15^th World Cardiac Surgery & Angiology Conference December 08-09, 2016 Philadelphia, Pennsylvania, USA

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

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

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 Sapien^TM 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

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

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 1^st and 5^th 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.

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

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.

Biography:

Giuseppe Petrone has completed his degree in medicina and surgery at the age of 24 years from
Second University of Naples (Italy) and he is specialist in Cardiovascular surgery since May 2015.
He worked as Registrar and Clinical Fellow in Hammersmith Hospital (Imperial College, London)
for a year (from May 2014 to April 2015). He is Resident in the Cardiovascular Department of
“Heart Centre – City of Alessandria”. He has been invited to discuss his research projects in
occasion of important meeting (59th annual conference of the Israel Heart society, Tel Aviv 2012;
61st annual conference of the Israel Heart society, Tel Aviv 2014, Heart Valve Society meeting,
New York 2014; Mitral Valve Conclave, New York 2015; EACTS,Amsterdam 2015; he has
published 4 papers in reputed journals

Abstract:

Background: Since 1996, we have developed an innovative technique of ventriculoplasty, the “Twist Technique”(TT). The procedure performed has the purpose of preserving not only the volume and the shape of the LV but, above all, to restore the physiologic counterclockwise (CCW) twist of the cardiac apex through a rearrangement of its fibers, rebuilding the natural apical vortex of the LV. We present our experience in LV remodeling.
Methods: From 1996 to 2015, 289 patients with post-infarction LV aneurysm underwent reconstructive procedures. Mean age was 56.4 ± 7.3 years. Average LV ejection fraction (EF) was 38.9% ± 11.6%. LV reconstruction was performed by using the TT in 265 patients (91.7%). Jatene technique is performed. Afterwards, the orifice closure is obtained performing the TT: a running 2-0 polypropylene suture orients cardiac fibers remodeling heart apex in a cone shape; stitches are outdistanced of 1 cm on the lateral side of the endocardial wall and of 1/2 cm on the endocardial septum. The distal and akinetic portion of the septum is folded and therefore excluded. In 257 patients (88.9%) concomitant myocardial revascularization was performed.
Results: Perioperative mortality was 2.4%. Mean follow-up was 8.45 ± 4.2 years. Actuarial survival rate at 13 years was 73 %. The physiological movement of the new apex, that unfolds in a natural CCW twist, considerably improved LV EF. Mean post-operatively EF was 46.1 ± 9.3 %.
Conclusion: LV remodeling using the TT reproduces physiological CCW torsion of the cardiac apex, it is a safe surgical procedure with low perioperative mortality and excellent long-term survival.

Biography:

Ayman Raweh, Medicine Doctor, is a surgeon in Heart Center Dortmund in Germany. He was born in 1982 and studied medicine between 2000 and 2006 then continued to specialize in cardiac surgery. His research focus includes aortic diseases and aortic surgery since 2010 and currently minimal invasive mitral valve repair. He is a member of several national and international cardiac surgery associations including the European Association for Cardio-Thoracic Surgery (EACTS) in Europe, the Society of Thoracic Surgeons (STS) in USA and the German Society of Cardiothoracic Surgery (DGTHG) in Germany

Abstract:

The aortic valved prosthesis is a reliable solution to repair the aneurysm in aortic root and ascending aorta with involved aortic valve. The introduction of biological valved conduits brought important benefits to a large group of patients suffering from the anticoagulation therapy.

Two of the most commonly used pre-sewn stentless biological conduits are BioValsalva™ and BioIntegral BioConduit™. As a result of the lack of comparative studies between the different biological valved conduits, there was a need to review the midterm haemodynamic performance of these two conduits. Between July 2008 and June 2014, a total of 55 patients underwent aortic root replacement using a BioValsalva conduit (n=27) or a BioIntegral conduit (n=28). The median echocardiographic follow-up for the BioValsalva group was 44.0 months compared with 8.4 months for the BioIntegral group. The echocardiographic followup for the BioIntegral group was shorter because of the later introduction of BioIntegral prosthesis to the market. It was hypothesised that the BioIntegral prosthesis with no sewing ring will provide benefits in valve haemodynamics; however, these potential benefits were not observed when compared with the BioValsalva prosthesis in our echocardiographic follow-up. The effective orifice area in the BioValsalva group was 1.85 cm² compared with 1.80 cm² in the BioIntegral group (p=0.24). The mean pressure gradient in the BioValsalva group was 11.0 mm Hg compared with 11.5 in the BioIntegral group (p=0.82).

In conclusion, we did not observe a significant difference in the outcome between the two biological valved conduits, and both of them had excellent outcomes.

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 5^th and 6^th 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

Biography:

To be updated soon

Abstract:

Background: Although the long-term benefits of angiotensin-converting enzyme inhibitors (ACEIs) in myocardial infarction and heart failure have been repeatedly proven, reports concerning their continuation in patients scheduled for heart surgery have produced conflicting results.  The purpose of this meta-analysis was to assess the impact of preoperative ACEIs on short term outcomes following cardiac surgery.

Methods: We performed a meta-analysis of articles comparing preoperative ACEIs with no ACEIs in patients undergoing cardiac surgery.  The EMBASE and MEDLINE databases were searched until the first week of October 2013 for English-language articles.  Two reviewers performed independent article review and study quality assessment.  Data on atrial fibrillation, vasopressor requirements, acute kidney injury and mortality all occurring in the first month following surgery were collected.  Since most included studies were retrospective, the generic inverse variance method was used to analyse adjusted odds ratios, calculating pooled odds ratios (ORs) and associated 95% confidence intervals (CIs) using a random effects model.

Results: We retrieved 21 studies (1 randomized trial, 18 cohort studies and 2 case-control studies) enrolling a total of 51 826 patients.  Preoperative administration of ACEIs significantly increased postoperative atrial fibrillation (OR: 1.16; 95% CI: 1.03 – 1.30) and vasopressor requirements (OR: 1.84; 95% CI: 1.32 – 2.56).  There was also a trend towards increased acute kidney injury (OR: 1.10; 95% CI: 0.91 – 1.33). However, no difference in mortality was observed (OR: 0.95; 95% CI: 0.79 – 1.15).

Conclusion: Preoperative use of ACEIs is potentially associated with an increased risk of adverse events following heart surgery, including atrial fibrillation and greater vasopressor requirements.  Large randomized trials are required to confirm these findings.

Biography:

Jing-song Ou has completed his M.D and Ph.D from Sun Yat-sen University of Medical Sciences and postdoctoral training from Medical College of Wisconsin at the age of 35 years. He is a Changjiang Scholar Professor and Pear River Scholar Professor as well as a Distinguished Young Scholars of National Science Fund. He is currently the Associate Chief of Division of Cardiac Surgery, and Vice Director of Guangdong Province Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases in The First Affiliated Hospital of Sun Yat-sen University. He has published more than 70 papers in peer review journals and serving as an editorial board member in American Journal of Physiology- Endocrinology and Metabolism

Abstract:

Circulating microparticles are a group of membrane vesicles which are released by cell activation or apoptosis. Previous studies demonstrated that circulating microparticles or certain subgroups of circulating microparticles increased in a variety of cardiovascular diseases, such as hypertension, acute coronary syndromes and mitral valve disease. Vascular function is very important for maintaining circulation after cardiac surgery. However, the impact of microparticles generated from patients with valvular heart disease before and after cardiac surgery on vascular function remains unknown. Therefore, we investigated if circulating microparticles from valvular heart disease patients undergoing cardiac surgery would lead to vascular dysfunction. We found that circulating microparticles from valvular heart disease patients could impair endothelium-dependent vasodilation by decreasing nitric oxide production and increasing superoxide anion generation, which was caused by uncoupling endothelial nitric oxide synthase and inhibition of its activity. As this effect was more prominent during perioperative period after cardiac surgery, hemodynamic abnormality might be induced. Our findings suggested that circulating microparticles might be potential therapeutic targets for maintaining vascular function after cardiac surgery

Biography:

Sonjoy Biswas has completed his MS (Cardiothoracic Surgery) under University of Dhaka, Bangladesh in 2013 and FCPS (Cardiovascular Surgery) in 2015 under Bangladesh College of Physicians and Surgeons (BCPS). He has been exposed to almost every facets of  both adult and congenital heart surgeries in Bangladesh.  He worked as  a Registrar in Cardiac Surgery at National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh  while doing these case reports  till December, 2015. Now, he has been working in United Hospital Limited, Dhaka, Bangladesh as a Specialist in the Department of Cardiac Surgery

Abstract:

Management of adult coarctation of aorta surgically is difficult. Moreover, concomitant acquired disease with it becomes more challenging and complex. Staged surgical procedures exhibit more complexity. We have depicted our experiences of single-staged surgery for those cases. From June, 2013 till to date we have performed 4 single staged repair for coarctation of aorta with concomitant acquired cardiac diseases at our centre. In this series, age ranged from 20 to 49 years, all were male.
Out of four, one case of operated coarctation of aorta with severe MR died on the 11^th post-operative day due to ARDS. Single-staged surgery for intracardiac procedure along with co-arctation of aorta is safe, cost effective and reproducible.
Key wards: Coarctation of aorta, single-staged surgery, mitral regurgitation etc.

Biography:

To be updated  soon

Abstract:

Background: Mitral valve repair in patients with mitral valve regurgitation is associated with an improved quality of life with less morbidity as well as better long-term survival as opposed to replacement. We assessed  the characteristics and outcome of patients treated with conservative mitral surgery in our centers. 

Methods and Materials: We considered for enrollment in this study 62  patients with mitral valve disease who underwent mitral valve repair for moderate to severe mitral regurgitation, in two hospitals between January 2009 and December 2012. Patients who underwent concomitant surgery for other conditions were also included. 34 patients (55%) were men. Mean age was 57.5+-12.5 years.  The primary outcome of interest was death, mitral residual regurgitation and need for reintervention. On admission, 79 % of the patients had heart failure NYHA III-IV. Severe mitral regurgitation was present in 40 (64.5%)patients. Median sternotomy was surgical aproach, using moderate hypotermia during bypass time. Surgical techniques used were implantation of a prosthetic ring in 95.2 %, quadrangular resection of posterior leaflet in 19.4%, cordal replacement in 6.5%, mitral commissurotomy in 14.5%, cordal transfer in 8%, Alfieri stich in 4.8% of patients. Patients were followed up for 1 and 6 months after the mitral surgical procedure. Evaluation of mitral valve repair is based in transthoracal and transesophageal echocardiographic examinations.

Results: No deaths in early postoperative period. Early after surgery, 58 % of patients had no mitral regurgitation, 34% had mild mitral regurgitation; only one patient had moderate mitral regurgitation. After one month, only 1 (1.8%) patient had more than  moderate mitral regurgitation.At six month follow-up only 2 (4%) patients had more than moderate mitral regurgitation. There were no deaths or reinterventions during 6-month follow up. 

Conclusion: Mitral valve repair for mitral regurgitation  has been associated with  good short to midterm results.

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.

Biography:

Antonio Romero Berrocal has completed his PhD at the age of 25 years from Alcalá University (Madrid) and postdoctoral studies from Alcalá University. Anesthesiologist at the Hospital Puerta de Hierro-Majadahonda. Team member postoperative critical care and lung transplantation.
He has published articles in scientific journals

Abstract:

Case Report
This is a patient who underwent left single lung transplantation for emphysema type COPD. During the immediate postoperative period came early graft dysfunction grade III, which necessitated the implantation of an ECMO (extracorporeal membrane oxygenator). Respirator ventilatory parameters were adjusted to avoid lung distension, low tidal volume (Vc) (280 ml), high respiratory rates (20 rpm) and a level of PEEP (positive pressure at end expiration) 8 cmH2O. By monitoring pulmonary tidal volume distribution Electrical Impedance Tomography (EIT), bedside, we note that most of the tidal volume was distributed in the native lung emphysema. Alveolar recruitment maneuver  under control of the EIT allowed to observe the volume and distribution of current which were necessary to ventilate the lung transplant was performed pressures.

Biography:

To be udated soon.

Abstract:

While some surgeons believe that one biopsy taken from the most suggestive part of the lung as shown by CT scan of the chest is enough to arrive at a histological diagnosis, others believe that multiple biopsies from different lobes (2 or 3) are less likely to result in a missed diagnosis due to inadequate or unrepresentative sample. We compared the results of the patients who had a single biopsy with those that had multiple biopsies in terms of positive yield of histological diagnosis, the length of in-hospital stay after the procedure, as well as the length of time the chest drain remained in the chest post-operatively before it was removed after cessation of post-operative air-leak.

Methods:

Data of all the patients referred by respiratory physicians and who underwent VATS lung biopsy for suspected ILD was collected retrospectively from our hospital data system and the patients were grouped into those that had a single lung biopsy (Group A) and those that had multiple lung biopsies (Group B). High resolution CT scan of the chest was reviewed for every patient prior to the procedure, and the part(s) of the lung that was most appropriate area(s) for sampling chosen, often buttressed by recommendation from the respiratory physicians. The lingula of the left upper lobe was avoided in all cases. All cases were performed through three-port VATS.

Results:

115 patients underwent VATS lung biopsy in our Department between 2009 and 2015. A single biopsy was taken from 67 patients, while 48 patients had more than one biopsy (36 patients had two biopsies while 11 had three biopsies from different lobes). Histological diagnosis was arrived at in all patients in both groups, with no incidence of inappropriate, insufficient, or normal lung tissue. There was no in-hospital or 30-day mortality reported in either group. The overall median length of post-operative hospital stay was 3 days, and the median duration of chest drainage was 1 day. There was no statistically significant difference between the two groups in terms of length of hospital stay post-operatively (p = 0.235), or in terms of the duration of chest drain post-operatively (p = 0.303).

Conclusion:

VATS lung biopsy for the diagnosis of ILD is a safe procedure and is an essential diagnostic tool in distinguishing the various types of ILD whose diagnosis cannot be reached with certainty on the basis of clinical presentation and HRCT alone. When the sampling site is guided by HRCT and multidisciplinary approach, a single biopsy is enough to arrive at a histological diagnosis. Our experience has shown no added advantage in taking more than a single biopsy in this regard. Even though in our experience there was no statistical difference in terms of length of post-operative hospital stay or chest drainage, multiple lung biopsies, however, result in more operative time and attendant increase in cost by the use of more lung stapler re-loads.

Biography:

Aleksei Elkin has completed his MD in 1984 at the age of 23 from 1^st Leningrad Medical University. After graduating, he worked in lung surgery department of Leningrad state institute of phthisiopulmonology. In 1993 he has completed his PhD and in 2000 he received his DSc degree. Aleksei Elkin is being the professor of surgery since 2006.

Since 2011 to the present days, Aleksei Elkin is the chairholder in the department of phthisiopulmonology and thoracic surgery in the North-West Medical University named after the I.I. Mechnikov (Russia, Saint-Petersburg), being an author of more than 100 scientific works regarding the surgical treatment of pulmonary tuberculosis

Abstract:

 The results of 38 operations, performed upon the subject of pulmonary tuberculosis complicated with tuberculous pleural empyema and drug-resistance of mycobacteria, were studied. In 11 cases disease manifested itself in pneumothorax with subsequent detection of destructive pulmonary tuberculosis. 27 patients previously received prolonged and ineffective therapy for drug-resistant pulmonary tuberculosis. In all 27 cases, pulmonary tuberculosis progressed at the background of ineffective chemotherapy and was complicated with pleural empyema and broncho-pleural fistula in 19 cases, and in 8 cases - with loculated pleural empyema without bronchial fistula. More than a half of the patients (21) were hospitalized into the surgical department after prolonged and ineffective treatment of pleural empyema, using pleurocentesis and pleural drainage. Mycobacteria of tuberculosis were detected at the sputum and in cavities of pleural empyema of all patients during examination at the hospital. Active tuberculosis of the bronchus was diagnosed during bronchoscopy in 11 cases, in 4 cases tuberculosis of soft tissues at the place of pleural drainage insertion was diagnosed. Choose of pre-operative treatment was determined by data on drug resistance of mycobacteria tuberculosis – pre-operative treatment included maximally intense polychemotherapy combined with sanitation of cavity of pleural empyema using one or two drainages. Endobronchial valves were inserted into bronchi of 16 patients in order to block air leak through drainages, which allowed to irrigate pleural cavity actively without risk of aspiration. In total 38 patients underwent 56 surgical operations – 17 patients received two-stage treatment: VATS sanitation of cavity of pleural empyema and thoracostomy after the main surgery stage. Surgeries structure included: isolated pleurectomy – 9 cases, including 4 cases of VATS pleurectomy; lung resection in combination with pleurectomy and decortication – 11 cases; pleuropneumonectomy – 18 cases. Complicated postoperative course was registered in 10 cases, including the development of bronchial fistula after pneumonectomy on the background of pleural empyema in 2 cases, which required reoperation. One patient died due to total drug resistant tuberculosis progression, development of thoracic wall tuberculosis and tuberculous pericarditis

Biography:

To be updated soon

Abstract:

Objective: The aim was to estimate the effectiveness of thoracoscopic debridement in the advanced stages of pleural empyema.

Methods: All patients with pyogenic empyema (stage II & Stage III) in our Hospital, (admitted from January 2009 to December 2013) who did not respond to chest tube/pigtail drainage and/or antibiotic therapy were treated with VATSD and/or open thoracotomy. Prospective evaluation was carried out and the effect of this technique on perioperative outcomes was appraised to evaluate our technical learning with the passage of time and experience with VATS for late stage empyema management.

Results: Out of total 63 patients, 26 had stage II empyema and 37 had stage III empyema. VATSD was employed on all empyema patients admitted in our Hospital. VATSD was successful in all patients with stage II empyema. Twenty-five patients (67.6%) with stage III empyema completed VATSD successfully. However, only 12 cases (32.4%) required conversions to open (Thoracotomy) drainage (OD). The median hospital stay for stage III VATSD required 9.65±4.1 days. Whereas, patients who underwent open thoracotomy took longer time (21.82±16.35 days). Similarly, stage III VATSD and stage III open surgery cases showed significance difference among chest tube duration (7.84±3.33 days for VATS and 15.92±8.2 days for open thoracotomy).

Conclusions: VATSD facilitates the management of fibrinopurulent, organized pyogenic pleural empyema with less postoperative discomfort, reduced hospitalization, and have fewer postoperative complications. VATSD can be an effective, safe as first option for patients with stage II pleural empyema, and feasible in most patients with stage III pleural empyema.

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.

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