Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd International Conference on Cardiovascular Medicine and Cardiac Surgery Golden Tulip Berlin – Hotel Hamburg.

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Scientific Program Day 1
Scientific Program Day 2

Day 1 :

Keynote Forum

Ihor Huk

Director of Vascular Laboratory, Medical University of Vienna, Austria

Keynote: Ischemia reperfusion phenomena during aortic surgery

Time : 09:25-09:55

Conference Series Cardiovascular 2018 International Conference Keynote Speaker Ihor Huk photo
Biography:

Ihor Huk is an International Member of Ukrainian Academy of Science. He has participated in scientific meetings of Medical University of Vienna and given some lectures.His interest was always with regards to biochemistry and pathophysiology of humans cells. In Vienna, he became one of the famous surgeons, as his rector mentioned it recently, by doing thousands of organ transplantations and vascular procedures. From his experimental laboratory Medi-cal University of Vienna many exciting papers were published in top journals e.g. Circulation, Stroke, EJVES, JVS etc. His fundamental work was published in Circulation trying to explain how endothelial nitric oxide synthase can derange and in spite of nitric oxide is going to synthetize oxygen radical-superoxide. This paper is a classical citation paper on the patho-physiology of endothelium.

Abstract:

Aortic abdominal aneurysm is a pathology that has become ever more prevalent and in the event of rupture, have fatal consequences.There are two widely accepted methods of treatment: open surgery (OS) and endovascular repair (EVAR). A combination of both, called a hybrid operation (HO), is useful in dealing with complex aortic morphologies. One of the main risk factors in dealing with complex forms of aortic aneurysm relates to ischaemia/reperfusion. We have, over the past 20 years, accumulated a greater understanding of how to mitigate ischaemia/reperfusion injury. Single-center experience in dealing with reperfusion phenomena will be discussed, and experimental and clinical data will be presented. Experience with some new mediators, in addition to nitric oxide, will be covered. The fundamental role of gasotransmitters will be examined, as will pertinent therapeutic concepts.

Keynote Forum

Rainer Moosdorf

Director for Department of Cardiovascular Surgery,University in Bonn

Keynote: Alternative TAVI-approaches in multimorbid patients

Time : 09:55-10:25

Conference Series Cardiovascular 2018 International Conference Keynote Speaker Rainer Moosdorf photo
Biography:

Rainer Moosdorf started his career as a Resident at the University Hospital in Giessen in 1978. In 1990, he became a Full Professor for Cardiovascular Surgery at the University in Bonn and Vice Chairman of the respective department. In 1989 and 1990, he spent two semesters at the Carolinas Heart Institute in Charlotte/NC as a Research and Clinical Fellow. Since 1994, he is working at the University Hospital in Marburg as a Full Professor for Cardiovascular Surgery and Director of the department. Between 2001 and 2011, he also held the position of the Vice Medical Director and since 2006 the Medical Director of the University Hospital in Marburg. His main specialties within cardiovascular surgery are laser- and arrhythmia surgery, endovascular procedures including TAVI´s and endovascular reconstructions of the aortic arch and reconstructive surgery of the coronaries. As the Chairman of the Board of Medical Network Hessen, he is an official representative of the State of Hessen in the field of Clinical Medicine and Medical Education.

Abstract:

Transapical aortic valve implantation (TAVIs) have become an established alternative to conventional aortic valve replacement in elderly high to intermediate risk patients. The main access is transfemoral; alternatively transapical, transaortic and other rare vascular approaches are used. Some patients however, are present with severe comorbidities, which necessitate further considerations.We will present two such patients. The first patient, 81 years of age, had severe bilateral carotid artery disease with status post stroke together with significant aortic stenosis. We choose to perform a bilateral carotid endarterectomy and in the operation also a transcarotid catheter guided aortic valve implantation via a vascular graft attached to the left common carotid artery. The second patient was referred to us for a TAVI, but heart catheterization revealed a filiform left main stem stenosis. We decided to perform an on pump double CABG and a direct transaortic TAVI through a mini aortotomy. By this hybrid approach, x–clamp time was really minimized and the 91 year old patient had an uneventful course as well. Since then we have performed a small series of such hybrid
interventions.

Keynote Forum

Tadeusz Malinski

Distinguished Professor

Keynote: Nitric oxide/peroxynitrite imbalance in dysfunctional endothelium – Clinical implications

Time : 10:25-10:55

Conference Series Cardiovascular 2018 International Conference Keynote Speaker Tadeusz Malinski photo
Biography:

Tadeusz Malinski PhD, Is the Marvin & Ann Dilley White Chair and Distinguished Professor of Biomedical Sciences at Ohio University. His research is interdisciplinary in the areas of Biochemistry, Biotechnology, and Nanomedicine. He was first in the world to measure, nitric oxide concentration in single cells and neurons with nanosensors.His ground-breaking discovery of the regulatory role of nitric oxide in the beating heart and the mechanism of dysfunction of nitric oxide synthase are historical contributions to world science. The dysfunction of nitric oxide synthase is a common denominator of several diseases of modern civilization heart failure, hypertension, diabetes, atherosclerosis, aging, obesity and stroke. His work appears in nearly 400 publications. He has received approximately 35 Awards and Distinctions among others:International Academy of Cardiology Award, Maria Curie Award in Biochemistry, and the Grand Gold Medal in Medicine from the Society of Arts, Sciences and Letters.

Abstract:

A dysfunctional endothelium is a common denominator of several cardiovascular diseases, including: hypertension, atherosclerosis, heart failure, diabetes, obesity and aging. Normal functioning endothelium mainly produces cytoprotective vasorelaxant, nitric oxide (NO) and traces of the cytotoxic vasoconstrictor, peroxynitrite (ONOO-). However, in dysfunctional endothelium, these proportions are reversed. The recent development of nanomedical systems allows for the simultaneous measurements, in situ, of small biomolecules like NO, ONOO- and superoxide (O2- in single a cell. NO is produced from L-arginine and O2 by a dimeric form of endothelial nitric oxide synthase (eNOS). However, destabilized/uncoupled eNOS dimer in dysfunctional endothelium can concomitantly produce O2- and NO. NO is a rapid scavenger of O2- to generate ONOO-, one of the most powerful oxidants in the cardiovascular system. ONOO- can also trigger a cascade of events leading to nitrosylation, nitration, apoptosis, necrosis,lipid peroxidation, enzyme inactivation and DNA modification. Using nanosensors, we found that absolute values of NO and ONOO- concentrations do not necessarily reflect the efficiency of the cardiovascular system. We observed that the balance between the concentrations of NO, [NO], and ONOO-, [ONOO-], was a more accurate metric. This balance between [NO]/[ONOO-] in functional endothelium varies between 2 and 6. However, if this balance falls below 1.0, it is usually associated with severe endothelial dysfunction in a diseased state. These nanomedical measurements of the [NO]/[ONOO-] balance/imbalance in a single endothelial cell can be used for the early diagnosis of cardiovascular dysfunction, as well as the design of early pharmacological intervention to restore endothelial function. The early diagnosis of the adverse balance of [NO]/[ONOO-] can be partially reversed with treatments of L-arginine, vitamin D3, nitroso albumin, and also by statins, β-blockers and some ACE inhibitors.

  • Special Session
Location: Hall - Sylt 3

Session Introduction

Aliki Peletidi

University of Nicosia, Cyprus

Title: The first study exploring pharmacists’ perceptions about their role in CVD prevention in Cyprus
Speaker
Biography:

Aliki Peletidi was graduated with an MPharm degree from Kingston University London in 2013. she and her Professor Reem Kayyali, initiated and delivered with high success rates the first pharmacy-led public health service to reduce the CVD risk in Greece in 2016 as part of her PhD research. Currently, she is a Lecturer at the University of Nicosia teaching Clinical Pharmacy and Pharmacy Practice modules.

Abstract:

Statement of the Problem: Cardiovascular disease (CVD) is the main killer, associated with 31% of all deaths in 2015 worldwide. In Cyprus, the mortality caused by CVD reached 38% in the same year. Specifically, in women CVD caused 52% of deaths and in men 55.4%. Pharmacists are one of the most accessible healthcare professionals (HCPs) and the first port of call for the general public. Therefore, pharmacists can have a key position in the prevention of CVD. Interestingly, another reason why pharmacists and most specifically Cypriot pharmacists could play a vital role in CVD prevention is the fact that there are 55.59% pharmacies per 100.000 inhabitants. The aforementioned classifies Cyprus as the second country among Europe which has this amount of pharmacies based on the PGEU report 2015. Our study aimed to explore the existing and the possible future role of Cypriots pharmacists in CVD prevention but also to identify any barriers that pharmacists may have as well as to detect their needs for their future role and their preferences of delivering public health services.
Methodology & Theoretical Orientation: This study used qualitative research methods utilizing semi-structured interviews with Cypriot pharmacists from the two largest cities, Nicosia and Limassol. Purposive sampling was used, with pharmacists randomly selected through a table of random numbers. The sample size was not predetermined and interviews were continued until data saturation was reached. The total number of interviews conducted was 15. The interview schedule was comprised of 27 open-ended questions including  demographic information. The first section of the interview dealt with the primary prevention of CVD, the second contained general questions about the role of the pharmacist in the prevention of CVD and finally the third part included the demographic information. Prior to the data analysis interviews were transcribed verbatim and translated into English.
Results: The analysis of the data was conducted using thematic analysis process. Four themes were arising:
(1) pharmacists' perceptions about their role,
(2) pharmacists' knowledge and education,
(3) pharmacists' communication and relationship
(4)barriers.
Pharmacists are keen to initiate and deliver public health services with the majority stating that pharmacy-led hypertension screening service should be the first one. Furthermore, an interesting point was that pharmacists expressed the need for a structured approach through the Cypriot Pharmaceutical Association and the Department of Health.
Conclusion & Significance: This is the first study exploring Cypriot pharmacists’ views on their role in CVD prevention. Pharmacists have the potential to actively participate in CVD prevention. They expressed the need to move forward by offering public health services but also, they indicated that the Cypriot National Health System should allow them to have a more active role and to incorporate them in the primary care system with an equal role compared with other HCPs.

  • Case Study on Heart Failure and Cardiovascular Diseases | Cardiac Regeneration
Location: Hall - Sylt 3
Speaker

Chair

Tadeusz Malinski,

Marvin White Chair and Distinguished Professor

Session Introduction

William E Feeman

Wood County Hospital, USA

Title: Survival of 101 year old woman on statin therapy

Time : 11:50-12:15

Biography:

William E Feeman MD is a Physician in private practice in Bowling Green, Ohio. He attended undergraduate school at Ohio State University (1961–1966) earning a Bachelor of Science in Physiology and became interested in a career in medicine during that time. He then attended medical school at Ohio State University (1966-1970), where he developed an interest in the primary and secondary prevention of atherothrombotic disease. He has ten articles as well as 67 letters to the editor published in various science/medical journals. Virtually all publications relate to the primary and second prevention of atherothrombotic disease. He has presented his research data at many annual scientific assemblies of the American Academy of Family Physicians and at a number of regional, National and International symposia in atherothrombotic disease.

Abstract:

Background: Treatment of the elderly patients with dyslipidemia remains controversial with concerns about drug safety in the very old patient population.
Objective: To report the course of a 102 year old woman who survived a severe myocardial infarction at age 75 years and has remained clinically free of atherothrombotic disease while receiving statin therapy for those 27 years and no other intervention.
Methods: Case report covering one individual over 27 years.
Results: The 102 year old woman survived for 27 years following a severe myocardial infarction while receiving statin/antihypertensive therapy and aspirin therapy, but no other intervention.
Conclusion: This report supports the literature for statin treatment of dyslipidemia in the very old population to maintain a clinical disease free state following an acute myocardial infarction. The safety of such therapy is also recorded. This report supports the effectiveness of optimal medical therapy in such patients.
Overview: The question of how best to treat dyslipidemia in the very old population remains unsettled, though most researchers would favor statin therapy. Concerns have been raised as to drug safety in the very old population. This report follows an elderly female survivor of an acute myocardial infarction at age 75 years, over the next 27 years, to an age of 102 years, on optimal medical therapy. No surgical interventions have been necessary. This report supports the concept of aggressive medical therapy in the very old.

Snehil V Mishra

Hinduja Healthcare, India

Title: Variant angina in chronic kidney disease: A case report of an unusual presentation of cardiac arrest following dialysis

Time : 12:15-12:40

Biography:

Snehil V Mishra is an Adult Interventional Cardiologist and has completed all his medical education from public hospitals in Mumbai, India. He has worked as an Assistant Professor in the Department of Cardiology of Nair Hospital, Mumbai and has recently completed a Fellowship Course from Rambam Health Care Campus, Haifa, Israel, where he performed several complex coronary and structural heart interventions. He aspires to master the most recent advances in therapeutic interventions for the benefit of the population at need in his country who cannot afford medical treatment abroad. He believes that sharing and learning from clinical experiences of his colleagues can help everyone enhance their competence and help to provide optimum patient care.

Abstract:

Introduction: Variant angina is an uncommon syndrome which is mostly benign, but carries a risk of serious complications.
Coronary vasospasm has been described in kidney diseases; however, its manifestations have not been elucidated. Also, haemodynamic changes occur during haemodialysis, but its acute effect on coronary circulation is not well understood. We report a rare case of variant angina (VA) in a patient with chronic kidney disease (CKD), presented with myocardial infarction (MI) and cardiac arrest secondary to ventricular fibrillation (VF).
Patient Information: A premenopausal female with CKD presented with acute coronary syndrome following haemodialysis.She complained of recurrent angina following haemodialysis sessions since few months which resolved with nitroglycerine.ECG revealed lateral wall myocardial infarction. Few minutes after admission, patient developed VF leading to cardiac arrest and was successfully resuscitated and shifted to the cardiac catheterization lab for emergency percutaneous coronary interventions (PCI). Coronary angiogram revealed >90% stenosis in mid left anterior descending coronary artery (LAD). In view of typical history suggestive of VA and no obvious thrombus or dissection in culprit artery, vasospasm of LAD was suspected as the likely etiology. Ergonovine provocative test was not performed. Instead, intracoronary nitroglycerine was administered which led to complete resolution of ST elevation, relief in chest pain and a patent LAD with improved calibre. Over next 24 hours, multiple episodes of ST elevation and chest pain occurred, resolving with sublingual nitroglycerine. High dose calcium channel blocker therapy was initiated and patient had no further clinical events. She had undergone several uneventful haemodialysis sessions on treatment and is doing well.
Discussion & Conclusion: To our knowledge, this is the first reported case of patient with CKD having VA complicated by VF causing cardiac arrest. The association of coronary vasospasm following haemodialysis has also not been described. VA can angiographically mimic organic stenosis and should be kept in mind during primary PCI.

Andiswa Nzimela

University of KwaZulu Natal, South Africa

Title: Apical LV aneurysms in children

Time : 12:40-13:05

Biography:

Andiswa Nzimela has an MBChB from Medical University of Southern Africa (1999), FCPead from the University of KwaZulu Natal (2006) and Certificate in Paediatric Cardiology CMSA (2009). She works as a Paediatric Cardiologist and Senior Consultant in the Department of Pediatric Cardiology, Inkosi Albert Luthuli Central Hospital in Durban since 2007. She looks after children with congenital and acquired heart defects, pericardial disease, cardiomyopathy and pulmonary hypertension. She is an Honorary Lecturer at the University of KwaZulu Natal

Abstract:

Congenital apical left ventricular (LV) aneurysms are rare in children and should be differentiated from congenital left ventricular diverticular. We present three cases of apical LV aneurysms in children. Case 1 is a five day old male infant, HIV exposed on nevirapine, who was referred for a soft systolic murmur. No cardiac failure was present and mild cardiomegaly was noted on chest X-ray. ECG demonstrated right axis with RVH. Echocardiogram showed a large apical left ventricular aneurysm measuring 16 mm by 19 mm with good ventricular function. This was confirmed on CT angiogram and the child underwent successful resection of the aneurysm. Histology demonstrated mural fibrosis and granulation tissue with no vasculitis. Case 2 is a two year old male, presented with one week history of coughing, shortness of breath and tachycardia. Clinical cardiac failure was present with cardiomegaly on CXR. Echocardiography demonstrated pericardial effusion with a LV apical aneurysm measuring 40 mm x 43 mm with good ventricular function. A CT angiogram further defined the aneurysm. HIV was positive with a high viral load and low CD4 count. TB work up was negative. He was started on antifailure medication and his clinical condition optimized. He was operated successfully two months after commencing antiretroviral therapy. Histology demonstrated transmural fibrosis. Case 3 was a nine year old male who was presented with palpitations, cough and dyspnoea. Cardiac failure and cardiomegaly were present. A large apical aneurysm with a pericardial effusion was again noted echocardiographically and further defined by CT angiography. Coronary angiogram was normal. He also tested HIV positive with a high viral load and low CD4 count. His tuberculosis (TB) work-up was negative. The child’s treatment started on antifailure medication and commenced on antiretroviral treatment. However, he was demised before he could be operated on. Patients with apical LV aneurysm may be asymptomatic or present with arrhythmias, heart failure, peripheral membolism, endocarditis, cardiac rupture or sudden death. We postulate a possible association with HIV infection or exposure. Surgical resection is the treatment of choice to prevent complications.

  • Case Reports on Arrhythmias and Pericardial Disease | Cardiac Surgery | Hypertension
Location: Hall - Sylt 3
Speaker

Chair

William E Feeman

Bowling Green, Ohio

Session Introduction

Jie He

Southern Medical University, China

Title: Reoperation for ascending aorta aneurysm after double valve replacement in a Takayasu’s aortitis
Biography:

Dr. Jie He graduated from Southern Medical University in China in 2016 and joined Prof. Fan’s team as a surgical resident at Guangdong Cardiovascular Institute in 2016. His main research field is aortic disease. Since then, he has published several articles on cardiovascular surgery and shared our team’s experience on different conferences.

Abstract:

Statement of the Problem: Takayasu’s aortitis (TA) is a chronic systemic vasculitis of unknown origin. It often involves the aorta, its major branches and the aortic valve. Surgical treatment such as valve replacement is occasionally required when cardiovascular symptoms occur. The most serious complications after valve replacement in TA are prosthetic valve detachment and aortic root aneurysm. The purpose of this study is to describe a complicated surgical case of reoperation presented with all of these complications.
Methodology & Theoretical Orientation: This study is based on a reoperation case of TA patient with previous double replacement, mainly focusing on the surgical technique and our experience during the treatment process.
Findings: A 29-year old male with TA was admitted due to tachypnea and exertional palpitations, three years after his previous double valve replacement (DVR). Transesophageal echocardiography showed severe detachment of the aortic valve and fistula from the aortic root to both the left ventricle and the left atrium. Computed tomography showed aneurysmal dilation of the aortic root to a diameter of 64 mm.
Conclusion & Significance: We successfully treated a case of aortic aneurysm combined with aortic valve detachment and aortic fistula after previous DVR in TA patient. The teaching points of this case were: The two key procedures in this operation, i.e. reconstruction of the central fibrous body and the shunt of aortic root-right atrial; due to the fragility of the tissue in TA patients, the surgical operation must be meticulous to ensure as little tension on the suture line as possible; for DVR operations in TA patients, proactively fixing the aortic valve to the mitral valve is recommended; and imaging follow-up should be done routinely. Even in such a challenging and complex case, surgery is still feasible and the preferable option.

Zhang Shaoheng

GuangZhou Red Cross Hospital - Jinan University, China

Title: TERT and GDF11 cooperate in rejuvenating senescent endothelial progenitor cells and predict the prognosis of elderly patients with acute myocardial infarction
Biography:

Abstract:

Background: Endothelial progenitor cells (EPCs) play a key role in cardiovascular regeneration following acute myocardial infarction (AMI); however, in older patients, EPCs appear to lose their regenerative capacity.
Objectives: This study aimed to evaluate the role of two potential anti-aging factors, TERT (the catalytic subunit of telomerase) and growth differentiation factor 11 (GDF11), in rejuvenating senescent EPCs in elderly patients with AMI.
Methods: We compared the quantity and capabilities of EPCs from old-aged (>60 years), middle-aged (45–60 years), and young-aged (<45 years) AMI patients. The role of TERT and GDF11 in young and old-aged EPCs were examined in vitro. Finally, we validated our finding by comparing GDF11/TERT expression in AMI patients with poor/good prognosis.
Results: Circulating count and survival of EPCs, and TERT and GDF11 expression levels, decline with age among patients with AMI. Meanwhile, upregulation of TERT and GDF11 can rejuvenate old-aged EPCs in vitro by renewing their survival and angiogenic abilities through activation of the eNOS- and pro-survival signaling pathways. Depletion of TERT causes senescence in vascular endothelial function and angiogenesis of young EPCs. An independent cohort of patients confirmed the predictive power of TERT and GDF11 expression as indicators of clinical outcomes post-AMI.
Conclusions: TERT cooperates with GDF11 to enhance regenerative capabilities of older EPCs. When combined with GDF11,TERT may represent a potential therapeutic target for the treatment of elderly patients with AMI.

Suna Aydin

Elazig Education and Research Hospital, Turkey

Title: Effect of sodium nitroprusside on renalase, catecholamines and nitric oxide changes in post-coronary bypass surgery complicated by hypertension
Biography:

Suna Aydin received her Doctor of Medicine degree (MD) from School of Medicine, University of Firat, and Elazig in 1998. In 2011 at the Dicle Medical School she received her specialization degree in Cardiovascular Surgery, and in 2015 she received her PhD diploma Anatomical Science from Firat University Institute of Health Sciences. She currently works as a Surgeon at Department of Cardiovascular Surgery of Elazig Education & Training Hospital of Elazig Campus of Health Sciences University. She is the author of numerous scientific articles within the field of Cardiac Surgery and Anatomical Sciences. She has served as an Editorial Board Member of several international journals and she is Reviewer for several international journals.

Abstract:

Renalase is an enzyme that mediates lowering of blood pressure by destroying catecholamines. Hypertension is one of the most common complications after coronary artery bypass (CABG) surgery, and this complication is usually averted by administration of sodium nitroprusside (SNP), which lowers blood pressure by dilating blood vessels through nitric oxide (NO). Thus, the aim of the present study is to examine the changes in renalase, catecholamine and nitric oxide (NO) before and after administration of sodium nitroprusside to lower blood pressure in patients developing hypertension following coronary artery bypass (CABG) surgery using biological samples collected in the first 6 to 8 hours, and at 24th, 48th and 72nd hours and to find out its relations with certain hemodynamic parameters. The study registered 26 patients who developed hypertension in the first 6 to 8 hours after CABG, 12 patients who had normal blood pressure after CABG, and 22 healthy individuals. ELISA method was used to measure renalase concentrations and catecholamine levels, and nitric oxide levels were quantified by spectrophotometry. Renalase concentrations and NO levels of the patients who developed hypertension in the first 6 to 8 hours were found significantly lower and catecholamine levels were significantly higher than those in controls and cases who did not develop hypertension. After starting sodium nitroprusside (SNP) administration, these patients showed a statistically significant increase in renalase concentrations and NO levels and a noteworthy decrease in catecholamine levels at 6 to 8, 24, 48 and 72 hours. In addition, a slight increase was found in heart rate and decreases was recorded in the systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) following sodium nitroprusside administration. Consequently, the data obtained in this study suggest that administration of nitroprusside lowers the blood pressure by not only increasing NO production (vasodilation), but also elevating the quantities of the renalase enzyme, which destroys catecholamines. It is believed that addition of renalase to medications used to lower blood pressure in the future can help in preventing hypertension.

Yusuf Turkmen

Karolinska University Hospital, Sweden

Title: Successful management of very scary complication of transseptal punctures
Biography:

Yusuf Turkmen has been working on Cardiac Electrophysiology for a long time. He is well-known Electrophysiologist as a result of his hard work. He is mainly involved in Clinical Electrophysiology and he has trained large numbers of fellows. It is a great pleasure for him to share and discuss about the different approaches on the treatment of cardiac arrhythmias and management of complications

Abstract:

Background: A transseptal puncture is one of the most challenging parts of advanced cardiac procedures for both electrophysiologists and interventional cardiologists. There are numerous complications that have been reported before, but there is no information about the puncture of descendent aorta. Here, we present the puncture of descendent aorta in a patient on dabigatran therapy.
Patient & Result: A 62-year-old woman was admitted because of frequent palpitations. She was diagnosed with hypertension, paroxysmal atrial fibrillation (AFib), complete atrioventricular block and DDDR pacemaker (PM) was implanted two years ago.Because of numerous AFib episodes and amiodarone therapy, we decided to isolate pulmonary veins. She was on dabigatran therapy. Echocardiography showed normal atriums with patent foramen ovale and mild depression of left ventricular functions. During transseptal access, descending aorta was punctured as a result of mainly inexperienced operator and other factors. It was confirmed by course of guidewire in aorta and blood pressure through the needle. Also, thrill on descending aorta was clearly felt over the proximal part of transseptal needle and measured blood pressure over the needle was 185/110 mm Hg. Finally, an injected contrast agent through the SLO dilatator seen in the lumen of descendent aorta and both in media and adventitia part of its wall 2x2.5 mg of idarucizumab was injected in order to reverse the effect of dabigatran. A transseptal set was left in descendant aorta for 60 minutes and we slowly pulled it back to the left atrium. There was no occurrence of any adverse outcome.
Conclusion: To our best knowledge, this is the first case report regarding to the puncture of descending aorta on dabigatran therapy. Also, it includes an invaluable experience for both interventional cardiologists and electrophysiologists.

Yael Yaniv

Technion-IIT, Israel

Title: Automatic detection of atrial fibrillation
Biography:

Yael Yaniv has headed the Bioelectrical and Bioenergetic Systems Lab in the Biomedical Engineering Faculty, Technion-IIT, since 2014. She is best known for her work in the pacemaker field, including characterization of pacemaker biochemical and bioenergetic properties. Her recent interest is the contribution of pacemaker cells to heart rate variability under normal and abnormal rhythms. Her lab has recently developed an algorithm to predict AF episodes.

Abstract:

Cardiac fibrillation is one of the leading causes of morbidity and mortality in the Western world, where atrial fibrillation (AF) is the most common sustained arrhythmia. Because cardiac fibrillation and specifically AF can lead to stroke, early detection of these episodes has enormous clinical impact. To date there are no real-time devices that can precisely detect the R peaks in the ECG signal before, during and after cardiac fibrillation. Our main research objectives were to design an algorithm that accurately detects the R peaks from ECG strips during AF and other arrhythmogenic events in the presence of noise or movement, and to use it as the basis for an artificial intelligence algorithm that accurately identifies AF events in short single ECG lead recordings. An algorithm which subtracts motion artifacts, electrical drift and breathing oscillations was developed.The algorithm fixes the signal polarity, filters environmental noise, and deals with electrical spikes and premature beats by heuristic filtering. The algorithm was tested on the MITDB Physionet database. Based on the R peak annotation, the T, P, Q and S peaks were detected and ECG beat morphology was extracted. Machine learning techniques that include a combination of 61 features were used for classification in to four groups. On average, our algorithm precisely detects the R peaks with 0.26% false negative and false positive detection, for a sensitivity of 99.69% and positive prediction of 99.74%. The algorithm performs similarly on AF and non-AF patient data. Our arrhythmia classification algorithm will classify AF ECG data in 89% of the cases (F1). Precise real-time identification of the heart rate on a beat-to-beat basis and classification of ECG strips can serve as a clinical tool to prescreen for cardiac diseases.

  • Molecular Cardiology| Case Reports on Cardiac and Cardiovascular Research
Location: Hall - Sylt 3

Chair

Sekib Sokolovic

Sarajevo University, Bosnia and Herzegovina

Session Introduction

Lale Hakami

University of Munich, Germany

Title: Is previous heart surgery a risk factor for Heart-Lung-Transplation?
Biography:

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German-board-certified cardiac surgeon with a subspecialization in pediatric cardiac surgery. From 2006-2008, she was the junior consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellowship at the Children's Hospital Boston/USA. From 2009 to 2011 she was director of pediatric cardiac surgery in Mainz/Germany. From 2011-2014 she was senior consultant in children heart center in Linz/Austria. From 2014 she is senior consultant at the University Hospital Munich/Germany and University Lecture of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.

Abstract:

Introduction: Since the 1980s heart-lung transplantation has been an effective method for the treatment of cardio-pulmonary diseases. Heart-lung transplantation is often the last choice to prolong the life or improve the quality of life of patients with complex congenital heart disease (CCHD) with Eisenmenger-reaction and pulmonary arterial hypertension. Especially in patients with CCHD, who underwent previous operations (group-A) and without any previous operation in group-B and were in end stage cardiopulmonary failure.
Methods: The study examined 51 patients, who were heart-lung transplanted in our hospital. We compared the patients into two groups: group I in children younger than 18 years and group II in adults older than 18 years. Particular postoperative parameters were collected by the inspection of files. Using the Chi-square test the significance of the results was shown. Survival is shown in Kaplan Meier curves and checked with the Log- Rank test.
Results: Among the 51 patients there are 17 children and 34 adults. In the adult population the incidence of congenital heart disease is dominant. In the children sample there are also patients with pulmonary arterial hypertension. 15 with CCHD were in group-A, (4 children and 11 adults). The overall survival of the patients with a previous operation was 0.16 years in the median. The survival of group-B was in the median 8.03 years (p-value: 0,027). 6 of the 15 group-A died within the first 30 years. In the group-B 4 out of 36 died (p-value: 0.018)
Discussion: In the Chi-square test a significantly higher 30 day mortality rate for the patients with previous operation. On the one hand this could be caused by complicated anatomy and strong adhesions. On the other hand there is a significantly higher rate of postoperative bleeding and early complications after heart-lung transplantation in the patients group with a previous operation, which could also be a cause for the higher 30-day mortality. In addition the sample shows a clear advantage of the patient group with no previous operation in relation to the overall survival.

Andrzej Polanczyk

Medical University of Vienna, Austria

Title: A new approach for blood hemodynamic reconstruction in human vessels with a new artificial circulatory model
Biography:

Andrzej Polanczyk is a Researcher and a Team Leader at the Lodz University of Technology, Poland. He earned his PhD in Medical Engineering in 2013. He participated in scientific grants in which he build the installation to simulate the blood flow through the abdominal section of the aorta. Recently he received a grant funded by The National Centre for Research and Development. His research areas comprise biomedical, chemical and environmental engineering.

Abstract:

Introduction: The aim of the study was to investigate a mechanical behavior of various types of artificial vessels in relation to the iliac arteries with the use of dedicated ex vivo bioengineering reactor.
Methods: Artificial circulatory model (ACM) for computational projection of vessel structure under different flow conditions was designed and built. Analyzed vessels were supplying with the homemade fluid mimicking blood. Following types of vessels were analyzed: synthetic prostheses (ePTFE, ePTFE with spiral, Dacron), biosynthetic prostheses (Omniflow II, gelatin sealedePTFE), iliac arteries and silicon tubes. Each time the same length of vessel (100 mm) was analyzed. Mechanical behavior was introduced with the use of following parameters: change of diameter, wall displacement, deformation factor and divergent factor. Moreover, ACM results were verified with medical data. 2D-speckle-tracking-technique (2DSTT) was applied to assess diameter dilatation for patients with ePTFE prostheses/iliac arteries.
Results: It was presented that both Dacron and bio prostheses act similarly to real tissue. Approximately 21% difference for gelatin sealed ePTFE prostheses and 25% for Dacron prostheses compare to iliac arteries was observed. While, ePTFE prostheses presented about 2.4-fold increase of stiffness compare to the flexibility of iliac arteries. Moreover, ePTFE prostheses act much more like silicon tubes rather than iliac arteries.
Conclusions: Artificial reconstruction of blood flow in different spatial configuration of human and artificial vessels allows simulating different mechanical response of tissue vascular grafts and silicon tubes.

Mahmoud Fouda

Cardiac Surgeon, Germany

Title: Combined transcarotid transcatheter aortic valve implantation and endarterectomy of the ipsilateral internal carotid artery
Biography:

Mahmoud Fouda has completed his PhD at the age of 24 years from the faculty of medicine Tanta University "Egypt" and postdoctoral studies from Ain Shams University "Egypt" and Paris Descartes "France". He is a cardiac surgeon with many years of experience in France, Germany and Egypt. He has acquired good experience in the newest surgical techniques over many years working at many hospitals in Paris, Lyon and Hamburg. His main interest is the minimal invasive surgery of cardiac valves as well as the total arterial coronary revascularization.

Abstract:

Over last few years, transcarotid TAVI has proved to be an acceptable substitute to other known approaches of TAVI, mainly transfemoral and transapical TAVI whenever the later ones are unfavorable due to severe femoral arteriopathy or previous iliofemoral surgery or when the patient is too frail to withstand transapical TAVI as in case of severe pulmonary or ventricular dysfunction for instance. When transcarotid TAVI becomes a must in case of inappropriate other approaches of TAVI, the presence of critical stenosis in the ipsilateral internal carotid artery as comorbidity could expose such fragile patients to be operated twice in two separate settings, for ICA endarterectomy at the first setting then for TAVI, which may entail double risk of bleeding, severe vascular and neurological complications, long hospital stay and mortality. " We report cases of transcatheter aortic valve implantation (TAVI) with the self-expanding Medtronic CoreValve bioprosthesis (Medtronic,Minneapolis, MI) through a left common carotid (LCC) artery in patients with a diseased ipsilateral internal carotid artery and high EUROSCORE risk who were rejected to undergo surgery and a transcatheter approach was planned. Due to severe peripheral vascular disease with iliofemoral lesions, significant calcifications and unfavourable angulations of the innominate artery as well as prior heart surgery precluding a direct aortic and subclavian approach, none of the established access sites were suitable. Therefore, we considered a left carotid access, which had to be combined with a surgical endarterectomy for treatment of a significant ipsilateral internal carotid artery. The procedure was successful without cardiac, cerebrovascular, or access complications. These cases illustrate a true heart team approach, establishing a unique access for TAVI for patients without regular access options".

Aleksandra Piechota-Polanczyk

Jagiellonian University, Poland

Title: Involvement of Nrf2 transcriptional activity in the induction of HO1 in abdominal aortic aneurysm wall of simvastatin treated patients
Biography:

Aleksandra Piechota-Polanczyk is currently employed as an Associate Professor at the Department of Medical Biotechnology, Jagiellonian University in the frame of the project entitled: Role of heme oxygenase 1 in the development and progression of abdominal aortic aneurysm. She received her PhD in Medicine with specialty of
Medical Biology in 2011. She was a Leading Researcher in Professor Ihor Huk research group (VASLAB) at the Medical University of Vienna, Austria with whom she is now cooperating. Her research interests focuses on finding of new anti-oxidative and anti-inflammatory proteins that could be potential markers and/or targets in treatment of gastrointestinal and cardiovascular diseases, as well as the role of Nrf2 and heme oxygenase 1 in cellular adaptation to oxidative stress and inflammatory reactions.

Abstract:

Statement of the Problem: Lack of Nrf2-regulated antioxidative heme oxygenase-1 (HO-1) may exacerbate abdominal aortic aneurysm (AAA). However, the effect of simvastatin on Nrf2/HO-1 pathway in patients with AAA has not been studied yet.
Methodology & Theoretical Orientation: We analyzed the localization of Nrf2 and HO-1 in human AAA wall and verified the influence of simvastatin treatment on Nrf2. We took AAA tissue from patients treated with simvastatin (N=28) or without statins (N=14) and verified the effect of simvastatin on primary human aortic endothelial (EC) and smooth muscle cells (SMC).
Findings: We found a positive correlation between expression of gene and glutathione (GSH) in AAA wall. Both, HMOX-1 and GSH are regulated by Nrf2. However, the expression of Nrf2 and HO-1 seemed not to colocalize in AAA wall. Simvastatin treatment up-regulated HO-1 in AAA, but Nrf2 level was only higher in vasa vasorum. In vitro studies showed that simvastatin raises HO-1 protein in EC and SMC but independently on NFE2L2.
Conclusion & Significance: Simvastatin-induced modulation of HO-1 in ECs and SMCs in vitro is not related to Nrf2/ARE activity. Different HO-1 and Nrf2 localization together with stable expression of Nrf2 target genes in AAA tissue signify Nrf2- independency.

Andrzej Polanczyk

Medical University of Vienna, Austria

Title: A novel methodology for the description acute type IIIb aortic dissection treated in patients’ treated with TEVAR – numerical reconstruction of blood hemodynamic
Biography:

Andrzej Polanczyk is a Researcher and a Team Leader at the Lodz University of Technology, Poland. He earned his PhD in Medical Engineering in 2013. He participated in scientific grants in which he build the installation to simulate the blood flow through the abdominal section of the aorta. Recently he received a grant funded by The National Centre for Research and Development. His research areas comprise biomedical, chemical and environmental engineering.

Abstract:

Introduction: The aim of the study was to reconstruct a blood hemodynamic for patients with type IIIb aortic dissection (TBAD) before and after thoracic endovascular aortic repair (TEVAR) with the use of computational fluid dynamics (CFD).
Methods: We prepared 3D models of the aorta with adjacent arteries using pre- and post-operative CT data from five patients treated for TBAD. Hemodynamic parameters (like, blood flow rate or wall shear stress (WSS)) were calculated with CFD technique. Results were verified with ultrasonography (USG) data.
Results: CFD indicated that TEVAR caused 7-fold improvement in overall blood flow through aorta (p=0.0001). Comparison of CFD and ultrasonography (USG) showed no significant change in blood flow through analysed arteries but a significant increase in flow rate for thoracic trunk and renal arteries, which was in accordance with USG (accuracy 90% and 99.9%). Moreover, we observed a significant decrease in wall shear stress (WSS) values within the whole aorta after-TEVAR compared to pre-TEVAR (1.34±0.20 Pa vs. 3.80±0.59 Pa; p=0.0001). This decrease was associated with a significant reduction in WSS in the thoracic
Conclusions: CFD technique denoted that post-operative remodeling of the aorta after TEVAR for TBAD improved
hemodynamic patterns reflected by flow, velocity and WSS with accuracy of 99%. Aorta (3.10±0.27Pa -1.34±0.11Pa; p=0.043) and renal arteries (4.40±0.25 Pa -1.50±0.22 Pa; p=0.043).

  • Special Session
Location: Hall - Sylt 3

Session Introduction

Lale Hakami

University of Munich, Germany

Title: Single center results after cardiac transplantation in infants and small children
Biography:

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German-board-certified cardiac surgeon with a subspecialization in pediatric cardiac surgery. From 2006-2008, she was the junior consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellowship at the Children's Hospital Boston/USA. From 2009 to 2011 she was director of pediatric cardiac surgery in Mainz/Germany. From 2011-2014 she was senior consultant in children heart center in Linz/Austria. From 2014 she is senior consultant at the University Hospital Munich/Germany and University Lecture of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.

Abstract:

Objectives: Heart transplantation is the last surgical option for infants and young children with congenital heart failure after failed conventional repair or palliative procedures. We aim to present our results in a retrospective and descriptive analysis.
Methods: 18 heart transplantations on children (nine female, nine male) were performed from 1988 to 2015. The range of age was between 0 days and 3 years. Indications for a transplantation were hypoplastic left heart syndrome (n=14), non-compactionsyndrome (n=2), Bland-White-Garland-syndrome (n=1) and transposition of the great arteries (n=1). 14 children (78%) had had a previous cardiac surgery. Four patients (22%) required mechanical circulatory support for bridging: ECMO (n=2; 11%), or LVAD and ECMO (n=2; 11%). 15 (83%) underwent a biatrial method, three (17%) a bicaval one.
Results: The median waiting time after listing was 68 days (min: 0 days, max: 386 days, standard deviation (SD): 102.8 days). The overall survival was 61%, 13 children (72%) survived the first year. Two patients (11%) had a retransplantation. The median time patients spent at intensive care unit was 17 days (min: 1 day; max: 121 days). They were respirated for seven days (min: 1 day; max: 91 days). Perioperative factors we analyzed were: the median myocardial ischemia time was 236 minutes; the median aortic clamp time was 95 minutes and the median time of circulatory arrest was 60 minutes. Three children (17%) got a pericardial effusion. Two patients (11%) suffered each: bleeding, cardiac arrhythmias, diaphragmatic paresis and cerebral complications. Five (28%) got a lymphoproliferative disease. Seven children (39%) got a coronary graft vasculopathy. Two (11%) needed interventional therapy. Three (17%) got a cardiac pace maker. According to our data, six children had a rejection which called for treatment.
Conclusion: Heart transplantation is still the best therapeutic option after end-stage heart failure in children. Cumulative results suggest one additional year of life in more than 70% and a survival of more than 20 years are possible. These results were comparable to those of the ISHLT registry in pediatrics.

  • Cardiac Neurodevelopment | Case Reports on Cardiac Surgery | Arrhythmias | Heart Failure
Location: Hall - Sylt 3
Speaker

Chair

Marco Picichè

San Bortolo Hospital, Italy

Session Introduction

Prerana Banerjee

University Hospital Basel, Switzerland

Title: Off-pump aortic valve bypass to treat severe aortic stenosis
Biography:

Prerana Banerjee has gained her experience in Cardiac Surgery. Her interest and work in different hospitals in Switzerland allowed her to witness various operation techniques. During residency with PD Dr. O. Reuthebuch she learned about the alternative technique for treating severe aortic stenosis.

Abstract:

Majority of patients suffering from aortic valve stenosis are treated by aortic valve replacement or via transcatheter aortic valve implantation. However, a subset of patients having severe comorbidities, such as renal insufficiency, severely impaired ejection fraction, bicuspid aortic valve, large aortic annulus, ostial encroachment, redo-operation as well as severely calcified porcelain aorta, have a relevant periprocedural risk. For this patient cohort an alternative treatment, aortic valve bypass (AVB) with placement of a valved fabric graft between the left apex and descending aorta, is considered. Though already developed in the early 1960’s surgical acceptance was low due to the lack of appropriate instruments and the need for cardiopulmonary bypass (CPB). However, with the development of a coring device (Correx, Inc., Waltham, MA, USA) these impediments have been overcome. We report on a 72-year-old male patient suffering from severe low-flow-low-gradient aortic valve stenosis (left ventricular ejection fraction 20%, mean pressure gradient 26 mmHg, valve orifice area 0.7 cm2). Clinical symptoms were those of congestive heart failure. Previously the patient had undergone balloon valvuloplasty without major improvement. On the basis of concomitant mutilating diagnosis the patient was rejected for conventional surgery and transcatheter treatment. Thus AVB was suggested. The AVB consists of two components (a straight valve-containing conduit with a porcine valve and an angled left ventricular connector) and bypasses the blood flow via the left ventricular apex into the descending aorta. Perioperative course of our patient with implantation of the AVB without CPB was uneventful as was the
postoperative course. A magnetic resonance imaging of the heart on the fourteenth postoperative day demonstrated 55% of the cardiac output passing via the conduit (2.6 l/min was measured in the descending aorta, 2.1 l/min in the ascending aorta). We recommend off-pump AVB in patients with severe aortic stenosis when other therapy options are ruled out.

Eva Delmo Walter

Cardio Centrum Berlin, Germany

Title: VAD in children with heart failure
Biography:

Abstract:

Ossama Maadarani

Ahmadi hospital, Kuwait Oil Company, Kuwait

Title: B-Lines on chest ultrasound predicts elevated left ventricular diastolic pressure
Biography:

Maadarani Ossama is trained in both Cardiology and Intensive Care Medicine. He developed a major interest in the application of whole body ultrasound and echocardiography in the critically ill. He developed modern protocols in daily use of ultrasound and echocardiography in intensive care unit. He has published number of publications in field of ultrasound in Intensive Care Medicine.

Abstract:

Background: Echocardiography and lung ultrasound are important tests for assessing left ventricular function in patients presented to the emergency department with acute pulmonary edema. Chest ultrasound is becoming an important tool in diagnosing acute pulmonary edema.

Aim: To investigate the relationship between the B profile on ultrasound chest and spectral tissue Doppler echocardiography (E/e’ ratio) in patients presented with the suspicion of acute pulmonary edema. Methods: This paper reports a prospective observational study of 61 consecutive patients, which was presented with symptoms and signs of pulmonary edema and B-profile detected by echocardiography with a 5 MHz curvilinear probe. Critical care physicians trained in ultrasound examination performed echocardiography and chest ultrasounds. Results: Sixty-one participants were included in the study. Forty-seven of the 61 patients had a B-profile and 14 patients had an A profile. The mean E/e’ level in the patients with B-profile was 20.8, compared with the mean level in the patients with an A-profile of 8.2 (CI=0.33–0.82). The distribution in the two groups differed significantly (p=0.003). Based on the value of E/e’, the sensitivity and specificity were determined; the sensitivity of B profile on ultrasound was 92% (95% confidence interval (CI)=0.812–0.968), and the specificity was 91% (CI=0.623–0.98). The positive predictive value of the B-profile was 97% (CI=0.889–0.996), and the negative predictive value was 71% (CI=0.454–0.883). The systolic function in the subjects with a B-profile was below 50% in 74.3% of the subjects and normal in 25.7% of the subjects. All the subjects with B profile and systolic function >50% had elevated ProBNP and E/e’ >15. An A-profile subjects had systolic function >55%. 

Conclusions: Detecting the B-profile in lung ultrasound is highly sensitive and specific for elevated left ventricular diastolic pressures, regardless of the systolic function of the left ventricle which may help in diagnosing pulmonary edema.

Bin Liu

The Second Hospital of Jilin University, China

Title: Comprehensive strategy to deal with chronic total occlusion
Biography:

Bin Liu is the Director of the Cardiovascular Department of the Second Hospital of Jilin University. He has his expertise in Interventional Cardiology, especially in Chronic Total Occlusion. He is the Fellow of European Society of Cardiology, the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions Foundation. He is also a Member of APHA, Director of Committee of Cardiology Section of the Jilin Province Medical Association.

Abstract:

Statement of the Problem: Coronary chronic total occlusions (CTOs) are common during diagnostic angiograms. Comprehensive application of various strategies can improve the success rate. It is important to note that despite these advancements in techniques, CTOs remain difficult to treat. We present a case of left anterior descending artery (LAD) and right coronary artery (RCA) CTO that was successfully revascularized using complex strategy. Methodology & Theoretical Orientation: A 63-year-old man with two times of myocardial infarctions was presented with new onset angina and dyspnea at rest. Angiography showed that LAD and RCA CTO, proximal LCX had a serious stenosis. RCA PCI was attempted using an antegrade approach. This approach was unsuccessful due to branch vessel nearby the occlusion and the wire got into the branch repeatedly. As a result, we used a balloon to expand the entrance of the branch in order to extrude the CTO lesions, the wire gets through the occlusion and the RCA had a successful reperfusion. RCA supplied obvious retrograde vessels to LAD, but from the retrograde, the nub of CTO was flat and the wiring process failed. Then the strategy was changed from retrograde to antegrade. Retrograde wire showed a good milestone. Finally, LAD had a successful reperfusion. At follow-up, the patient was asymptomatic and returned to her usual activity. Conclusion & Significance: Side branch technique is an important method to antegrade strategy for CTO. Also, antegrade and retrograde should be used together to increase the success rate.

  • Pediatric Cardiology | Case Reports on Heart Devices | Cardiac Nursing and Healthcare
Location: Hall - Sylt 3
Speaker

Chair

Ihor Huk

Medical University of Vienna, Austria

Session Introduction

Muhammad Azam Shah

King Fahad Medical City, Saudi Arabia

Title: Left Atrial Appendage (LAA) Closure with Double WATCHMAN Devices; A case report
Biography:

Muhammad Azam Shah is working as Non-Invasive Cardiologist at King Fahad Medical City, Riyadh, Saudi Arabia. He has special interests in research and is currently working on multiple projects. Echocardiography is his area of specialty. He has presented abstracts and posters in multiple scientific meetings.

Abstract:

The risk of cardioembolic stroke is high in patients with atrial fibrillation. Antiplatelet agents, vitamin K antagonists and new oral anticoagulants (NOACS) are effectively used to reduce the risk of thromboembolism in high-risk patients. However, increased risks of life-threatening bleeding and narrow therapeutic indexes result in inadequate utilization of these therapies. There is growing practice and shreds of evidence in favor of closing left atrial appendage (LAA) percutaneously, using different devices in patients with either contraindicated or difficult anticoagulation. We are reporting a rare case of an old male with atrial fibrillation, high thromboembolic risk (CHADSVASc sore 4) and high bleeding risk score (HASBLED score 4). He underwent LAA closure using two LAA percutaneous closure devices (WATCHMAN) due to bi-lobed LAA. Considering a great variability in the shape and size of LAA, sometimes, a single device may not cover the whole ostium, leading to residual leaks, which can lead to nidus for thrombus formation. Although it technically sounds feasible but there are few challenges associated with double device implantation. Sealing of bi-lobed LAA is technically possible especially with favorable anatomy, which includes totally separated bodies of both lobes with adequate body sizes.

Lale Hakami

University of Munich, Germany

Title: Could ABO-incompatible heart transplantation (HTX) in infants and newborns be a good option to decrease the death risk on waiting list: “A Meta-Analysis"
Biography:

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German-board-certified cardiac surgeon with a subspecialization in pediatric cardiac surgery. From 2006-2008, she was the junior consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellowship at the Children's Hospital Boston/USA. From 2009 to 2011 she was director of pediatric cardiac surgery in Mainz/Germany.  From 2011-2014 she was senior consultant in children heart center in Linz/Austria. From 2014 she is senior consultant at the University Hospital Munich/Germany and University Lecture of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.

Abstract:

Introduction: Due to an increasing waiting time for available donor organs in pediatric heart transplantation (pHTx) ABOincompatible HTx (HTxi) may be a satisfying option and probably an unpreventable one. There is an immunological window of tolerance during the human embryonic development which persists into the time of infancy. It has the potential of developing natural antibodies to ABO-antigens. This process plays a significant role in ABOi organ transplantation and could maintain long-term tolerance to a certain degree in the setting of HTxi.

Methods: This systematic review and meta-analyses aims at providing an overview of the reported outcome of infants and small children with end stage heart failure after undergoing an HTx. A systematic literature search for publications reporting the outcome after pHTx published between 2001 and 2017 was conducted. Studies written in English with a study size of more than 10 patients were included. The primary outcome was mortality at HTx-listing and one year after ABO-compatible HTx (HTxc) or HTxi. Exploratory data analysis of four studies was analyzed. Two types of model (fixed effect model and random effect model) were represented. Primary outcome measure was all cause mortality or delisting on the HTx list. Results: Total mortality on HTx list in all groups was: I2=89.9%, 95% CI=64%, 99.3%. Delisted from HTx list because of recovering or worsening of clinical status before HTx: I2 =72.6%, 95% CI=16.8%, 97.5%. HTxc: I2 =99%, 95% CI=97.3%, 99.8. 12 months survival after HTx was: I2= 87.5%, 95%CI =56.1%, 99.1%. 86% of the patients survived 12 months after HTx in average with a 95% confidence interval of 0.84, 0.88.

Conclusion: HTxi is a good option with similar results compared to HTxc in infants. It might avoid the long waiting time and minimizes the risk of death on the waiting list. However, long-term results are yet to be determined, as well as complications and risks. Aspects such as renal function, infections, graft vasculopathy, the risk for malignancy and chronic rejection after HTxi remain to be examined closely.

Christine Brostjan

Medical University of Vienna, Austria

Title: Histone citrullination of neutrophil extracellular traps is a novel biomarker and target to inhibit progression of abdominal aortic aneurysms
Biography:

Abstract:

Background: Neutrophil extracellular traps (NETs) have been implicated in the pathogenesis of abdominal aortic aneurysms (AAAs). NET formation involves histone modifications such as citrullination allowing for DNA decondensation and DNA release into extracellular space. NETs have been detected in the adventitia and intraluminal thrombus (ILT) of AAAs and the associated proteins have been proposed to promote the inflammatory reaction that drives aneurysm development. Purpose: Our study has addressed the notion that NET components might serve as AAA biomarkers or novel targets of AAA therapy.

Methods: Parameters of neutrophil activation as well as NET formation were determined in blood and tissue samples collected from 40 AAA patients (scheduled for surgical repair) and 40 healthy controls matched for age, sex, body mass index and smoking habit. Neutrophil and NET components were determined by ELISA in patient plasma or conditioned medium of resected tissue. NETs were visualised in aortic wall and ILT by immunofluorescence microscopy. In a model of AAA formation based on angiotensin II administration to ApoE null mice, inhibition of NET formation was tested by applying a citrullination blocker. Results: Among the tested parameters of neutrophil activation and NET formation, citrullinated histone H3 was found to be significantly increased in blood (median 362 vs. 309 ng/ml; p=0.004) and aortic tissue (50.9 vs. 3.7 ng/mg; p=0.001) of AAA patients compared to healthy controls. Furthermore, NETs were highly prevalent in the intraluminal thrombus (corresponding to 642.3 ng citrullinated histone H3 per mg ILT). Plasma levels of citrullinated histone H3 decreased significantly after surgical repair. In vivo application of a citrullination inhibitor significantly reduced the capacity of mouse neutrophils to undergo NET formation. Furthermore, when aneurysm formation was initiated by angiotensin II application, disease progression was prevented in mice treated with the NET inhibitor (N=5) as compared to controls (N=5; p=0.014).

Conclusions: Histone citrullination which occurs during the formation of neutrophil extracellular traps was revealed as a biomarker of AAA formation and a potential therapeutic target to control aneurysm progression in established disease (as would be required for clinical application).

Rostislav Belobrov

Tel -Aviv University, Israel

Title: The association between I. V. Cannula size and event of thrombophlebitis at intravenous amiodarone administration
Biography:

Rostislav Belobrov is Senior Nurse at Cardiology Intensive Care Unit of Wolfson Medical Center and a student for Magister of Public Health at Tel -Aviv University.
 

Abstract:

Statement of the Problem: Patients, which arrive to the hospital with ventricular arrhythmia due to the different causes, in most cases are getting loading dose of intravenous amiodarone. The most common side effect of intravenous amiodarone is thrombophlebitis of intravenous access. Central venous line causes much less thrombophlebitis, but complications of central venous line exceed the peripheral vein access. This pilot study is aimed to find association between the use of larger size peripheral vein cannula and decreased of thrombophlebitis. Second goal of this pilot study is to define the variables which are associated with incidence of thrombophlebitis.

Methodology: Observation prospective pilot study was conducted in Intensive cardiac care unit of single medical center during one year. 53 patients were prescribed to get intravenous amiodarone due to medical indication. Eight patients were excluded from the pilot study due to comatose state or use of central vein line. For 45 patients, information about peripheral I.V. cannula was obtained, including place, size (18 gauges or 20 gauges), and time of event of thrombophlebitis, if appeared. Additional clinical information was collected from medical records. Kaplan-Meier method and Breslow test were used to find significance between time to event of thrombophlebitis for two sizes of I.V. cannulas. Cox proportional hazard model was used to find the variables, which could be associated with the event of thrombophlebitis.

Findings: According to Breslow test, 18 gauge I.V. cannula has significant longer time without thrombophlebitis (χ²=4.717 p=0.03 18G median time to event 32.5 h CI 95%: 10.6-54.4, 20G median time to event 20.0 h CI 95%: 18.6-21.4). According to Cox proportional hazard model, adjusted for I.V. cannula size, each BMI unit and female gender were associated with more thrombophlebitis events.

Conclusion: In order to prevent thrombophlebitis, using large sized I.V. cannula is preferable for intravenous amiodarone administration, especially in overweighed and female patients.

Mirela-Anca Stoia

University of Medicine and Pharmacy Cluj-Napoca, Romania

Title: Cardiovascular risk evaluation before vascular surgery- to be practically or to be pragmatic?
Biography:

Mirela Anca Stoia has her expertise in cardiovascular investigation and diagnostics, based on Cardiology, Internal Medicine and European Fellow in Angiology specializations. She is working in an Emergency Clinical University County Hospital and promoting an integrative medicine, she is implicated in evaluation of atherosclerotic patients in order to assesses the screening and the hierarchs of the multisite arterial lesions for an adequate management in patients undergoing non-cardiac, particularly vascular surgery, in the cardiac patients with other comorbidities association care and in the emergencies cardiac assistance. As an Assistant Professor she teaches Cardiology, Echocardiography, Vascular Ultrasonography and Internal Medicine to medicine students and to residents. Her research interests are related to multidisciplinary cardiology, imaging exploration, biomarkers in cardiology. Her algorithm which identified significant coronary and cervical arterial lesion in patient with critical leg ischemia, from a long experience with many investigated patients, is practical, accessible and applicable.

Abstract:

Statement of the Problem: Patients with peripheral artery disease (PAD) have multisite arterial lesions especially in coronary and cervical arteries, often less symptomatic and diagnosed, which increase dramatically the mortality through myocardial infarction and stroke and the duration of hospitalization, especially after vascular surgery. The purpose of this study was to assess the role of an overall cardiac and arterial screening, including non-invasive and invasive investigation, revealing the role of more accessible examinations, in order to estimate the perioperative cardiovascular risk and to define the therapeutic strategy for revascularization.

Methodology & Theoretical Orientation: We studied 142 patients with critical leg ischemia (CLI) scheduled for vascular surgery. The history, clinical examination, cardiovascular risk factors (CVRF) profile and systematic ECG examination of these patients looked for suspected atherosclerotic lesions in coronary and cervical arteries beside the symptomatic peripheral arterial territory. In patient presented acute coronary syndrome in the last six months or Eagle score >2, the coronary angiography was performed systematically. In all patients cervical arterial ultrasonography and in selected patients, cervical arterial angiography was performed.

Findings: More of 50% of CLI patients had multiple CVRF. We find significant coronary and/or cervical arterial lesions in 44.4% of the investigated subjects. Hemodynamic significant coronary arteries stenosis >70% were diagnosed in 29.6% and hemodynamic significant cervical stenosis >70% or carotid thrombosis were diagnosed in 11.8% of patients with CLI. The clinical and imagistic non-invasive algorithm selecting patients with CLI and significant stenosis in the coronary and/or arterial cervical territories was confirmed through invasive angiography evaluation in 69.1% of cases.

Conclusion & Significance: Demonstrating the multisite arterial lesions profile in patients with CLI and with significant stenosis in coronary and/or cervical arteries changes the treatment strategy and management. In these cases, medical therapy should be more intensive and revascularization interventions in coronary and cervical arteries might precede peripheral arterial revascularization procedures. 

Jong-Hau Hsu

Kaohsiung Medical University, Taiwan

Title: Regulatory mechanisms and novel pharmacologic targets of ductus arteriosus
Biography:

Jong-Hau Hsu M.D. is a professor of Pediatrics in Kaohsiung Medical University in Kaohsiung, Taiwan. He is also the director of pediatric cardiology and pediatric intensive care unit in Kaohsiung Medical University Hospital, and the vice director of school of medicine of Kaohsiung Medical University. As a pediatric cardiologist and intensivist, his current research interests focus on biomarker of pediatric intensive care and novel pharmacologic targets on regulation of pulmonary circulation and ductus arteriosus patency.

Abstract:

The ductus arteriosus (DA) is an artery indispensable in fetal circulation. PDA is a major cause of morbidity and mortality in premature infants, whereas persistent PDA is life-saving in newborns with DA-dependent CHDs. Therefore, elucidating molecular mechanisms underlying regulation of DA patency is an important field of vascular biology and translational research of pediatric cardiology. DA closure is a complex process including two mechanisms: functional and anatomical closures. Functional closure is a transient response mediated mainly by vasoconstriction caused by abrupt increase of oxygen tension and postnatal withdrawal of vasodilatory PGE2. Anatomical closure is a constitutive process of luminal obliteration characterized by intimal thickening, resulting in progressive DA vascular remodeling and permanent DA closure. Current clinical approach for management of DA patency is mainly targeted on the PGE/cAMP pathway. However, recent studies have shown that PGE can promote DA remodeling through EP4 receptor while maintaining DA vasodilation. Therefore, novel pharmacologic strategy regulating vaso-reactivity and remodeling would be helpful for management of functional and anatomic closure of DA. The purposes of this talk are to review the complex mechanisms regulating DA patency, and share our translational research of novel pharmacologic targets, including BNP, cGMP pathway and Notch signaling. An improved understanding of the mechanistic pathways regulating DA patency may yield novel or additional therapeutic strategies for patients with PDA and DA-dependent CHDs.

Volodymyr Isaienko

National Medical Academy, Ukraine

Title: The tactics of optimal surgical treatment of heart myxomas, the experience of 818 operations
Biography:

Volodymyr Isaienko was born on October 07, 1961, in the Kyiv, Ukraine.Education: higher, Kyiv Medical Institute named O.O. Bogomolets, medical faculty in 1984 Academic rank, scientific degree: associate professor (2013), PhD (2005). Total work experience - 33 years, in this institution - 17 years. Labor Path: After education in the Kiev Medical Institute named O.O. Bogomolets in 1984, worked as a surgeon in the Kyiv’s clinic â„– 1 until 1988. From 1988 to 2001 worked in the National Institute of Cardio-Vascular surgery named N.M. Amosov of the Academy of Medical Sciences of Ukraine as doctor-surgeon. V. Isaenko has a higher qualification category in the field of "Surgery of the heart and main vessels. He defended in 2005 his Ph.D. thesis on the topic: "Surgical correction of mitral valve lesions in infectious endocarditis". Since 2001, V. Isaenko works as an assistant, since 2012 to present - Associate Professor of the Department of Cardiac and main vessels surgery at the National Medical Academy of Postgraduate Education named P.L. Shupik, existing on the base of the National Institute of Cardiovascular Surgery named N.M. Amosov AMS of Ukraine. Associate professor received his academic title in 2013. V. Isaenko is the author of more than 125 scientific articles on various aspects of cardiac surgery, has 12 author's certificates for inventions. V. Isaenko is the member of the Association of Cardiovascular Surgeons of Ukraine.

Abstract:

Material & Methods: In the N M Amosov National Institute of Cardiovascular Surgery of the Academy of Medical Sciences of Ukraine for the period from 1.01.1969 to 1.01.2018. 916 interventions were performed in heart tumors. Heart myxomas were found in 818 (89.3%) cases, of which 718 (87.8%) are myxomas of the left atrium. The age of patients with myxomes was 3 to 78 years (on average 47.5±3.4 years). The embolic syndrome was detected in 44 (5.4%) cases with a heart myxomas, of which 35 (4.1%) patients were in the cerebral vessels. The most traditional access through the right atrium and the interatrial septum was used in 543 (75.6%) cases with a myxomas of the left atrium, tumor fragmentation was observed in 109 (20.1%) cases. At the same time, an important stage of the operation is an adequate dissection of the interatrial septum. Analysis of the attachment of the left atrial myxoma to the interatrial septum in 124 patients showed that 66 (53.2%) had the tumor base in its middle third. In 45 (36.3%) cases the place of tumor fixation is the lower third of the interatrial septum. And only in 13 (10.5%) patients the upper third of the septum was affected. This is the safest site of introduction through the interatrial septum, and for the subsequent visualization of the tumor's foundation, which became the basis of our methodology.

Results: In 91 of 93 patients, the use of the new technique allowed the safe detection and isolation of the leg of the myxoma. The frequency of fragmentation of the tumor upon its removal decreased to 2.2%. The need for emergency surgery is proved, which reduces the threat of hospital preoperative mortality. Over the past 17 years, 455 operations have been performed without fatalities. Survival in the period up to 20 years was 79.7%. Relapses of myxogma were found in 16 (2.1%) patients in the period from 2 to 12 years after the initial operation.

Conclusions: With the most frequent localization of the myxoma in the left atrium, it is expedient to eliminate the myxoma by accessing the right atrium and the interatrial septum with an improved method of manipulation on it, with the subsequent possibility of switching to alternate atrial access to prevent fragmentation of the tumor.