52 research outputs found
Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study
No full textObjectives
The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies.
Methods
The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299).
Results
No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases.
Conclusions
Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes.
© 2022 The Author
Delta-type senior civil service for the 21st century
No full textO artigo estuda um aspecto da reforma do Estado que, segundo o autor, tem sido
sistematicamente negligenciado pelas atuais propostas que focalizam o modelo da administração
gerencial. Trata-se das funções vitais do governo de tomar decisões críticas e
adotar políticas diante das mudanças provocadas pela revolução global. Segundo Dror, as
tarefas de alto comando (high-order tasks) de definir trajetórias e as novas formas de
governança exigem um ajuste significativo do governo central. Este ajuste refere-se, principalmente,
à concepção e ao desenvolvimento de um novo padrão de funcionários do
primeiro escalão público, o qual contribuiria com conhecimento e perspectivas para
enfrentar as tarefas de alto comando.
O autor estabelece uma tipologia para caraterizar a evolução do perfil do serviço
público, marcando suas fases históricas: a) tipo alpha (status atribuído, fusão de papéis
políticos e administrativos); b) tipo beta (compra de cargos governamentais) e c) tipo
gamma (quase profissionalismo). O novo funcionário sênior, do tipo delta, se concentraria
nas questões de ordem estratégica, deixando as funções gerenciais para servidores do
tipo gamma e para os serviços técnicos.
Após uma breve análise, Dror conclui que o funcionalismo público de primeiro
escalão, na maioria dos países (com exceção de alguns países do Sudeste Asiático),
encontra-se obsoleto, com base profissional inadequada e capacidade insuficiente para
lidar com escolhas críticas.El artículo estudia un aspecto de la reforma del Estado que, según el autor, ha sido
sistematicamente negligenciado por las actuales propuestas que enfocan el modelo de la
administración gerencial. Se trata de las funciones vitales del gobierno de tomar decisiones
críticas y adoptar políticas delante de los cambios provocados por la revolución global.
Según Dror, las tareas de alto comando (high-order tasks) de definir trayectorias y las
nuevas formas de governanza exigen un ajuste significativo del gobierno central. Este
ajuste se refiere, principalmente, a la concepción y al desarollo de un nuevo padrón de
funcionarios de primera jerarquía, lo que contribuiria con conocimiento y perspectivas
para afrontar las tareas de alto comando.
El autor establece una tipologia para caracterizar la evolución del perfil del servicio
público, marcando sus fases historicas: a) tipo alpha: (status atribuido, fusión de papeles
políticos y administrativos); b) tipo beta: (compra de cargos gubernamentales) y c) tipo
gamma: (casi profesionalismo). El nuevo funcionario senior, del tipo delta, se concentraria
en las cuestiones de orden estratégica, quedándose las funciones gerenciales para los
servidores del tipo gamma y para los servicios técnicos.
Tras un breve análisis, Dror concluye que el funcionarismo público de primera jerarquía,
en la mayoria de los países (excepto algunos países del Sudeste Asiático), se encuentra
obsoleto, con bases professionales inadecuadas y capacidad insuficiente para lidar con
opciones críticas.The article alludes to one aspect of the State reform that, according to the author, has
been systematically neglected by present proposals focused on the management
administration model. Government’s vital functions are to make critical decisions and to
adopt policies when facing changes brought about by the global revolution. According to
Dror, the high-order tasks of defining trajectories and new forms of governance demand
a significant adjustment of central governments. This adjustment refers mainly to the
creation and development of a new profile of senior civil servants, who would present
their contribution to high-order tasks with more knowledge and perspective.
The author establishes a categorization to illustrate the evolution of the civil servant
profile, highlighting its historical phases: a) alpha type (attributed status, fusion of
political and administrative roles); b) beta type (purchase of governmental positions);
and c) gamma type (quasi-professionalism). The new delta-type senior civil servant
should concentrate on strategical issues, leaving managerial functions to gamma-type
civil servants and to technical services.
After a brief analysis, Dror declares that the senior civil service in most countries
(exceptions to be made to some East-Asian countries) is obsolete, lacking adequate
professional basis and capacity to deal with critical decisions.Número padronizado: v. 48, n. 2 (1997)
Revista do Serviço Público - RSP, ano 48, n. 2, p. 5-26Administração PúblicaISSN impresso: 0034-9240ISSN eletrônico: 2357-801
Governance: A Garbage Can Perspective. IHS Political Science Series: 2002, No. 84
No full textAs I worked through the revisions of this paper I realized that I was to a great extent returning to the dominant themes from one of the first books I ever published. This was Can Government Go Bankrupt?, written with Richard Rose and published in 1978. That book and this paper both deal with the authority of governments and their capacity to govern. Dror (2001) provides a very detailed analysis of governance capacity, but much of that analysis will actually come down to the presence of legitimacy for the governing system, and the capacity to use steering instruments effectively to reach desired collective goals. The issues to be raised in this paper are concentrated primarily on governance questions at the level of central governments and multi-level interactions, rather than of the international system, but much of the same logic of sovereignty/authority is in operation
Beating vs arrested heart isolated tricuspid valve surgery. long-term outcomes
No full textBackground: Isolated tricuspid valve (TV) surgery is a rare procedure generally considered at high risk for perioperative mortality and poor long-term outcomes. Surgical treatment can be performed with either an arrested heart (AH) or beating heart (BH) technique. The aim of this study was to compare the outcomes of isolated tricuspid surgery with 2 different approaches.
Methods: The Surgical-Tricuspid Study is a multicenter international retrospective study enrolling adult patients who underwent isolated TV procedures (n = 406; age 56 ± 16 years; 56% female) at 13 international sites. The AH and BH strategies were performed in 253 and 153 patients, respectively. Propensity score-matched analysis was used to compare groups.
Results: After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2% versus 5.0% in the AH and BH groups, respectively (P = .9). The rates of acute renal failure requiring replacement therapy (10% versus 3%; P = .02) and stroke (1.6% versus 0%; P = .08) were numerically higher in the AH group. The 6-year survival rate was 67% ± 6% versus 78% ± 5% in the AH and BH groups, respectively (P = .18), whereas freedom from cardiac death was 75% ± 5% versus 84% ± 4% (P = .21). The 6-year composite cardiac end point of cardiac death and reoperation rate was 60% ± 9% versus 86% ± 5% (P = .024) comparing AH-TV replacement and BH-TV repair groups.
Conclusions: Isolated TV surgery performed with a BH strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation compared with the standard AH technique. Patients undergoing BH valve repair had the best long-term outcome
Mechanical Valves: Past, Present, and Future—A Review
No full textThe mechanical valve was first invented in the 1950s, and since then, a wide variety of prostheses have been developed. Although mechanical valves have outstanding durability, their use necessitates life-long treatment with anticoagulants, which increases the risk of bleeding and thromboembolic events. The current guidelines recommend a mechanical prosthetic valve in patients under 50–60 years; however, for patients aged 50–70 years, the data are conflicting and there is not a clear-cut recommendation. In recent decades, progress has been made in several areas. First, the On-X mechanical valve was introduced; this valve has a lower anticoagulant requirement in the aortic position. Second, a potential alternative to vitamin K-antagonist treatment, rivaroxaban, has shown encouraging results in small-scale trials and is currently being tested in a large randomized clinical trial. Lastly, an innovative mechanical valve that eliminates the need for anticoagulant therapy is under development. We attempted to review the current literature on the subject with special emphasis on the role of mechanical valves in the current era and discuss alternatives and future innovations
Transit time flow measurement in arterial grafts
No full textCoronary artery bypass grafting (CABG) is one of the foundations of treatment for coronary artery disease. While it has improved substantially since its inception more than 50 years ago, including a rising use of multiple arterial grafting, intraoperative quality assessment is yet to be disseminated as an integral part of the procedure. Herein we review the fundamentals of intraoperative quality assessment in CABG using transient time flow measurement (TTFM) with a focus on its use in arterial grafting
Open Access to Research: Changing Researcher Behavior Through University and Funder Mandates
No full textThe primary target of the worldwide Open Access initiative is the 2.5 million articles published every year in the planet's 25,000 peer-reviewed research journals across all scholarly and scientific fields. Without exception, every one of these articles is an author give-away, written, not for royalty income, but solely to be used, applied and built upon by other researchers. The optimal and inevitable solution for this give-away research is that it should be made freely accessible to all its would-be users online and not only to those whose institutions can afford subscription access to the journal in which it happens to be published. Yet this optimal and inevitable solution, already fully within the reach of the global research community for at least two decades now, has been taking a remarkably long time to be grasped. The problem is not particularly an instance of "eDemocracy" one way or the other; it is an instance of inaction because of widespread misconceptions (reminiscent of Zeno's Paradox). The solution is for the world's research institutions and funders to (1) extend their existing "publish or perish" mandates so as to (2) require their employees and fundees to maximize the usage and impact of the research they are employed and funded to conduct and publish by (3) depositing their final drafts in their Open Access (OA) Institutional Repositories immediately upon acceptance for publication in order to (4) make their findings freely accessible to all their potential users webwide. OA metrics can then be used to measure and reward research progress and impact; and multiple layers of links, tags, commentary and discussion can be built upon and integrated with the primary research
Outcome of patients undergoing isolated tricuspid repair or replacement surgery
No full textOBJECTIVES: The interest in isolated tricuspid valve disease has rapidly increased recently. However, clinical trials and registry data are rare in the surgical literature. This study aimed to describe the early and long-term outcomes of a real-world experience in isolated tricuspid procedures comparing repair and replacement strategies.METHODS: The Surgical-Tricuspid study is a multicentre retrospective study that enrolled adult patients who had undergone isolated tricuspid valve surgery at 13 international sites. Propensity score-matched analysis was used to compare repair versus replacement.RESULTS: A cohort of 426 patients was enrolled [mean age: 55 (16) years; 56% female]. After matching, 175 comparable pairs were analysed. Preoperative left ventricular ejection fraction was 55(9) vs 56(9) (P = 0.8) while moderate-severe tricuspid regurgitation was present in 95% of cases. The 30-day mortality rate was 4.0% vs 8.0% in the repair and replacement groups, respectively (P = 0.115). The rates of reexploration for bleeding (6.9% vs 13.1% P = 0.050), permanent pacemaker implantation (5.1% vs 12.0%; P = 0.022) and blood transfusion (46% vs 62%; P = 0.002) were higher in the replacement group. Cumulative survival rates at 3, 5 and 7 years in the repair group were 84 (3)%, 75 (4)% and 56 (9)% vs 71 (4)%, 66 (5)% and 58 (5)% in the replacement group (P= 0.001) while cumulative incidence for reoperation at 10 years did not differ between groups [repair 10 (1)% vs replacement 9 (1 )%; P = 0.469].CONCLUSIONS: The data from the Surgical-Tricuspid study reported a high risk for patients undergoing tricuspid surgery. Isolated valve repair offered reduced early and late mortality with no difference regarding reoperation rate when compared with replacement
The effect of COVID-19 vaccination on 30-day mortality after cardiac surgery – Insights from the Israel national registries
No full textSummary: Background: We compared the effect of perioperative COVID-19, before and after vaccination, on 30-day mortality after cardiac surgery. Methods: Data was extracted from several national registries. The study period was March 1st, 2020–March 31st, 2022. Results: 2594 adult patients underwent cardiac surgery before the availability of a universal COVID-19 vaccine. 33 patients were diagnosed with COVID-19 prior to surgery (mean age 58.3±10.0, mean length of time 73.6±60.1 days) and 7 patients were diagnosed with COVID-19 0–14 days after surgery (age 66.4±7.6). These were compared to 4426 patients who underwent cardiac surgery after the availability of a universal vaccine: 469 patients were diagnosed with COVID-19 prior to surgery (age 62.1±10.1, length of time 175.8±158.2) and 32 patients diagnosed with COVID-19 0–14 days after surgery (age 60.8±14.5). In patients diagnosed with COVID-19 prior to surgery, there was no excess 30-day mortality either before or after vaccination (1 (3.0%) vs. 57 (2.2%), respectively, P<0.8, and 8 (1.7%) vs. 87 (2.2%), respectively, P<0.5). Patients diagnosed with COVID-19 after surgery, but before vaccination, had significantly higher 30-day mortality compared to COVID-19 negative patients (2 (28.6%) vs. 56 (2.2%) respectively, P<0.0001). This excess mortality disappeared after universal vaccination (1 (3.1%) vs. 94 (2.1%) respectively, P<0.7). Conclusions: COVID-19, when diagnosed in the early post-operative period, was a risk factor for mortality before available vaccinations, but not after vaccination was widely available. Pre-surgery screening and post-surgical isolation is essential until vaccines are available. This data may be useful for patient management in future respiratory pandemics
Predictors and Long-Term Prognostic Significance of Acute Renal Function Change in Patients Who Underwent Surgical Aortic Valve Replacement
No full textThere are few reports on short-term changes in renal function after surgical aortic valve replacement, and data are scarce regarding its impact on long-term outcomes. This is a retrospective study of patients who underwent isolated aortic valve replacement between 2009 and 2020 in four medical centers. Patients with end-stage renal disease were excluded. Renal function was assessed based on short-term changes. Multivariable regression models were used to identify predictors of improvement/deterioration. Cox proportional hazard models were used to assess survival trends. The study included 2402 patients, with a mean age of 69.3 years and a mean eGFR of 82.3 mL/min/1.73 m2. Short-term improvement rates were highest in stage 4 (24.4%) and stage 3 (16.8%) patients. Deterioration rates were highest in stage 1 (38.1%) and stage 2 (34.8%) patients. Deterioration in the chronic kidney disease stage was associated with a higher ten-year mortality (p < 0.001, HR 1.46); an improved stage trended toward improved survival (p = 0.14, HR 0.722). Patients with stage 3 and 4 kidney disease tended to remain stable or improve in the short term after aortic valve replacement while patients at stages 1 and 2 were at increased risk of deteriorating
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