Day 1 :
Keynote Forum
Anthony Martin Gerdes
New York Institute of Technology-College of Osteopathic Medicine, USA
Keynote: What you should know about cardiac remodeling
Time : 09:00-09:30
Biography:
Anthony Martin Gerdes has done PhD in Anatomy (1978), from University of Texas Medical Branch at Galveston. He was the Professor/Chair of Anatomy, University of South Dakota. Also the founding Scientist for Sanford Research-University of South Dakota. His Current position is Professor/Chair Biomedical Sciences, NYIT College of Osteopathic Medicine, Old Westbury, NY, 2011-present. Publications: ~120 peer reviewed journal articles. 2013 Distinguished Alumnus, Graduate School of Biomedical Sciences, UTMB at Galveston Anthony Martin Gerdes developed a precise method to determine cardiac myocyte shape. He then provided a comprehensive understanding of how cardiac myocytes remodel during growth, maturation, aging, cardiac hypertrophy, and heart failure (HF) from many etiologies. After demonstrating that low thyroid hormone function alone can cause heart failure, he showed remarkable beneficial changes in myocyte shape and vascular remodeling, reduced fibrosis, and improved LF function after thyroid hormone treatment of various models of HF (including ischemia, diabetes and hypertension).
Abstract:
The "Age of Cardiac Remodeling" began in the mid-1990s with the realization that drugs leading to improved ventricular remodeling were doing something remarkable in cardiac patients. This created an experimental need for high quality assessment of changes in cardiac tissue composition, including myocyte shape, myocardial fibrosis/collagen, and vascular remodeling. Many working in the field today have little or no training related to recognition of fixation artifacts or common errors associated with quantitative morphology. Unfortunately, such skills had become somewhat of a lost art during the ages of cardiac physiology in the mid-20th century and molecular biology, gaining prominence by the mid-1970s. Consequently, cardiac remodeling studies today are often seriously flawed to the point where data are not reproducible and subsequent researchers may be chasing the molecular basis of a non-existent or erroneous phenotype. The current unacceptably high incidence of irreproducible data is a serious waste of time and resources as noted recently in comments by the NIH Director. The goal of this talk is to share some lessons I have learned during nearly 40 years of assessing morphological changes in the heart. It is possible for any lab to routinely publish highly reproducible morphologic data that stand the test of time and contribute to our fundamental knowledge of cardiac remodeling and the molecular mechanisms that drive it.
Keynote Forum
Louis Samuels
Lankenau Medical Center, USA
Keynote: The evolution of adult extra-corporeal membrane oxygenation (ECMO): An emerging standard of care The evolution of adult extra-corporeal membrane oxygenation (ECMO): An emerging standard of care
Biography:
Louis Samuels received his Undergraduation education at the University of Rochester in New York and attended Medical School at Hahnemann University in Philadelphia. He completed his General Surgery and Cardiothoracic Surgery training at Hahnemann and. joined the faculty in 1995, assuming the Directorship of the Heart Transplant and Ventricular Assist Device Program in 1997. In 2001, Samuels and his team implanted the world’s fifth total artificial heart (AbioCor). In 2003, Samuels joined the Main Line Health System at Lankenau Medical Center (Wynnewood) as the Surgical Director of Heart Failure and rose to the rank of Full Professor of Surgery at Thomas Jefferson University School of Medicine (Philadelphia) in 2009.rnSamuels has published more than 100 peer-reviewed manuscripts, has participated as Principle or Co-Investigator in numerous Ventricular Assist Device (VAD) trials, serves as the medical monitor for and Clinical Events Committee member of VAD trials, and continues to engage in a busy clinical practice. rn
Abstract:
Acute Cardio-Respirtory Failure refractory to conventional therapy has been perceived of as a therapeutic exercise in futiluty for over half a century. In the 1950s, cardiopulmonary bypass (CPB) was introduced by Dr. John Gibbon Jr at Thomas Jefferson Hospital in Philadelphia, PA. While the use of CPB for surgical procedures has flourished, important “spin-off” technologies began to be conceived of and considered for use beyond the operating room—hence, Extra-Corporeal Membrane Oxygenation (ECMO). ECMO came into existence approximately four decades ago primarily through the efforts of its pioneers Drs. JD Hill and Robert Bartlett. However painful and disappointing the results were initially (and for several decades thereafter) these investigators and others persisted in the belief that this technology was life-saving and not likely to be discarded.rnIn 1983, only three institutions regularly performed ECMO (Medical College of VA, University of Michigan, and University of Pittsburgh). By 1986, nineteen institutions provided ECMO support for neonates. And by 1989, the Extra-Corporeal Life Support Organization (ELSO) was established. It would take another two decades before ECMO for adults was more formally adopted, particularly for respiratory failure. In 2009, two important events occurred: 1) The CESAR Trial was published and 2) The H1N1 Flu epidemic. The CESAR Trial compared ECMO therapy versus Conventional Ventilatory Support for respiratory failure and showed superior outcomes in the former. At the same time, the treatment for ARDS related to the Flu epidemic also showed improved outcomes with ECMO support. As a result of these findings, rescue ECMO therapy for respiratory failure in a variety of clinical conditions (i.e. pre- and post-lung transplant, sepsis etc.) has exploded in popularity. Similar findings began to be observed in the cardiac failure categories, both medical (e.g. AMI-Shock) and surgical (e.g. Post-Cardiotomy Shock).rnAs of 2014, there are 278 ECMO Centers that are members of and report to the ELSO Organization. The number of cases for calendar year 2014 was 6510! The latest ELSO Registry Data (July 2015) reported that—for adults—the survival for Respiratory, Cardiac, and E-CPR ECMO were 58%, 42%, and 30% respectively. These results, compared to the outcomes four decades earlier, represent a monumental improvement with every reason to believe that further success is ahead.rnAmong the reasons for continued opimism with ECMO therapy is the progress made in education and technology. With the help of the ELSO Organization, data driven quality measures are being reported and presented at national and international meetings. Every aspect of ECMO application is being critiqued, including patient selection, technical issues, and post-cannulation managment. Furthermore, commercial industry has contributed to marked improvements in the device itself, particularly the pump-oxygenator unit along with the monitoring safeguards that go along with it. Lastly, innovative strategies combining ECMO with other tecnologies—hybrid mechanical support-- may prove worthwhile in selected cases.rnIn summary, ECMO in general and Adult ECMO in particular is emerging as something much more than an exercise in futility. It is evolving into a standard of care for acute cardio-respiratory failure refractory to conventional therapies.