World Congress on Cardiac Surgery & Medical Devices 2019 April 19-20, 2018 Montreal | Quebec | Canada

Biography:

Diamond Fernandes is your authority on cardiac rehabilitation and prevention. He is a graduate of the University of Calgary, and certified by the American College of Sports Medicine. He started his career with Total Cardiology Rehabilitation in Calgary, and was then recruited to go to Dubai, UAE. From there, he went on to manage the Kelowna (BC) Cardiac Rehabilitation program before starting the Heart Fit Clinic in Calgary, AB.  He serves on the executive board for the Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR). He is the published author of the book "Beating Heart Disease" and is the director of the Heart Fit Clinic. His focus is on an integrative approach to helping people prevent, halt, and reverse heart disease.

Abstract:

Biography:

Gibran Roder Feguri has completed his PhD from Federal University of Mato Grosso and is pursuing his Post-doctoral studies. He is a specialist in Cardiovascular Surgery and Artificial Cardiac Stimulation by the Brazilian Society of Cardiovascular Surgery (BSCVS). He is currently the Head of the Medical Residency Program in Cardiovascular Surgery at the General University Hospital (HGU/UNIC) and is a Professor at the same institution. He has published more than 10 papers in reputed journals and has been serving as a Reviewer in the Brazilian Journal of Cardiovascular Surgery, among others.

Abstract:

Background: A strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in surgery.

Aim: The aim of this study was to evaluate clinical variables, mortality and effects on the metabolism and inflammation after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.

Methods: Fifty-seven patients were randomly assigned to receive 12.5% maltodextrin (200ml, 2h before anesthesia), (CHO, n=14); water (200ml, 2h before anesthesia), (controls, n=14); 12.5% maltodextrin (200ml, 2h before anesthesia) plus intraoperative ω-3 PUFA (0.2g/kg) (CHO+W3, n=15); or water (200ml, 2h before anesthesia) plus intraoperative ω-3 PUFA (0.2g/kg) (W3, n=14). Insulin resistance and glucose control were analyzed.

Results: Two deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Patients given preoperative CHO loads experienced fewer instances of hospital infection (P<0.05) and were less reliant on vasoactive amines during surgery (RR=0.60, 95% CI: 0.38-0.94; P=0.020), and while recovering in ICU (P=0.008). Groups given ω-3 PUFA experienced significantly fewer instances of POAF (RR=4.83, 95% CI: 1.56-15.02; P=0.001). Patients given preoperative CHO loads also got better glycemic control in ICU (P=0.015) and less need for exogenous insulin (P=0.018). Patients in the W3 Group presented lower values of the ultrasensitive CRP with 36 h of PO (P=0.008).

Conclusion: When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG was observed.

Biography:

Ravi Kumar Baral is a young and vibrant Cardiac Surgeon working in a position of Assistant Professor in the Department of Cardiothoracic and Vascular Surgery at University Hospital. He has completed his MCh in Cardiothoracic and Vascular Surgery in the year 2015. He has special interest in aortic surgery and mini-invasive cardiac surgery. He has performed more than 60 cases of mini atrial septal defect surgeries before moving into more complex valvular surgeries through a mini-invasive approach.

Abstract:

Background: Heart valve surgery from minithoracotomy has become in most centers worldwide but still is not much popular in our part of world in view of high cost involved. Suture less heart valve cost a lot in our part of world and has become most limiting factor for use of minithoracotomy in heart valve surgeries. We in our center have reexplored use of the conventional valve from right minithoracotomy aortic position.

Method: It is a review of a prospectively collected data of patient undergoing mini aortic valve replacement over one-year period. We have used conventional mechanical heart valve in aortic position in rheumatic aortic stenosis and regurgitation.

Result: Total 20 AVR has been performed from right anterior mini thoracotomy over one year. 12 (60%) of patient were male, one of the patient got reexplored from same incision for mediastinal bleeding. Mean total pump run and aortic cross clamp time was 96 and 88 minutes respectively.

Biography:

Aris Lacis, cardiac surgeon, professor, MD, PhD graduated Riga Medical Institute in 1961. General and thoracic surgeon in P. Stradina University Hospital in Riga (1964–1969). Cardiac surgeon in the Latvian Centre for Cardiovascular Surgery (1969–1994). Since 1994 until 2012 – the head of Pediatric Cardiology and Cardiac Surgery Clinic in University Children’s Hospital, Riga; since 2012 – a consulting professor of this Clinic. 2008–2013 – President of Latvian Association for Cardiovascular Surgeons. 2012–2016 – President of Latvian Association for Pediatric Cardiology. Author of 395 scientific publications, 3 monographs and 13 patents. Investigator in more than 10 clinical trials including cardio-surgical procedures performed under deep hypothermia, hybrid procedures etc. In May 2009 have been used transcutan intramyocardial delivery techniques for treatment 3 months aged patient (idiopathic dilated cardiomyopathy) using autologous bone marrow derived progenitor cells. In November 2010 the first patient with end stage pulmonary hypertension received intrapulmonary implantation autologous stem cells.

Abstract:

Context: The promising field of regenerative medicine is working to restore structure and function of damaged tissues and organs. The adult heart represents an attractive candidate for cell-based technologies. While there is a wealth of preclinical and clinical data showing the safety, feasibility, and efficacy of stem cells in adults with acute myocardial infarction and heart failure, less is known about possible implementation of stem cell therapy in infants and children with heart failure due to dilated cardiomyopathy and pulmonary arterial hypertension. The challenges facing cardiac stem cell therapy are multiple. There are uncertainties around the destiny of stem cells after their injection into the blood stream. In particular, it regards migration and homing of implanted cells in the target tissues. As yet unclear is the possible role of sympathetic nervous system in the context of osteoreflexotherapy. There is still no definitive answer to the question on which is the preferred type of stem cells to be use for transplantation in different settings. Since 2008, at first we used autologous bone marrow-derived mononuclear cells (BM-MNCs) in patient with acute myocardial infarction. We have investigated the use of stem cells not only for myocardial regeneration, but also in patients with diabetes mellitus and osteoarthritis in adult patients. Since 2009, we started stem cells implantation for pediatric patients.

Objective: To determine the role of BM-MNCs in management of wide spectrum of pathologies, including critically ill pediatric patients suffering from idiopathic dilated cardiomyopathy and severe pulmonary arterial hypertension and adult patients with acute myocardial infarction and heart failure and adult patients with osteoarthritis.

Design, Settings, Participants: Two patients (9 and 15 years old) with trisomy 21 and severe pulmonary arterial hypertension due to uncorrected large ventricular septal defects received intrapulmonary BM-MNCs implantation. Radionuclide scintigraphy showed improvement of lungs vascularization during 36 months follow-up. Seven patients (4 months – 17 years) with dilated idiopathic cardiomyopathy received intramyocardial BM-MNCs injections. During follow-up (up to 10 years), we observed improvement of left ventricular ejection fraction (LVEF), decrease of left ventricular end diastolic dimension by echocardiography and cardio-thoracic index at chest X-ray exams, reduction of serum brain natriuretic peptide serum levels and decrease of the stage of heart failure from stage IV to stage I, by NYHA classification. No periprocedural harmful side effects were observed. Two children had heart transplantation (on the 2^nd and 4^th year after stem cells implantation). We performed BM-MNCs intracoronary infusion in 101 adult patients with acute myocardial infarction with reduced LVEF and in 14 patients with chronic heart failure. Our results showed statistically significant improvement in LVEF at 12 months. We also infused BM-MNCs to the pancreas directly via branches of splenic artery or superior pancreaticoduodenal artery we have performed single intra-articular BM-MNCs injections in 70 patients with knee or hip joint osteoarthritis (stage II–III). No adverse effects after the BM-MNC injection were observed. Preliminary analysis showed decrease in pain and other symptoms and statistically significant improvement by clinical scoring system using different questionnaires.

Conclusions: The results are promising and we suggest that BM-MNCs might be used for the stabilization of the adult and pediatric patients to improve symptoms and outcomes or serve as a bridge for heart or lung transplantation or delay joint replacement surgery. It also could be recommended in cases if other more traditional treatment options fail or are contraindicated.

Biography:

Diamond Fernandes is your authority on cardiac rehabilitation and prevention. He is a graduate of the University of Calgary, and certified by the American College of Sports Medicine. He started his career with Total Cardiology Rehabilitation in Calgary, and was then recruited to go to Dubai, UAE. From there, he went on to manage the Kelowna (BC) Cardiac Rehabilitation program before starting the Heart Fit Clinic in Calgary, AB.  He serves on the executive board for the Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR). He is the published author of the book "Beating Heart Disease" and is the director of the Heart Fit Clinic. His focus is on an integrative approach to helping people prevent, halt, and reverse heart disease.

Abstract:

Biography:

Dr. Bo Dong graduated from China Medical University in 2009 and got the Bachelor's Degree in Medicine. Then he completed further training in 2011 and got the Master Degree in Surgery. After that he was admitted to School of Medicine in Tsinghua University, majoring in cardiac surgery. Under          the guidance of Prof. Qingyu Wu, he received surgical training in The First Hospital of Tsinghua University, Beijing, China. In 2015, he went to Frontier Lifeline Hospital in Chennai, India, to learn techniques in cardiac surgery and research, guided by the pioneer in Indian medical history—Dr. K.M.Cherian. Besides clinical training, he also got involved in animal research on vein graft restenosis after CABG.

Abstract:

Objective: The objective of this study was to evaluate the outcomes of patients who underwent the different techniques according to the pathology of Ebstein anomaly (EA).

Methods: From March 2004 to February 2017, 228 patients (mean age, 19.8±15.4 years; range, 7 months-64 years) with EA underwent 232 cardiac operations at our hospital. Twenty-nine patients had a prior cardiac procedure before. Among the patients in first procedures, 92 patients (46.2%) were categorized to Carpentier type C and 63 patients (31.7%) were type D, 7 patients (3.5%) had isolated anterior leaflet downward displacement. Anatomical repair were performed in 179 patients (Type B, n=35; type C, n=92; Type D, n=29; unclassifiable, n=7; reoperation, n=16), 1½ ventricle repair in 37 (Type D, n=33; reoperation, n=4), tricuspid valve repair in 3 (Type A, n=2; Type B, n=1), tricuspid valve replacement in 10 (7 reoperations), and Fontan procedure in 3 (TCPC, n=2; Glenn, n=1). Atrialized right ventricle was presented in 194 cases (168 excised, 6 incorporated). The pathology of 199 patients who underwent first procedures at our center described in Table 1.

Results: The mortality was 1.7% (n=4: anatomical repair, n=3; 1½ ventricle repair, n=1). Among these, 1 pathology type was Carpentier type C and 3 were type D. 1 A-V block (0.4%) newly occurred. 214 patients were available to follow up. The range of follow-up duration was 10 months to 13 years (mean, 7.3±3.2 years). Late survival was 99% (2 late deaths) at 10 years. Three patients received reoperation (reoperation rate, 1.3%; TVR, n=1; 1½ ventricle repair, n=2). Mean New York Heart Association class improved from 3.5 to 1.1.

Conclusions: The principle of the techniques is to reconstruct the tricuspid valve and right ventricle anatomically. For most cases, the anatomical repair was demonstrated with low mortality, less complications and excellent durability at long-term follow-up. The Carpentier classification cannot categorize all the patients. It is critical to choose applicable surgical techniques individually according to the pathologic morphology for EA surgical results. If the tricuspid valve is severely hypoplastic, 1½ ventricle repair and valve replacement may be alternative.

Biography:

Lale Hakami has her expertise in Pediatric Cardiac Surgery in infants and newborn. She is a German-Board-Certified Cardiac Surgeon with a sub specialization 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 Fellow at the Children's Hospital Boston/USA. From 2009 to 2011, she was the Director of Pediatric Cardiac Surgery in Mainz/Germany. From 2011-2014, she was the Senior Consultant in Children Heart Center in Linz/Austria. From 2014, she has been the Senior Consultant at the University Hospital Munich/Germany and University Lecturer 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. Fifteen 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). Six of the 15 group-A died within the first 30 years. In the group-B, four 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.

Biography:

Lale Hakami has her expertise in Pediatric Cardiac Surgery in infants and newborn. She is a German-Board-Certified Cardiac Surgeon with a sub specialization 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 Fellow at the Children's Hospital Boston/USA. From 2009 to 2011, she was the Director of Pediatric Cardiac Surgery in Mainz/Germany. From 2011-2014, she was the Senior Consultant in Children Heart Center in Linz/Austria. From 2014, she has been the Senior Consultant at the University Hospital Munich/Germany and University Lecturer 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: Eighteen heart transplantations on children (nine females and nine males) were performed from 1988 to 2015. The range of age was between 0 days and three years. Indications for a transplantation were hypoplastic left heart syndrome (n=14), non-compaction-syndrome (n=2), Bland-White-Garland-syndrome (n=1) and transposition of the great arteries (n=1). Fourteen children (78%) 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%). Fifteen (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 transplantation. 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; 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.