Day 1 :
University of Western Ontario, Canada
Keynote: Twenty-years of experience with robotic-assisted Coronary artery bypass grafting with post-operative angiography
Time : 10:00-10:45
Bob Kiaii is working as a Professor in the Department of Surgery and Chair of the Division of Cardiac Surgery at the Schulich School of Medicine at the University of Western Ontario. He is a Cardiac Surgeon and the Chief of the Division of Cardiac Surgery and Director of the Minimally Invasive Robotic Cardiac Surgery Program at the London Health Sciences Centre. He is also one of the Founding Members of Canadian Surgical Advanced Technology and Robotics (CSTAR) of the Lawson Health Research Institute. He has performed ground-breaking minimally invasive robotic-assisted cardiac procedures including the first North American simultaneous integrated coronary artery revascularization procedure on September 1, 2004.
Objective: Minimally Invasive coronary artery bypass grafting (CABG) is a rapidly evolving technology that has been shown to increase patient satisfaction and to reduce surgical morbidity and recovery times. Therefore, we present out institutional experience with minimally invasive robotic-assisted CABG with post-operative cardiac catheterization.
Methods: The study cohort includes all patients who underwent robotic-assisted CABG between September 1998 and March 2018. Anastomoses were manually constructed through a small anterior non-rib spreading incision or closed chest robotic assistant without cardiopulmonary bypass on the beating heart and all internal thoracic arteries were harvested with robotic-assistance. Angiographic confirmation of graft patency was performed either immediately within the same operative suite equipped with angiographic equipment or next day in the cardiac catheterization lab.
Results: Since 1998, a total of 645 patients underwent robotic-assisted minimally invasive CABG. Total of 484 patients were males and mean age was 60 years. There were two deaths (0.4%) secondary to respiratory complications and six wound infections (1.2%). Seven (1.4%) patients required re-exploration for bleeding. Median length of stay in the intensive care unit was one day and length of hospital stay was four days. The patency rate of left internal thoracic artery (LITA) grafts to the left of the anterior descending artery (LAD) was 97% with eight occluded grafts, which underwent revision.
Conclusion: Robotic-assisted CABG is a safe and feasible alternative approach to surgical revascularization. It has the potential of reducing morbidity of surgery by reducing infection and bleeding. Post-operative assessment with cardiac catheterization enables the achievement of a very high post-operative patency rate.
McMaster University, Canada
Time : 11:05-11:55
Michael McGillion is an Associate Professor and Assistant Dean (Research) in the School of Nursing at McMaster University. He holds the Heart and Stroke Foundation/Michael G DeGroote Endowed Chair of Cardiovascular Nursing Research at McMaster and is a Scientist at the Population Health Research Institute in Hamilton, Ontario. His program of research focuses on remote automated monitoring and virtual nursing recovery support models to improve hemodynamic, pain and related recovery outcomes following cardiac, vascular and other forms of surgery. He is Co-Chair of the Heart and Stroke Foundation Pan-Canadian Council on Mission: Priorities in Advice, Science and Strategy (CoMPASS).
Although surgery has the potential to improve quality and duration of life, it can also precipitate major complications. Current systems for monitoring patients after surgery, both on surgical wards and after transition to home, are not adequate. In operating rooms and intensive/post anesthetic care units, there is continuous hemodynamic surveillance. Yet, when patients are transferred to surgical wards, most will have their vital signs evaluated only every 4 to 12 hours. This scenario leads to thousands of cases of undetected hemodynamic compromise, associated with poor clinical outcomes. This state of the science talk, focused on perioperative digital health, will review remote automated postoperative monitoring and virtual care models, as well as lessons learned for moving the field forward. Key considerations for overcoming current barriers to implementation in Canada will also be presented.
University of Ottawa, Canada
Time : 11:55-12:45
Tofy Mussivand achievements and sustained outstanding scientific excellence through research, innovations, discoveries, publications, teaching, and mentoring have led to significant and meaningful contributions to the accumulation, transfer, dissemination, technologies, products and utilization of knowledge that have shaped the present and future of medical devices, with major impacts on health care worldwide. Prof. Mussivand is an internationally acclaimed and renowned scientist, problem solver, educator, humanitarian and inventor. He is an inspiring leader who through sustained creative innovations; hard work and perseverance grew to be one of the world’s most prominent and respected scientists.
Generally, blood flow throughout the circulatory system, is laminar. In a laminar flow, each particle is moving in parallel in a smooth path through the vessel with constant velocity at any point. The highest velocity is in the center. Under certain conditions such as high velocity and low blood viscosity (as in anemia caused by reduced hematocrit), stenosis, and other cardiovascular diseases, laminar flow can be disrupted and become turbulent. A turbulent flow is chaotic, irregular, with fluctuating velocity at any point with eddies, whirlpools, microbruits, and specific acoustic signatures. Turbulent flow increases shear forces activating platelets and thrombus development, can damage red blood cells. Turbulent blood flow impacts the endothelial lining causing initiation of atherosclerosis. Aging and calcification, cause hemodynamic (velocity, shear stress) changes. Assessing the degree of turbulent is highly desirable. Turbulence can be predicted by (Reynolds number) Re=p d V/n Where Re: Reynolds number. Below 2000 laminar, above 2500 usually turbulent. p: fluid's density, d: diameter of the vessel, V: flow velocity and n: viscosity. Turbulent flow properties can be used for diagnosis of cardiovascular disease (stenosis, murmur and anemia). Several technologies have been developed for detecting turbulent. The Ottawa heart Institute is testing one of these technologies. So far, 290 patients are enrolled in the study and the results are promising. A multi-center clinical trial is planned.
Brown University, USA
Time : 13:30-14:15
Jun Feng is currently an Associate Professor of Surgery (Research) at Warren Alpert Medical School of Brown University and at Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital. He is also the Director and Senior Research Scientist of Cardiothoracic Surgery Research Laboratory at Rhode Island Hospital. He serves as Principal Investigator on grants funded by National Institute of Health (2 active R01s and 2-NIH-COBRE-pilot projects), American Heart Association (Grant-In-Aid, active), and Rhode Island Foundation. He also serves as Co-investigator on a number of grants funded by the National Institute of Health and other research-funding organizations. He has published more than 120 peer-reviewed/editorial articles/book chapters and 140 abstracts as correspondent author, first author and co-author. He has served as an Editorial Member, Editorial Commentator and Peer Reviewer for several scientific journals in Cardiovascular Research and Medicine.
Diabetes mellitus (DM) is associated with severe autonomic dysfunction and vasomotor dysregulation. DM has been associated with increased morbidity and mortality in patients undergoing any cardiac surgical procedures and following coronary artery bypass grafting (CABG) specifically. In particular, these changes are more profound in patients with poorly controlled diabetes. Diabetes is associated with vascular dysfunction in all tissues, including the microvasculature. DM is associated with significant changes in vascular reactivity of coronary/peripheral microcirculation, vascular permeability, gene/protein expression, and programmed cell death, as well as with increased morbidity and mortality after surgical procedures. Many of the microvascular and macrovascular complications of diabetes are related to increased oxidative/nitrosative stress, hyperglycemia, and changes in vascular signaling. Recently, we reported differential microvascular regulation before and after CP/CPB, correlating to the extent of serum glucose control. Alterations in vasomotor regulation can lead to vasoplegia, a common complication of CP/CPB seen in up to 25% of patients. Vasoplegia manifests with decreased systemic vascular resistance and hypotension. These patients are at increased risk of morbidity and mortality following cardiac surgery and CP/CPB. The incidence of postoperative vasodilatory shock is higher in patients with diabetes for a number of reasons. Vasoplegia has traditionally been treated with vasopressors, such as phenylephrine, and vasopressin. These medications must be administered carefully to avoid potentially dangerous side effects, including peripheral ischemia of the extremities and mesenteric ischemia, leading to tissue necrosis, mucosal injury and metabolic acidosis. In addition, peripheral vascular responses to vasoactive agents such as phenylephrine may affect the coronary circulation in a differential manner from the rest of the body by increasing systemic blood pressure suddenly while reducing coronary artery blood flow. A better understanding of the regulation of the microvasculature may lead to improved outcomes in the patients with and without diabetes.