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 2 :

Keynote Forum

Nanette K Wenger

Emory University School of Medicine, USA

Keynote: Transforming CVD prevention for women: Time for the Pygmalion construct to end

Time : 9:00 AM

Cardiac Surgery 2016 International Conference Keynote Speaker Nanette K Wenger photo
Biography:

Wenger is Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine and a consultant to the Emory Heart and Vascular Center.Coronary heart disease in women is one of Dr. Wenger’s major clinical and research interests. She chaired the U.S. National Heart, Lung, and Blood Institute Conference on Cardiovascular Health and Disease in Women. Dr. Wenger has expertise in cardiac rehabilitation. She chaired the World Health Organization Expert Committee on Rehabilitation after Cardiovascular Disease, and co-chaired the Guideline Panel on Cardiac Rehabilitation for the U.S. Agency for Health Care Policy and Research. Dr. Wenger has had a longstanding interest in geriatric cardiology, is a Past President of the Society of Geriatric Cardiology and was Editor-in-Chief of the American Journal of Geriatric Cardiology for more than 15 years

Abstract:

Gender-specific atherosclerotic cardiovascular disease (ASCVD) risk assessment for women is requisite owing to a number of non-traditional ASCVD risk factors that are unique to or predominant in women and because many traditional ASCVD risk factors impart differential risk for women and for men. Cardiovascular disease remains the leading cause of morbidity and mortality for women in the US and 2 of 3 US women have at least one major traditional coronary risk factor.

Non-traditional ASCVD risk factors requiring assessment for all women include a history of complications of pregnancy, use of oral contraceptive therapy,  therapy hormonal fertility, and menopausal hormone therapy. Systemic autoimmune disorders are highly prevalent in women and impart increased ASCVD risk.

Hypertension increases the population-adjusted CVD mortality more for women than for men, and cigeratte smoking imparts a greater CVD risk for women than men, as does diabetes mellitus. Hypercholesterolemia imparts the highest population-adjusted CVD risk for women, 47%. Two of three US women are obese or overweight, and obesity is double in women compared with men in low and middle0income nations. Physical inactivity is the most prevalent risk factor of US women. Psychosocial issues, particularly depression, preferentially disadvantage women.

Gender-specific risk assessment and intervention have the potential to improve CVD outcomes in women.

  • Symposium
Location: Philadelphia
Speaker
Biography:

To be updated soon..

Abstract:

Over the past decade, there have been remarkable changes in our approach to Antithrombotic therapy.  Our therapeutic options have been enriched by the availability of new Antiplatelet agents--more potent P2Y12 inhibitors, protease-activated receptor inhibitors--and new anticoagulants--novel oral anticoagulants which inhibit factors IIa or Xa, low molecular weight heparins, and  intravenous direct thrombin inhibitors--which have dramatically changed the way we approach patients who require Antithrombotic therapy.  There are new inhibitors available which permit the safe and effective reversal of overdosage of some of these agents, or reduction of effect if emergency surgical interventions are necessary.  Past studies informing the use of anticoagulants such as heparin and warfarin and Antiplatelet agents such as aspirin were performed in patient cohorts of generally less than 1,000; modern trials leading to FDA approval generally randomize 10,000-25,000 patients.

There are now accepted protocols that guide the cardiac surgicalteam in the safe management of these agents during the peri operative period which will be discussed in this presentation.

  • Paediatrics Cardiac Surgery

Session Introduction

Elnur Hasanov

Pediatric Cardiac centre scientific Center of Surgery, Azerbaijan

Title: Reconstructive surgery of hypoplasia of the aortic arch
Speaker
Biography:

He is Head of Pediatric Cardiac center in scientific Center of Surgery named after M.A. Topchubashov, Azerbaijan. He holds a Master Degree (PhD) from Novosibirsk Research Institute of Circulation Path, Russia in the 2008-2009, followed by a Post-Graduation from Novosibirsk Research Institute of Circulation Path, Russia in the 2006-2008. He is extending his valuable service as a cardiac surgeon in Federal State Institution Academician E.N.Meshalkin Novosibirsk State Research Institute of Circulation Pathology Rusmedtechnology, for 2009-2010 years and has been a recipient of many award and grants. His research experience includes various programs, contributions and participation in different countries for diverse fields of study. His research interests as a cardiac surgeon reflect in his wide range of publications in various international journals

Abstract:

Objective: to evaluate the function of baroreceptors in patients after different types of surgical correction of hypoplastic aortic arch.

Materials and methods: In this prospective cohort study evaluated the results of surgical treatment of 54 patients who underwent surgical treatment for aortic coarctation. The patients were divided into two groups according to the method of correction of the defect: reconstruction with the use of a modified reverse plasty of LPA (group I, n=27) and reconstruction using the "extended" anastomosis (group II, n=27 patients).

Results: the Postoperative period of observation was 25 (21-30) months. Spontaneous sensitivity of the baroreceptors differed between groups and was significantly higher in group II is 11.6 (10,5; 12,6) vs 9,1 (8,2;10,1) in group I, p -0,04. The velocity of pulse blood flow was also higher in group II 7,7 (5,8;9) (m/s) -1 compared to 6.5 (5,4;7,1) (m/s) -1 in group I and differed between groups P – 0,04.

Conclusions: Reduced sensitivity of baroreceptors in patients after a modified reverse plastic of the left subclavian artery may be regarded as the method of choice in patients with coarctation and hypoplasia of the arch as a method of reducing the frequency of arterial hypertension in the late postoperative period

  • Cardiothoracic Case Report

Session Introduction

Blaz Mrevlje

Ljubljana University School of Medicine, Slovenia

Title: Percutaneous dual-valve intervention in a high-risk patient with severe aortic and mitral stenosis
Speaker
Biography:

Blaz Mrevlje completed his primary qualification in general medicine in 2004 and received his license as a consultant of internal medicine in 2011. He has been working in the field of cardiology since 2006 and has been focusing on interventional cardiology since 2008. In the field of research he is interested in the coronary artery disease and intravascular imaging, namely the optical coherence tomography in elective and acute coronary syndrome patients

Abstract:

Introduction: Aortic stenosis is the most frequent and mitral stenosis is the least frequent native single-sided valve disease in Europe. Patients with the combination of severe symptomatic degenerative aortic and mitral stenosis are very rare. Guidelines for the treatment of heart valve diseases are clear for single-valve situations. However, there is no common agreement or recommendation for the best treatment strategy in patients with multiple-valve disease and severe concomitant comorbidities.

Case presentation: 76-yr old female patient with the combination of severe degenerative symptomatic aortic and mitral stenosis and several comorbidities including severe obesity, who was found unsuitable surgical candidate by the Heart Team and unsuitable for two-time general anesthesia in the case of two-step single-valve percutaneous approach by anesthesiologists, underwent successful percutaneous dual-valve single-intervention (transcatheter aortic valve implantation and percutaneous mitral balloon commissurotomy).

Conclusion: Percutaneous dual-valve single-intervention is feasible in selected symptomatic high-risk patients.

Blaz Mrevlje

Ljubljana University School of Medicine, Slovenia

Title: Biologic response of a porcine coronary artery to stent implantation
Speaker
Biography:

Blaz Mrevlje completed his primary qualification in general medicine in 2004 and received his license as a consultant of internal medicine in 2011. He has been working in the field of cardiology since 2006 and has been focusing on interventional cardiology since 2008. In the field of research he is interested in the coronary artery disease and intravascular imaging, namely the optical coherence tomography in elective and acute coronary syndrome patients

Abstract:

Introduction: Stent implantation in a coronary artery results in mechanical injury of the vessel wall and involves de-endothelisation, stretching and tearing of media and in the case of an atherosclerotic plaque also plaque rupture. These processes are followed by the activation of platelets, thrombus formation and inflammation in the vessel wall. Activated chemokines and cytokines activate the proliferation and migration of smooth muscle cells within the media and from media into intima resulting in hypertrophy of the intima and restenosis of the stented segment of the coronary artery.

Methods: Three groups of young pigs were included in the study and followed-up with optical coherence tomography 14 days, 1 month and 2 months after angiographically-guided stent implantation. Three types of stents (bare-metal - BMS, drug-eluting - DES and multimode - MMS) were implanted in each individual pig in a randomized fashion. All stents were of 3.0 x 15 mm in size.

 

Results: After 14 days the neointima thickness was 118,77±54,27µm in BMS, 57,15±12,01µm in MMS and 53,04±9,50µm in DES. After 1 month the neointima thickness was 323,02±174,07µm in BMS, 173,46±60,11µm in MMS and 112,08±26,00µm in DES. After 2 months the neointima thickness was 250,25±213,66µm in BMS, 138,86±110,42µm in MMS and 159,55±53,95µm in DES.

Conclusion: Biologic response of a porcine coronary artery in terms of neoitnima thickness to stent implantation is as expected according to stent type and the time of follow-up

  • Cardiothoracic Diseases
  • Medical Management for Cardiothoracic Diseases
Biography:

To be updated soon.

Abstract:

Objective Evaluate the efficacy of biventricular lead location match on cardiac resynchrinization.
Methods Consecutive patients with dilated cardiomyopathy who candidate to CRTD were enrolled into the study. After posterior-lateral lead was implanted, patients were randomized into right ventricular apex match pacing group (RVA) and right ventricular output tract match pacing group (RVT). Active screw-in leads were anchored on the endocardial wall of RVA and RVOT respectively. Physiocurve CRTD generaters (Medtronic Co.) were connected and optimal working parameters were adjusted by ECG and echocardiography. Regular follow up was conducted in clinic for more than 6 months. NYHA class decrease, 6MWD increase, EF increase, BNP level decrease and QRS width decrease were compared between RVA and RVT groups.

Results  Fifty patients were enrolled into the study. Four patients were excluded for LV lead location. Forty-six patients (92%, 56.3+-5.7 yrs, male 27) were randomized into RVA group (22, 56.1+-5.3 yrs, male13) and RVT group (24, 56.5+-5.9 yrs, male 14). All procedures were successful wihout conplications. At the follow up of 11.3+-4.7 months, the resynchronization efficacy in RVT group was significantly superior to that in RVA groyp (NYHA class decrease 1.2+-0.5 vs 0.7+-0.3, P<0.05; 6MWD increase 236.75+-39.6m vs 129.3+-53.8m, P<0.01; EF increase 12.6+-5.1% vs 7.3+-6.5%, P<0.01; BNP decrease 3756.3+-379.2u vs 2027.5+-493.2u, P<0.01; QRS width decrease 19.6+-6.1ms vs 13.5+-7.2ms, P<0.05).

Conclusions RVOT lead location is superior to RV apex in the improvement of cardiac resynchronizayion efficacy by matching posterio-lateral LV pacng

Biography:

To be updated soon.

Abstract:

Objective  Evaluate the relationship between ablation dot number at pulmonary vein antrum (PVA)  and longterm efficacy of paroxysmal atrial fibrillation (PAF).

Methods  Parients with PAF history more than 6 minths were selected to isolate pulmonary veins (PV) at PVA. 3D mapping system (Carto-C3) and coolflow catheter (SmarTouch) were used to make the shell of atrium-PVA and ablation cicle around PVA. Superior and inferior PVAs were ablated by single ablation circle. Maxmal pependicular diameters of the circle were measured. The ablation dot on the circle was counted and divided by the sum of two maximal cicle diameters. Ablation dot number was defined as addition of left and right PVA ablation dot number. PVA isolation was defined as complete disappear of PV potential. PAF longterm efficacy was evaluated by regular clinical check and Hoter monitering at 6 and 12 months after procedure.

Results  160 patients with PAF (65.7+-8.6 yrs, male 110) and with PAF history of 15.7+-9.3 months were enrolled into the study. All PVs in each patient were isolated successfully by single procedure. Ablation dot number per circle and per patient was 32.6+-7.3 and 61.7+-9.1 respectively. During the follow up of 16.5+-3.3 months, 131 patients (81.9%) were free of PAF. PAF was recurrence in 29 patients (18.1%) in 4.2+-2.7 months after procedure. Ablation dot number was singnificantly different between patients with and without PAF recurrence (56.3+-5.7 vs 63.8+-7.1, P<0.01).

Conclusions  Ablation dot number around PVA is positively related to the longterm efficacy of PAF. Dot creation per patient more than 63 singnificantly decreases PAF recurrence.

 

  • Video Presentation
Location: Philadelphia

Session Introduction

Manuela Stoicescu

University of Oradea, Romania

Title: Surgical treatment of atrial fibrillation between benefit and risk
Speaker
Biography:

Manuela Stoicescu is Consultant Internal Medicine Physician (PhD in Internal Medicine), Assistant Professor of University of Oradea, Faculty of Medicine and Pharmacy, Romania. She was invited as speaker at more than 30 International Conferences is USA, China, Japan, Canada, Thailand, Dubai, Spain, Germany, she is Committing Organizing Member at  many  International Conferences, is editorial board member in two ISSN prestigious Journal in U.S.A, published  more than 30 articles in prestigious ISSN Journals in U.S.A., published five books (two on Amazon– one is :“Sudden cardiac death in the young”), one monograph and two chapter books – Cardiovascular disease: Causes, Risks, Management CVD1- Causes of Cardiovascular Disease 1.5,1.6, U.S.A on Amazon

Abstract:

OBJECTIVE: The main objective of this presentation is to put in discussion the surgical treatment of atrial fibrillation between benefit and risk. Atrial fibrillation is one of the most common arrhythmia in the clinical practice, with a well-established protocol management. However a patient's response to treatment is very unpredictable.

Why some patients after a simple administration of an ampoule of digoxin i.v , or after a perfusion with an ampoule of 150mg  Cordarone i.v. come in sinus rhythm and they maintained in sinus rhythm after long-term treatment with the drugs scheme with Digoxin one drug/day five days/week  or with Cordarone 200mg/day and other patients after multiple repeated surgeries outbreaks ectopic ablation, atrial fibrillation relapse in repeated remaining after all the medication in order to maintain sinus rhythm, and this we fully secure.
What unpredictable factors can lead to these paradoxes therapeutic responses?
What could be the best decision of a person in this situation?                   
The conservative therapy with drugs or to follows surgical therapy?

MATHERIAL AND METHODS: Present the situation  of a patient 52 years old, with good life style non-smoker, no coffee drink,  non alcohol consumption, with normal weight of the body mass, who had an episode of paroxysmal atrial fibrillation, who didn’t came in sinus rhythm after therapy with Cordarone i.v. The heart ultrasound was normal without clots in the left atrium. Thyroidal hormones levels were normal and thyroid ultrasound was normal as well. Electric shock was performed but without any result. The patient follows therapy with beta-blocker but remain in atrial fibrillation. For this reason decided to perform ablation surgical procedure to revue in sinus rhythm. After the surgical procedure remained also with beta-blockers drugs 2X50mg/day but for a short period of time was in sinus rhythm and again revue in atrial fibrillation under therapy. For this reason performed again ablation surgical procedure follows also therapy with beta-blocker after that and the sinus rhythm was present for a short period of time. In this time appear two episodes of paroxysmal atrial fibrilation under medications and decided a third surgical procedures of ablation but during surgery procedure was induced atrial fibrillation and needs anti-arrhythmic therapy i.v. to become in sinus rhythm and after that remain on beta-blocker drugs in sinus rhythm during therapy. After two months the patient develops again atrial fibrillation under antiarrhythmic therapy.

Of course, this surgical procedure appears with all the good intentions for the patients to try solving the real cause of the problem – ectopic foci – but these must to can be localized first and we must to take into account also the risk of myocardial fibrosis induced. One thing is certain repeated surgeries through ablation process are themselves risky and can become a risk factor for subsequent episodes of atrial fibrillation. Sometimes the surgical procedure itself can induce this rhythm disorder. Moreover mechanical process of the atrium, with intent to destroy ectopic foci can affect healthy myocardial tissue, which can then generate new ectopic foci, plus they can induce atrial myocardial fibrosis.

CONCLUSION: Repeated surgeries ablation procedures to treat atrial fibrillation are not beneficial and even can become risky in itself a risk factor for new episodes of atrial fibrillation and myocardial fibrosis. If one procedure is with therapeutic success is good, but repeated procedures become risky.

  • Cardio Devices - Industry Analysis
  • Valve Replacement

Session Introduction

Jaideep Kumar Trivedi

Apollo hospitals,Visakhapatnam,Andhra Pradesh, India.

Title: Intrapericardial dermoid cyst presenting with acute coronary syndrome
Speaker
Biography:

Jaideep Kumar Trivedi after completing his MBBS and MS did MCh in cardiothoracic surgery in 2007 from Grant Medical College,Mumbai. He was awarded 1st rank by the Mumbai university in MCh examination. He has published papers in national and international journals.Presently he is working as consultant cardiothoracic surgeon at Apollo hospital Vishakhapatnam, India. Till date he has performed more than 1000 cardiothoracic surgeries independently

Abstract:

Dermoid cysts usually arise in the ovary.They can occur at other sites including the mediastinum.However,their intrapericardial location has been reported very occasionally .This case is being presented because of its rarity and unusual presentation as acute coronary syndrome and its successful removal on beating heart along with CABG. 44yrs male presented with severe chest pain and breathlessness in our emergency department.His ECG was done which showed T wave inversion in inferior and lateral leads,Xray showed calcified rim in middle mediastinum. Echocardiogramand ct scan thorax revealed large mass pressing over RA and RV.  Coronary angiogram was done which revealed severe tripple vessel disease and large calcified cystic mass pressing RA & RV and compressing right coronary artery.We did CABG on beating heart, 3grafts were given LIMA to LAD and SVG to OM and PDA.Intraop TEE was done and dermoid cyst was also removed on beating heart under TEE guidance carefully. It contained creamy sebaceous material H.P. report confirmed dermoid cyst.Pt. was discharged on 7th day ,asymptomatic and following up with us since last 2 years.

Conclusion                                                                                             
Dermoid cyst rarely occur intrapericardially and presentation as acute coronary syndrome is very unusual.Successful removal along with coronary artery bypass grafting on beating heart has not been reported in the literature till date.

Naseer Ahmed

University OF Verona Medical School, Italy

Title: Electrocardiographic Alterations after Aortic Valve Replacement
Biography:

Naseer Ahmed has completed his MBBS (Basic Medical Degree) from Pakistan at the age of 23 years from Riphah International University Islamabad, Pakistan. After that I completed my 1 year Internship. In January 2014, I started my PhD program at University of Verona, Verona Italy in program of Cardiovascular Sciences. Here I am working with collaboration of other European centers

Abstract:

Background:

Aortic Valve Replacement (AVR) is first line therapy of aortic stenosis (AoS). As the aortic valve is in close proximity to the atrioventricular node and His bundle manipulation during AVR may cause atrioventricular conduction abnormalities. The objective of this study was to examine the time course of alterations in the surface electrocardiogram after surgical aortic valve replacement.

Methods:

The study population consisted of 127 consecutive patients (mean age 66±12 years, 84 male), with AoS underwent AVR. Standard 12-lead ECGs were obtained at baseline (within 6 months prior to procedure) named as Group I, early (within 3 days) considered as Group II and late (4th post-operative day until 6 months) named Group III after valvular heart surgery.

Results

In 127 pre-operative ECGs, SR, Atrial Fibrillation (AF) and Atrial Flutter (AFL) was present in respectively 108(79%), 18(20%) and 1(1%) patients. Atrio-Ventricular (AV) block (first degree) (N=15, 13%), Left Bundle Branch Block (LBBB) (N=11, 9%) Right Bundle Branch Block (RBBB) (N=10, 8%) and Left Anterior Fascicular Block (LAFB) (N=8, 6%) were present in Group I. In Group III, AVB (N=13, 24%) (P=0.034), LBBB (N=10, 13%) (P=0.705), RBBB (N=12, 17%) (P=0.025), and LAFB (N=8, 12%) (P=0.414) were detected. Frequency of AF/AFL increased in Group III (N=23, 30%) (P=0.012) versus Group I (N=18, 14%). (p= 0.012).

Conclusion:

The electrocardiographic changes during aortic valve replacement surgery increases significantly incidence of conduction abnormalities including AV block (grade 1) and RBBB. Incidence of late post-operative AF is also significant as compared to pre-procedural AF

  • Cardiothoracic Vascular Surgery
Speaker
Biography:

Kalpnath, pursuing PhD at the age of 33 years from All India Institute of Medical Sciences, New Delhi , INDIA. I have published 2 papers. I have involved in the  project entitled “Induction of therapeutic Angiogenesis in Limb Ischemia by Intra-arterial delivery of Autologous Bone-Marrow derived Stem cells” and Transplantation of Mesenchymal Stem Cells in animal models of Myocardial Infarction and Parkinson’s Disease” funded by Department of Biotechnology (DBT), Govt. of India.

Abstract:

Objective: Genetic susceptibility is an important risk factor for aortic wall degeneration and its leads to thoracic aortic aneurysm and dissection (TAAD). In many patients with TAD, the aorta progressively dilates and ultimately ruptures. The purpose of this study was to determine the single nucleotide polymorphism in 6 genes associated with thoracic aortic aneurysm and dissection patients in Indian population-A case-control study.

Methods: Genomic DNA was isolated from blood and aortic wall tissue of 66 patients with degenerative TAAD, and 67 control individuals. Six SNPs– rs819146, rs8003379, rs2853523, rs326118, rs3788205, and rs10757278 – were genotyped using TaqMan SNP Genotyping Assays (Applied Biosystems, Foster City, Calif). The data was analysed using STATA11.0 Statistical software. Associations between polymorphisms and disease in tissue, blood and within gender were estimated with odds ratios and their 95% confidence intervals.

Results: The T allele frequency for the SNP on 21q22.3, 5’ near gene as rs3788205 (- 2174 C/T) was higher in male patients than in male controls (P-.049). Moreover, with adjustment for traditional cardiovascular risk factors (sex, age, hypertension dyslipidemia diabetes and smoking), the rs3788205 {odd ratio (OD) 0.41, 95% confidence interval (CL) 0.14 to 1.09} polymorphism was found to be an independent susceptibility factor for TAAD in males.

CONCLUSION: Our results suggest that a sequence variant on 21q22.3 is an important susceptibility locus that confers high cross-race risk for development of TAAD in Indian population.

Key words: Single Nucleotide Polymorphism, Thoracic Aortic Aneurysm and Dissection