The cost of transcatheter aortic valve implantation according to different access routes

Abstract OBJECTIVE Identifying the average direct cost of TAVI (Transcatheter Aortic Valve Implantation) for the different access routes. METHOD This is a research with a quantitative, exploratory and descriptive approach carried out in a government teaching hospital in the state of São Paulo. RESULTS The average direct cost of TAVI procedures by the access routes resulted in R$82,826.38 (transfemoral route), R$79,440.91 (transaortic route) and R$78,173.41 (transapical route). The transcatheter valve cost represented a percentage variation between 78.47% and 83.14% of the total cost of the procedure. The Kruskal-Wallis test was used and presented a statistically significant difference between the three access routes: p=0.008. The Bonferroni test showed a difference in the association between transfemoral and transapical routes, while no statistically significant difference was observed in association with the transaortic route. CONCLUSION The results are important for formulating adequate funding policies for the hospital network and understanding the costs according to the route facilitates rationalizing resources in order for them to be guaranteed for patients who present surgical contraindication to the valve implant

Early warning indicators of decadal shifts in the planktonic assemblage of the Cabo Frio upwelling ecosystem

Long-term monitoring of coupled environmental and biological components in upwelling ecosystems is critical for early warning under the global warming context. Temperature, salinity, nutrients, and plankton populations are promising indicators of the ecosystem state that help us to address the current status of the oceans and construct better predictions for the future. The Cabo Frio Upwelling System (CFUS) is a regionally productive wind-driven coastal upwelling ecosystem on the northern boundary of the South Brazilian Shelf sustaining diverse marine life including large stocks of fish and squid. Like other cold marine ecosystems, most of its functioning is likely threatened by ocean warming which emphasizes the need for ecological indicators. This study aimed to analyze the causal relationships between the temporal changes in the physical and chemical properties and the dominant planktonic communities leveraging long-term observations (20 years). The results suggested a link between the temporal changes in the ecosystem conditions and the composition of the plankton assemblage, notably an increasing proportion of dinoflagellates relative to diatoms and cladocerans relative to copepods. This increase in the proportional abundance of dinoflagellates and cladocerans over time suggests a regime shift in the plankton assemblages during the 2000s, highlighting some large phytoplankton and zooplankton groups as early indicators of productivity shifts in upwelling ecosystem