Incidence of prosthesis-patient mismatch in patients receiving mitral Biocor® porcine prosthetic valves

Background: The aim was to assess the incidence of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) in patients receiving Biocor® porcine or mechanical valves, and to evaluate the effect of PPM on long-term survival. Methods: All patients undergoing MVR between 2009 and 2013 received either mechanical or bioprosthetic valves (Biocor® porcine). PPM was defined as severe when the indexed effective ori­fice area was < 0.9 cm2/m2, moderate between 0.9 cm2/m2 and 1.2 cm2/m2 or absent > 1.2 cm2/m2. The primary endpoint was all-cause long-term mortality. Results: Among a total of 136 MVR, PPM was severe in 27%, moderate in 44% and absent in 29% of patients. Implanted valves were 57% mechanical and 43% bioprosthetic. Only 3% of patients with mechanical valves had severe PPM vs. 59% with bioprostheses (p < 0.0001). Sixty-month survival with severe mismatch was 0.559 (SE 0.149) and with no mismatch 0.895 (SE 0.058) (p = 0.043). Survival of patients suffering from severe mismatch, or moderate mismatch with pulmonary hypertension (PH) was 0.749 (SE 0.101); while for patients with no mismatch or with moderate mismatch without PH, survival was 0.951 (SE 0.028) (p = 0.016). Conclusions: About one-fourth of patients had severe PPM and almost all of them had received a bioprosthesis. Sixty-month survival was significantly lower in patients with severe mismatch, or moderate mismatch with PH. Specifically, when a bioprothesis is chosen and while further evidence on the impact of PPM on clinical outcomes appears, surgeons are recommended to follow a preoperative strategy to implant a mitral prosthesis of adequate size in order to prevent PP

Mortality in low- and very low-risk patients undergoing cardiac surgery: Evaluation according to the EuroSCORE II as a new standard

Background: Only a few reports have analyzed low-risk patient outcomes and in every case, the risk was based on a logistic EuroSCORE ≤ 2. Since this original EuroSCORE overestimates surgical risk, we developed this study to prospectively evaluate the immediate results of cardiac surgery in patients with an expected mortality risk ≤ 2% according to the EuroSCORE II as a new gold standard. We also examined the cause of death and whether it could be considered preventable. Methods: A prospective risk stratification of all cardiac surgical patients treated at the Bue­nos Aires University Hospital of Argentina was performed between 2012 and 2014 using the EuroSCORE II. Causes of death were classified as preventable or not preventable. Results: From a total of 990 patients, 63.2% had EuroSCORE II ≤ 2 (low-risk group) and 32.5% EuroSCORE II < 1 (very low-risk group). In the low-risk group, in-hospital mortal­ity was 1.8%, whereas predicted mortality was 1.04% (AUC 0.765). The observed/expected ratio was 1.73 (95% CI 0.68–4.43) and the observed-expected difference was 0.76 (95% CI –0.68–2.10). Fifty-four percent of deaths were considered preventable. Conclusions: We propose to use and further validate the EuroSCORE II as a new standard for assessing low-risk patients. This model proved to be useful in evaluating the quality standards of local cardiac surgery. The review of cause of death in low-risk patients provided valuable information, which revealed potentially correctable issues. Adoption of a more demanding standard, as the EuroSCORE II to identify low-risk patients, avoids the sense of safety offered by previous versions of the score

Perception of consultation length in cardiology and its ethical implications

Objectives. This study considered whether the time employers allotted to medical consultations in many working environments in Argentina might be inadequate to carry out an interview. The objective was to conduct a survey to gather information on the length of cardio Conclusions. This study showed that 60% of physicians perceived as insufficient the time their employers allotted for conducting an adequate consultation. Most believed that allotting such a short time for examining patients could be considered an ethical flaw. Referral and consultation, cardiology, ethics, Argentina. ABSTRACT One of the main resources of health care systems is the time the physician can devote to patients. This time is crucial in medicine as it allows patients and physicians to interact not only from a technical and scientific perspective but from a human perspective as well, in accordance with the empathy the patient requires. The successive economic crises in the region of Argentina as well as inadequate planning have contributed to the depreciation of the medical consultation. As a result, in order to maintain the same costs, many health systems have shortened the net time of the consultation. This circumstance has been consolidated by the sanitary authorities of some other countries of the region (1). The same situation exists in Spain and has been the subject of court appeals and review of some deontological rules (2, 3). Efficient use of time is on

Perception of consultation length in cardiology and its ethical implications Percepción sobre la duración de las consultas de cardiología y sus implicaciones éticas

OBJECTIVES: This study considered whether the time employers allotted to medical consultations in many working environments in Argentina might be inadequate to carry out an interview. The objective was to conduct a survey to gather information on the length of cardiologic medical consultations in Argentina. METHODS: During 2007, a survey was carried out that included 816 cardiologists. RESULTS: Seventy-six percent of participants said they needed 20 to 30 minutes, and 14% considered that 15 minutes was sufficient, for an adequate consultation. On the other hand, 64% reported that their employer required that consultations be done in 10 to 15 minutes, and 86% cited limits of less than 20 minutes (P < 0.0001). This time was inadequate for 60% of physicians. With regard to ethics, 89% answered affirmatively that requiring that patients be attended in such a short time could be considered an ethical flaw of the employer; 75% acknowledged their own ethical flaw when agreeing to conduct the consultation in an inadequate amount of time. When opinions were grouped, 22% considered that an adequate consultation length was fundamental for a correct patient-physician relationship, 27% reported that this time depended on "pressures" of the system, 19% indicated that inadequate consultation length affected the quality of attention patients received, 17% thought that low fees forced employers to reduce this time with a resulting detriment in quality of care, and 15% said that consultation length was variable and depended on the patient. CONCLUSIONS: This study showed that 60% of physicians perceived as insufficient the time their employers allotted for conducting an adequate consultation. Most believed that allotting such a short time for examining patients could be considered an ethical flaw.<br>OBJETIVOS: Se analizó si el tiempo asignado por los empleadores para las consultas médicas en centros de trabajo en Argentina es insuficiente. El objetivo fue recopilar información mediante una encuesta sobre la duración de las consultas de cardiología en Argentina. MÉTODOS: Se aplicó una encuesta a 816 cardiólogos en 2007. RESULTADOS: De los participantes, 76% dijo necesitar de 20 a 30 minutos para una consulta adecuada, mientras 14% consideró que 15 minutos era suficiente. Por otra parte, 64% informó que sus empleadores exigían que las consultas se realizaran en 10-15 minutos y 86% citó límites menores de 20 minutos (P < 0,0001); 60% de los médicos consideraron inadecuado ese tiempo. De los entrevistados, 89% respondió que exigir que se atienda a los pacientes en ese corto tiempo podría considerarse una falla ética de los empleadores; 75% reconoció su propia falla ética al aceptar realizar la consulta en un tiempo inadecuado. Cuando se agruparon las opiniones, 27% manifestó que ese tiempo dependía de "presiones" del sistema, 22% consideró que realizar la consulta en un tiempo suficiente era fundamental para una correcta relación médico-paciente, 19% indicó que un tiempo insuficiente de consulta afectaba a la calidad de la atención que recibía el paciente, 17% pensaba que los bajos honorarios forzaban a los empleadores a reducir ese tiempo con el consiguiente detrimento en la calidad de la atención y 15% dijo que la duración de la consulta era variable y dependía del paciente. CONCLUSIONES: Estos resultados muestran que 60% de los médicos percibían como insuficiente el tiempo que sus empleadores les asignaron para llevar a cabo las consultas. La mayoría consideró que asignar un tiempo tan corto para examinar a los pacientes puede considerarse una falla ética