Cost-Effectiveness Analysis for Surgical, Angioplasty, or Medical Therapeutics for Coronary Artery Disease 5-Year Follow-Up of Medicine, Angioplasty, or Surgery Study (MASS) II Trial

Background-The Second Medicine, Angioplasty, or Surgery Study (MASS II) included patients with multivessel coronary artery disease and normal systolic ventricular function. Patients underwent coronary artery bypass graft surgery (CABG, n = 203), percutaneous coronary intervention (PCI, n = 205), or medical treatment alone (MT, n = 203). This investigation compares the economic outcome at 5-year follow-up of the 3 therapeutic strategies. Methods and Results-We analyzed cumulative costs during a 5-year follow-up period. To analyze the cost-effectiveness, adjustment was made on the cumulative costs for average event-free time and angina-free proportion. Respectively, for event-free survival and event plus angina-free survival, MT presented 3.79 quality-adjusted life-years and 2.07 quality-adjusted life-years; PCI presented 3.59 and 2.77 quality-adjusted life-years; and CABG demonstrated 4.4 and 2.81 quality-adjusted life-years. The event-free costs were $9071.00 for MT;$19 967.00 for PCI; and 18 263.00 for CABG. The paired comparison of the event-free costs showed that there was a significant difference favoring MT versus PCI (P<0.01) and versus CABG (P<0.01) and CABG versus PCI (P<0.01). The event-free plus angina-free costs were 16 553.00, $25 831.00, and$24 614.00, respectively. The paired comparison of the event-free plus angina-free costs showed that there was a significant difference favoring MT versus PCI (P=0.04), and versus CABG (P&lt;0.001); there was no difference between CABG and PCI (P&gt;0.05). Conclusions-In the long-term economic analysis, for the prevention of a composite primary end point, MT was more cost effective than CABG, and CABG was more cost-effective than PCI

A new surgical technique for ventricular septal rupture closure after myocardial infarction

Universidade Federal de São Paulo, São Paulo Hosp, Div Cardiovasc Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Rim Hosp, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo Hosp, Div Cardiovasc Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Rim Hosp, São Paulo, BrazilWeb of Scienc

Tratamento cirúrgico das valvopatias aórticas com bioprótese de pericárdio bovino sem suporte: resultados imediatos Surgical treatment of aortic valve disease with stentless bovine pericardium prosthesis: immediate results

OBJETIVO: Apresentar os resultados imediatos e avaliar o desempenho clínico e hemodinâmico das biopróteses sem suporte de pericárdio bovino (stentless) em posição aórtica. MÉTODOS: Foram operados 20 pacientes com indicação de troca valvar aórtica por bioprótese, sendo 11 homens, 16 com estenose aórtica; a média de idade foi 66,3 ± 8,8 anos. A técnica operatória utilizada foi o implante subcoronariano. Cinco pacientes receberam procedimentos associados. No pós-operatório, a morbidade-mortalidade e o desempenho hemodinâmico foram avaliados por meio de ecocardiograma transtorácico. RESULTADOS: Os tempos médios de circulação extracorpórea e anóxia foram, respectivamente, 136,5 ± 24,41 min e 105,2 ± 21,62 min. A mortalidade hospitalar foi 5% (um paciente). A permanência na UTI foi, em média, 3,65 ± 3,23 dias. A média dos gradientes transvalvares no pós-operatório foi 25,39 ± 7,82 mmHg. A fração de ejeção do ventrículo esquerdo no pré-operatório era 67 ± 13,49% e, no pós-operatório, foi 63,24 ± 16,06% (p = 0,45). Onze pacientes não apresentaram nenhum grau de refluxo valvar, 8 apresentaram refluxo leve, e um, refluxo leve a moderado. CONCLUSÃO: As próteses stentless podem ser utilizadas no tratamento cirúrgico das valvopatias aórticas, com morbidade e mortalidade na fase hospitalar semelhante à descrita na literatura para procedimentos semelhantes, e apresentam desempenho hemodinâmico satisfatório.<br>OBJECTIVE: To present the immediate results and assess the clinical and hemodynamic performance of stentless bovine pericardial bioprostheses in aortic position. METHODS: Twenty patients were operated who were indicated for surgery for valve replacement with biological prostesis. Eleven patients were male; sixteen had aortic stenosis; four, insufficiency; the mean age was 66.3 ± 8.8 years. The surgical technique used was subcoronary implant. Associated procedures were performed in five patients. Postoperative morbidity,mortality and hemodynamic performance were assessed on transthoracic echocardiogram. RESULTS: Mean time of cardiopulmonary bypass was 136.5 ± 24.41 minutes and mean anoxic time was 105.2 ± 21.62 minutes. Hospital mortality was 5% (one patient). Mean time of intensive care unit stay was 3.65 ± 3.23 days. Mean postoperatively transvalvular gradient was was 25.39 ± 7.82 mmHg. Left ventricle ejection fraction was 67 ± 13.49% preoperatively and 63.24 ± 16.06% postoperatively (p = 0.45). Eleven patients did not present any degree of valve regurgitation, eight presented mild regurgitation and one ,mild to moderate regurgitation. CONCLUSION: Stentless prostheses can be used for the surgical tratment of aortic valve diseases, with in hospital mortality and morbidity similar to the mortality and morbidity described in the literature for similar procedures, with satisfactory hemodynamic performance

Homoenxerto aórtico criopreservado no tratamento cirúrgico das lesões da valva aórtica: resultados imediatos Cryopreserved aortic homograft for aortic valve replacement: immediate results

OBJETIVO: Analisar os resultados imediatos, clínicos e ecocardiográficos, com o uso do homoenxerto aórtico criopreservado no tratamento cirúrgico da valva aórtica. MATERIAL: Dezoito pacientes com lesão na valva aórtica receberam homoenxerto aórtico criopreservado, sendo 15 homens, 10 com insuficiência aórtica e oito, estenose aórtica. A idade variou de 18 a 65 (média de 44,5 ± 18,14) anos. Quatro pacientes apresentavam endocardite bacteriana em atividade, 12 estavam em classe funcional II, seis em classe funcional III (NYHA). A função ventricular esquerda era normal em 15 pacientes. RESULTADOS: A mortalidade hospitalar foi de 5,5% (um paciente), por insuficiência respiratória, os demais receberam alta hospitalar entre o 5° e 8° dia de pós-operatório em classe funcional I. O gradiente transvalvar aórtico máximo, ao ecocardiograma, variou de zero a 30 mmhg, com média de 10,9 ± 9,2 mmhg. Cinco pacientes não apresentavam nenhum grau de refluxo pelo homoenxerto, 11 (61,1%) tinham refluxo mínimo e dois apresentavam refluxo leve. O tempo de circulação extracorpórea variou de 130 a 220 (média de 183,9 ± 36,7) minutos. O tempo de pinçamento da aorta variou de 102 a 168 (média de 139,14 ± 25,10) minutos. O sangramento no pós-operatório variou 210 a 1220 ml, com média de 511,4 ± 335,1 ml e não houve reoperações. O tempo de intubação orotraqueal variou de 2h e 50min a 17 h com média de 9,14 ± 3,6 h. CONCLUSÃO: O homoenxerto aórtico criopreservado pode ser utilizado rotineiramente com baixa morbi-mortalidade hospitalar.<br>OBJECTIVE: To assess immediate clinical and echocardiographic results of the use of cryopreserved aortic homografts for aortic valve replacement. METHODS: Eighteen patients with aortic valve disease underwent aortic valve replacement, receiving a cryopreserved aortic homograft, 15 were male, 10 had aortic regurgitation, and 8 had aortic stenosis. Age ranged from 18 to 65 years (mean, 44.5 ± 18.14 years). Four patients had infective endocarditis, 12 patients were in functional class II, and 6 patients were in functional class III (NYHA). Left ventricular function was normal in 15 patients. RESULTS: Hospital mortality was 5.5% (1 patient) due to respiratory distress; the other patients were discharged from the hospital between the fifth and eighth postoperative days in functional class I. Maximal aortic transvalvular gradient, on echocardiography, ranged from 0 to 30 mmHg, with a mean of 10.9 ± 9.2 mmHg. Five patients did not have any degree of regurgitation through the aortic homograft, 11 patients (61.1%) had minimal regurgitation, and 2 had mild regurgitation. Duration of extracorporeal circulation ranged from 130 to 220 minutes (mean, 183.9 ± 36.7 minutes). Duration of aortic clamping ranged from 102 to 168 minutes (mean, 139.14 ± 25.10 minutes). Bleeding in the postoperative period ranged from 210 to 1220 mL, with a mean of 511.4 ± 335.1 mL. Reoperations were not necessary. Duration of orotracheal intubation ranged from 2 hours 50 minutes to 17 hours with a mean of 9.14 ± 3.6 hours. CONCLUSION: Cryopreserved aortic homografts may be routinely used with low hospital morbidity and mortality

Cryopreserved Aortic Homograft for Aortic Valve Replacement. Immediate Results

Objective To assess immediate clinical and echocardiographic results of the use of cryopreserved aortic homografts for aortic valve replacement

Perfis visíveis na gestão social do desenvolvimento Visible profiles in the social management of development

Este artigo estuda a relação existente entre a gestão social do desenvolvimento, a performance de organizações da sociedade civil e o perfil de seus líderes. Para tanto, foram realizadas duas entrevistas, por meio da técnica da história oral, com dois gestores fundadores das respectivas organizações onde trabalham, situadas em Salvador e consideradas de reputação. Algumas questões nortearam o estudo qualitativo. Como a história de vida do seu principal gestor contribuiu para a organização ser o que é hoje? Como a sua história de vida se confunde com a história da organização? O que o levou a ser um gestor social e, mais especificamente, a fundar a organização? O que se vislumbra para o futuro da organização? Conclui-se que as organizações e seus gestores estão estreitamente imbricados e o sucesso das organizações reflete a trajetória bem-sucedida de seus líderes.<br>This article studies the relations between the social management of development, the performance of civil society organizations and their leaders' profile. For that purpose two interviews using oral history technique were carried out with two CEOs who founded their respective well-reputed organizations in the Brazilian city of Salvador. The following issues guided the qualitative study: To what extent did CEO's life history contribute to the present status of the organization? In what sense is his life history tied with the history of the organization? What turned him into a social manager, and, more particularly, what led him to found the organization? What are the expectations concerning the future of the organization? Conclusions point out that organizations and their managers are intimately imbricated, and that the success of organizations reflects the successful life history of their leaders