Disfunção aguda devido a uma trombose da prótese da válvula mitral mecânica

Um homem de 64 anos recebeu uma prótese mecânica CarboMedics de 31 mm para refluxo mitral grave. Após quatro dias, o paciente apresentou-se com fadiga e dispnéia em repouso. Estudos do Doppler ecocardiografia transtorácica e transesofágica confirmaram uma disfunção na mobilidade do folheto da válvula protética devido à trombose e uma operação de emergência foi feita. O pós-operatório transcorreu sem intercorrências. Este é um caso incomum de disfunção grave devido à trombose de uma prótese mitral mecânica em um paciente tomando anticoagulantes orais e calciparinaAn 64-year-old man received a 31-mm CarboMedics mechanical prosthesis for severe mitral regurgitation. After four days the patient presented fatigue and dyspnoea with rest; transthoracic and transesophageal Doppler echocardiographic study confirmed a failing mobility of prosthetic valve leaflet from thrombosis and an emergency operation was done. The postoperative course was uneventful. This is an unusual case of acute dysfunction from thrombosis of a mechanical mitral valve prosthesis in a patient on oral anticoagulant therapy and calciheparin

Left Main Coronary Artery Stent Misadventure

Coronary artery bypass grafting has long been the standard of care for patients with left main coronary artery (LMCA) disease. Lately, percutaneous coronary intervention (PCI) has become a suitable alternative for these patients, but the procedure may be challenging. We describe 2 cases of LMCA PCI failure requiring surgical intervention

Giant aortic arch aneurysm in elderly patient

Here we present you a Type II of Crawford classification aortic aneurysm. Our patient 89-year-old woman with history of hypertension, diabetes mellitus, smoking habits and polyposis of descending/sigmoid colon came to our attention for rectorrhagia, asthenia, dyspnoea and dizziness. A computer tomography exam revealed an aortic arch aneurysm, aortic ectasia at a level of aortic hiatus and infra-renal aortic aneurysmal dilation.In accord to aortic team meeting and patient decision, to refer this lady to medical therapy instead to surgery/hybrid treatment for age patient, comorbidities and high mortality relates to intervention. Aortic arch pathologies are unusual and their treatment is challenging.The aetiology of aortic arch diseases is congenital, chronic, post traumatic, inflammatory, infectious, mechanical and anastomotic, but most frequently is degenerative. Furthermore, the improvement in diagnostic imaging and the aging populations, aortic arch aneurysms have increasingly diagnosed.The incidence of aortic arch diseases is 10-11% and many patients were asymptomatic. Otherwise, many patients came to hospital with catastrophic, life-threatening events and urgent treatment is required. Despite the progress and new technologies have produced new therapeutic options for both cardiac and vascular surgeons is important to highlight the primary role of the aortic team, an interdisciplinary assessment, to find the best tailored treatment, both in acute and chronic setting, for the interest of each patient

Family firm network strategies in regional clusters: evidence from Italy

Plain English SummaryFamily firms are key in supporting local development, especially in regional clusters. However, while it is well established that their strategies differ from other (non-family) firms, it is still unclear what is their networking behaviour for supporting knowledge exchange-and thus innovation. This paper provides an empirical overview of this phenomenon, by analyzing an Italian case study: the Parabiago footwear cluster. The results show that (a) family firms are more proactive in establishing network relationships; (b) family firms tend to exchange knowledge with other family firms, while non-family firms do not show the same homophilous approach. Overall, this indicates that policies for clusters need to balance support for distinct business types and recognize the familiness characteristics of regional productive structures.Knowledge networks in regional clusters are fundamental to support innovation and local development. Within clusters, family firms are key in creating business opportunities and supporting the establishment of inter-organizational networks. Yet, their role within regional clusters for knowledge transfers is still not well understood, especially in comparison with non-family firms. This paper applies Exponential Random Graph Models (ERGMs) to network data collected from the Parabiago cluster, one of the most important Italian footwear clusters, to contribute to a better understanding of the network strategies of family firms. We identify distinct network strategies associated with the cluster firms, accounting for different knowledge exchange types: technological, market, and managerial. In our modelling, we control for firm-level attributes and dyadic-level attributes, such as geographical distance and cognitive proximity between cluster firms. Our results suggest that the proneness of family firms to grow networks is highly robust relative to non-family firm relationships, irrespective of knowledge types being exchanged. Moreover, family firms tend to establish connections with other family firms, showing the presence of homophily in their networking approach; however, non-family firms are rather different, since they do not have the same homophilous approach when it comes to exchange knowledge with other non-family firms. These results indicate that the nature of ownership is driving knowledge exchange differences. This key feature of family-only relationships in clusters may help managers and policymakers in devising more effective and targeted cluster strategies.Peer reviewe

Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: A meta-analysis of 5100 patients

ObjectiveOur objective was to determine whether the use of unilateral (u-ACP) or bilateral antegrade cerebral perfusion (b-ACP) results in different mortality and neurologic outcomes after complex aortic surgery.MethodsPubMed, Embase, and the Cochrane Library were searched for studies reporting on postoperative mortality and permanent (PND) and temporary neurologic dysfunction (TND) in complex aortic surgery requiring circulatory arrest with antegrade cerebral protection. Analysis of heterogeneity was performed with the Cochrane Q statistic.ResultsTwenty-eight studies were analyzed for a total of 1894 patients receiving u-ACP versus 3206 receiving b-ACP. Pooled analysis showed similar rates of 30-day mortality (8.6% vs 9.2% for u-ACP and b-ACP, respectively; P = .78), PND (6.1% vs 6.5%; P = .80), and TND (7.1% vs 8.8%; P = .46). Age, sex, and cardiopulmonary bypass time did not influence effect size estimates. Higher rates of postoperative mortality and PND were among nonelective operations and for highest temperatures and duration of the circulatory arrest. The Egger test excluded publication bias for the outcomes investigated.ConclusionsThis meta-analysis shows that b-ACP and u-ACP have similar postoperative mortality and both PND and TND rates after circulatory arrest for complex aortic surgery

Intensive hyperglycemia control reduces postoperative infections after open heart surgery

Background: Diabetes mellitus increases the risk of infections in patients undergoing cardiac surgery. We hypothesized that intensive perioperative hyperglycemia control by intravenous insulin infusion reduces postoperative infections in all patients undergoing open heart surgical procedures. Methods: Sixty diabetics patients who underwent CABG operation (Group 1) were compared with fifty-five patients who underwent other cardiac surgery (Group 2) between January 2004 and March 2005. A continuous infusion of insulin was used in all these patients. Results: There were no 30-day mortalities in either group. There was no difference in the incidence of infections between the two groups: in Group 1, 3 (5%) patients were diagnosed to have postoperative infection (superficial sternal wound infections in 1 (1.66%) and lung infection in 2 (3.33%) patients); postoperative infection occurred in only 2 patients (3.63%) in Group 2, 1 superficial sternal wound infections (1.81%) and 1 lung infection (1.81%). Conclusions: Our analysis indicates that continuous intravenous insulin infusion improves outcome and reduces postoperative infections in patients undergoing CABG as well as those undergoing other cardiac surgery procedures.

Lack of protective role of HDL-C in patients with coronary artery disease undergoing elective coronary artery bypass grafting

Aims Primary prevention studies have confirmed that high-density lipoprotein cholesterol (HDL-C) levels are strongly associated with reduced cardiovascular events. However, recent evidence suggests that HDL-C functionality may be impaired under certain conditions. In the present study, we hypothesize that HDL-C may lose their protective role in the secondary prevention of coronary artery disease (CAD). Methods and results A consecutive series of 1548 patients undergoing isolated first-time elective CABG at one institution between 2004 and 2009 was studied. According to the ATPIII criteria, pre-operative HDL-C values were used to identify patients with high (Group A) vs. low HDL-C (Group B). To eliminate biased estimates, a propensity score model was built and two cohorts of 1:1 optimally matched patients were obtained. Cumulative survival and major adverse cardiovascular events (MACE) were analysed by means of Kaplan-Meier method. Cox proportional-hazards regression models were used to identify independent predictors of MACE and death. Propensity matching identified two cohorts of 502 patients each. At a median follow-up time of 32 months, there were 44 out of 502 (8.8%) deaths in Group A and 36 out of 502 deaths in Group B (7.2%, HR 1.19; P = 0.42). MACE occurred in 165 out of 502 (32.9%) in Group A and 120 out of 502 (23.9%) in Group B (P = 0.04). Regression analysis showed that pre-operative HDL-C levels were not associated with reduced but rather increased MACE occurrence during follow-up (HR 1.43, P = 0.11). Conclusion Higher HDL-C levels are not associated with reduced risk of vascular events in CAD patients undergoing CABG. Our findings may support efforts to improve HDL-C functionality instead of increasing their level