevention of fractures after heart transplant (HTx) are controversial in the literature. Understanding the effects of HTx on bone may guide appropriate treatments in this high-risk population. Methods. Seventy adult HTx patients were followed for 12 months. Clinical and laboratory parameters, bone mineral density, microarchitecture, and vertebral fractures were assessed at baseline (after intensive care unit discharge) and at 6 and 12 months. Patients received recommendations regarding calcium intake and vitamin D supplementation after HTx. Results. At baseline, 27% of patients had osteoporosis, associated with the length of hospitalization before HTx (P = 0.001). Bone mineral density decreased in the first 6 months, with partial recovery later. Bone microarchitecture deteriorated, mainly in the trabecular bone in the first 6 months and cortical bone in the subsequent 6 months. At baseline, 92.9% of patients had vitamin D levels <30 ng/mL and 20.0% <10 ng/mL. Patients also had calcium at the lower limit of normal, high alkaline phosphatase, and high bone resorption biomarker. These abnormalities were suggestive of impaired bone mineralization and normalized at 6 months with correction of vitamin D deficiency. The majority of vertebral fractures were identified at baseline (23% of patients). After multivariate analyses, only a lower fat mass persisted as a risk factor for vertebral fractures (odds ratio, 1.23; 95% confidence interval, 1.04-1.47; P = 0.012). Conclusions. High frequencies of densitometric osteoporosis, vitamin D deficiency, bone markers abnormalities, and vertebral fractures were observed shortly after HTx. Calcium and vitamin D supplementation should be the first step in correcting bone mineralization impairment before specific osteoporosis treatment.
article 3rd Brazilian Directive on Cardiac Transplantation (vol 111, pg 230, 2018)(2019) BACAL, Fernando; MARCONDES-BRAGA, Fabiana G.; ROHDE, Luis Eduardo Paim; JUNIOR, Jose Leudo Xavier; BRITO, Flavio de Souza; MOURA, Lidia Ana Zytynski; COLAFRANCESCHI, Alexandre Siciliano; LAVAGNOLI, Carlos Fernando Ramos; GELAPE, Claudio Leo; ALMEIDA, Dirceu Rodrigues; GAIOTTO, Fabio Antonio; ATIK, Fernando Antibas; FIGUEIRA, Fernando Augusto M. S.; SOUZA, Germano Emilio Conceicao; RODRIGUES, Helcio; CAMPOS, Iacara Wozniak; NETO, Joao David de Souza; NETO, Joao Manoel Rossi; GASPARETTO, Juliano; GOLDRAICH, Livia Adams; BENVENUTI, Luiz Alberto; SEGURO, Luis Fernando B. C.; JUNIOR, Marcelo Botelho Ulhoa; MOREIRA, Maria da Consolacao V.; AVILA, Monica Samuel; CARNEIRO, Rodrigo; MANGINI, Sandrigo; FERREIRA, Silvia Moreira Ayub; STRABELLI, Tania Mara- Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation(2020) CAFEZEIRO, Caio Reboucas Fonseca; LOPES, Mariana Pezzute; SILVA, Caio Tavares; AVILA, Monica Samuel; SEGURO, Luis Fernando B. C.; MANGINI, Sandrigo; CAMPOS, Iascara Wozniak; GAIOTTO, Fabio A.; MARCONDES-BRAGA, Fabiana G.; BACAL, FernandoEpipericardial fat necrosis is an uncommon clinical condition of unknown etiology. It typically presents as acute pleuritic chest pain and should be differentiated from acute pulmonary embolism and acute coronary syndrome. This condition is diagnosed by characteristic chest computed tomography findings of an ovoid mediastinal fatty lesion with intrinsic and surrounding soft-tissue stranding. Treatment of epipericardial fat necrosis includes the administration of anti-inflammatory agents, and symptoms usually resolve within a few days after treatment initiation. This disease entity has rarely been reported since it was first described in 1957. Most current knowledge of epipericardial fat necrosis is based on case reports that describe this condition in previously healthy individuals. We present the case of a 39-year-old woman with a history of heart transplant, who presented with chest pain secondary to epipericardial fat necrosis. Serial computed tomography revealed lesion resolution after appropriate treatment.
- A modified heterotopic heart transplant technique to bridge patients with ""fixed"" pulmonary hypertension: A case report(2022) GAIOTTO, Fabio Antonio; BACAL, Fernando; STEFFEN, Samuel Padovan; MARCONDES-BRAGA, Fabiana Goulart; SEGURO, Luis Fenando Bernal da Costa; MANGINI, Sandrigo; CAMPOS, Iascara Wozniak de; AVILA, Monica Samuel; KALIL FILHO, Roberto; JATENE, Fabio Biscegli
- Transplantation for Chagas Heart Disease: a Comprehensive Review(2021) BACAL, Fernando; MURAD, Ciro Mancilha; ARAGAO, Carlos Aurelio dos Santos; CAMPOS, Iascara Wozniak de; SEGURO, Luis Fernando Bernal da Costa; AVILA, Monica Samuel; MANGINI, Sandrigo; GAIOTTO, Fabio Antonio; STRABELLI, Tania Varejao; MARCONDES-BRAGA, Fabiana G.Purpose of Review Chagas cardiomyopathy (CC) has a worse prognosis than other forms of cardiomyopathy and up to 10% of patients may progress to end-stage heart failure. In this article, we have performed a comprehensive literature review of heart transplantation (HT) for CC, including results after HT, management of immunosuppression, and Chagas disease (CD) reactivation. Recent Findings CD used to be considered a contraindication to HT due to the risks of disease reactivation with immunosuppression. Nonetheless, multiple reports have consistently demonstrated the feasibility and safety of HT for refractory CC. CD reactivation must be routinely screened in the first-year post-transplant, and in recent years, polymerase chain reactions (PCR)-based techniques have been used more often. HT is now considered the best treatment for end-stage Chagas heart disease. In addition, studies of immunosuppressive medications have shown that these patients require a lesser degree of immunosuppression, mainly to balance reactivation risks.
- COVID-19 complicating perioperative management of LVAD implantation: A case report and systematic review(2021) BELFORT, Deborah de Sa Pereira; BISELLI, Bruno; AVILA, Monica Samuel; LIRA, Maria Tereza Sampaio de Sousa; GALAS, Filomena Regina Barbosa Gomes; STEFFEN, Samuel Padovani; GAIOTTO, Fabio Antonio; JATENE, Fabio Biscegli; BOCCHI, Edimar Alcides; FERREIRA, Silvia Moreira AyubThe coronavirus 2019 disease (COVID-19) affected 125 million people worldwide and caused 2.7 million deaths. Some comorbidities are associated with worse prognosis and left ventricular assist device (LVAD) recipients are probably part of this high-risk population. We report a 31-year-old male patient who developed COVID-19 during LVAD implantation. His postoperative period was complicated by severe pneumonia and mechanical ventilation (MV) leading to right ventricular failure (RVF) and inotrope necessity. He experienced multiple complications, but eventually recovered. We present a systematic review of LVAD recipients and COVID-19. Among 14 patients, the mean age was 62.7 years, 78.5% were male. A total of 5 patients (35.7%) required MV and 3 patients (21.4%) died. A total of 2 patients (14.2%) had thromboembolic events. This case and systematic review suggest LVAD recipients are at particular risk of unfavorable outcomes and they may be more susceptible to RVF in the setting of COVID-19, particularly during perioperative period.
- Dispositivo de Assistência Ventricular Esquerda Seguido de Transplante Cardíaco(2015) BISELLI, Bruno; AYUB-FERREIRA, Silvia Moreira; AVILA, Monica Samuel; GAIOTTO, Fabio Antonio; JATENE, Fabio Biscegli; BOCCHI, Edimar Alcides