Day 1 :
Keynote Forum
Sekib Sokolovic
University Clinical Center Sarajevo, Bosnia and Herzegovina
Keynote: Future trend in the heart pacing
Time : 10:30-11:30
Biography:
Sekib Sokolovic is the Head of the Governmental Organization in Bosnia and Herzegovina. He is graduated from Medical Faculty Sarajevo in 1983. He is awarded as the specialist in Internal Medicine in 1994. He has done Master of Science in 1998. He was awarded PhD in 2004. Mr. Sokolovic is a fellow of University California Irvine, Oxford, AKH Vienna. He is specialist in both Cardiology and Rheumatology. He had started working in University Clinical Center Sarajevo from 1990 in the Department of Cardiology. He is the Director of Excellence Center for Arterial Hypertension. Vice-President of the Association of Cardiologists of Bosnia and Herzegovina, ESC Nucleus Member of Working Group on Pulmonary Circulation and Right Heart, President of the Working Group on Arterial Hypertension of UKBiH and He served as the Editorial Board Member of Rheumatology International Journal, European Journal of Rheumatology, Mediterranean Journal of Rheumatology. He had published many papers and books. He also have done many research projects in his field.
Abstract:
About 3 million pacemakers are implanted worldwide and each year about 600.000 new implants occurs. The current pacemaker provides the benefit, but it has also disadvantages since they may have unwanted impact on the apical pacing of the right and left heart ventricle. Some of them include adverse events li. The new recent pacemakers are magnetic resonance imaging safe. That’s why the future pacemakers should provide more physiological pacing, and possible wireless pacemakers with a implanted different location in the heart. The current proposed location is inside the coronary venous sinus system. This device is implanted into coronary sinus by the balloon Tran’s catheter delivered system, eliminating the need for the cardio surgery procedure. The wireless remote pacing and management with digital mobile applications will be the future of cardiology. The patient mobile phones will be of great assist in the connection with a wireless pacing technology. So, the future trend in pacemaker’s technology will provide better design of pacemakers, longer battery duration and good safety profile.
Break: Group photo with Networking & Refreshments 11:30-12:00 @ Foyer
- Angiography and Interventional Cardiology | Vascular Surgery | Cardiovascular Medicine | Arrhythmias | Cardio-Oncology | Clinical Cardiology | Cardiac Surgery
Location: Akdeniz 3
Session Introduction
Taner Seker
Osmaniye State Hospital, Turkey
Title: Late PCI and CABG for secondary intervention are associated with decreased MACE in patients with multivessel disease after successful primary PCI
Time : 12:00 - 12:30
Biography:
Taner Åžeker is cardiologist interested in intervetional cardiology. He is a member of Europian Sociaty of Cardiology and Turkish Sociaty of Cardiology. He contributes abstracts or cases regularly for international and national congress.
Abstract:
Background: Most patients with ST elevation myocardial infarction (STEMI) have critical multivessel disease that requiring a second intervention. The optimal timing of secondary intervention is not clear. In this study, we aimed to investigate MACE rate regarding the type of secondary procedure to non-infarct related critical lesions in patients with STEMI and critical multi vessel disease.
Methods: A total of 212 consecutive patients with STEMI and critical multi vessel disease had been included in our study. Patients were divided into two groups according to occurrence of MACE. Primary PCI data were collected. Pre and post intervention coronary blood flow and complications were recorded. MACE data of patients were evaluated before discharge, after 3 and 9 months.
Results: A second coronary angiography was performed 132 (62.3%) of STEMI patients in 90 day after primer PCI. The non- infarct related lesions in 26 of 132 patients who underwent second coronary angiography were evaluated non-critically and decided to follow with medical treatment. Secondary PCI was performed 89 of 132 and 17 of 132 patients underwent CABG operation. Patients were divided into two groups according to MACE occurrence. Mean time interval to PCI was significantly lower in patients with MACE (p=0.028). EF (p=0.59) and rate of patients who underwent CABG (p=0.108) were lower, syntax score (p=0.55) and CAD history (p=0.056) were higher in patients with MACE; but there was no statistical significance. The cut-off value of time interval to PCI obtained by ROC curve analysis was 16,5 days for prediction of MACE in 9 months (sensitivity: 75.0%, specificity: 69.2%). The area under the curve (AUC) was 0.680 (p=0.039) (Figure-1).
Conclusion: Late PCI or CABG can be thought to be the optimal strategy for patients with STEMI and multivessel disease.
Abigali Vowels
Community Regional Medical Center, USA
Title: PHQ – 9 Scores does not predict driveline site infection in patients with a left ventricular assist device
Time : 12:30-13:00
Biography:
Abstract:
Introduction: Left ventricular assist device (LVAD) therapy can improve mortality and quality of life in patients with end-stage heart failure who are either waiting for or not a candidate for cardiac transplantation. 1 LVAD therapy is associated with significant complication and comorbidity including; device infection, bleeding, thrombus, stroke, and mechanical failure. 2 Patients with chronic heart failure have a high incidence of the major depressive disorder, which has been shown to negatively affect outcomes in patients being treated with medical therapy. 3 This study was designed to evaluate the relationship between LVAD driveline infection and depression.
Methods: After our study was approved by our local Institutional Review Board, we evaluated all left ventricular assist device patients who were implanted between January 2016 and November of 2017 who were implanted at Community Regional Medical Center and who underwent screening for depression with the Patient Health Questionnaire (PHQ) 9 prior to implantation. Chart review was performed to identify those patients with a documented history of driveline infection which was defined by either a positive culture from the driveline exit site or documentation of an infection which led to the use of antibiotics. Kaplan Meyer event-free survival curves were generated and the difference between the two curves was analyzed using the log-rank test. (Figure 1)
Results: Twenty-three patients were identified during the time period in question who met our inclusion criteria. 10 patients developed a driveline infection during the time in question. Of the 10 patients who developed a driveline infection, 9 patients had score ≥ 5 on the PHQ-9 score indicating possible depression, while only 1 patient who scored < 5 had documented driveline infection (HR 5.3391, 95% confidence intervals 1.407 to 20.257, P = 0.064). Meantime to development of a driveline infection was 49 months in the PHQ < 5 group as compared to 35 months in the PHQ ≥ 5 group.
Conclusion: Depression, as indicated by a score of ≥ 5 on the PHQ 9 score, does significantly predict driveline infections. Our data did show a strong signal and was likely underpowered to detect a significant difference during our observation period. Further testing using a larger sample size may provide a more definitive answer to the relationship between the driveline exit site infections and depression.
Agata W Dżeljilji
National Tuberculosis and Lung Diseases Research Institute, Poland
Title: Alpha-1 antitrypsin deficiency (AATD) as a risk factor of aortic aneurysm- Is it still actual?
Time : 13:00-13:30
Biography:
Agata W Dżeljilji is a practicing surgeon at the Institute of Tuberculosis and Lung Disease in Warsaw, where she is studying management of thoracic disease. She
conducts research in pulmonology and vascular surgery. Her main clinical intrests are metabolic aspects of elastin and collagen fibers proteolysis in the diseases
of the respiratory and vascular system, and the significance of alpha-1 antitrypsin deficiency. Her most recent publication is 'The role of alpha-1-antitrypsin protein
in the pathogenesis of aortic aneurysm'. She is also a reviewer for JTD.
Abstract:
Alpha-1-antitrypsin is a potent antiprotease playing an important role in maintaining protease-antiprotease balance. It protects the structures of extracellular matrix against destruction by proteolytic enzymes. Loss of elasticity occurs when increased protease activity is accompanied by qualitative impairment or reduced con- centrations of antiproteases. Alpha-1-antitrypsin de ciency is a risk factor for obstructive lung disease, including emphysema, liver and kidney disorders and, less often, follicular panniculitis, granulomatosis with polyangiitis (previously Wegener’s granulomatosis). Literature also emphasises the role of AAT in the development of aortic aneurysms, and results of biochemical studies support this theory. Aortic aneurysm is an important clinical problem, unceasingly associated with high mortality. For this reason, it is exceptionally important to identify its risk factors. Studies on the relationship between AAT and development of AAA (abdominal aortic aneurysm) have been conducted since the 1990s. Due to the development in molecular diagnostic techniques, new reports on the topic appeared over the last decade.
Break: Lunch Break 13:30-14:30 @ Daphe Restaurant
Mansoor Ahmed
J B Gupta Hospital Bhiwani, India
Title: Effect of Intravascular metoprolol administration to prevent fatal arrhythmias in patients of STEMI undergoing primary percutaneous coronary angioplasty
Time : 14:30-15:00
Biography:
Abstract:
Background: Fatal ventricular arrhythmias, including serious ventricular tachycardia (VT) and ventricular fibrillation (VF), have been reported to occur in 1–5% of the patients undergoing primary coronary angioplasty. These events may cause hemodynamicaly instability and affect procedure outcome.
Objectives: To assess effect of Intravascular Metoprolol administration to prevent fatal arrhythmias in patients of STEMI undergoing Primary Percutaneous coronary angioplasty
Methods: An open, randomized study was carried out at single centre to treat 220 patients who had undergone primary PCI for STEMI. The patients were randomized to either receive IV metoprolol 15 mg(110 subjects) or not to receive the medication(110 subjects) prior to procedure . The outcomes were the detection of arrhythmias before ,during procedure and
post 12 hours of PCI.
Results: Number of patients with normal sinus rhythm was significantly higher (p <0.001) in treatment group (47.27%) when compared to control group (24.45%). Incidence of fatal arrhythmias was lower in treatment group (6.36%) but it was statistically insignificant (p>0.05).
Conclusion: Metoprolol lowers the incidence of fatal arrhythmias in patients undergoing primary PCI. More large scale studies
are required to establish its definitive role in prevention of fatal arrhythmias during primary PCI
Pervaiz Chaudry
Diplomate American Boards of Cardiothoracic Surgery, USA
Title: Initial experience of minimally invasive concomitant aortic & mitral valve replacement / repair at a tertiary care cardiac centre of a developing country
Time : 15:00-15:30
Biography:
Pervaiz Chaudry is Working as Co. Chairman& Programme Director at Cardiac Surgery Department, National Institute of Cardiovascular Surgery NICVD, Karachi. He is a pioneer of Heart Failure Programme and Minimally Invasive Surgeries at this institute. Currently, 13 residents and 4 fellows are under his training. He is doing all heart surgeries minimally invasive including LVAD, Multi-vessel CABG, all Valves, CABG Valves, Adult Congenital Heart Surgery, and multiple time redo procedures. He is traveling entire country to teach all procedures and make them in working. His efforts are to “Never Say No to any Patient”.
Abstract:
Introduction: Minimally invasive double valve replacement (DVR) surgery through a small transverse anterior thoracotomy is an alternate technique than sternotomy for concomitant aortic and mitral valve (AVR, MVR)surgery that
can reduce surgical stress and length of hospital stay. Endoscopy and robot-assisted surgery is being practised in developed countries but its technically very difficult, time-consuming, costly and not reproducible by all surgeons. As median sternotomy is preferred approach for DVR, therefore, we aimed to introduce direct vision minimal invasive DVR (DVMI-DVR) to the surgeons in our setting for common public.
Objectives: Aim of this research was to evaluate the in hospital and early outcomes of direct vision minimal invasive double valve surgery at a tertiary care cardiac centre of a developing country.
Patients And Methods: This prospective observation study was conducted at National Institute of Cardiovascular Diseases Karachi, Pakistan from January 2018 to September 2018. 19 consecutive patients undergoing DVMI-DVR for aortic and mitral disease without any prior cardiac surgery were included in this study. For all procedures access was through small transverse anterior thoracotomy incision with wedge resection (Chaudhry’s Wedge) of sternum opposite to 3rdand 4thcosto-sternal joints. Patients were observed during hospital stay and were followed to observe length of hospital stay(LOHS), ventilatory support, pain score, and mortality. Data were entered and analysed using SPSS version 23.
Results: The male/female ratio was 11:8 with mean age of 35± 12 years.Mean total bypass time was 129.8 ± 23.83 min (range 98-181 mins).Mean mechanical ventilation time was 3.16± 1.12 h (range 2–6 h). Mean post operative LOHS was 5.63 ± 1.12 days (range 4–8 days). We had zero surgical mortality. Mean pain score of 4.32 (on predefined pain scale of 1 to 9 with high
value indicating severe pain).
Conclusions: Minimally Invasive DVR surgery is a safe and reproducible technique with the acceptable surgical outcome. It carries good post-operative recovery, patient’s satisfaction and early return to daily activity.