Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 15th World Cardiac Surgery & Angiology Conference Philadelphia, Pennsylvania, USA.

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Day 1 :

Keynote Forum

Louis Samuels

Thomas Jefferson University, USA

Keynote: Beating Heart Coronary Artery Bypass Grafting (BH-CAB): The Pursuit of Perfection

Time : 09:00

Cardiac Surgery 2016 International Conference Keynote Speaker Louis Samuels photo
Biography:

Louis Samuels graduated Medical School from Hahnemann University (Philadelphia, PA) in 1987 and completed his Cardiothoracic Surgical training in 1995. He joined the faculty of Drexel University as the Surgical Director of Cardiac Transplantation. In 2001, Dr. Samuels and his team implanted the world’s 5th totally implantable electric artificial heart (AbioCor™). In 2003, he joined the Main Line Health System as the Surgical Director of Heart Failure. In addition to cardiac transplantation and LVAD implantation, Dr. Samuels performs CABG and Valvular surgery. In 2012, Dr. Samuels became Professor of Surgery at Thomas Jefferson University School of Medicine. Dr. Samuels has authored over 100 peer reviewed manuscripts and serves as a reviewer for the Annals of Thoracic Surgery. In addition to participating in several clinical trials related to mechanical circulatory support, he continues to serve as a consultant and medical advisor to new technologies currently in trial

Abstract:

Surgeons in general, and heart surgeons in particular, are perfectionists who constantly attempt to improve their skills and outcomes.  Coronary Artery Bypass Grafting (CABG), the most common procedure performed by adult cardiac surgeons, has undergone significant changes and equally significant scrutiny in the five decades since its inception.  The techniques used today are similar to those originally described, but important modifications have been made to make it one of the most successful operations ever conceived.  The traditional CABG involves establishment of cardiopulmonary bypass (CPB) with aortic and right atrial cannulation, aortic cross-clamping, and instillation of a cardioplegic solution to achieve electromechanical arrest.  In recent decades, Beating Heart Coronary Artery Bypass (BH-CAB) has been performed by some cardiac surgeons with or without the aid of the heart-lung machine—the purpose being to reduce or eliminate the effects of blood in contact with foreign surfaces as well as the non-pulsatile nature of CPB flow.

Hospital mortality for CABG surgery varies depending upon several factors, some of which involve preoperative patient selection, intraoperative technique, and postoperative management.  In an attempt to address the intraoperative technical aspects, various maneuvers have been done and certain devices have been introduced to reduce or eliminate elements of the operation that have been associated with complications.  The purpose of this presentation is to describe a single surgeon’s experience with BH-CABG, including totally OFF-PUMP (OP-CAB) as well as PUMP-ASSIST (PAD-CAB)—the ‘PUMP’ referring to the use of the Cardio-Pulmonary Bypass (CPB) machine.

From May 2003 through October 2013, over 1000 BH-CABG surgeries were performed by the author.   Approximately two-thirds were performed without the aid of CPB (i.e. OP-CAB) and one-third was performed with PUMP-ASSIST (PAD-CAB).  The demographics of the patients included an average age of 75 years with three quarters of the male gender.  Approximately 12% were emergency cases, the remainder being equally divided between elective and urgent.  The hospital/30-day mortality was 1.02% overall; OP-CAB mortality was 1.08% and PAD-CAB mortality was 0.65% respectively. There were no deep sternal wound infections, the incidence of stroke was 0.98%, and the incidence of post-operative bleeding requiring re-exploration was 1.63%.  The average number of bypass grafts was 3.2. 

Specific enabling devices allowed for safe, complete, and accurate bypass grafting, with no need to convert to a traditional CABG approach.  Specific technologies included: 1) suction-supported stabilizers, 2) intra-coronary shunts, 3) blow-mister, and 4) flow probe.  Determination of OP-CAB vs PAD-CAB was made in accordance with the territory of diseased vessels to be bypassed, the configuration of the heart itself (e.g. enlarged, dilated, hypertrophic, etc), the right and left sided function (i.e. RVEF, LVEF), the presence or absence of arrhythmia, and so forth.

In summary, BH-CABG procedures are safe and effective and should be considered as an alternative to the traditional CABG in which the aorta is cross-clamped and the heart arrested with cardioplegic solution. The mortality rates and major adverse complication events (MACE) are extremely low

  • Special Session
Location: Philadelphia

Session Introduction

Dmitry Giller

I.M.Sechenov First Moscow State Medical University, Russia

Title: Surgery for bilateral drug-resistant pulmonary tuberculosis with totally destroyed lung
Speaker
Biography:

Dmitry Giller is currently the Director of the University Clinic of Phthisiopulmonology and also the Head of the Department of Phthisiopulmonology and Thoracic Surgery IM Sechenov First Moscow State Medical University. He has completed his PhD at the age of 33 years at the Central Research Institute of Tuberculosis RAMS. In 1997 he received the scientific title of Professor. In 2014 -2015 he was Chairman of the Society of Thoracic Surgeons of Moscow and Moscow region. Dmitry Giller is the author of more than 200 publications, including 35 patents, monographs, and manuals for doctors and students. 32 research works were done under his supervision and most his students are now PhD holders

Abstract:

189 patients (aged from 14 till 57) underwent surgery for bilateral drug-resistant destructive pulmonary tuberculosis with one totally destroyed lung from 1998 to 2015. All patients underwent pneumonectomies. In 54 cases – with contralateral lung resections, 30 preliminary transsternal occlusions of the main bronchus were performed on patients with low functional respiratory and cardiovascular reserve or with pleural empyema, including 6 cases of straightway one-stage contralateral lung resections. Lung collapse surgery on the pneumonectomy side or on the side of the only one lung was carried-out in 126 cases. All of them were performed with our original minimally invasive technique. We analyzed complications, the direct and remote results of the surgical treatment this group of patients. The 30-days mortality was in 3 cases: 1 after pneumonectomy, 1 after thoracomioplasty, 1 after transsternal occlusions of the main bronchus with straightway contralateral right lobectomy

Speaker
Biography:

Dmitry Giller: Сurrently director of the University Clinic of Phthisiopulmonology. Head of the Department of Phthisiopulmonology and Thoracic Surgery IM Sechenov First Moscow State Medical University.

He has completed his PhD at the age of 33 years at the Central Research Institute of Tuberculosis RAMS. In 1997 he received the scientific title of Professor. 
In 2014 -2015 he was Chairman of the Society of Thoracic Surgeons of Moscow and Moscow region. 
Dmitry Giller is the author of more than 200 publications, including 35 patents, monographs, and manuals for doctors and students.
32 research works were done under his supervision and most his students are now PhD holders

Abstract:

We summarized the experience of performing repeated surgery for destructive drug-resistant pulmonary tuberculosis and other pathologies from 1984 to 2014. In total 276 (60,8%) pneumonectomies and pleuropneumonectomies and 178 (39,2%) lung re-resections were performed for recurrence of various diseases in the previously operated lung. 402 patients had a recurrence of pulmonary tuberculosis, 29 -  nonspecific pathology  and 25 – lung cancer. 454 patients underwent  765 operations including 44 preliminary transsternal occlusions of the main bronchus, 276 pneumonectomies and pleuropneumonectomies, 178 re-resections, 23 resections of the only one lung, 14 thoracoplasties  on the only one lung side, 32 operations for early postoperative complications.  Extrapleural VATS  thoracoplasty on the side of the first operation (by using our original method)  were carried-out on 75 patients with pneumonectomies and at 123 patients with re-resections for the purpose of the prevention of postoperative recurrence in the only one lung in the presence of considerable focal changes or cavities .

We explored frequency and character of the complications for re-operation and the risk factors of occurrence. Recommendations about the technique of performing of re-operations were developed that allowed to reduce the frequency of complications significantly. The postoperative mortality was 1% after pneumonectomies and pleuropneumonectomies. There was no mortality after re-resections. Full clinical effect reached in 94, 9% cases as a result of the carried-out surgical treatment. Long-term results and long-term survival after surgery were studied

  • Workshop
Location: Philadelphia
Speaker
Biography:

Enrico Ferrari, is a graduate of Turin Medical School (MD) in Italy and received Cardiovascular surgery training at University of Padova (Italy), Catharina Hospital of Eindhoven (The Nederland), and at University of Lausanne (Switzerland). He received special training in minimally invasive cardiac surgery and transcatheter heart valve procedures at University Hospital of Lausanne, Switzerland, where he became Associate Professor in 2010. Since 2015, he works as team leader at Cardiocentro Ticino Foundation in Lugano, Switzerland, and continues the academic career at Cardiovascular Research Unit of Lausanne. He is a member of the STS/AATS joint workforce on New Technology (2011-2018) and STS workforce on International Relationship 2011-2018. He is Associate Editor of the Interactive Cardiovascular and Thoracic Surgery Journal (ICVTS), member of the Editorial Board of the Archive of Sciences Journal, and member of the Editorial Board of the Multimedia manual of Cardio-Thoracic Surgery (MMCTS).

Abstract:

The aim of this brief report is to show technical details and feasibility of balloon-expandable stent-valve implantation in aortic position during conventional redo open-heart surgery in overweight patients with small-sized mechanical aortic prosthesis and patient-prosthesis mismatch.

Methods and results
Two consecutive symptomatic overweight patients (BMI of 31 and 38) with small mechanical aortic prosthesis (a 4 year-old 21mm Hancock II valve and a 29 year-old 23mm Duromedic valve), increased gradients (59/31mmHg and 74/44mmHg) and reduced indexed effective orifice area (0.50cm2/m2 and 0.43cm2/m2) were treated successfully with surgical implantation of two 26mm balloon-expandable SapienTM 3 valves during redo procedures. Under full sternotomy, cardiopulmonary bypass and cardioplegic arrest the stent-valves were implanted under direct view through the aortotomy and after mechanical valves removal. In one patient, a concomitant regurgitant mitral valve was replaced with a standard bioprosthesis. Aortic cross clamp times were 162 and 126 minutes; cardiopulmonary bypass times were 178 and 180 minutes; total surgical times were 360 and 318 minutes. At discharge, the echocardiographic control showed transvalvular peak and mean gradients of 13/9mmHg and 23/13mmHg, and indexed effective orifice areas of 0.64cm2/m2 and 1.08cm2/m2. The 3-month echocardiographic control showed transvalvular peak and mean gradients of 18/9mmHg and 19/11mmHg, and indexed effective orifice areas of 0.78cm2/m2 and 0.84cm2/m2, with improved symptoms.

Conclusion
Balloon-expandable stent-valve implantation during redo open-heart surgery is feasible and safe and prevents patient-prosthesis mismatch in overweight and obese patients. Moreover, in case of stent-valve degeneration this approach allows for additional valve-in-valve procedures with big-size stent-valves and prevents high-risk re-redo surgery

  • Cardiothoracic Anesthesiology

Session Introduction

Branko Furst

Albany Medical College, USA

Title: The Heart: Pressure-Propulsion Pump or Organ of Impedance
Speaker
Biography:

Branko Furst, is a graduate of the University at Ljubljana Medical School, Slovenia and completed post-graduate training in anesthesiology in London, UK, before embarking on an academic career at Texas Tech University Health Sciences Center in El Paso, Texas. Presently he holds the position of associate professor of anesthesiology at Albany Medical College in Albany, NY and divides his time between clinical work, resident education and research. His long-term research interest in circulation models has been summarized in a recently published book “The Heart and Circulation – An Integrative Model” (Springer, 2013). He has lectured on various aspects of circulation in the US and abroad

Abstract:

In spite of the general agreement that the pressure gradient provided by the heart is the source of blood propulsion, the issue about the control of cardiac output (CO) continues to be the subject of a vigorous debate. A systematic review of the circulation models shows that the classic pressure propulsion (PP) model falls short of explaining an increasing number of circulatory phenomena. For example: the debate over the source of blood propulsion in the valveless embryo heart remains unresolved; mechanical occlusion of the aorta results in a paradoxical increase in CO by 20-40% under controlled experimental conditions; a 4-5 fold increase in CO during aerobic exercise that exceeds the theoretical pumping capacity of the heart has long baffled exercise physiologists.

It is proposed that the long-standing impasse in the debate over the control of CO can be resolved by adopting the phenomenon-based, evolutionary model of circulation. Evidence shows that the movement of blood is the primary phenomenon generated at the levels of the capillaries. It exists before the functional maturity of the heart and is intricately linked with metabolic demands of the tissues. Accordingly, the pressure in the vessels is a derived phenomenon resulting from the rhythmic interruption of flow by the heart in combination with the dynamic response of the peripheral vasculature. The heart thus functions as an impedance-pump generating pressure, but not the flow of blood.

The importance of the proposed open-system, evolutionary circulation model for the understanding of basic physiology and clinical cardiology will be discussed and contrasted with the existing, closed-system PP models

  • Cardiac Surgery

Session Introduction

Eyal Porat

Texas Health Science Center, USA

Title: Timing of cardiac catheterization and acute renala failure after cardiac surgery
Speaker
Biography:

Dr. Eyal Porat is a Professor within the Department of Cardiothoracic and Vascular Surgery of the University of Texas Health Science Center at Houston. He serves as the department’s Division Director at St. Joseph Medical Center, Houston, Texas. Prior to his recent arrival to Houston, Porat served for 6 years as the Chairman of the Department of Cardiothoracic Surgery at Rabin Medical Center, Petah Tikva, Israel. He also headed the Division of Aortic Surgery within that Department. From 2000 until 2006 Dr. Porat served as Director of Minimally Invasive Surgery and Director of the Robotics Program, which he established at the Department of Cardiothoracic and Vascular Surgery of the University of Texas at Houston. He also founded “The Memorial Hermann Institute for Cardiovascular Research and Robotics Technology” where he served as Medical Director. Porat was born in Haifa, Israel. He attended medical school at Ben Gurion University in Be’er Sheva, Israel. He completed his residency in cardiothoracic surgery Suma Cum Laude at Carmel Medical Center, Haifa, Israel. During his residency, Dr. Porat was involved in clinical research at University Hospital “Vrije Universiteit” in Amsterdam, The Netherlands. Porat conducted academic teaching and research within the Tel Aviv University – Sackler School of Medicine and continues this activity at the University of Texas. His research and clinical interests include aortic surgery, robotic surgery as well as minimally invasive and beating heart coronary artery surgery. He is a member of many professional organizations and medical societies and serves on the editorial boards of prestigious professional journals. Porat is married and father of 3 children, the oldest serving as an air-force intelligence officer.

Abstract:

Background: The incidence of acute renal failure (ARF) after cardiac surgery and the risk of mortality associated with it continues to be high. The aim of this study was to evaluate if timing of cardiac catheterization influences the incidence of postoperative ARF.

Patients and methods: 408 patients undergoing cardiac surgery were prospectively evaluated. Mean age was 66+/-10 years, 22% were female, 38% diabetic, 69% had hypertension and 15% had peripheral vascular disease. Preoperative creatinine level and calculated creatinine clearance (CrCl) were 1.05+/-0.6 and 82+/- 27 respectively. Of the study population 39% underwent surgery within 24h of cardiac catheterization, 30% underwent surgery between the first and fifth day of catheterization, and 31% underwent surgery more than 5 days after cardiac catheterization. Endpoints were ARF, defined as a decrease in the calculated CrCl of 25% or more by the third postoperative day, and hospital mortality.

Results: 47% of patients who underwent surgery within 24h from cardiac catheterization have shown a decrease in calculated CrCl of 25% or more, as apposed to 29% in patients who underwent surgery between the 1st and 5th day after catheterization, and 23% in those who underwent surgery more than 5 days after catheterization (p=0.05). Mortality rate among patients who underwent surgery within 24h from catheterization was independently associated with acute renal failure ([OR]1.9, p=0.02). Preoperative calculated CrCl of less than 60ml/min and cardiac surgery within 24h from catheterization was independently related to hospital mortality ([OR]8, p=0.005).

Conclusion: Cardiac surgery performed within 24h from cardiac catheterization is a significant risk factor for acute renal failure, especially among patients with preoperative reduced renal function. Proper timing and patient selection is highly recommended.

Speaker
Biography:

Sivaraj has completed his MBChB at the age of 26 years from  MBChB  at University of Glasgow, UK and MRCS  at Royal Colleage of Surgeons Edinburgh, UK. He works as senior resident at the Department of Cardiothoracic Surgery, National Heart Centre Singapore. Dedicated professional working in multi disciplinary team to manage patients. He is in year 4 of Cardiothoracic Surgery Residency Training program, National Heart Centre Singapore.

Abstract:

Heart disease incidence increases with advancing age. Patients with single vessel disease can undergo coronary bypass graft surgery (left internal mammary artery to left anterior descending coronary artery) with the approach of median sternotomy or left anterior thoracotomy. Left anterior Thoracotomy approach is used in the hope of achieving a less invasive operation. A total of 53 cases of single vessel coronary artery bypass graft (CABG) surgeries (left internal mammary artery to left anterior descending coronary artery) were performed at the National Heart Centre, Singapore between Oct 2009 and Nov 2011.  We performed a retrospective study on all 53 patients to compare surgical and post-surgical outcomes for single vessel CABG using two surgical approaches: median sternotomy (MS) and left anterior thoracotomy (LAT). 25 cases were performed using the left anterior thoracotomy approach and 28 cases were performed using the median sternotomy approach. 2 cases (8%) were converted from left anterior thoracotomy approach to median sternotomy. The average Euroscore-2 among all cases was 1.43; left anterior thoracotomy, 1.04; and median sternotomy, 1.72.  Extubation rates did not differ significantly between LAT and MS in the OT, or at 6 or 10 hours post surgery. The longest intubation was 22 hours among MS cases and 18 among LAT cases. One MS patient was re-intubated. Preoperative creatinine > 110 μmol/L occurred in 25.0% of MS cases compared to 20.0% for LAT (NS); 17.9% of MS cases had higher postoperative creatinine compared to 0.0% of LAT (p = 0.053). One of the MS case required Lasix infusion for acute renal failure and another required dopamine. No case in either group required dialysis. 1 LAT case experienced atrial fibrillation compared to 3 MS cases (NS). At 6 months post-surgery 12.0% of LAT and 21.4% of MS cases had not fully recovered (NS). 72% of LAT cases were not home by POD6 compared to 50% of MS cases (p = 0.013). Of 7 LAT cases, 4 were not discharged due to logistics or social reasons.  No significant differences were found between LAT and MS for ventilation duration, ICU stay, or hospital stay. However, after adjustment for confounders, a significant difference (p = 0.033) was exhibited between procedures for Blood loss (ml) (MS, 333; LAT, 230). The main finding of this report is that single coronary revascularization can be performed in a significant number of patients via the thoracotomy approach, giving similar results to that of the median sternotomy approach. In our single centre study, during a minimum period follow up of 1 year, morbidity and mortality were comparable.  In conclusion, left anterior thoracotomy approach for LIMA-LAD shortened both hospital and ICU stay. Benefits of less pain and earlier return to work cannot be understated from the left anterior thoracotomy approach

Speaker
Biography:

Sibu P. Saha MD, MBA, Chief and Program Director of Residency and Fellowship Program in CT Surgery at UK. He is the Frank Spencer Endowed Chair of Surgery as well as Chairman of the Directors’ Council at the Gill Heart Institute.  He was the founding director of the Baptist Heart Institute in Lexington, KY. He is the benefactor of the Saha Cardiovascular Research Center.  He has received many awards including the Abraham Flexner Master Educator award. He is a past president of the International College of Surgeons, US Section and International College of Angiology. He is an Alley-Sheridan Fellow, Kennedy School of Government at Harvard

Abstract:

Purpose

This is a retrospective review of eleven cases of serious complications of pneumonectomy.

Materials and Methods

Eleven patients developed serious complication after pneumonectomy.(112 consecutive cases), which included Herniation of the Heart  (1), ARDS (4), Bronchopleural fistula (4), Tension hemothorax (1) and post pneumonectomy empyema (2). All patients had emergent or urgent surgical intervention except for patients with post pneumonectomy pulmonary edema (ARDS).

Results

3 patients died from respiratory failure and sepsis.

Conclusion

Current management has improved survival of this group of patients.

However, this requires vigilance and prompt intervention in the management of these serious complications.

Speaker
Biography:

Tajdit has completed his MBBS from Sir Salimullah Medical College, Dhaka and working as a resident student of thoracic surgery in National Institute of Chest Disease Hospital, Dhaka. He is a very enthusisatic student from his early days and attached with several research works. He has published several conference paper and working hard to start a new era of research in thoracic surgery in Bangladesh

Abstract:

Esophageal cancer is the eighth most common malignancy worldwide. It shows marked diversity in geographical distribution both internationally and nationally with exceptionally high rates in limited areas of Asia. However, the patterns are changing in several western countries. But there are very few studies in Bangladesh regarding the trend and epidemiology of esophageal cancer though many of the patients undergo surgical intervention. The aim of this study was to determine the epidemiology and pattern of esophageal carcinoma with respect to age and sex groups and to identify the trends of histology, site and specific risk factors of esophageal carcinoma of the patients who undergone surgical intervention. A prospective study was carried out in 210 patients with esophageal carcinoma to find out the trend and risk factors who admitted for surgical intervention. Maximum number of the patients of esophageal carcinoma was seen in male in 5th and 6th decades of life. Etiology of the cancer is multi-factorial. Tobacco & betel nut chewing were the most common risk factors for esophageal cancer. Squamous cell carcinoma was the most common malignancy seen in patients (93.81%) and mainly localised in lower oesphagus. Additional research on the etiology of this emerging carcinoma may provide more information which will add more aid in the development of readily implementable preventive strategies in Bangladesh

  • Thoracic Surgery

Session Introduction

Dmitry Giller

I.M.Sechenov First Moscow State Medical University, Russia

Title: VATS in diagnostic and management of pulmonary tuberculosis
Speaker
Biography:

Dmitry Giller: Сurrently director of the University Clinic of Phthisiopulmonology. Head of the Department of Phthisiopulmonology and Thoracic Surgery IM Sechenov First Moscow State Medical University.

He has completed his PhD at the age of 33 years at the Central Research Institute of Tuberculosis RAMS. In 1997 he received the scientific title of Professor. 
In 2014 -2015 he was Chairman of the Society of Thoracic Surgeons of Moscow and Moscow region. 
Dmitry Giller is the author of more than 200 publications, including 35 patents, monographs, and manuals for doctors and students.
32 research works were done under his supervision and most his students are now PhD holders

Abstract:

5721 thoracic operations at 5502 patients (aged from 3 till 89) were performed during the period from 1999 to 2015 by one surgeon.
73,5% of operations were for pulmonary tuberculosis, 15,8% - for oncopathology and 10,7% - for other diseases.
4011 (70,1%) operation were performed with miniaccesses and VATS.
VATS was used during 236 (31,8%) of 741 pneumonectomies and pleuropneumonectomies, 739 (72,8%) of 1015 lobectomies and bilobectomies, 695 (73,8%) of 942 anatomic polysegmentary resections, 768 (87,4%) of 879 not anatomic lung resections, 181 (84,2%)  of 215 pleuroectomies, 636 (70,9%) of 897 thoracoplasties and thoracomioplasties.
Most operated patients had expressed pleural adhesions, typically for pulmonary tuberculosis.
We studied frequency and character of complications, the direct and remote results of all operations for pulmonary tuberculosis with the minimally invasive and standard accesses.
The 30-days mortality was 0,02% in the VATS group and 1% in thoracotomy group.

 

  • Paediatrics Cardiologists

Session Introduction

Sonia Shahid

Karachi Medical and Dental College, Pakistan

Title: Systemic Review on Pediatric Cardiology
Speaker
Biography:

Sonia Shahid is a final year M.B.B.S student of Karachi Medical and Dental College, Karachi Pakistan. She has been a part of several national and international researches and many are ongoing. She has attended several national and international seminars and conferences. She has good knowledge of clinical practices and protocols in variety of settings.
Sonia is an inquisitive student with a passion for education as a power for change and improvement in the healthcare field of her country and is very ambitious in pursuing her career

Abstract:

Objective: To determine the effect of congenital heart diseases on other systems of body in pediatric population.

Introduction: Congenital heart disease is defined as the structural, functional or positional defect of the heart in isolation or in combination, present from birth, but may manifest at any time after birth or may not manifest at all. There are many different types of congenital heart defects, they can be divided into three main categories; heart valve defects, heart wall defects and blood vessel defects. A normal heart has valves, arteries and chambers that carry the blood in a circulatory pattern: body--heart--lungs- -heart--body. When all chambers and valves work correctly, the blood is pumped through the heart, to the lungs for oxygen, back the heart and out to the body for delivery of oxygen. When valves, chambers, arteries and veins are malformed, this circulation pattern can be impaired. Common congenital heart diseases are tetralogy of Fallot, truncus arteriosus, transposition complexes, endocardial cushion defects, and univentricular heart. Conditions occurs are pulmonary hypertension, arrhythmias, infective endocarditis, anticoagulation and congestive heart failure. Causes of CHD are genetic defects, viral infection during 1st trimester, diabetic mellitus/gestational diabetes mellitus, drugs and alcohol intake. Affecting systems are respiratory system causing breathing problems and pulmonary hypertension, clotting disorders causing anticoagulation and skeletal malformations.

Methodology: This cross-sectional study was conducted from January 2015- September 2016. Sample size is 397. Pediatric patients under 7 years of age were recruited in this study. A history and examination form designed from an application "Forms" particularly for the study which was filled by concerned doctor. Diagnostic tests carried out to collect the data were fetal echocardiogram/echocardiogram (to record the electrical activity of patient's heart and can help diagnose heart defects or rhythm problems), CT scan (to take an X-ray movie of the heart and lungs), angiogram, chest X-ray (to see if the heart is enlarged, or if the lungs have extra blood or other fluid in them) and pulse oximetry (to check oxygen concentration in patient’s blood) . For data analysis SPSS 16.0 software was used.

Results: The median age of all patients with severe CHD was 3 years (interquartile range, 1.5 to 6 years). Distribution of CHD are 32.8% tetralogy of Fallot, 25.2% truncus arteriosus, 23.1% transposition complexes, 10.4% endocardial cushion defects and 8.5% univentricular heart.

Causes are genetic defects 47.2%, viral infection 29.8%, alcohol 17% and drugs 6%. Percentages of affecting systems are 47.2% respiratory system causing breathing problems and pulmonary hypertension, 24.8% clotting disorders causing anticoagulation and 24% skeletal malformations.

Conclusion: The best prognosis was found in pulmonary stenosis (survival rate 95.55%). The first week was survived by 91.46%, the first month by 87.14%, 6 months by 82.42%, and the first year of life by 80.02%, and 77.11% (95% CI 75.91–78.31%) survived to age 7 years.

Patients with severe primary pulmonary hypertension have a poor prognosis, but those with a patent foramen ovale may survive longer.

  • Angiology

Session Introduction

Daniel G Cacione

Federal University of São Paulo, Brazil

Title: Pharmacological treatment for Buerger’s disease – a Cochrane review
Speaker
Biography:

Daniel G Cacione is post graduate student at the Federal University of São Paulo and assistant medical doctor at São Paulo Hospital in Vascular & Endovascular Surgery. A Cochrane Collaboration  member since 2013, working with the Cochrane Vascular Group.
 

Abstract:

Objective: To assess the effectiveness of any pharmacological agent (intravenous or oral) compared with placebo or any other pharmacological agent in patients with Buerger's disease

Methods: The Cochrane Vascular Trials Search Co-ordinator searched their Specialised Register (last searched in April 2015) and the Cochrane Register of Studies (Issue 3, 2015). The review authors searched trial registers and the European grey literature; screened reference lists of relevant studies, and contacted study authors and major pharmaceutical companies. Selection criteria was randomised controlled trials (RCTs) involving pharmacological agents used in the treatment of Buerger's disease.

Results: Five randomised controlled trials (total 602 participants) compared prostacyclin analogue with placebo, aspirin, or a prostaglandin analogue, and folic acid with placebo.

Conclusions Moderate quality evidence suggests that intravenous iloprost (prostacyclin analogue) is more effective than aspirin for eradicating rest pain and healing ischaemic ulcers in Buerger's disease, but oral iloprost is not more effective than placebo. Very low and low quality evidence suggests there is no difference between prostacyclin (iloprost and clinprost) and the prostaglandin analogue alprostadil for healing ulcers and relieving pain respectively in severe Buerger's disease. Very-low quality evidence suggests there is no difference in pain scores and amputation rates between folic acid and placebo, in people with Buerger's disease and hyperhomocysteinaemia. High quality trials assessing the effectiveness of pharmacological agents (intravenous or oral) in people with Buerger's disease are needed