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Corso R B, Kraychete N, Nardeli S, Moitinho R, Ourives C, Barbosa P J, Pereira RBCCV R E -Aneurisma luético de arco aórtico roto, complicado pela oclusão de vasos braquiocefálicos e acidente vascular encefálico isquêmico: relato de caso tratado cirurgicamente. Rev Bras Cir Cardiovasc 2002; 17(2): 63-69.

Resultados da implementação de modelo organizacional de um serviço de cirurgia cardiovascularResults of the establishment of an organizational model in a cardiovascular surgery service Abstract Objective: Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes.Methods: From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra-and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis. Results:After establishment of such model, there was reduction of hospital mortality (from 12% to 3.6%, relative risk= 0.3; P=0.003) and combined events (from 22% to 15%, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Rev Bras Cir Cardiovasc 2009; 24(2): 116-125 relevance, because they are the base of cardiovascular surgery programs of excellence [5]. Quality control programs aim at adequacy of hospitals units and professionals involved in order to provide the best possible medical care. With this, the influence of organizational factors in the surgical outcomes can be minimized, with only the team human error [6] and individual factors linked to the patient, such as, socioeconomic status, severity of the disease and its comorbidities [7,8].Although the literature is extremely important for the development of medical practice in various specialties, there are few publications aiming at hospital organizational aspect and its quality control. Little evidences correlates integrated measures for care to outcomes after heart surgery [9-11], which encourages broad discussion on the subject, considering the increasing transparency of the outcomes of medical procedures to the lay public [12] and the consequent tendency of payment based on parameters such as quality and performance [13].The aim of this study is to assess the short-term impact of the adoption of an organizational model of cardiovascular surgery service on the surgical outcomes.

Background: Cardiopathies are high prevalence conditions. Among them, rheumatic carditis is of high relevance in developing countries. Left cardiac chamber changes are associated to endothelial dysfunction and ET-1 levels increase. Pulmonary circulation is then affected, and not seldom leading to pulmonary hypertension (PH). However, the presence of ET-1 and its receptors in the mitral valve itself -promoting pulmonary vascular changes, with increased rheumatic valvular deformation -has not been discussed in the literature.

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