Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 4th International Conference on Clinical & Experimental Cardiology Hilton San Antonio Airport, USA.

Day 1 :

  • Track 1: Heart Diseases
Speaker

Chair

Anastasia Susie Mihailidou

Royal North Shore Hospital, Australia

Speaker

Co-Chair

Anthony W Ashton

The University of Sydney at Royal North Shore Hospital, Australia

Speaker
Biography:

Ewa Szczepanska-Sadowska, MD, Ph.D. graduated from the Medical Faculty, Medical University of Warsaw, Poland. Her scientific education includes British Council fellowship and Humboldt Foundation Fellowship. She was a Visiting Professor in the Department of Physiology, Medical College of Wisconsin, USA. Since 1990 she was a full Professor and Head of Department in the Medical University of Warsaw. She was a member of Council of International Union of Physiological Society and other societies. She is a Member of the Polish Academy of Science, Polish Academy of Arts and Sciences and of several international, national scientific societies.

Abstract:

There are solid grounds for recognition of importance of multiple neuronal/neurotransmitter networks in the regulation of the cardiovascular system. Clinical and preclinical studies provide evidence that heart failure is associated with significant changes in central control of some of these systems. In addition, it has been shown that some of the brain’s neurochemical pathways, which are involved in central control of blood pressure, play a role in the regulation of emotions and cognitive functions. Stress and depression are regarded as potential challenges for the cardiovascular system, causing inappropriate regulation of cardiovascular parameters and worsening prognosis of heart failure. There is also evidence that heart failure increases sensitivity to stress and depression. Recently, the knowledge of neurochemical background of comorbidity of stress, depression and heart failure increased markedly. Our studies and those of other authors provided evidence for significant role of improper function of neuropeptides, and in particular of angiotensinergic, vasopressinergic and oxytocinergic systems in exaggerated responsiveness of the cardiovascular system to stress in heart failure and depression. Current evidence indicates that inappropriate regulation of release of these neuropeptides and/or expression of their receptors play particularly important role in long-term changes of central cardiovascular control during post-infarct heart failure.

Speaker
Biography:

Anastasia Susie Mihailidou is a cardiovascular clinical scientist, graduating with a Ph.D. in Pharmacology from University of Sydney in 1988. She is currently Clinical Senior Lecturer for Sydney Medical School, University of Sydney and Senior Hospital Scientist at Royal North Shore Hospital. Anastasia has both clinical and basic research interests as Director of the Ambulatory Blood Pressure Monitoring Service for a major Tertiary Referral Centre and Head of the Cardiovascular & Hormonal Research Laboratory. Her research focus is regulation of aldosterone/mineralocorticoid receptors in the heart and has made a significant contribution to understanding the role of corticosteroid hormones (and antagonists). She was the first to show aldosterone has both rapid and sustained effects on regulation of sodium transport in the heart, with increased levels of intracellular sodium. These findings have generated great interest, leading to award of the Pfizer Prize for best research at the International Society of Hypertension (2002). Her current research focus is to determine the role of aldosterone and mineralocorticoid receptors in diabetes.

Abstract:

Diabetic patients continue to have 2-4-fold increased risk of short- and long-term mortality after acute myocardial infarction (AMI), with hyperglycemia consistently and independently predicting complications. Although not defined, a possible mechanism for hyperglycemia-aggravated cardiac damage and remodelling is augmentation of increased receptor for advanced glycation end products (RAGE), precipitated during myocardial ischemia reperfusion (I-R). Mineralocorticoid receptor (MR) antagonists reduce morbidity and mortality, although mechanism (s) not fully defined. We tested the hypothesis that MR blockade would intercept hyperglycemia-aggravated RAGE expression and reduce reperfusion injury.
Methods: Male Sprague Dawley rats (SD) and obese Zucker rats (ZDF) were anesthetized and hearts isolated and subjected to regional ischemia (30min) followed by reperfusion (2.5hr) ex vivo. For acute hyperglycemia, 22 mM glucose was perfused 15 min. prior to inducing ischemia and throughout reperfusion. MR antagonist spironolactone (SP, 1 μM) was added to perfusate and maintained throughout reperfusion.
Results: I-R activated RAGE expression [10.9 x 105 ± 1.7 (N=4) vs 2.9 x 105 ± 0.7 (N=4) (sham I-R), p<0.05], which was significantly exacerbated by acute hyperglycemia [25 x 105 ± 2.5, N=4, p<0.05]. Changes with acute hyperglycemia were of similar magnitude to chronic hyperglycemia in the ZDF rats [26.9 x 105 ± 2.8, N=4, p<0.05]. Immunoblotting confirmed increased RAGE protein expression. These changes correlated with significantly larger infarct size in the hearts from ZDF rats (49 ± 1%, N=7) and acute hyperglycemia (58 ± 2%, N=8) compared with control rats (39 ± 2%, N=8, p<0.05). Acute exposure to SP attenuated infarct area and RAGE expression in the hearts of both ZDF rats (43 ± 2%, N=5, p<0.05) and acute hyperglycemia (45 ± 2%, N=7, p<0.05).
Conclusion: Our results indicate that even short periods of hyperglycemia aggravate cardiac damage by activating RAGE. Addition of MR blockade prevented activation of RAGE and attenuated infarct size. This confirms results of the large clinical studies where MR blockade had benefit in patients with diabetes.

Ashutosh Wechalekar

University College London Medical School, UK

Title: Cardiac Amyloidosis: A changing landscape

Time : 12:00-12:20 PM

Speaker
Biography:

Ashutosh Wechalekar is a Senior Lecturer at University College London Medical School and the Royal Free London NHS Foundation Trust. He trained in medicine at Medical College Nagpur, India and when on to do further training in haematology in UK and Canada. He joined the UK National Amyloidosis Centre funded in 2004 and is now a senior faculty at the centre. His scientific interests are focused on biomarkers in cardiac amyloidosis, novel imaging methods for the heart in all types of amyloidosis (especially DPD scintigraphy – he now has the largest cohort in the world of over 700 patients with amyloidosis imaged by this modality), characterization and treatment of systemic AL amyloidosis with a focus on the study new and novel agents in these disorders. He has published extensively in these areas.

Abstract:

Systemic amyloidoses are a group of rare diseases caused by deposition of protein fibrils. This talk will focus on major advances in the approaches to diagnosis, changing epidemiology and recent advances in treatment. Light chain (AL) amyloidosis remains the most frequently identified type but cardiac transthyretin amyloidosis is being increasingly recognised. Senile cardiac amyloidosis appears to be an epidemic awaiting diagnosis. Mass spectrometry using laser capture microdissection of a tiny amount of amyloid deposits from histological sections has enabled improved amyloid fibril typing. Understanding of proteotoxicity of amyloidogenic precursors has paved the way for new therapeutic approaches. Developments in cardiac magnetic resonance imaging such a Eq-CMR and T-1 mapping has lead to accurate quantitation of the myocardial interstitial deposits for diagnosis and response assessment. 99mTc-DPD/PyP scintigraphy is transforming evaluation of cardiac amyloidosis. The availability of novel chemotherapy agents and better selection of patients for autologous stem cell transplantation have enabled delivery of therapy in AL with less toxicity and improved outcomes. An array of novel agents, including RNA inhibitors, stabilisers of amyloid precursor proteins, inhibitors of fibril formation and immunotherapeutic targeting of amyloid deposits are all now in clinical development offering great hope for specific and effective new therapies.

Break: Lunch Break 12:20-13:05 @ Texas D&E

Alexandra Lucas

University of Florida, USA

Title: Serpins as therapy: From virus to man

Time : 13:05-13:25

Speaker
Biography:

Alexandra Lucas moved to the University of Florida in 2006_Present from the Robarts Research Institute and University of Western Ontario in London, Ontario, Canada, where she has been a principal investigator studying inflammation, specifically monocyte and T lymphocyte activation in vascular disease. She also a co-inventor and co-founding scientist for Viron Therapeutics, Inc., a biotechnology company that is now in clinical trial analyzing viral anti-inflammatory proteins as a new class of therapeutic agents. She is a practicing interventional cardiologist in addition to running an active basic research lab in vascular inflammatory research with bovver 100 paper and reviews and 16 patents published. She has been an active member of the Canadian Society for Atherosclerosis and Thrombosis Board having also served as Editor-in-Chief and serves on the American Heart Association grant panel. She is additionally on the editorial board for several journals. She also directs an annual medical mission to Fte. Liberte in Haiti.

Abstract:

Serpins have critical regulatory roles in coagulation and inflammatory pathways. These ubiquitous regulators are present in organisms from viruses to horseshoe crabs and to mammals, representing a large percentage of circulating proteins in the blood. The impact of serpins on normal physiological function and homeostasis is evident in patients with genetic mutations that case severe disorders such as deficiency in alpha1 antitrypsin and neuroserpin and lethal sepsis with disseminated intravascular coagulation (DIC) where there is serpin dysregulation. Modification of serpin activity is used for treating some clinical disorders, e.g. heparin is used to decrease clotting through activation of antithrombin (AT III) and AAT replacement which is given to patients with genetic deficiency and emphysema. Prior studies have also reported the use of N terminal serpin peptides for treatment in sepsis and HIV. Our research group has been examining virus-derived serpins as potential therapeutics. Prior work beginning with our original studies with the Myxomaviral serpin, Serp-1, have demonstrated significant reductions in vascular disease with Serp-1 treatment in models of arterial balloon angioplasty and in aortic, renal and cardiac transplants in rodent models. Serp-1 treatment improved mortality in lethal Mouse gamma herpes virus (MHV68) in interferon gamma receptor (IFNgR) knockout mice. and mouse adapted Zaire Ebola infection with associated reduced pulmonary hemorrhage, and congestion Serp-1 has also been tested in a phase 2A clinical trial after coronary stent implant with a demonstrated significant reduction in markers for myocardial damage, Related work with mammalian serpins such as NSP have also demonstrated anti-inflammatory activity in animal models. In recent work we have assessed the capacity of Viral and mammalian serpin reactive center loop (RCL) peptides to expand serpin functions and to reduce inflammatory responses with significant reductions in plaque growth in a aortic transplant model. In conclusion, viral serpins have evolved over many millions of years to form highly efficient regulators of host central inflammatory pathways, identifying new therapeutic targets and potential function as anti-inflammatory protein drugs.

Anthony W Ashton

The University of Sydney at Royal North Shore Hospital, Australia

Title: Mineralocorticoid receptors in myocardial infarction- No good, just bad and ugly

Time : 13:25-13:45

Speaker
Biography:

Anthony Ashton has completed his Ph.D. in 1998 at the University of New South Wales, Australia. His Postdoctoral studies at the Albert Einstein College of Medicine focused on novel mechanisms of treatment for the heart post-infarction. He is currently the Director of Basic Research, in the Division of Perinatal Research at the Kolling Institute for Medical Research in Sydney. He has published more than 51 papers in reputed journals (cited over 1,100 times; h index =23), serves on the editorial board as a reviewer for multiple biomedical journals and for multiple funding bodies.

Abstract:

Coronary heart disease remains the most prominent single cause of death despite advances in clinical care. Restoration of blood flow to the myocardium following ischemia induces reperfusion injury. Conditional knockout mice have identified central roles for mineralocorticoid receptor (MR) activation in promoting reperfusion injury and hypertension. These studies are born out by large clinical trials showing MR antagonists reduce rehospitalisation/mortality rates and slows progression to heart failure. However, the mechanism for these effects is not clearly delineated and made more contentious by the recent identification of GPR30 as an aldosterone (Aldo) receptor. Cell permeable (Aldo) and impermeable (Aldo-PEG) ligands were used to identify the receptor that promotes reperfusion injury. Aldo-PEG activated only GPR30 while Aldo activated both MR and GPR30. Aldo increased infarct size and aggravated apoptosis in ex vivo reperfusion injury whereas Aldo-PEG had no effect. These data indicate that GPR30 activation is insufficient to promote reperfusion injury and that activation of MR are required. Aldo not only alters transcription but also mediates non-genomic pathways, such as the loss of anti-apoptotic regulators like ARC and promotion of superoxide production. Indeed, the cardioprotective effects of MR antagonists involve the reversal of these non-genomic effects. By stabilizing the oxidant stress it was determined that these non-genomic effects accounted for ~50% of the protective effect in the presence of MR antagonists. Collectively these data suggest that MR activation promotes myocardial damage during reperfusion injury through non-genomic mechanisms and altered transcription.

Speaker
Biography:

Augusto Parra graduated from the University del Bosque Medical School (Bogota-Colombia) in 1988. He obtained an MPH in Biostatistics/Epidemiology from Harvard University in 1992. He pursued clinical training in Neurology and Internal Medicine at Duke University. He completed a Fellowship in Neurocritical Care and Stroke at Duke University in 2001. He is a Neurocritical Care Faculty at Columbia University and at the University of Texas –SA, where he currently directs the Neuro –ICU Program. He has done basic and clinical research, published in the leading scientific medical journals, done editorial peer review, and has been part of the American Heart Association –Brain 1 Basic Science Grant Review Committee for several years. He has special research interest in the repercussions of brain injury into the cardiovascular system and vice versa.

Abstract:

Objective: To study the influence of moderate to severe left ventricular dysfunction [SLVD] from myocardial stunning in increasing the risk of cerebrovascular and cardiovascular events among patients with acute aneurysmal subarachnoid hemorrhage [aSAH].
Methods: A subset of 119 patients (from an prospective cohort of 481 aSAH) with at least one echocardiogram, serial transcranial Doppler [TCD] data, and with no prior history of cardiac disease and or left ventricular dysfunction [LVD] was analysed. LVD’s cutoff was a LVEF of < 40%. The study population for cardio- and cerebrovascular events, and functional outcome and the most predicable Troponin I cut-off for SLVD and role of delayed vasospasmin increasing the likelihood of cerebral ischemic injury in the presence of SLVD were assessed.
Results: SLVD was found in 11% of our study-patients.Younger age, hydrocephalus, and complete filling of the quadrigeminal and fourth ventricles wereassociated with SLVD (all P<0.05). None of the patient's taking antihypertensive medications developed SLVD in our study population. There was a significant association between SLVD and infarction from vasospasm after adjusting for clinical grade, age and peak TCD mean velocities (surrogate for delayed vasospasm severity) (P=0.03). SLVD was also a significant predictor for cardiogenic shock (P=0.001), and pulmonary edema (P=0.002). However, a significant association between SLVD and 14 –day functional outcome in study population was not found.
Conclusions: SLVD after aSAH increases the risk of ischemic cerebrovascular events (especially if significant delayed vasospasm occurs), cardiogenic shock, and pulmonary edema. We were unable to find a significant association of SLVD and 14-day functional outcome or mortality. The later could be explained by the benefits of specialized Neuro-ICU support and an underpowered study population to detect this specific association. Antihypertensive medication appears to be cardio-protective for the development of SLVD after aSAH (myocardial stunning).

  • Track 2: Cardiac Surgery
Speaker

Chair

Louis E Samuels

Thomas Jefferson University School of Medicine, USA

Speaker

Co-Chair

Edmo Gabriel

Nove de Julho University, Brazil

Session Introduction

Louis Samuels

Thomas Jefferson University School of Medicine, USA

Title: The implantable left ventricular assist device: A bridge to a destination
Speaker
Biography:

Louis Samuels graduated Medical School from Hahnemann University (Philadelphia, PA) in 1987 and completed his Cardiothoracic Surgical training in 1995. He joined the faculty of Drexel University as the Surgical Director of Cardiac Transplantation. In 2001, Samuels and his team implanted the world’s 5th totally implantable electric artificial heart (AbioCor™). In 2003, he joined the Main Line Health System as the Surgical Director of Heart Failure. In addition to cardiac transplantation and LVAD implantation, Samuels performs CABG and Aortic Valve surgery. In 2012, Samuels became Professor of Surgery at Thomas Jefferson University School of Medicine.

Abstract:

The Implantable Left Ventricular Assist Device (LVAD) has been in clinical use for several decades, serving originally as a therapy for bridging patients to heart transplantation (BTT). For the past fifteen years, the implantable LVAD has also served as a permanent device in patients who are not eligible for cardiac transplantation-Destination Therapy (DT). Although early results were markedly superior to optimal medical management (OMM), device durability was limited. In response, improvements in patient selection and pump design have translated into improved outcomes. As such, a broader acceptance of LVAD therapy for end-stage heart failure has been observed. At present, second and third generation implantable LVADs are commercially available. The second generation units are beginning to overcome the limited durability issues-in fact, there are over 1900 patients currently on support for greater than 2 years and nearly 1000 patients on support for greater than 3 years. The third generation units, with their magnetically-levitated technology, may be even more rewarding. Finally, for the first time in artificial heart history, the annual number of long-term LVADs implants has exceeded the number of transplantation, raising the question of whether they (i.e. the implantable LVAD) will one day replace transplantation as a therapy for end-stage heart failure.

Arthur T. Martella

Our Lady of Lourdes Medical Center, USA

Title: Minimally invasive coronary arteries bypass grafting
Speaker
Biography:

Arthur T. Martella graduated from Jefferson Medical College (Philadelphia, Pa) in 1989. He completed his general surgery training at Albert Einstein Medical Center in The Bronx, NY. He then went on to University of Rochester for his Cardiothoracic Surgical Training. He is currently the Chief of Cardiothoracic Surgery at Our Lady of Lourdes Medical Center and has interest in robotic coronary surgery and minimally invasive valve surgery.

Abstract:

The invasiveness of coronary artery bypass grafting (CABG) surgery has not decreased since the operation was introduced over 40 years ago. Although the benefits of bilateral mammary artery use are well known, only 4 percent of CABG procedures utilize both mammary arteries. We have utilized two strategies to reduce the use of the sternotomy incision for multivessel coronary artery disease. The first is hybrid coronary revascularization (HCR) which combines a minimally invasive, sternal-sparing left internal mammary artery to left anterior descending coronary artery bypass (LIMA-LAD) with percutaneous coronary intervention (PCI) to non-LAD coronary lesions. We have utilized a robotic platform for mammary harvesting which facilitated the transition to a totally endoscopic (TECAB) approach for selected patients. The second is multivessel minimally invasive direct coronary artery bypass with utilization of bilateral mammary arteries and radial artery when appropriate. This approach has also been facilitated by the use of the Davinci Robot for bilateral mammary artery harvesting and the ability to reach the ascending aorta from the left thoracotomy for proximal anastomoses. We review our experience of the last 24 months with 182 patients and discuss how the procedures and the selection process have evolved during this time.

Speaker
Biography:

Basar Sareyyupoglu has completed his M.D. at age of 24 years from Ankara University School of Medicine and completed his residency in Istanbul Kosuyolu Heart and Research Hospital in Turkey. He worked at Mayo Clinic, Rochester for 3 years and assigned as a clinical instructor at University of Pittsburgh Medical Center where he specialized in Thoracic Transplantation and mechanical circulatory support. Today he is an Assistant Professor of Surgery at Texas A&M Collage of Medicine and Director of Thoracic Transplantation and Mechanical Circulatory Support at Baylor, Scott & White Healthcare at Temple, Texas. He is a member of the Society of Thoracic Surgeons and International Society for Heart and Lung Transplantation.

Abstract:

Left Ventricular Assist Devices (LVADs) have been a successful therapy for patients in decompensating heart failure. However, there is often a substantial decision-making process involved prior to placing an LVAD, during which time a patient's condition can rapidly deteriorate. Short term mechanical circulatory support plays an important role to keep these heart failure patients stable enough to be eligible for more durable therapies. Heart failure teams are looking for better device solutions or surgical strategies to keep these patients stable, infection free, better mobilized, providing a multiorgan recovery out of a cardiogenic shock period. Short term devices are also widely used to support right ventricle in patients with right ventricle failure and/or after LVAD therapy.

Hitoshi Hirose

Thomas Jefferson University, USA

Title: The current ECMO (VV and VA-ECMO)
Speaker
Biography:

Hitoshi Hirose has graduated from Nagasaki University School of Medicine, Nagasaki Japan. In 1990, he had his general surgery residency in St. Luke's Roosevelt Hospital, New York and Nagasaki University Hospital, Japan. He started cardiovascular surgery training in Japan and then had clinical fellowship in Cleveland Clinic Foundation during 2002-2004. He received Ph.D. from Juntendo University College of Medicine in 2005 for his clinical research regarding cardiac surgery. Then he moved into Philadelphia and has been working as Attending Physician in the Division of Cardiothoracic Surgery, Thomas Jefferson University since 2009. His major interest include management of cardiogenic shock and mechanical circulatory device, especially ECMO.

Abstract:

Background: ECMO has been utilized for refractory cardiac and respiratory failure. It's outcomes were almost dismal if it were not utilized appropriately. Since July of 2010, we have developed new ECMO program in our institution and our outcomes have improved remarkably.
Objective: We would like to share the current ECMO system, including technology and patient care, to optimize patient outcomes.
Methods: New ECMO program consisting of standard cannulation technique (groin venous and arterial access with retrograde perfusion catheter for VA-ECMO, Avalon dual lumen cannula for VV-ECMO), standard circuit (closed crystalloid primed circuit, heparin coated tubing and cannulae, diffusion membrane hollow-fiver oxygenator and Rota flow centrifugal pump), standard monitoring system (upper extremity arterial line, cerebral and lower extremity tissue saturation monitoring and hemodynamic transesophageal echocardiography), monitoring by multidisciplinary providers (ICU RN, mid-level providers and intensivists), and weaning using standard protocol with hemodynamic transesophageal echocardiography.
Results: Since the beginning of new ECMO program, a total of 94 ECMO (76 VA and 18 VV ECMO) procedures were performed. The mean age was 48 ± 13, of 53 male and 41 female patients. There were 30 salvage cases (post code). The overall ECMO survival rate was 55% (VA ECMO 51%, and VV ECMO 70%), and discharged from hospital in alive in 45%.
Conclusion: The outcomes of new ECMO program are reasonable. The expansion of the ECMO program is expected.

Speaker
Biography:

Edmo Atique Gabriel, MD, Ph.D. is a brazilian cardiovascular surgeon and university professor, cardiovascular surgery consulting and editor of two textbooks by Springer- "Principles of Pulmonar Protection in Heart Surgery" (2010-2011) and "Inflammatory Response in Cardiovascular Surgery" (in press).

Abstract:

Objective: Assessing complement system activation and index of thrombogenicity and platelet aggregation between methacrylate-coated cardiopulmonary bypass (CPB) circuit and conventional CPB circuit.
Method: Twenty-six pigs were equally divided into 2 groups-with and without coating. They were placed on CPB for 90 minutes and blood samples were collected in three different time points(T0- right before CPB establishment, T1- 45 minutes,T2-90 minutes) to measure total count of inflammatory cells(leukocytes, neutrophils, lymphocytes and platelets) and serum level of fraction C3 of complement system. Upon completion of 90 minutes CPB, fragments of different compartments of CPB circuit were taken for assessing index of thrombogenicity and platelet aggregation. Student's t-test; Student's t-test for paired samples adjusted with Bonferroni correction; Friedman test; Mann-Whitney test were used, considering level of significance 5%.
Results: There were not differences between both groups regarding total count of leukocytes, neutrophils and lymphocytes; however, there was lower count of platelets at T2 in coated group (p=0,020). Serum level of fraction C3 was lower in coated group at T1 (p=0,020) and T2 (p=0,017).Higher index of thrombogenicity and platelet aggregation was detected in conventional CPB circuit (77% animals within conventional CPB group) than in coated group (46% animals within coated group).
Conclusion: In heart surgery requiring CPB, use of methacrylate-coated CPB circuit may be useful to reduce complement system activation as well as attenuating index of thrombogenicity and platelet aggregation.

George P. Batsides

Rutgers-Robert Wood Johnson Medical School, USA

Title: Circulatory support in cardiogenic shock
Speaker
Biography:

George P. Batsides is an Assistant Professor of Surgery and Section Chief of Cardiac Surgery at Rutgers-Robert Wood Johnson Medical School. He received his MD from St. George's University School of Medicine. He has a dedicated practice which includes directing mechanical circulatory support at Rutgers-Robert Wood Johnson, as well as minimally invasive surgery, complex aortic surgery and coronary artery bypass grafting. He has been at Rutgers-Robert Wood Johnson, formerly UMDNJ, since 1997 where he completed his general surgery residency and cardiothoracic training and has been an attending surgeon there for over 9 years. He has a high volume practice which specializes in high risk cardiothoracic procedures. He is on the Advisory Board for Abiomed, Inc. and is an international speaker on minimally invasive circulatory support.

Abstract:

A bridge to recovery- Novel use of minimally invasive circulatory support, the talk will touch upon a brief summary of incidences of acute MI and cardiogenic shock and post cardiotomy cardiogenic shock. Identify cardiogenic shock and the use of inotropes and medical support for shock. The discussion will cover short term ventricular assist devices as a "Bridge to Decision". Specifically, the talk will deal with the use of the Impella 5.0 micro-axial flow pump and will cover the institution's experience with Impella ventricular assist device's various insertion methods and clinical scenarios of its use. The presentation will highlight the importance of early intervention with mechanical circulatory support for shock patients; the ultimate goal being myocardial recovery.

Speaker
Biography:

Allen Cheng completed his general surgery residency at UCLA and postdoctoral fellowship at Stanford University. He then completed his cardiothoracic surgery training at Massachusetts General Hospital in Boston and pursued further training at University of Rochester specializing in mechanical circulatory support and transplantation. He is currently an attending cardiac surgeon with Dr. Mark Slaughter at University of Louisville, specializing in mechanical circulatory support and heart transplantation. He has published numerous papers in major journals and is a reviewer for multiple journals. He is also an investigator at the Cardiovascular Innovation Institute very active in ventricular assist devices research supported by multiple NIH grants.

Abstract:

Heart failure (HF) remains to be a global problem with approximately 5.7 million individuals suffering from heart failure in the US alone. Heart transplantation has been the gold standard with good and predictable long term outcomes, but its applicability has been limited by the number of available donors. This has stimulated the advancement of mechanical circulatory support as an alternative to improve survival and quality of life in patients suffering from late stage congestive heart failure. First generation pulsatile-flow left ventricular assist devices (LVADs) were able to demonstrate improved survival to transplantation compared to the standard treatment of intra-aortic balloon pump and inotrope and improved survival in non-transplant eligible patients compared to optimal medical management. The second generation LVAD, i.e. the axial continuous-flow LVAD, has demonstrated tremendous improvement in patient survival and better durability with less complications and smaller in device size. Recent data from trails with the second generation continuous flow LVAD implanted as bridge-to-transplantation therapy demonstrate a survival rate approaching 90% at one year, similar to the heart transplantation survival. The improvement in outcomes has also been achieved in patients not eligible for transplant as destination therapy with similar survival to transplantation out to two years. The third generation centrifugal continuous-flow LVADs with noncontact bearings, have a significant improvement in technology and reduction in pump size with less device-related complications and improved patient outcomes. One of the third generation LVADs has been approved by FDA recently to be used as bridge-to-transplant therapy for heart failure patients with destination therapy approval pending and coming soon. Significant amount of intensive research is currently underway with multiple smaller devices and the possibility of driveline elimination with the transcutaneous energy transmission technology will likely further reduce the device-related complication significantly and improve patient outcomes. Minimal invasive off-pump LVAD implantation has been shown possible and will further increase the application of the mechanical circulatory support devices to an even larger patient population. The development of implantable LVADs has revolutionized the treatment of late-stage heart failure and its continuous advancement will open door to a large market of potential recipients with improved durability, cost and effectiveness.

Speaker
Biography:

Sheetal Chandhok completed a 6 year accelerated BA/MD program at Lehigh University and MCP/Hahnemann Medial School. He completed residency at University of Pennsylvania and Cardiology and Electrophysiology at University of Pittsburgh. He has been practicing for 6 years at the Main Line Health System outside of Philadelphia, PA.

Abstract:

Background: Atrial Fibrillation (AF) portends a progressively higher risk of embolic complications, reflected by a patient’s CHADS2-VA2SC score. Unfortunately many patients are unable or ineligible to take anticoagulation secondary to bleeding complications. Recently, the Lariat suture delivery device has become available to effectively deliver a single ligature around the left atrial appendage (LAA), with closure rates of 98% at 1 year.
Methods: 21 patients (15M, 6 F) Age 81 ± 7 years, CHADS2-VA2SC of 4.5 ± 1.2, with both persistent and paroxysmal AF underwent CT scanning of their LAA to evaluate their candidacy for the Lariat procedure.13/21 LAA's were deemed adequate, and were offered the procedure. 7/13 patients refused the procedure, and 6 underwent LAA closure. One patient was discovered to have an anatomical variant which prevented transseptal puncture, so the procedure was aborted. The remaining 5 successfully underwent the Lariat procedure.
Results: 8/21pts were unable to undergo the procedure secondary to their LAA anatomy. 5 LAA were behind the pulmonary artery, 2 were larger than 40mm, and 1 patient had pectus excavatum. Immediate, complete closure was achieved in 5/5 patients without complications. 4/5 had TEE performed in 3 months with persistent complete occlusion of LAA. 2 patients had exacerbation of CHF as outpatients that required escalation of their diuretic therapy. Average procedure time was 94 ± 20 mins and fluoroscopy time was 30.8 ± 11 mins. No embolic complications have been observed in 171 ± 115 Days of follow up.
Conclusion: The Lariat suture closure device can completely close the LAA without significant procedural risk. A significant number of patients are currently excluded from undergoing the procedure secondary to LAA anatomy.

Speaker
Biography:

Fouad AlMutairi has completed his Ph.D. from University of Chester, UK in 2013. He is in respiratory care certified by American board since 2005. He currently is working as a clinical cardiopulmonary researcher at hospital and university in Saudi Arabia and United Kingdom. He has published more than five papers and he is focused in the study of cardiovascular rehabilitation post CABG.

Abstract:

Lung expansion therapies are usually used to treat or prevent post- surgical atelectasis after cardiac surgery. The type of lung expansion therapy used was different in most of the hospital that has cardiac surgery procedure all over the world. This depends on the availability of the therapy in the hospital and the acceptance of medical staff to use it. The present study aims to evaluate the medical staff experiences regarding the use of CPAP therapy to treat or prevent post-surgical atelectasis after CABG.
This study was conducted at King Fahd Armed Forces Hospital between September 2011 and December 2011. An e-mail letter was sent through the hospital intra-net mail system that invited all relative medical staff to participate in this study. Inclusion criteria in selecting the participants of this study are: (1) medical staff who worked with the new method of CPAP therapy for more than 3 months (2) worked in cardiac unit or ward (3) able to read and understand English language.A personal semi-structured (face to face) interview for 30 minutes was used to gather the medical staff experiences in this study. The interviews were documented by the investigator and recorded by audio-tape. Fifty four letters were sent via intra-net e-mail to all registered e-mail for all medical staff working in the cardiac unit or ward at King Fahd Armed Forces Hospital. Forty two replied to the invitation e-mail with response rate of 77%. Eleven males and 19 females participated in the study. Of thirty participants, 9 were cardiac doctors, 5 cardiac nurses and 16 cardiac respiratory therapists. When the participants were asked a question about if they worked with the new method of CPAP therapy before twenty four of the participants (80%) had not worked with it before. Most of the participants (26/30) had agreed to use the new way of CPAP therapy to treat or prevent post surgical atelectasis after CABG. In addition, thirteen of participants (43%) said CPAP therapy required less patient effort than IS therapy. There was a high accepting rate (86%) of the new method of lung expansion therapy (CPAP via mask therapy) to treat or prevent post- surgical atelectasis by the participating medical staff.

Speaker
Biography:

Christoph Thomas Starck is a Consultant Cardiac Surgeon at the University Hospital Zurich, Switzerland. He additionally holds a degree in Emergency Medicine, after several years of additional commitment in Emergency Medicine. His research activities focus on the development of innovative technologies in assist device therapy, the optimization of extracorporeal circulation technologies and techniques and pacemaker-/ICD-lead extraction tools and techniques.

Abstract:

Objective: Patients with ARDS or in cardiogenic shock have a poor prognosis at primary care hospitals, due to the missing therapeutic option of extracorporeal membrane oxygenation (ECMO). Therefore an extracorporeal life support (ECLS) transport team was established at our tertiary care center.
Methods: An ECLS transport team implanted an ECMO at the site of the primary care center with subsequent transport of the patient to the tertiary care center. Between September 2009 and November 2013, 14 patients with ARDS or cardiogenic shock were treated by our ECLS transport team. Mean age was 43.7±13.6 years. All implantations were done percutaneously.11 patients received an ECMO in veno-venous configuration, two patients in veno-arterial and one patient in veno-venoarterial configuration.
Results: No complications occurred during the implant procedure and the subsequent transport. 8 patients were transported by ambulance, 6 by helicopter. Mean transport distance was 47.5 km (12-120km). Mean duration of ECMO therapy was 11.1±12.3 days. 71.4% of the patients were successfully weaned from ECMO-therapy and 64.3% were discharged from hospital with one patient still being in hospital in stable condition.
Conclusions: With a specialized transport team, ECMO-implantation can be achieved successfully in a peripheral hospital, and patients can be transported safely to a tertiary care center.