No abstract

Objective: To evaluate the presence of sinus rhythm or atrial fibrillation (AF) in patients who had mitral valve surgery with concomitant surgical ablation of AF, by unipolar or bipolar radiofrequency. Methods: Adults patients who had mitral valve replacement or mitral valvuloplasty with concomitant surgical ablation of AF, either by unipolar or bipolar radiofrequency, were consecutively included between the 2008 and 2012. Surgery was done by conventional median sternotomy. Results: A total of 99 patients were included; 20 (20.2%) had surgical ablation by unipolar energy and 79 (79.8%) by bipolar energy. There were 76 (76.8%) women, and mean age± SD was 51 ±11 years.  The median duration of AF before surgery was 41 months. Type of AF was paroxysmal in 21 (21%), persistent in 11 (11%), and long-standing persistent in 67 (67%). Mean left atrium size in the preoperative period was 5.54 ± 0.82 cm. Mean left ventricular ejection fraction was 58±12.4%. Types of mitral valve surgery were valvuloplasty (n=10), mechanical valve replacement in 30, and bioprosthesis replacement in 59. Concomitant tricuspid annuloplasty was performed in 39 patients. Thirty- day mortality was 8/99 (8%). Mean follow-up time was 1274 days (3.49 years). Survival was 92%. After 4 years no patient who had had unipolar ablation was in sinus rhythm, whilst 67% of those who had bipolar energy ablation were in sinus rhythm (p<0.001). Conclusion: The use of bipolar energy is superior to unipolar energy in the surgical ablation of atrial fibrillation in patients submitted to mitral valve surgery.

No abstract

No abstract

BACKGROUNDChronic Lymphocytic leukemia is the most common leukemia in the western world. In the last decade, treatment options expanded with an expressive rise in treatment costs. In Brazil the overall cancer treatment costs are rising mainly due to the judicialization law suits. The efficacy and safety of associating rituximab to fludarabine and cyclophosphamide (R-FC) for the treatment of chronic lymphocytic leukemia has been demonstrated by the CLL8 trial, which was conducted in previously untreated patients positioning the immunochemotherapy regimen as the standard choice for physically fit patients. Considering this scenario, the current study has as objective to evaluate the cost-effectiveness of the addition of rituximab to the FC protocol considering the Brazilian public health system perspective. METHODSWe developed a Markov model with three health states to extrapolate the CLL8 trial results. The transition probabilities and adverse events incidence were obtained from the trial published data. The costs were assessed from Brazil’s ministry of health pricing database (public available). A simplified treatment algorithm was developed according to the current available treatment options in the Brazilian public health system and assuming the availability of rituximab. RESULTSThe addition of rituximab to the FC regimen results in an incremental cost-effectiveness ratio (ICER) of 8389 USD (45003,86 BRL) per year life free of progression. The sensititvity analysis conducted shows a From the Brazilian public health system perspective, the combination of rituximab with the FC chemotherapy represents a cost-effective strategic approach for first-line treatment of patients with CLL.CONCLUSIONSconsidering the data described in this study, we cqn conclude that the addition of rituximab to the first-line treatment of CLL is cost-effective strategy for the Brazil public health system. With the advent of new drugs and new treatment regimens that presents positive clinical outcomes in patients refratary to the R-FC regimen (del17p, p53 mutations), new studies must be conducted to evaluate their cost-effectiveness considering this population of patients.