The digital transformation of public administrations contributes to the re-design and re-structuring of the organizational processes and practices. Research on the digital transformation of public administrations often focuses on responding to the needs and providing benefits to external stakeholders and users, such as citizens and businesses. The study presented here focuses on one specific stakeholder, the employees of a department within the Federal Government of Lower Austria. Using a multi-method and granular qualitative research approach, the results are interpreted in the context of Perez's (2009) four phases of the digital transformation paradigm. The results show how the department is implementing the recommendations made in the literature and digital strategies: an extensive use of ICTs, the development of information-based services, and an acceleration of transactions and interactions with external stakeholders. At the same time, their perspectives point out some barriers regarding the implementation and use of new digital tools such as digital signatures, the legal frameworks at the national and regional level, and the need for an organizational culture that supports innovation. This study empirically contributes to the literature by providing an analysis of the digital transformation of a public administration as perceived by the employees.

Objectives: Pronounced mitral annular disjunction (pMAD ≥8 mm) in myxomatous mitral valve disease has been associated with ventricular arrhythmias in selected cohorts, whereas minor degrees of mural separation are frequently observed in structurally normal hearts. Its clinical relevance after mitral valve surgery remains unclear. We investigated whether pMAD is associated with postoperative symptom burden and rhythm outcomes. Methodsv: In this retrospective cohort with prospective follow-up, 246 adults undergoing mitral valve surgery for Barlow’s disease were classified intraoperatively as pMAD (≥8 mm) or non-pMAD (<8 mm). The primary end point was patient-reported postoperative palpitations. Propensity score–based inverse probability weighting was applied to adjust for baseline differences. Structured follow-up in pMAD patients included transthoracic echocardiography (TTE) and 24-hour Holter monitoring. Results: pMAD was present in 103 patients (41.9%). Surgery effectively reduced disjunction distance. At follow-up, palpitations were more frequent in pMAD compared with non-pMAD patients (40.8% vs 18.9%, P = .011), remaining significant after adjustment. In the pMAD follow-up cohort, atrial fibrillation prevalence decreased significantly after surgery. Holter monitoring did not demonstrate sustained malignant arrhythmias. Survival and major adverse events were comparable between groups. Conclusions: After mitral valve surgery for Barlow’s disease, pMAD is independently associated with increased postoperative palpitations despite anatomical correction. This association was not accompanied by excess malignant arrhythmias or adverse clinical end points, suggesting persistent symptom susceptibility rather than overt electrical instability.

Background: Mitral regurgitation due to Barlow’s disease remains surgically demanding. Despite widespread experience, consensus is lacking on whether the Alfieri repair can serve as a deliberate and durable rather than a rescue strategy in this complex pathology. Methods: We retrospectively analyzed patients undergoing mitral valve repair due to severe mitral regurgitation resulting from Barlow’s disease using either the Alfieri or Neochordae repair techniques. Patients received a uniform semi–rigid annuloplasty ring, while leaflet resection and concomitant coronary or aortic procedures were excluded. Results: Baseline demographics and echocardiography were broadly comparable. Perioperative mortality was 0% in both cohorts, with similarly low rates of major complications. Aortic cross–clamp time was significantly shorter with Alfieri repair (p < 0.001). No relevant postoperative transmitral gradient or systolic anterior motion occurred. At a mean follow–up of 4.2 years, more–than–moderate MR was observed in one patient per group (Alfieri 2.4% vs. Neochordae 1.2%). At 10 years, the cumulative incidence of more–than–moderate mitral regurgitation and redo mitral surgery was similarly low between techniques (p = 0.810 and p = 0.460). Most patients were NYHA class I–II at last follow–up, demonstrating improved functional status. Echocardiography showed left ventricular reverse remodeling without intergroup differences. Conclusions: These data indicate that the Alfieri approach provides durable competence and hemodynamic safety comparable to the Neochordae technique while reducing cross–clamp time, supporting its use as a deliberate strategy rather than a bailout in anatomically suitable valves.

Background: Outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis with concomitant severe mitral regurgitation (MR) remain incompletely defined. This study aimed to quantify the evolution of high-grade MR after TAVI, compare changes using MR etiology, and assess associations between MR etiology, early improvement, or residual discharge MR and mortality. Methods: In a retrospective single-center cohort, 112 TAVI patients with baseline more-than-moderate MR were included (functional n = 94; degenerative n = 18). MR grade was assessed pre-TAVI, at discharge, and at last available follow-up (serial studies up to ≥5 years), and 5-year all-cause mortality was analyzed. Results: At discharge, 34% of patients improved by more than one MR grade, and 26% by one grade. Among 45 patients with available late echocardiographic follow-up, 62% improved by more than one grade, 24% by one grade. Exploratory five-year survival analyses did not demonstrate a significant difference for MR etiology (p = 0.23), discharge MR grade (p = 0.11), or MR improvement status (p = 0.12). Conclusions: Among patients surviving to longitudinal echocardiographic follow-up, MR reduction was frequently observed after TAVI. Exploratory analyses did not demonstrate statistically significant differences in 5-year survival according to MR etiology, early MR improvement, or discharge MR severity. However, limited sample size and incomplete follow-up preclude definitive prognostic conclusions. Overall, these findings are compatible with a surveillance-first management, and with individualized consideration of adjunctive mitral therapy for persistent higher-grade symptomatic MR.