Long-delayed localization of a cardiac functional paraganglioma with SDHC mutation

International audienc

Total aortic arch replacement under intermittent pressure-augmented retrograde cerebral perfusion

Kitahori, Kawata, Takamoto et al. described the effectiveness of a novel protocol for retrograde cerebral perfusion that included intermittent pressure augmentation for brain protection in a canine model. Based on their report, we applied this novel technique clinically. Although the duration of circulatory arrest with retrograde cerebral perfusion was long, the patient recovered consciousness soon after the operation and had no neurological deficit. Near-infrared oximetry showed recovery of intracranial blood oxygen saturation every time the pressure was augmented

Increased cerebral blood flow velocities assessed by transcranial Doppler examination is associated with complement activation after cardiopulmonary bypass

The role of complement activation on the cerebral vasculature after cardiopulmonary bypass (CPB) is unclear. The goal of the study was to assess whether heparin-coated CPB reduces complement activation, and influences cerebral blood flow velocities (CBFV). Twenty-four patients undergoing coronary surgery were randomly allocated to non-coated (NC-group) or heparin-coated (HC-group) CPB. Complement activation was assessed by measuring sC5b-9. Transcranial Doppler (TCD) was performed on middle cerebral arteries before and after CPB. Systolic (SV), diastolic (DV) and mean (MV) CBFV were measured. Significant increase of sC5b-9 (p=0.003) was observed in the NC-group and CBFV increased after CPB (SV by 27%, p=0.05; DV by 40%, p=0.06; MV by 33%, p=0.04) whereas no changes were detected in the HC-group. TCD values were higher in the NC-group than in the HC-group (SV, p=0.04; DV, p=0.03; MV, p=0.03) although cardiac index, systemic vascular resistance, haematocrit and pCO2 were similar. Postoperative SV, DV and MV were significantly correlated with sC5b-9 (r=0.583, p=0.009; r=0.581, p=0.009; r=0.598, p=0.007, respectively). Increased CBFV after CPB are correlated to the level of complement activation and may be controlled by heparin-coated circuits

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Background/introductionCurrently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure.PurposeTo assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD.MethodsPatients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age.ResultsWe considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p < 0.001) while patients above 60 years-old received principally biological SAVR (p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 (p = 0.03). Patients 50–60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR (p < 0.001). We observed a shift towards more biological SAVR (p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR (p < 0.0001), while associated CABGs were more frequent in case of biological SAVR (p < 0.0001).ConclusionIn a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines

Once the shovel hits the ground : Evaluating the management of complex implementation processes of public-private partnership infrastructure projects with qualitative comparative analysis

Much attention is being paid to the planning of public-private partnership (PPP) infrastructure projects. The subsequent implementation phase – when the contract has been signed and the project ‘starts rolling’ – has received less attention. However, sound agreements and good intentions in project planning can easily fail in project implementation. Implementing PPP infrastructure projects is complex, but what does this complexity entail? How are projects managed, and how do public and private partners cooperate in implementation? What are effective management strategies to achieve satisfactory outcomes? This is the fi rst set of questions addressed in this thesis. Importantly, the complexity of PPP infrastructure development imposes requirements on the evaluation methods that can be applied for studying these questions. Evaluation methods that ignore complexity do not create a realistic understanding of PPP implementation processes, with the consequence that evaluations tell us little about what works and what does not, in which contexts, and why. This hampers learning from evaluations. What are the requirements for a complexity-informed evaluation method? And how does qualitative comparative analysis (QCA) meet these requirements? This is the second set of questions addressed in this thesis

The Dark and Bright Sides of Renegotiation: An Application to Transport Concession Contracts

Renegotiations of public-private partnerships have recently been the subject of much attention. Economists regularly analyse them through the lens of 'hold up' theories. According to these models, renegotiations are a problem to be avoided: renegotiations become opportunistic because agents are self-interested, and they use renegotiation to seek rents. As a result, renegotiating destroys social surplus. Even when renegotiations occur to fill in the blanks of the contracts, and implement investments that had not been contracted ex ante, they typically predict a process by which parties use renegotiations to maximise their short run individual benefit. This paper sets out an alternative and new view. Through two case studies, we show that renegotiations may be cooperative, contrary to the conventional view. We find that when parties give an important value to their present and future bilateral relationships, they are prone to find solutions that are sustainable and profitable for both parties. Even acting according to their own self-interest, at the stage of renegotiation, parties try to maximise joint utility. In this way, they reinforce the durability of their relationship.Renegotiation Concession contracts Cooperation Opportunistic behaviour

The Economics of Public-Private Partnerships

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Les partenariats public-privé institutionnalisés: intérêts, limites et risques d’une structure hybride public-privé

International audienceInstitutionalized Public‑Private Partnerships : Advantages, limits, and risks of an hybrid organisational structure — In July 2014, a new type a public‑private joint venture (Société d’économie mixte à opération unique) was created in France. This is the translation into French legislation of the European originated concept of institutionalized public‑private partnership (IPPP). This new governance modality for the development of public projects aims at addressing some of the limits of contractual public‑private partnerships, i.e. their financial costs, their opacity that impairs the public ontractor’s control and their lack of flexibility that increases the risk of contractual hold‑ups. We show that although IPPPs address to some extent these difficulties, they may also induce other specific risks.La loi du 1er juillet 2014 créant les sociétés d’économie mixte à opération unique a introduit en droit français la notion européenne de partenariat public‑prive institutionnalisé. Ces structures hybrides public‑prive visent à répondre aux difficultés induites par les montages classiques en partenariat public‑prive : leur coût pour les finances publiques, leur opacité qui fait obstacle à leur contrôle par le contractant public et, enfin, leur rigidité qui place souvent ce dernier dans une situation d’otage contractuel. Si la résolution de ces difficultés est possible, elle risque de n’être que partielle et potentiellement porteuse de nouveaux facteurs de risques