Gerardo Bozovich | Universidad Favaloro (original) (raw)

Papers by Gerardo Bozovich

Revista Argentina de Cardiología, Aug 1, 2013

Heart transplantation is a surgical procedure performed to remove a heart with end-stage function... more Heart transplantation is a surgical procedure performed to remove a heart with end-stage functional impairment and replace it by a healthy heart from a deceased donor. The first heart transplantations were performed in the late 1960s, but it was in the 1980s-with the use of anti-rejection (immunosuppressive) drugs-that this procedure was consolidated as a surgery of choice to improve life expectancy and quality in patients with end-stage heart failure.

Revista Argentina de Cardiología, Oct 1, 2012

This study received the XXXVII Argentine Congress of Cardiology award.

Revista Argentina de Cardiología, Oct 1, 2014

Material y métodos: Desde junio de 1998 a diciembre de 2011 se intervinieron 66 pacientes con cir... more Material y métodos: Desde junio de 1998 a diciembre de 2011 se intervinieron 66 pacientes con cirugía de preservación de la válvula aórtica. Se incluyeron 53 pacientes operados con técnica de reimplante y se excluyeron 13 pacientes intervenidos con técnica de remodelación. Se realizó seguimiento clínico y ecocardiográfico. La insuficiencia aórtica se clasificó en: 0: ausente; 1+: leve; 2+: moderada; 3+: moderada-grave; 4+: grave. La supervivencia y la ausencia de insuficiencia aórtica > 2+ y de reoperación se analizaron con el método de Kaplan-Meier. Resultados: La edad media de los pacientes fue de 45 ± 17 años, el 79% eran de sexo masculino, el 36% con síndrome de Marfan. La mortalidad hospitalaria y tardía fue del 3,8%. La supervivencia global a los 8 años fue del 91% (IC 95% 78-97%). La ausencia de insuficiencia aórtica > 2+ y de reoperación a los 8 años fue del 84% (IC 95% 66-92%) y del 90% (IC 95% 74-96%), respectivamente. La insuficiencia aórtica preoperatoria > 2+ no se asoció con insuficiencia aórtica > 2+ (RR 1,45; p = 0,16) ni con reoperación (RR 1,96; p = 0,4) durante el seguimiento. Conclusiones: En nuestra experiencia, la cirugía de preservación de la válvula aórtica con técnica de reimplante en pacientes con patología de la raíz aórtica muestra resultados comparables a los de otras series internacionales publicadas. Esta técnica quirúrgica es una opción válida para pacientes seleccionados, correctamente informados sobre las diferentes técnicas quirúrgicas, y debe realizarse en centros con experiencia.

Revista Argentina de Cardiología, Jun 1, 2008

Argentine Journal of Cardiology, Aug 16, 2013

Background Previous studies have reported that women with acute coronary syndromes have worse out... more Background Previous studies have reported that women with acute coronary syndromes have worse outcomes compared to men and also undergo less diagnostic tests and interventions. It would thus be useful to establish whether this trend occurs in our country and which are the possible associations of prognostic value. Objective The aim of this study was to evaluate the clinical characteristics, treatments and outcomes of an Argentine cohort of patients with acute coronary syndromes at 2-year follow-up. Methods The Argentine cohort of the GRACE study included 4708 men and 2027 women with non-ST segment elevation acute coronary syndromes. The clinical history, type of presentation, final diagnosis, pharmacological treatments, revascularization and cumulative incidence of mortality and reinfarction were analyzed during hospitalization and at 6-month and 2-year follow-up. Results Women were older (69.4 ±12.3 vs. 63.1 ±11.9 years; p < 0.01), and had greater prevalence of heart failure and hypertension. The proportions of ischemic electrocardiographic changes and abnormal cardiac enzymes were similar in both sexes. Use of aspirin, clopidogrel and beta blockers was significantly lower in women, who had 50% chance of undergoing either percutaneous coronary intervention (OR= 0.55;95% CI 0.48-0.62) or coronary artery bypass graft surgery (OR= 0.49; 95% CI 0.36-0.67) than men. The crude incidences of mortality and reinfarction during hospitalization and at two-year follow up were higher in women with no differences in the relative risk of major events after adjusting for age and other covariates. Conclusions Despite similar risk than men to that of men, women were exposed to fewer interventions during hospitalization. Our results should alert physicians to indicate antiischemic treatments and interventions adjusted to risk in women.

Revista Argentina de Cardiología, Oct 1, 2012

Introducción La cirugía de Ross, empleada por cirujanos de diferentes partes del mundo desde su i... more Introducción La cirugía de Ross, empleada por cirujanos de diferentes partes del mundo desde su introducción en 1967 como alternativa quirúrgica en el tratamiento de la enfermedad valvular aórtica, tiene ventajas y beneficios que son bien conocidos. No obstante ello, trae aparejadas algunas preocupaciones que han limitado su aplicación, como su complejidad técnica y la incertidumbre, que aún existe, respecto de la durabilidad de sus sustitutos valvulares. Objetivo Analizar los resultados a largo plazo de la cirugía de Ross en el tratamiento de la enfermedad valvular aórtica en el Hospital Universitario Fundación Favaloro. Declaración de conflicto de intereses Los autores declaran que no poseen conflicto de intereses.

Circulation, Nov 26, 2013

Metodo Se incluyeron 1.293 acientes que fueron intervenidos quirlirgicamente con tecnica de by as... more Metodo Se incluyeron 1.293 acientes que fueron intervenidos quirlirgicamente con tecnica de by ass aortocoronario con circulaci6n extracor 6rea en 41 centros asistenciales de la Argentina, durante un eriodo de once meses (octubre 1992-setiembre 1993) . Para cuantificar los redictores indeendientes de mortalidad inmediata se establecieron los odds ratios mediante un analisis de regresi6n logistica.

Archivos del Instituto de Cardiología de México

Evidence exists showing an association between Chlamydial infection and infarction. Our purpose w... more Evidence exists showing an association between Chlamydial infection and infarction. Our purpose was to identify an interactive relationship between Chlamydia pneumoniae and unstable angina. We analyzed IgG antibodies for Chlamydia pneumoniae, Mycoplasma pneumoniae, and C reactive protein in patients during the acute phase of unstable angina. Chlamydia antibodies were present in 16.92% (11 cases) of the unstable angina patients. They were also present in 34.61% of those patients who experienced ischemic events vs 5.1% who did not (odds ratio 9.79, 95% CL 1.65 to 75.26, p = 0.002). Mycoplasma pneumoniae antibodies were present in 12.30% of patients but did not emerge as a predictive variable. C-reactive protein was present in 22 cases (33.84%), 9 of which were associated with recurrent events (34.61%) vs 13 which were free of them (odds ratio, p = 0.5). The interactive relationship between infection plus C-reactive protein achieved a statistical significant association with ischemic e...

European Heart Journal, 1999

Aims Mounting evidence suggests infection, specifically Chlamydia pneumoniae, plays a role in ath... more Aims Mounting evidence suggests infection, specifically Chlamydia pneumoniae, plays a role in atherosclerosis. We tested whether antibiotic treatment with the macrolide roxithromycin improves clinical outcome in patients with acute non-Q-wave coronary syndromes. Preliminary reports revealed a reduction in events in the roxithromycin group at 30 days. We now report the long-term follow-up results. Methods and Results Sixty-four per cent of the initial 202 patients with unstable angina who were randomly assigned to receive either roxithromycin or placebo for 30 days completed the active treatment period. At day 30, the primary triple and double end-point rates were 9% and 4% in the placebo group compared to 2% and 0% in the roxithromycin group (unadjusted P=0•032 and 0•058, respectively). The secondary triple and double end-point rates were again higher in the placebo group at day 90 (12•5% and 6•25% vs 4•37% and 0%, unadjusted P=0•065 and 0•029, respectively), and at day 180 (14•6% and 7•29% vs 8•69% and 2•17%, unadjusted P=0•259 and 0•17, respectively). Anti-C. pneumoniae IgG titres were unchanged in both groups while C-reactive protein levels decreased in both strategies, with a more significant decrease in the roxithromycin arm (P=0•03). Elevated C-reactive protein levels predicted the need for revascularization. Conclusions In this pilot trial, roxithromycin appears to extend the clinical benefit of preventing death and re-infarction for at least 6 months after initial treatment.

Circulation-cardiovascular Quality and Outcomes, Apr 1, 2012

Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwi... more Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwide. Poor teamwork and communication skills rather than lack of technical knowledge have been identified as a common factor in numerous studies. Objective: To promote a safer medical practice through the adoption of Crew Resource Management (CRM) procedures directly adapted from the aviation industry for the first time in Argentina. Methods: Starting in 2009 we organized a hybrid team of two physicians/amateur aviators and two expert airline pilots with a significant background on safety analysis and CRM training . The setting for the initial experience was a teaching hospital with high volume cardiovascular and organ transplantation departments. CRM training has been offered at least once a year in a non compulsory manner to the entire spectrum of healthcare personnel, including medical and nursing students. Courses are structured in two day sessions divided in several chapters and workshops: Introduction, statistics, leadership, communication skills, and avoidance of risky behaviors. Slides, full text articles and reports are available for permanent consultation by personnel along with discussion forums at the Moodle based site of the program. Results: Satisfaction levels among attendees has consistently averaged 92%. Following training, briefings and debriefings have been implemented as standard procedures along with checklists both at Intensive Care, Operating Rooms and General Ward. No wrong side or wrong patient interventions have been reported over 3 years, while in 1/9500 surgical procedures a misidentification of a patient occurred with successful detection at the second crossed check on admission to the OR. Overdosing was reported in 1 every 4960 admissions, none fatal or disabling. Conclusions: Choosing a hybrid team of physicians and airline pilots rather than physicians or nurses alone as facilitators was a key factor to spark interest in teamwork factors and to avoid fear of punishment following reports. Despite cultural differences, CRM can be as feasible and successful in a Latin American hospital environment as previously shown in several centers in the United States.

Circulation: Cardiovascular Quality and Outcomes, 2012

Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwi... more Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwide. Poor teamwork and communication skills rather than lack of technical knowledge have been identified as a common factor in numerous studies. Objective: To promote a safer medical practice through the adoption of Crew Resource Management (CRM) procedures directly adapted from the aviation industry for the first time in Argentina. Methods: Starting in 2009 we organized a hybrid team of two physicians/amateur aviators and two expert airline pilots with a significant background on safety analysis and CRM training . The setting for the initial experience was a teaching hospital with high volume cardiovascular and organ transplantation departments. CRM training has been offered at least once a year in a non compulsory manner to the entire spectrum of healthcare personnel, including medical and nursing students. Courses are structured in two day sessions divided in several chapters and works...

Revista Argentina de Cardiología, 2014

Introduction: The aortic valve-sparing operation offers the unique possibility of preserving the ... more Introduction: The aortic valve-sparing operation offers the unique possibility of preserving the native valve in patients whoneed surgical treatment for aortic root disease. Objective: The aim of this study was to assess the long term outcome of the aortic valve-sparing operation with reimplantation technique at the Hospital Universitario Fundacion Favaloro. Methods: A total of 66 patients underwent aortic valve-sparing operation from June 1998 to December 2011. Fifty threepatients operated on with the aortic valve reimplantation technique were included in the study and 13 patients operatedwith the remodeling technique were excluded. Clinical and echocardiographic follow-up was performed. Aortic insufficiencywas graded as: 0: absent; 1+: mild; 2+: moderate; 3+: moderate-severe, and 4+: severe. Survival and freedom from aorticinsufficiency >2+ and reoperation were analyzed using the Kaplan-Meier method.Results: Mean age was 45±17 years, 79% of patients were men and 36% had Marfan ...

Revista Argentina De Cardiologia, Jun 1, 2008

Revista Americana De Medicina Respiratoria, Jun 1, 2014

Resumen Introducción y objetivos: En Argentina, no se conocen datos de pacientes con hipertensión... more Resumen Introducción y objetivos: En Argentina, no se conocen datos de pacientes con hipertensión pulmonar (HP) con diagnóstico de certeza. El propósito del presente registro fue conocer las características de nuestra población de pacientes con HP del Grupo I de la clasificación de Dana Point 2008, hipertensión arterial pulmonar (HAP), estudiar la supervivencia y las variables asociadas a mayor mortalidad. Métodos: Estudio de cohorte de 134 pacientes admitidos por primera vez en el consultorio de HP de nuestra institución en el período comprendido entre enero/2004 y marzo/2012. Se excluyeron 9 pacientes; total analizado: 125 pacientes. Resultados: Edad promedio: 34 ± 15,7 años y la relación mujer/hombre: 3,8/1. Las etiologías más prevalentes fueron la HAP idiopática (HAPI) (61, 48.8%), asociadas a cardiopatías congénitas (35, 28%) y a colagenopatías (18, 14.4%). La supervivencia libre de trasplante o muerte fue de 63.2%; a 12, 24 y 36 meses la supervivencia fue del 94% (IC95% 88-97), 90% (IC95% 83-94) y 83% (IC95% 75-89), respectivamente. Las variables basales asociadas a mayor mortalidad y/o trasplante fueron la disnea clase funcional III/IV (OR 3.6 IC95% 1.5-8.9, p < 0.01), la distancia recorrida en la prueba de la caminata de 6 minutos menor de 380 m (OR 2.7 IC95% 1.1-6.5 p = 0.023) y el derrame pericárdico (OR 4.2 IC95% 1.3-14.6 p = 0.021). Conclusiones: Esta serie muestra las características y supervivencia actuales de pacientes con HP en un centro de referencia en Argentina. Variables de fácil obtención y reproducción permitieron estratificar subgrupos de mayor riesgo de muerte y/o trasplante en el seguimiento.

Capitulos Cardiol, Jul 1, 1999

Circulation, Nov 23, 2010

Background: Prior studies have shown an association between atherosclerotic burden and vascular e... more Background: Prior studies have shown an association between atherosclerotic burden and vascular events, as well as the relationship among severe carotid obstruction and stroke, in patients undergoi...

Argentine Journal of Cardiology, Aug 16, 2013

Background Previous studies have reported that women with acute coronary syndromes have worse out... more Background Previous studies have reported that women with acute coronary syndromes have worse outcomes compared to men and also undergo less diagnostic tests and interventions. It would thus be useful to establish whether this trend occurs in our country and which are the possible associations of prognostic value. Objective The aim of this study was to evaluate the clinical characteristics, treatments and outcomes of an Argentine cohort of patients with acute coronary syndromes at 2-year follow-up. Methods The Argentine cohort of the GRACE study included 4708 men and 2027 women with non-ST segment elevation acute coronary syndromes. The clinical history, type of presentation, final diagnosis, pharmacological treatments, revascularization and cumulative incidence of mortality and reinfarction were analyzed during hospitalization and at 6-month and 2-year follow-up. Results Women were older (69.4 ±12.3 vs. 63.1 ±11.9 years; p < 0.01), and had greater prevalence of heart failure and hypertension. The proportions of ischemic electrocardiographic changes and abnormal cardiac enzymes were similar in both sexes. Use of aspirin, clopidogrel and beta blockers was significantly lower in women, who had 50% chance of undergoing either percutaneous coronary intervention (OR= 0.55;95% CI 0.48-0.62) or coronary artery bypass graft surgery (OR= 0.49; 95% CI 0.36-0.67) than men. The crude incidences of mortality and reinfarction during hospitalization and at two-year follow up were higher in women with no differences in the relative risk of major events after adjusting for age and other covariates. Conclusions Despite similar risk than men to that of men, women were exposed to fewer interventions during hospitalization. Our results should alert physicians to indicate antiischemic treatments and interventions adjusted to risk in women.

Thrombosis journal, Jan 13, 2005

Natural disasters, war, and terrorist attacks, have been linked to cardiac mortality. We sought t... more Natural disasters, war, and terrorist attacks, have been linked to cardiac mortality. We sought to investigate whether a major financial crisis may impact on the medical management and outcomes of acute coronary syndromes. We analyzed the Argentine cohort of the international multicenter Global Registry of Acute Coronary Events (GRACE). The primary objective was to estimate if there was an association between the financial crisis period (April 1999 to December 2002) and in- hospital cardiovascular mortality, with the post-crisis period (January 2003 to September 2004) as the referent. Each period was defined according to the evolution of the Gross Domestic Product. We investigated the demographic characteristics, diagnostic and therapeutic procedures, morbidity and mortality. We analyzed data from 3220 patients, 2246 (69.8%) patients in the crisis period and 974 (30.2%) in the post-crisis frame. The distribution of demographic and clinical baseline characteristics were not significa...

Revista Argentina de Cardiología, Aug 1, 2013

Heart transplantation is a surgical procedure performed to remove a heart with end-stage function... more Heart transplantation is a surgical procedure performed to remove a heart with end-stage functional impairment and replace it by a healthy heart from a deceased donor. The first heart transplantations were performed in the late 1960s, but it was in the 1980s-with the use of anti-rejection (immunosuppressive) drugs-that this procedure was consolidated as a surgery of choice to improve life expectancy and quality in patients with end-stage heart failure.

Revista Argentina de Cardiología, Oct 1, 2012

This study received the XXXVII Argentine Congress of Cardiology award.

Revista Argentina de Cardiología, Oct 1, 2014

Material y métodos: Desde junio de 1998 a diciembre de 2011 se intervinieron 66 pacientes con cir... more Material y métodos: Desde junio de 1998 a diciembre de 2011 se intervinieron 66 pacientes con cirugía de preservación de la válvula aórtica. Se incluyeron 53 pacientes operados con técnica de reimplante y se excluyeron 13 pacientes intervenidos con técnica de remodelación. Se realizó seguimiento clínico y ecocardiográfico. La insuficiencia aórtica se clasificó en: 0: ausente; 1+: leve; 2+: moderada; 3+: moderada-grave; 4+: grave. La supervivencia y la ausencia de insuficiencia aórtica > 2+ y de reoperación se analizaron con el método de Kaplan-Meier. Resultados: La edad media de los pacientes fue de 45 ± 17 años, el 79% eran de sexo masculino, el 36% con síndrome de Marfan. La mortalidad hospitalaria y tardía fue del 3,8%. La supervivencia global a los 8 años fue del 91% (IC 95% 78-97%). La ausencia de insuficiencia aórtica > 2+ y de reoperación a los 8 años fue del 84% (IC 95% 66-92%) y del 90% (IC 95% 74-96%), respectivamente. La insuficiencia aórtica preoperatoria > 2+ no se asoció con insuficiencia aórtica > 2+ (RR 1,45; p = 0,16) ni con reoperación (RR 1,96; p = 0,4) durante el seguimiento. Conclusiones: En nuestra experiencia, la cirugía de preservación de la válvula aórtica con técnica de reimplante en pacientes con patología de la raíz aórtica muestra resultados comparables a los de otras series internacionales publicadas. Esta técnica quirúrgica es una opción válida para pacientes seleccionados, correctamente informados sobre las diferentes técnicas quirúrgicas, y debe realizarse en centros con experiencia.

Revista Argentina de Cardiología, Jun 1, 2008

Argentine Journal of Cardiology, Aug 16, 2013

Background Previous studies have reported that women with acute coronary syndromes have worse out... more Background Previous studies have reported that women with acute coronary syndromes have worse outcomes compared to men and also undergo less diagnostic tests and interventions. It would thus be useful to establish whether this trend occurs in our country and which are the possible associations of prognostic value. Objective The aim of this study was to evaluate the clinical characteristics, treatments and outcomes of an Argentine cohort of patients with acute coronary syndromes at 2-year follow-up. Methods The Argentine cohort of the GRACE study included 4708 men and 2027 women with non-ST segment elevation acute coronary syndromes. The clinical history, type of presentation, final diagnosis, pharmacological treatments, revascularization and cumulative incidence of mortality and reinfarction were analyzed during hospitalization and at 6-month and 2-year follow-up. Results Women were older (69.4 ±12.3 vs. 63.1 ±11.9 years; p < 0.01), and had greater prevalence of heart failure and hypertension. The proportions of ischemic electrocardiographic changes and abnormal cardiac enzymes were similar in both sexes. Use of aspirin, clopidogrel and beta blockers was significantly lower in women, who had 50% chance of undergoing either percutaneous coronary intervention (OR= 0.55;95% CI 0.48-0.62) or coronary artery bypass graft surgery (OR= 0.49; 95% CI 0.36-0.67) than men. The crude incidences of mortality and reinfarction during hospitalization and at two-year follow up were higher in women with no differences in the relative risk of major events after adjusting for age and other covariates. Conclusions Despite similar risk than men to that of men, women were exposed to fewer interventions during hospitalization. Our results should alert physicians to indicate antiischemic treatments and interventions adjusted to risk in women.

Revista Argentina de Cardiología, Oct 1, 2012

Introducción La cirugía de Ross, empleada por cirujanos de diferentes partes del mundo desde su i... more Introducción La cirugía de Ross, empleada por cirujanos de diferentes partes del mundo desde su introducción en 1967 como alternativa quirúrgica en el tratamiento de la enfermedad valvular aórtica, tiene ventajas y beneficios que son bien conocidos. No obstante ello, trae aparejadas algunas preocupaciones que han limitado su aplicación, como su complejidad técnica y la incertidumbre, que aún existe, respecto de la durabilidad de sus sustitutos valvulares. Objetivo Analizar los resultados a largo plazo de la cirugía de Ross en el tratamiento de la enfermedad valvular aórtica en el Hospital Universitario Fundación Favaloro. Declaración de conflicto de intereses Los autores declaran que no poseen conflicto de intereses.

Circulation, Nov 26, 2013

Metodo Se incluyeron 1.293 acientes que fueron intervenidos quirlirgicamente con tecnica de by as... more Metodo Se incluyeron 1.293 acientes que fueron intervenidos quirlirgicamente con tecnica de by ass aortocoronario con circulaci6n extracor 6rea en 41 centros asistenciales de la Argentina, durante un eriodo de once meses (octubre 1992-setiembre 1993) . Para cuantificar los redictores indeendientes de mortalidad inmediata se establecieron los odds ratios mediante un analisis de regresi6n logistica.

Archivos del Instituto de Cardiología de México

Evidence exists showing an association between Chlamydial infection and infarction. Our purpose w... more Evidence exists showing an association between Chlamydial infection and infarction. Our purpose was to identify an interactive relationship between Chlamydia pneumoniae and unstable angina. We analyzed IgG antibodies for Chlamydia pneumoniae, Mycoplasma pneumoniae, and C reactive protein in patients during the acute phase of unstable angina. Chlamydia antibodies were present in 16.92% (11 cases) of the unstable angina patients. They were also present in 34.61% of those patients who experienced ischemic events vs 5.1% who did not (odds ratio 9.79, 95% CL 1.65 to 75.26, p = 0.002). Mycoplasma pneumoniae antibodies were present in 12.30% of patients but did not emerge as a predictive variable. C-reactive protein was present in 22 cases (33.84%), 9 of which were associated with recurrent events (34.61%) vs 13 which were free of them (odds ratio, p = 0.5). The interactive relationship between infection plus C-reactive protein achieved a statistical significant association with ischemic e...

European Heart Journal, 1999

Aims Mounting evidence suggests infection, specifically Chlamydia pneumoniae, plays a role in ath... more Aims Mounting evidence suggests infection, specifically Chlamydia pneumoniae, plays a role in atherosclerosis. We tested whether antibiotic treatment with the macrolide roxithromycin improves clinical outcome in patients with acute non-Q-wave coronary syndromes. Preliminary reports revealed a reduction in events in the roxithromycin group at 30 days. We now report the long-term follow-up results. Methods and Results Sixty-four per cent of the initial 202 patients with unstable angina who were randomly assigned to receive either roxithromycin or placebo for 30 days completed the active treatment period. At day 30, the primary triple and double end-point rates were 9% and 4% in the placebo group compared to 2% and 0% in the roxithromycin group (unadjusted P=0•032 and 0•058, respectively). The secondary triple and double end-point rates were again higher in the placebo group at day 90 (12•5% and 6•25% vs 4•37% and 0%, unadjusted P=0•065 and 0•029, respectively), and at day 180 (14•6% and 7•29% vs 8•69% and 2•17%, unadjusted P=0•259 and 0•17, respectively). Anti-C. pneumoniae IgG titres were unchanged in both groups while C-reactive protein levels decreased in both strategies, with a more significant decrease in the roxithromycin arm (P=0•03). Elevated C-reactive protein levels predicted the need for revascularization. Conclusions In this pilot trial, roxithromycin appears to extend the clinical benefit of preventing death and re-infarction for at least 6 months after initial treatment.

Circulation-cardiovascular Quality and Outcomes, Apr 1, 2012

Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwi... more Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwide. Poor teamwork and communication skills rather than lack of technical knowledge have been identified as a common factor in numerous studies. Objective: To promote a safer medical practice through the adoption of Crew Resource Management (CRM) procedures directly adapted from the aviation industry for the first time in Argentina. Methods: Starting in 2009 we organized a hybrid team of two physicians/amateur aviators and two expert airline pilots with a significant background on safety analysis and CRM training . The setting for the initial experience was a teaching hospital with high volume cardiovascular and organ transplantation departments. CRM training has been offered at least once a year in a non compulsory manner to the entire spectrum of healthcare personnel, including medical and nursing students. Courses are structured in two day sessions divided in several chapters and workshops: Introduction, statistics, leadership, communication skills, and avoidance of risky behaviors. Slides, full text articles and reports are available for permanent consultation by personnel along with discussion forums at the Moodle based site of the program. Results: Satisfaction levels among attendees has consistently averaged 92%. Following training, briefings and debriefings have been implemented as standard procedures along with checklists both at Intensive Care, Operating Rooms and General Ward. No wrong side or wrong patient interventions have been reported over 3 years, while in 1/9500 surgical procedures a misidentification of a patient occurred with successful detection at the second crossed check on admission to the OR. Overdosing was reported in 1 every 4960 admissions, none fatal or disabling. Conclusions: Choosing a hybrid team of physicians and airline pilots rather than physicians or nurses alone as facilitators was a key factor to spark interest in teamwork factors and to avoid fear of punishment following reports. Despite cultural differences, CRM can be as feasible and successful in a Latin American hospital environment as previously shown in several centers in the United States.

Circulation: Cardiovascular Quality and Outcomes, 2012

Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwi... more Introduction: Medical errors are a frequent cause of morbidity and mortality in hospitals worldwide. Poor teamwork and communication skills rather than lack of technical knowledge have been identified as a common factor in numerous studies. Objective: To promote a safer medical practice through the adoption of Crew Resource Management (CRM) procedures directly adapted from the aviation industry for the first time in Argentina. Methods: Starting in 2009 we organized a hybrid team of two physicians/amateur aviators and two expert airline pilots with a significant background on safety analysis and CRM training . The setting for the initial experience was a teaching hospital with high volume cardiovascular and organ transplantation departments. CRM training has been offered at least once a year in a non compulsory manner to the entire spectrum of healthcare personnel, including medical and nursing students. Courses are structured in two day sessions divided in several chapters and works...

Revista Argentina de Cardiología, 2014

Introduction: The aortic valve-sparing operation offers the unique possibility of preserving the ... more Introduction: The aortic valve-sparing operation offers the unique possibility of preserving the native valve in patients whoneed surgical treatment for aortic root disease. Objective: The aim of this study was to assess the long term outcome of the aortic valve-sparing operation with reimplantation technique at the Hospital Universitario Fundacion Favaloro. Methods: A total of 66 patients underwent aortic valve-sparing operation from June 1998 to December 2011. Fifty threepatients operated on with the aortic valve reimplantation technique were included in the study and 13 patients operatedwith the remodeling technique were excluded. Clinical and echocardiographic follow-up was performed. Aortic insufficiencywas graded as: 0: absent; 1+: mild; 2+: moderate; 3+: moderate-severe, and 4+: severe. Survival and freedom from aorticinsufficiency >2+ and reoperation were analyzed using the Kaplan-Meier method.Results: Mean age was 45±17 years, 79% of patients were men and 36% had Marfan ...

Revista Argentina De Cardiologia, Jun 1, 2008

Revista Americana De Medicina Respiratoria, Jun 1, 2014

Resumen Introducción y objetivos: En Argentina, no se conocen datos de pacientes con hipertensión... more Resumen Introducción y objetivos: En Argentina, no se conocen datos de pacientes con hipertensión pulmonar (HP) con diagnóstico de certeza. El propósito del presente registro fue conocer las características de nuestra población de pacientes con HP del Grupo I de la clasificación de Dana Point 2008, hipertensión arterial pulmonar (HAP), estudiar la supervivencia y las variables asociadas a mayor mortalidad. Métodos: Estudio de cohorte de 134 pacientes admitidos por primera vez en el consultorio de HP de nuestra institución en el período comprendido entre enero/2004 y marzo/2012. Se excluyeron 9 pacientes; total analizado: 125 pacientes. Resultados: Edad promedio: 34 ± 15,7 años y la relación mujer/hombre: 3,8/1. Las etiologías más prevalentes fueron la HAP idiopática (HAPI) (61, 48.8%), asociadas a cardiopatías congénitas (35, 28%) y a colagenopatías (18, 14.4%). La supervivencia libre de trasplante o muerte fue de 63.2%; a 12, 24 y 36 meses la supervivencia fue del 94% (IC95% 88-97), 90% (IC95% 83-94) y 83% (IC95% 75-89), respectivamente. Las variables basales asociadas a mayor mortalidad y/o trasplante fueron la disnea clase funcional III/IV (OR 3.6 IC95% 1.5-8.9, p < 0.01), la distancia recorrida en la prueba de la caminata de 6 minutos menor de 380 m (OR 2.7 IC95% 1.1-6.5 p = 0.023) y el derrame pericárdico (OR 4.2 IC95% 1.3-14.6 p = 0.021). Conclusiones: Esta serie muestra las características y supervivencia actuales de pacientes con HP en un centro de referencia en Argentina. Variables de fácil obtención y reproducción permitieron estratificar subgrupos de mayor riesgo de muerte y/o trasplante en el seguimiento.

Capitulos Cardiol, Jul 1, 1999

Circulation, Nov 23, 2010

Background: Prior studies have shown an association between atherosclerotic burden and vascular e... more Background: Prior studies have shown an association between atherosclerotic burden and vascular events, as well as the relationship among severe carotid obstruction and stroke, in patients undergoi...

Argentine Journal of Cardiology, Aug 16, 2013

Background Previous studies have reported that women with acute coronary syndromes have worse out... more Background Previous studies have reported that women with acute coronary syndromes have worse outcomes compared to men and also undergo less diagnostic tests and interventions. It would thus be useful to establish whether this trend occurs in our country and which are the possible associations of prognostic value. Objective The aim of this study was to evaluate the clinical characteristics, treatments and outcomes of an Argentine cohort of patients with acute coronary syndromes at 2-year follow-up. Methods The Argentine cohort of the GRACE study included 4708 men and 2027 women with non-ST segment elevation acute coronary syndromes. The clinical history, type of presentation, final diagnosis, pharmacological treatments, revascularization and cumulative incidence of mortality and reinfarction were analyzed during hospitalization and at 6-month and 2-year follow-up. Results Women were older (69.4 ±12.3 vs. 63.1 ±11.9 years; p < 0.01), and had greater prevalence of heart failure and hypertension. The proportions of ischemic electrocardiographic changes and abnormal cardiac enzymes were similar in both sexes. Use of aspirin, clopidogrel and beta blockers was significantly lower in women, who had 50% chance of undergoing either percutaneous coronary intervention (OR= 0.55;95% CI 0.48-0.62) or coronary artery bypass graft surgery (OR= 0.49; 95% CI 0.36-0.67) than men. The crude incidences of mortality and reinfarction during hospitalization and at two-year follow up were higher in women with no differences in the relative risk of major events after adjusting for age and other covariates. Conclusions Despite similar risk than men to that of men, women were exposed to fewer interventions during hospitalization. Our results should alert physicians to indicate antiischemic treatments and interventions adjusted to risk in women.

Thrombosis journal, Jan 13, 2005

Natural disasters, war, and terrorist attacks, have been linked to cardiac mortality. We sought t... more Natural disasters, war, and terrorist attacks, have been linked to cardiac mortality. We sought to investigate whether a major financial crisis may impact on the medical management and outcomes of acute coronary syndromes. We analyzed the Argentine cohort of the international multicenter Global Registry of Acute Coronary Events (GRACE). The primary objective was to estimate if there was an association between the financial crisis period (April 1999 to December 2002) and in- hospital cardiovascular mortality, with the post-crisis period (January 2003 to September 2004) as the referent. Each period was defined according to the evolution of the Gross Domestic Product. We investigated the demographic characteristics, diagnostic and therapeutic procedures, morbidity and mortality. We analyzed data from 3220 patients, 2246 (69.8%) patients in the crisis period and 974 (30.2%) in the post-crisis frame. The distribution of demographic and clinical baseline characteristics were not significa...