20^th European Cardiology Conference October 16-18, 2017 Hotel Mercure Budapest Buda, Budapest, Hungary

Biography:

Adj Associate Professor Sophia Chew obtained her MBBS, MMED(Anaesthesia) from the National University of Singapore and is a Fellow of the Australian and New Zealand College of Anaesthestists.  She trained in cardiac anaesthesia at the Duke University Medical Centre in the United States of America.

She is the Director of Research at the Department of Anaesthesiology at the Singapore General Hospital and Deputy Vice Chair of the Academic Clinical Program.  A/P Chew has published more than 25 papers in reputed journals and won numerous awards for abstract presentations both locally and internationally.

Abstract:

Acute kidney injury (AKI) is common, occurring in about 1 in 3 patients after cardiac surgery.  It is associated with increased mortality, morbidity and healthcare costs.  It is a multifactorial disorder and there is currently limited renoprotective mechanisms, hence prevention and early recognition of AKI is the focus of extensive clinical and basic science research.

AKI risk models are useful for predicting acute renal failure requiring dialysis but are limited in  non dialysis requiring AKI due to non-standardized definitions of AKI used, differing intraoperative variable, small cohorts and lack of external validation. Furthermore, all these models have been based on the Western population which may not be valid in the Asia-Pacific region.

We developed and validated a risk model that utilized both preoperative and intraoperative variables to predict AKI after cardiac surgery in our local population.  Similar to other studies, increased age, hypertension, eGFR less than 60ml/min, prolonged bypass time and use of intra-aortic balloon pump were risk factors for AKI.  In addition, preoperative anemia, lowest haematocrit during bypass and intraoperative red blood cell transfusion are significant modifiable  risk factors in our model.  The risk score is easy to use, robust and allows for early detection of the patient at risk of AKI and institution of early management strategies.  Our AKI risk model is the first developed for an Asian population and has high clinical utility given the large population of Chinese and Indians globally . 

Biography:

Will be updated soon...

Abstract:

31-year-old woman with a diagnosis of mitral valve endocarditis and left sacroiilitis due to streptococcus viridians with intermediate CIM to Penicillin (0,25 ug/ml). In another institution she was treated with ampicillin for 3 weeks and then with oral amoxicillin. She is admitted to our Hospital with fever and petechiae on both lower extremities. Negative blood culture tests to common germs. Transaesophagial echocardiogram in anterior valve of mitral valve: 1.9 by 1.2 cm sessile image, lobulated, mobile, within left auricle, with slight mitral insufficiency. During her admission she shows embolic phenomena in inferior extremities, without compromising peripheral pulses. Assessed by vascular cardio- surgeon, a non-surgical conduct is decided. The patient completes 4 weeks of ampicillin 12g/day plus 240mg/day gentamicin with a favorable evolution. 10 days after being released she complains of pain on left calf. A complete body bone scintigraphy is performed with T99 marked with ciprofloxacin: hyper-uptake in left leg middle third in tibia topography and clear reduction sacroiliac hyper-uptake. Left leg RMI: in the deep sector of superior third there appears a structure with lobulated contours and well-defined margins of 89 mm height and a diameter of 44mm in the axial shaft with re-enforcement of paramagnetic contrast, with iso, hypo and hyper-uptaking areas. Inferior extremities arterial Ecodoppler: in tibio-peroneal trunk and anterior tibia artery source: a saccular, hypoechogenic and heterogeneous structure is found of 10cm-long lobulated contours. Turbulent arterial flow with a positive Doppler signal. Conclusion: a pseudoaneurysm compromising tibio-peroneal trunk with peroneal and tibial posterior arteries with hypoflow. Endoluminal repair of giant sterile mycotic pseudoaneurysm of tibio-peroneal trunk was performed, with satisfactory evolution and without complications.

Biography:

Tareq Aleinati MD FRCSC is a consultant cardiac surgeon who had his training done at McMaster University, Hamilton, Canada. He then did fellowships in the fields of complex mitral valve surgeries and heart failure surgical interventions with VAD and heart transplantation at University of Toronto, Toronto and McGill University, Montreal, Canada. He currently works at Chest Diseases Hospital in Kuwait, one of the leading specialized hospitals in Middle East. Areas of expertise include valvular and aortic reconstruction, heart failure surgery, total arterial coronary artery revascularization, atrial fibrillation surgery and minimally invasive cardiac surgery ( Aortic, Mitral and Tricuspid valves, CoxMaze ablation, ASD repair).

Abstract:

The full-length median sternotomy is the standard approach for single, double and triple valve operations. Right anterior mini-thoracotomy is a well-known minimal access approach for isolated aortic valve replacement or combined aortic and mitral valve surgeries. However, replacing or repairing three valves with concomitant CryoMaze through such an access is not well established. We hereby describe a case of 49 year-old male patient with rheumatic heart disease and a large left atrium associated with permanent atrial fibrillation. He underwent a successful aortic and mitral valve replacement with tricuspid valve repair and concomitant left atrial Maze using argon based Cryo-ablation through right anterior minithoracotomy. This was approached via the 3rd intercostal space with establishment of cardiopulmonary bypass through peripheral arterial and venous cannulation. Post-operative Echo showed good results and six months later the patient continues to be in normal sinus rhythm. The patient regained full functional capacity in four weeks post-operatively. Thus, we have shown that performing such a complex procedure through minimal access is feasible with successful outcomes.

Biography:

Leoné Malan aims to underpin a novel pathway pertaining brain-heart health. Considering this focus she designed the first well-controlled psychophysiological prospective cohort study in Sub Saharan Africa (SABPA), and as PI received an international award for design excellence (France, 2008). She conceptualized a Hypertension Research clinic on-campus and induced cardiovascular monitoring programs. Apart from being a council member of the European Society Cardiology on Hypertension, she holds various professional memberships. International peer-reviewed publications totals >135 publications and several grants support her research. She and her international expert and pharmaceutical stake holders’ network aims to develop a diagnostic tool to phenotype stress and related cardiomyopathy.

Abstract:

Sympatho-adrenal responses are activated as an innate defense coping (DefS) mechanism during emotional stress. Whether these sympatho-adrenal responses drive cardiac troponin T (cTnT) increases are unknown. Therefore, associations between cTnT and sympatho-adrenal responses were assessed. A prospective cohort, excluding atrial fibrillation, myocardial infarction and stroke cases, was followed for 3 years (N=342; 45.6±9.0 years). We obtained serum high-sensitive cTnT and outcome measures [Coping-Strategy-Indicator, depression/Patient-Health-Questionnarie-9, 24h BP, 24h heart-rate-variability (HRV) and 24h urinary catecholamines]. Blacks showed moderate depression (36% vs. 13%) and 24h hypertension (67% vs. 42%) prevalence compared to Whites. A receiver-operating-characteristics cTnT cut-point 4.2 ng/L predicted hypertension in Blacks [AUC 0.68 (95% CI 0.60-0.76); sensitivity/specificity 63/70%; P≤0.001], which was used as binary exposure measure in relation to outcome measures. In cross-sectional analyses, elevated cTnT was related to DefS [OR 1.34 (95% CI 0.98-1.83); P=0.06]; 24h BP [OR 1.03-1.04 (95% CI 1.01-1.08); P≤0.02] and depressed HRV [OR 2.19 (95% CI 1.09-4.41); P=0.03] in Blacks, but not in Whites. At 3 year follow-up, elevated cTnT was related to attenuated urine norepinephrine:creatinine ratio in Blacks [OR 1.46 (95% CI 1.01-2.10); P=0.04]. In Whites, a cut point of 5.6 ng/L cTnT (P≤0.001) predicted hypertension but was not associated with outcome measures. To conclude, central neural control systems exemplified a brain-heart stress pathway. Desensitization of sympatho-adrenal responses occurred with initial neural- (HRV) followed by neuroendocrine dysfunction (norepinephrine:creatinine) in relation to elevated cTnT. Chronic defensiveness may thus drive desensitization, reflecting ischemic heart disease risk in Blacks at a 4.2 ng/L cTnT cut-point.

Biography:

James I-Sheng Huang received his DDS degree at Chung Shan Medical University, with more than 30 years of experience in clinical dentistry, specializing in implantology. He was the former president of Taiwan Dental Association and contributed in dental health care by implementing a global budget in Taiwan National Health Insurance. In recent years, the occurrence of syncope in clinical cases marked his interest in the trigeminocardiac reflex (TCR), and subsequently received his PhD at Chung Shan Medical University researching the relationship and between TCR and dental reflexes.

Abstract:

Background/Purpose: Trigeminocardiac reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. To date, no study evaluated the impact of non-surgical root canal treatment (NSRCT) of irreversible pulpitis teeth, cavitary filling, or implantation under either local infiltration or block anesthesia on hemodynamic changes. Methods: We enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions. Results: The incidences of NSRCT patients with MABP decrease ≧ 10%, ≧ 15%, or ≧ 20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values < 0.001). In the first NSRCT session, the incidence  of patients with MABP decrease ≧ 10% was significantly associated with tooth type. For both upper and lower teeth,the patients with premolars treated by NSRCR had significantly higher incidences of MABP decrease ≧ 10% than those with either anterior or molar teeth treated by NSRCR (all the P-values < 0.05).

Conclusion: We conclude that vital pulp extirpation may lead to a substantial drop in patient’s blood pressure possibly related to TCR.

Biography:

Dr. Anna Rekhviashvili MD, PhD is currently working as a cardiologistchief of the Outpatients and Diagnostics Department at Archangel St Michael Clinical Hospital and is leading Arterial Hypertension and Vascular Study Center, Tbilisi, Georgia. She completed her M.D. in Tbilisi State University, Georgia in 2002. She was Junior doctor and PhD student from 2003-2008 in the National Institute of Cardiology. She worked as a cardiologist at the Iv. Javakhishvili Tbilisi State University Hospital, Tbilisi, Georgia. She was Visiting Research Fellow at the Continuum Heart Institute, Beth Israel Medical Center, Albert Einstein College of Medicine New York, NY in 2010 and Visiting Professor at the AMC, Amsterdam, Netherlands in 2016. She is a member of many professional national and international societies in cardiology, hypertension and atherosclerosis. Research interests are diurnal variation of blood pressure, endothelial dysfunction, micro- and macrocirculation in hypertension. She has many publications in national and international journals.

Abstract:

Introduction: Left ventricular hypertrophy (LVH) is the most common target organ damage in arterial hypertension (AH). Hence, the association of LVH and circadian rhythm of blood pressure (BP) is still under debate. Nondipping circadian BP pattern increase risk of cardiovascular and cerebrovascular events, that may be due to the abnormalities in blood coagulation and activation of thrombogenesis

The purpose of this study is to proof hypothesis, that non-dipper hypertensive patients in comparison with dippers have an adverse blood coagulation and activated thrombogenesis, as well as more severe LVH.

Methods: 57 patients with AH and 17 controls with normal BP were included in the study. 24-hour ambulatory BP monitoring, cardiac ultrasound and examination of blood rheology, namely plasma and whole blood viscosity, fibrinogen concentration, platelet aggregation and adhesive activity was performed in all the patients according to the standard protocols. Written informed consent was obtained from all participants.

Results: Dipper pattern was revealed in 20 patients and nondipping in 37 hypertensive patients. Nondipper hypertensives in comparison with dippers had higher levels of fibrinogen concentration, plasma and whole blood viscosity, platelet aggregation, as well as adhesiveness (P<0.001). The prevalence of LVH was markedly higher among non-dipper patients with AH than among those without this disease or dipper pattern.

Conclusion: Results of our study confirm the hypothesis, that nondipper hypertensive patients in comparison with dipper hypertensive patients have statistically significant deterioration of blood rheology and have markedly higher prevalence of significant LVH. Hence, we can conclude that nondipper hypertensive patients are markedly prone to the cardiovascular complications due to the significant LVH and high risk of thrombogenesis.

Recommendations are made for the doctors involved in AH management to check blood rheology besides the LVH assessment and ABPM for proper evaluation of a patient’s potential risk and avoid possible CV complications. 

Biography:

Alexander Manché is the Chairman of the Cardiothoracic Surgery at Mater Dei Hospital, Malta. He qualified at Westminster Medical School, London in 1979 and spent 18 years in the UK and the US, including 2 years of research at the Rayne Institute. He returned to Malta in 1995 and set up the Cardiothoracic Unit, which offers a comprehensive adult service including surgery for ischaemic and valvular heart disease, thoracic vascular conditions, heart transplantation, vascular access as well as lung disease.

His journal publications and presentations at scientific meetings number over two hundred.  He has a special interest in the epidemiology of aortic valve surgery.

Abstract:

Transcatheter Aortic Valve Implantation (TAVI) is increasingly employed in the treatment of severe aortic stenosis. Initially the indication was in patients who were refused surgery on the grounds of an unacceptably high risk. Long-term results following TAVI are sparse and current data suggests that about a third of patients are alive at 6 years.  TAVI is now being offered to intermediate risk patients without available long-term data. Surgery in such patients offers excellent results, both in the short and long term.

We present our unit’s long-term outcomes after surgical aortic valve replacement (sAVR), with or without concomitant coronary revascularisation. We conclude, from a 20-year relative survival study, that patients aged 68 or older can achieve a normal life expectancy after sAVR. This study correlated long-term survival with patient-related, procedure-related and post-operative complication-related factors. In a second study we evaluated the effect of prosthesis-patient mismatch on long-term survival.

We believe that sAVR remains the gold standard of treatment for severe aortic stenosis.

The decision to offer patients TAVI should take into consideration the known long-term results of surgery.

Biography:

Tareq Aleinati MD FRCSC is a consultant cardiac surgeon who had his training done at McMaster University, Hamilton, Canada. He then did fellowships in the fields of complex mitral valve surgeries and heart failure surgical interventions with VAD and heart transplantation at University of Toronto, Toronto and McGill University, Montreal, Canada. He currently works at Chest Diseases Hospital in Kuwait, one of the leading specialized hospitals in Middle East. Areas of expertise include valvular and aortic reconstruction, heart failure surgery, total arterial coronary artery revascularization, atrial fibrillation surgery and minimally invasive cardiac surgery ( Aortic, Mitral and Tricuspid valves, CoxMaze ablation, ASD repair).

Abstract:

AF is the most frequently encountered tachyarrthymia in cardiac surgery patients. Maze IV and its LA lesion set are both associated with the highest success rate of treatment of AF. Recently we introduced minimally invasive cryoablation Maze in our institution. Our study objective is to evaluate feasibility, safety, and early results of concomitant AF treatment with argon based cryoablation in patients undergoing valvular procedures through right minithoracotomy.

Methods and results

Between October 2016 and January 2017, data were retrospectively collected of all patients who underwent cryoablation Maze combined with valve surgeries through right minithoracotomy approach. Argon based cryoablation devices were used in all cases. Seven patients were identified. Five of those underwent one-valve surgery, one had two-valve surgery with ASD closure, and one had three-valve surgery, all with cryoablation Maze. Four (58%) were females, average age was 56 years, 4(58%) had rheumatic valvular disease while 3(42%) had degenerative MR. LVEF 51±9.1% and left atrial size 69.4±20 mm. All patients had permanent AF. CPB and cross clamp times were 256±60 and 184±52 minutes respectively. There were no mortality, MACE or stroke. Five patients (71%) were in normal sinus rhythm at 8 month follow up.

Conclusion

Our initial experience using Argon based cryoablation for concomitant treatment of AF through right minithoracotomy seems to be feasible and safe. Our early success rate (71%) in treating AF through this approach is promising. We also demonstrated that such approach seems to be feasible and successful in complex multiple valve procedures associated with permanent AF and large atria. A bigger study group  and more than one year follow up results are needed to support our initial conclusion.

Biography:

Biography: Dr. Gasparovic is an associate professor of surgery at the University Hospital Rebro Zagreb where he serves as the Director of the Adult cardiac surgical division. He has been trained in cardiac surgery at both the University Hospital Rebro Zagreb and the Brigham and Women’s Hospital, Harvard University. He is the author of over 80 peer-reviewed publications, and has also written six book chapters on cardiac surgery. 

Abstract:

INTRODUCTION: Infections are an important source of morbidity and mortality among heart transplantation (HTx) recipients. Understanding the origins and predisposing conditions are critical for improvement of outcomes. Patients requiring renal replacement therapy (RRT) after HTx are particularly susceptible to infections.

METHODS: All 167 consecutive patients undergoing heart transplantation in a single academic center from January 2008 to December 2016 were screened for analysis.  Patients with missing microbial data were excluded (N=9).  The remaining 158 patients were dichotomized according to the need for periprocedural RRT. Twenty-seven patients required RRT (17%). Patients requiring postoperative RRT had lower preoperative creatinine clearance (53±21 vs. 62±21 ml/min, P=0.044), greater body mass indices (27±3 vs. 25±5, P=0.014) and were more likely to be diabetic (41% vs. 20%, P=0.026). Propensity score adjustment was used in order to account for multiple covariates (recipient age and gender, organ ischemic time, body mass index, pulmonary vascular resistance, creatinine clearance, duration of cardiopulmonary bypass, diabetes, preoperative and postoperative mechanical circulatory assistance). 

RESULTS: The incidence of any positive microbial isolates among patients requiring RRT after Htx was significantly higher on unadjusted analysis (25/27 (93%) vs. 95/131 (73%), OR 4.77 [1.01-30.53], P=0.026). Patients requiring RRT had an increased susceptibility to positive microbial isolates from blood cultures (13/26 (50%) vs. 20/90 (22%), OR 3.50 [1.28-9.67], P=0.012). Propensity score adjusted analysis corroborated the significant difference for positive blood cultures (OR 3.97 [1.28-12.32], P=0.017), while the incidence of total microbial isolates was just below the level of statistical significance (OR 4.55 [0.90-23.05], P=0.067).

CONCLUSIONS: We have shown that patients requiring early RRT following HTx had an increased susceptibility to infections via various portals of entry, predominantly due to an increase in blood borne infections.  Understanding the underlying conditions leading to infection-related morbidity is paramount in infection control and prevention

Biography:

Will be updated soon...

Abstract:

Background- Cardiovascular disease is the number one cause for mortality in women. There has been a steady increase in mortality in women younger than 55. There is a lack of awareness and knowledge regarding signs and symptoms of cardiovascular disease in women. A unique sub-group of this population is pregnant women. Acute Myocardial infarction incidence is 0.2-1% in pregnant women. There has been a steady increase of pregnancy in older women and cardiovascular complications. In this group-Mother Mortality is 9% and fetal mortality is 6%.

Aim-  early identification and assessment of women and high risk pregnancy.

Method-case presentation of 37 year old woman with Ischemic heart disease and Status post coronary stent placement. Before discharge home from ICCU she consults with nursing staff about becoming pregnant. 

Results- women suffering from ischemic heart disease are able to become pregnant and undergo labor and vaginal delivery while under close surveillance. Epidural anesthesia should be preformed and the birthing mother should be attached to cardiac monitoring while in labor and delivery. Caesarian section should be performed only is cases when mother is hemodynamically unstable, or in cases that myocardial infarction occurred close to day of delivery.

Conclusion- Since the increase of pregnancy in older women and cardiovascular complications, it is imperative that intensive care nurses know how to instruct and guide these women regarding their obstetric future.

Biography:

Dr. Andris Skride is an interventional cardiologist and pulmonary hypertension expert at Pauls Stradins Clinical University Hospital in Riga, Latvia. He is the founder and current manager of Latvian pulmonary hypertension registry and head of Rare Disease Specialist Association of Latvia. Dr. Skride has been actively involved in education of health professionals in Latvia, aiming to increase the awareness of rare diseases in daily practice as many of those diseases are severely underdiagnosed in developing countries. He is also one of the main organizers of two local conferences on rare diseases and of the first Baltic Pulmonary Hypertension Conference which took place in Riga last spring.

Abstract:

Choriocarcinoma of the pulmonary artery is rare but curable. The condition is characterized by unspecific symptoms and radiological findings, which can mimic pneumonia and tuberculosis in early stages and pulmonary embolism and chronic thromboembolic pulmonary hypertension in later stages of disease, representing diagnostic challenges. It is important to identify unspecific respiratory symptoms in the presence of meno-metrorrhagia after pregnancy and/or childbirth, and to measure β-hCG levels.

Biography:

Tomohiro Asahi graduated from Tokyo Medical and Dental University in 1991 and started training in internal medicine and cardiology at University of the Ryukyus. He has completed his PhD program in 2001. He is currently a chief cardiologist at Naha City Hospital since 2007 and continues clinical research mainly on heart failure.

Abstract:

Background: The evaluation of the inferior vena cava (IVC) diameter and respiratory collapse is useful in the management of acute heart failure (HF) syndrome. However, its impact on the prognosis is unknown.

Methods: Seventy-four consecutive patients admitted for acute HF syndrome were analyzed and followed for 1 year. The measurement of IVC diameter after stabilization of respiratory distress were performed on admission. The IVC collapsibility index (IVC-CI) was calculated as (maximal IVC−minimal IVC)/maximal IVC. According to the initial IVC-CI, the patients were divided into the collapse group (IVC-CI≥0.5: n=34) and the non-collapse group (IVC-CI<0.5: n=40). During 1 year, the endpoints were mortality due to HF and the combined event of mortality and readmission for HF.

Results: Age, the proportion of male subjects, and left ventricular ejection fraction were comparable between the groups. Initial blood pressure (178±35 mmHg vs. 143±34 mmHg, p<0.01) and initial amount of oxygen administration (5.7±5.6 L/min vs. 2.9±4.2 L/min, p<0.05) were higher in collapse group than in non-collapse group. The Kaplan-Meier curves showed that survival free of the mortality and combined event during 1 year were higher in collapse group.

Conclusions: Although the degree of pulmonary congestion was severer in collapse group, prognosis of HF was better. This might indicate that the lower central venous pressure and the less fluid accumulation contribute the better prognosis of HF. 

Biography:

Will be updated soon...

Abstract:

Will be updated soon...

Biography:

Abstract:

Introduction: Work within cardiac catheter lab is rapidly advancing with increasingly complex procedures on patients with multiple co-morbidities. This results in a steep learning curve for team members and an increase need for vigilance, situation awareness and effective teamwork. The rapid development of simulation technology provides a safe and realistic environment in which to develop important non-technical skills as part of a multidisciplinary team.

Methods:  A multidisciplinary team of catheter laboratory staff from the University Hospital of South Manchester developed a two-day simulation course using a multimodal format including lectures, high fidelity simulations and small group workshops. The course focuses on a structured approach to the recognition, assessment and management of the critical ill patient, effective use of pre-procedure checklists and team role allocation. Candidates develop their non-technical skills through experiential learning simulating clinical scenarios. Six high fidelity simulations are based in the laboratory and recovery room followed by debriefing. Scenarios include ventricular fibrillation, anaphylaxis, tamponade and major haemorrhage. Workshops and lectures are designed to teach and develop practical skills and knowledge used in the initial management of a deteriorating or critical ill patient including basic airway skills, post resuscitation care and safe sedation.

Results: Feedback on lectures has revealed that 100% of candidates agreed or strongly agreed that lectures were easy to understand, relevant and useful for future clinical practice. 100% of candidates believed that the knowledge and skills gained would be useful to their future clinical practice, that it helped consolidate their learning and that the facilitation of their debriefing was effective.

Discussion: This multidisciplinary course has been designed to develop an effective team approach to critical situations in the cardiac catheter laboratory. Course development includes investigating the link between attendance on the course and change in practice and improved patient care.