Scientific Program

Conference Series Ltd invites all the participants across the globe to attend Global Cardiology Summit Osaka, Japan.

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Scientific Program Day 1

Day 1 :

Keynote Forum

Ehud Baron

X-Cardio Corp. KK, Japan

Keynote: Cardiovascular health maps for health positioning and optimize interventions

Time : 9:15-10:00

Conference Series Cardiology Summit 2018 International Conference Keynote Speaker Ehud Baron photo
Biography:

Ehud Baron was the Professor and Researcher in Technion at Israel Institute of Technology, Aalborg University, UC Berkeley and Stanford University. He was also a serial entrepreneur who served as a Chairman, President/CTO in Medical device companies like X-Cardio Corp. KK, Tokyo, GoldTech Sino-HK, Concardio, Inc., Cleveland and Heart Beat Technologies, Ltd., Israel and JV with LifeQ, SA, US, NL. He was also the Interventional Cardiologist at SHLV, St. Louis and Inventor of bifurcation stent that has 30 patents to his name. He serves as an Assistant Professor of Clinical Medicine in the Department of Medicine at Washington University School of Medicine. 

Abstract:

Statement of the Problem: Several studies attempted to predict patient’s deterioration or progress using a combined score. However, since the combined score is just numeric value that combines many parameters, it does not provide the multidimensional health status or where to go from here, how to evaluate alternative treatments, etc. Medicine in general including cardiology, does not have one acceptable and explicit framework that defines the position of a patient in the cardiovascular health space, her/his target zone and paths (interventions) from the current position to the target. This makes it difficult to decide about the costs/benefits of each alternative treatment and even more to quantify effectiveness and visualize it in a way that both the doctor and the patient can understand it. According to this approach we use the BP pulse shape as indication to the cardiovascular status of the patient and create a continuous space spanned by its N dimensional features.
Method: The theoretical framework we suggest is that of fuzzy sets, where each patient get different level of membership in different pathological and healthy conditions i.e. we view health and sickness in different diseases as a continuous space, where subjects do not fall into one category or another but are points in this continuous space. Their position defines their health condition in a certain moment in time and changes dynamically with the interventions. The methodology was to do a multicenter study, record the BP pulse wave continuously over long periods of time and in parallel use continuous or frequent BP measurements. In one clinical study in Fresenius Kidney Care, St. Louis the trial was done on 14 patients, each patient had 2-4 sessions and each session was about of 4 hours. PPG (Photoplethysmogram) has been recorded continuously by a watch with finger optical sensor probe and compared to CNAP continuous hemodynamic monitor. In another clinical study done in a Calcutta hospital for hypertensive and diabetic patients, we used the same watch for continuous recording of PPG and use ABPM (Ambulatory Blood Pressure Monitoring) every 15 minutes for 24 hours on hypertensive and diabetic patients. In a third center in Meir Hospital in Israel, recording with the same watch was done during stress tests, where each 2 minutes BP is measured and ECG is measured continuously. Also, cardiac output has been measured in the beginning and end using echocardiography. Using 2-4 light wavelengths allowed us also to interrogate the capillary bed at different penetration levels to estimate features related to the microcirculation.
Findings: In all the three studies which provided tens of thousands BP measurements with simultaneous BP pulse shapes, we did fuzzy clustering algorithm we developed to cluster the pulse shapes in the N dimensional feature space and minimize dimensionality by looking for the smallest dimensionality space and its 2D projections. By doing it we discovered that different health conditions fell into different clusters. For example diabetics tended to fall into a cluster of their own, where the severity of the diabetic condition indicated the position between diabetic centroid and healthy subjects.
Conclusion: The finding concluded that different health conditions can be defined by the BP pulse shape clustering generates a continuous health space, cluster centroids that represent various pulse.

Keynote Forum

David F Kong

Duke Clinical Research Institute, USA

Keynote: Harmonization By Doing: Looking to the next decade

Time : 10:00-10:45

Conference Series Cardiology Summit 2018 International Conference Keynote Speaker David F Kong photo
Biography:

David F Kong is an Associate Professor of Medicine at Duke University Medical Center and Co-Director of the Cardiovascular Devices Unit at the Duke Clinical Research Institute. An Interventional Cardiologist at Duke Hospital and a Faculty Member in the Duke Center for Healthcare Informatics, he specializes in cardiovascular informatics research and integration of evidence from cardiovascular clinical trials. He has completed his graduation in magna cum laude from Harvard University, where he also received a Master’s degree in Organismic and Evolutionary Biology. He has received his Medical degree from the Johns Hopkins University School of Medicine and was a Resident on the Osler Medical Service at the Johns Hopkins Hospital. He has completed his Fellowships in Cardiovascular Disease and Interventional Cardiovascular Medicine at Duke University before joining the Duke Faculty. He is board certified in Internal Medicine, Cardiology and Interventional Cardiology. He is a Certified Diver Medic, Master Diver and Dive Medical Examiner and has been elected Fellow of the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions.

Abstract:

The US-Japan Medical Device Harmonization By Doing (HBD) program has enabled the US FDA, Japan PMDA, international regulators, academia, and industry to develop practical standards for global clinical trials. This has facilitated development of novel cardiovascular devices and helped overcome regulatory barriers that have historically delayed timely medical device approvals in both countries. The collaborative activity is expanding its scope to create additional synergies in global medical device development, particularly for early feasibility studies, non-cardiovascular therapeutic areas and pediatric medical device applications. Encouraging single global clinical trial protocols will facilitate device evaluation in both the US and Asia by improving the timeliness and cost-effective generation of more informative clinical datasets for pre-market, and potentially post market evaluation. This will reduce the data requirements for device development programs by reducing redundant data collection. For example, the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS) registry and the US Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry, both collect and analyze clinical and laboratory data from patients receiving mechanical circulatory support devices for end-stage heart failure. The complementary datasets in these registries provide valuable information for improving the treatment of advanced heart failure patients in both countries. Clinical trial programs, such as the HARMONEE (NCT02073565) and COAST (NCT02132611) trials, represent a new approach to evaluating efficacy and safety in a global environment. Future directions will extend these initiatives and their benefits to additional countries and facilitate patient access to new medical device technology worldwide.

Keynote Forum

Deepak Puri

Ivy Healthcare, India

Keynote: Cardiomersion: Balancing advancing technology with comprehensive cost effective cardiovascular management

Time : 11:15-12:00

Conference Series Cardiology Summit 2018 International Conference Keynote Speaker Deepak Puri photo
Biography:

Deepak Puri is the former Director, Cardiovascular and Thoracic Surgery Max Super specialty Hospital Mohali and Additional Director Fortis Healthcare Mohali, Assistant Professor at PGIMER Chandigarh. He also has 65 publications in reputed international and national journals. He is the former Vice President, Chandigarh Surgical Society and IGMC alumni society, Convener Cardiovascular Sciences National Stem Cell Regenerative Medicine and Anti-aging Society, India. Editor in Chief CTVS and Reviewer for several reputed international journals. He is currently the Visiting Surgeon for Leipzig Heart Centrum Germany, Swedish Medical Center Seattle Washington, USA and University of Maryland Medical Center, Baltimore, USA. He is having experience of OPCAB surgeries in high risk patients like acute MI, ischemic heart failure and cardiogenic shock. He is interested in minimally invasive and cosmetic incisions for closure of septal defects, thymectomies, cardiac re-synchronization therapy, pericardectomies, PDA closure, valve, vascular, endovascular, thoracic surgeries and several own innovative techniques published in international journals. He has successfully repaired several penetrating cardiac injuries and he has also been a part of liver and renal transplant team.

Abstract:

Technological advances and improved surgical skills combined with better intensive care have improved outcome of
cardiovascular interventions in the last decade. Th is has necessitated for integrated approach involving team of cardiologists, cardiac surgeons, cardiac anesthesiologists, endocrinologists, nephrologists as well as community physicians for delivery of comprehensive care. Despite tremendous progress in management of cardiovascular diseases every year 17 million people die because of heart disease across the globe. Coronary artery disease has emerged as biggest threat and WHO has predicted India will be the coronary capital of the world by 2020. Although most interventions are safe, long term result are limited by the progression of disease and delayed treatment especially in acute coronary syndromes which can be responsible for high mortality and the increasing volumes of heart failure patients especially in regions located at far off distance from tertiary cardiovascular facilities. Although 80% of heart diseases are preventable this aspect is usually ignored by the patients as well as healthcare professionals. Prevention is the simplest and most cost-eff ective modality that plays major role in slowing progression of disease throughout life and includes primordial prevention, primary prevention and secondary prevention. Early diagnosis and prompt appropriate intervention improves immediate outcome as well as long term survival. We have a wide range of options in our armamentarium from percutaneous interventions to minimally invasive beating heart bypass, hybrid procedures, endovascular and robotic interventions and need to work in close coordination to deliver best possible prompt management judiciously using the advanced technology cost eff ectively and avoid complications. Wasteful and nonessential interventions can be avoided by making best use of prevention and medical management. Th e cost can be further minimized by having a highly skilled team willing to do multitasking and delivering their services at various centers as per need instead of having disproportionately large teams at each center where their services will remain underutilized. Cardiomersion promotes comprehensive cardiovascular care made cost eff ective by adopting integrated approach and utilizes the resources in a best possible way. Since 2011 we have delivered comprehensive cardiovascular services at more than 10 hospitals and the concept is expanding.

Keynote Forum

Ezzeldin A Mostafa

Ain Shams University Hospital, Egypt

Keynote: Comparative study between two devices of radio-frequency energy for bi-atrial maze operation for the treatment of long-standing atrial fibrillation: Prospective randomized trial

Time : 9:00AM to 6:00 PM

Conference Series Cardiology Summit 2018 International Conference Keynote Speaker Ezzeldin A Mostafa photo
Biography:

Ezzeldin A Mostafa is an Emeritus Professor and Past HOD of Cardiovascular and Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt. He is the Ex-Managing Director of Cardiac Surgery Academy, Ain-Shams University, Cairo, Egypt. He has Bachelor’s degree from Faculty of Medicine, Ain- Shams University (1976), MSc in General Surgery and then in Cardiology and Vascular Diseases (MCVD), and then his PhD (MD) in Thoracic and cardiovascular surgery (1984) and lastly MBA from ESLSCA (2010). He is a Member of the Society of Thoracic Surgery; the European Association of Cardio-Thoracic Surgery; the World Society of Pediatric Cardiology and Cardiac Surgery and the Egyptian Society of Cardio-Thoracic Surgery (ESCTS), etc. His major interests are neonatal and
pediatric cardiac surgery, mitral and aortic valve repair, Ebstein’s repair, dysrhythmia and maze surgery and health management by information system. 

Abstract:

Background & Aim: The Electro Surgical Unit (ESU or Bovie) is a Radio Frequency (RF) generator and can be used to create surgical lesions, which cause interruption of the basic flutter cycle that initiates/maintains chronic permanent Atrial Fibrillation (AFib). The aim of the study is to evaluate the efficacy and efficiency of the bi-atrial electro-maze plus amiodarone in the management of chronic permanent AFib in mitral valve surgery and to compare between two sources of RF energy;
namely, ESU or bovie and RF devices.
Method: After approval of Local Ethics Committee and obtaining written informed consent, a prospective, comparative randomized study was conducted on 90 patients who were referred for mitral valve surgery with chronic AFib. They were divided into three groups. Group-1: 30 patients were submitted to bi-atrial RF maze and amiodarone protocol. Group-2: 30 patients were submitted to bi-atrial ESU or bovie maze and amiodarone protocol. Group-3: 30 patients were treated with amiodarone only. Patients were followed-up in the post-operative period at the following time intervals, 2 weeks, 3 months and 6 months.
Results: There was no mortality in any group. The aortic-cross clamp time, bypass time were slightly longer in the electro-maze groups, but without any statistical signifi cance. There was no statistical significance amongst the 3 groups as regard morbidity. There was an immediate intraoperative conversion to sinus rhythm in the 3 groups respectively (83.3%, 80% and 20%). Sinus rhythm has remained stable over 3-month duration in the 3 groups respectively (70%, 66.6% and 16.6%) and over a follow-up of 6-month duration (66.6%, 63.3% and 13.3%). In the electro-maze groups, there has been a signifi cant reduction in left atrial size.
Conclusion: The bi-atrial electro-maze protocol appears to be a simple, effective, and quick method to cure chronic permanent AFib. The ESU or bovie is as effective as radiofrequency device as a source of energy for ablation.

  • Heart and Cardiovascular Diseases | Interventional Cardiology and Heart Surgery | Cardio-Oncology | Pediatric Cardiology | Advances in Cardiology
Location: ANA Crowne Plaza, Osaka
Speaker

Chair

Ehud Baron

X-Cardio Corp. KK, Japan

Session Introduction

Ezzeldin A Mostafa

Ain Shams University Hospital, Egypt

Title: Comparative study between two devices of radio-frequency energy for bi-atrial maze operation for the treatment of long-standing atrial fibrillation: Prospective randomized trial
Speaker
Biography:

Ezzeldin A Mostafa is an Emeritus Professor and Past HOD of Cardiovascular and Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt. He is the Ex-Managing Director of Cardiac Surgery Academy, Ain-Shams University, Cairo, Egypt. He has Bachelor’s degree from Faculty of Medicine, Ain- Shams University (1976), MSc in General Surgery and then in Cardiology and Vascular Diseases (MCVD), and then his PhD (MD) in Thoracic and cardiovascular surgery (1984) and lastly MBA from ESLSCA (2010). He is a Member of the Society of Thoracic Surgery; the European Association of Cardio-Thoracic Surgery; the World Society of Pediatric Cardiology and Cardiac Surgery and the Egyptian Society of Cardio-Thoracic Surgery (ESCTS), etc. His major interests are neonatal and
pediatric cardiac surgery, mitral and aortic valve repair, Ebstein’s repair, dysrhythmia and maze surgery and health management by information system. 

Abstract:

Background & Aim: The Electro Surgical Unit (ESU or Bovie) is a Radio Frequency (RF) generator and can be used to create surgical lesions, which cause interruption of the basic flutter cycle that initiates/maintains chronic permanent Atrial Fibrillation (AFib). The aim of the study is to evaluate the efficacy and efficiency of the bi-atrial electro-maze plus amiodarone in the management of chronic permanent AFib in mitral valve surgery and to compare between two sources of RF energy;
namely, ESU or bovie and RF devices.
Method: After approval of Local Ethics Committee and obtaining written informed consent, a prospective, comparative randomized study was conducted on 90 patients who were referred for mitral valve surgery with chronic AFib. They were divided into three groups. Group-1: 30 patients were submitted to bi-atrial RF maze and amiodarone protocol. Group-2: 30 patients were submitted to bi-atrial ESU or bovie maze and amiodarone protocol. Group-3: 30 patients were treated with amiodarone only. Patients were followed-up in the post-operative period at the following time intervals, 2 weeks, 3 months and 6 months.
Results: There was no mortality in any group. The aortic-cross clamp time, bypass time were slightly longer in the electro-maze groups, but without any statistical signifi cance. There was no statistical significance amongst the 3 groups as regard morbidity. There was an immediate intraoperative conversion to sinus rhythm in the 3 groups respectively (83.3%, 80% and 20%). Sinus rhythm has remained stable over 3-month duration in the 3 groups respectively (70%, 66.6% and 16.6%) and over a follow-up of 6-month duration (66.6%, 63.3% and 13.3%). In the electro-maze groups, there has been a signifi cant reduction in left atrial size.
Conclusion: The bi-atrial electro-maze protocol appears to be a simple, effective, and quick method to cure chronic permanent AFib. The ESU or bovie is as effective as radiofrequency device as a source of energy for ablation.

John Wang

Philips Healthcare, United States

Title: A review of advances in ECG based cardiac ischemia monitoring for in-hospital application
Speaker
Biography:

John Wang has received his MS degree in Physics from Northeastern University, Boston and MS degree in Aeronautics and Astronautics from MIT, Cambridge. He has more than 30 years’ industrial experience in the development of patient monitoring devices and is currently a Principal Scientist with Philips Healthcare responsible for the development of ECG monitoring algorithms and related applications used in all Philips’ patient monitoring devices. He has over 50 publications and 9 issued patents. He is an AAMI ECG Committee Member responsible for developing industry standards for ECG devices. He is also an Editorial Board Member of the Journal of Electrocardiology and a Referee for several biomedical signal processing journals and conferences.

 

Abstract:

Real-time ST-segment monitoring for ischemia detection was introduced for clinical use in the 80’s. To overcome the earlier systems’ limitation on the number of ECG leads monitored, systems that support continuous diagnostic 12-lead ECG acquisition were subsequently developed. Derived 12-lead ECGs from 5-wire and 6-wire monitoring lead sets were also developed when direct 12-lead acquisition using a 10-wire lead set was not practical. Several innovative graphical solutions were developed to manage the large amount of data associated with continuous 12-lead ST monitoring, including ST-map for better visual tracking of ST measurements and deviations from a baseline, STEMI-map for more accurate tracking of STEMI criteria and ST-topology for more efficient ST trend review. A single-valued parameter, ST-index, was also developed to reduce the space required for displaying 12 ST measurements. To further improve diagnostic accuracy of acute ischemia/infraction detection, two 12-lead ECG based methods suitable for both continuous monitoring and diagnostic ECG application are being developed. The Vessel-Specific Leads (VSLs) method measures ST elevation from 3 optimal leads, calculated from the 12-lead ECG, for detecting ST-segment deviation during coronary occlusion. Preliminary results show that the method can identify acute ischemia with higher sensitive and specificity in comparison to the currently used STEMI criteria applied to the same 12 standard leads. The Computed Electrocardiographic Imaging (CEI) method presents a bulls-eye polar plot of the heart surface potentials based on inverse calculation from the body-surface potential map derived from the 12-lead ECG. Early results show that this method could be a useful clinical decision support tool for increasing the accuracy of ECG-based triage of chest-pain patients.

 

 

Mohammad Risandi Priatama

Faculty of Medicine Universitas, Indonesia

Title: Clinical presentation and prognosis in heart failure patients with reduced ejection fraction: A prospective one-year follow-up study in National Cardiovascular Center Harapan Kita, Indonesia

Time : 13:50-14:15

Speaker
Biography:

Mohammad Risandi P has worked as a General Practitioner for 2 years at Bintuni General Hospital, West Papua and Sofifi General Hospita, North Maluku, East Indonesia. He has completed his Medical education from Faculty of Medicine, Universitas Indonesia. He has obtained Fellowhip in Hypertension, Heart Failure, Pulmonary Hypertension and is working as a Research Assistant at National Cardiovascular Center Harapan Kita. He is the Member of Indonesian Doctors Association.

Abstract:

Statement of the Problem: Systolic Heart Failure (HFrEF) is characterized by ejection fraction of <40% and causes significant mortality and morbidity rate. We seek to characterize Indonesian patients’ clinical presentation (low to middle income country), one-year outcome and prognostic factors of HFrEF patients.

Method: Prospective cohort with consecutive sampling method was done in National Cardiovascular Center Harapan Kita (NCCHK), Jakarta from October 2013 to March 2014. NCCHK is a national heart referral center for 34 provinces in Indonesia. Data was obtained from medical records of HFrEF patients enrolled in ASIAN-HF study. One-year follow up was done via medical record or phone interview. Data was analyzed using SPSS version 23.

Findings: 90 HFrEF subjects (57.3±1.17 years) were obtained. Angina was more commonly seen in higher EF group (21-40%; p=0.016). At one-year, 22.2% died. Lower EF group had higher rate of death (p>0.05). Age, rales and elevated JVP were predictive of death regardless of EF (p<0.05).

Conclusion: Angina was more commonly seen in higher EF group. Signs of congestion are associated with poorer prognosis. Low EF (<20% vs. 21-40%) had clinically high rate of death (26.7% vs. 13.3%, p>0.05).

Ezzeldin A Mostafa

Ain Shams University Hospital, Egypt

Title: Outcomes of right atrial electromaze ablation of supraventricular tachydysrhythmias in patients with non-neonatal Ebstein’s anomaly
Speaker
Biography:

Ezzeldin A Mostafa is an Emeritus Professor and Past HOD of Cardiovascular and Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt. He is the Ex-Managing Director of Cardiac Surgery Academy, Ain-Shams University, Cairo, Egypt. He has Bachelor’s degree from Faculty of Medicine, Ain-Shams University (1976), MSc in General Surgery and then in Cardiology and Vascular Diseases (MCVD), and then his PhD (MD) in Thoracic and cardiovascular surgery (1984) and lastly MBA from ESLSCA (2010). He is a Member of the Society of Thoracic Surgery; the European Association of Cardio-Thoracic Surgery; the World Society of Pediatric Cardiology and Cardiac Surgery and the Egyptian Society of Cardio-Thoracic Surgery (ESCTS), etc. His major interests are neonatal and pediatric cardiac surgery, mitral and aortic valve repair, Ebstein’s repair, dysrhythmia and maze surgery and health management by information system.

Abstract:

Background: Favorable outcomes in EA reparative procedures are predicated on tricuspid valve competence, right ventricular function and presence of arrhythmia. We report our experience with right atrial electromaze for supraventricular tachydysrhythmias in patients with non-neonatal Ebstein’s Anomaly (EA)

Objectives: Assessment of clinical outcomes of right atrial electromaze for supraventricular tachydysrhythmias in patients with non-neonatal Ebstein’s Anomaly (EA).

Method: Between January 2002 and December 2013, retrospective review of 37 patients had operations for refractory atrial dysrhythmias, 6-step right atrial electromaze with concomitant anatomy-specific repair, as a part of this three-step surgical protocol for Ebstein's anomaly was done. A 6th step had been added to previously described 5-step right atrial electromaze. Mechanisms of arrhythmia included atrial re-entry (n=16), atrial fibrillation (n=15), automatic atrial (n=3), accessory connections (n=6) and atrio-ventricular nodal reentry (n=2). Mean age at operation was 17.3 (9.1-56.2) years. Postoperatively all patients were followed up regularly for mean period 5.3 (1-12) years by clinical examination, electrocardiography and echocardiography.

Results: The in-hospital mortality was one patient (2.7%) with no late deaths. Doppler echocardiographic examination revealed significant improvement of valve regurgitation (p<0.0001). New York Heart Association (NYHA) functional class was class I in 77.8% of the survivors and II in 22.2%. Mild Tricuspid Regurgitation (TR) (grade-1) was found in 72.2% and required no treatment and moderate TR (grade-2) in 25% which necessitated continuous anti-failure medical treatment. The cardiothoracic ratio decreased significantly (p<0.05). No deleterious effects of the Bidirectional Cavopulmonary Anastomosis (BDCPA) have been reported. Sinus rhythm has remained stable over the follow-up period in 31 patients (86.1%).

Conclusion: Successful surgical therapy of arrhythmias can be performed safely at the time of repair of non-neonatal EA. Early consideration for single-stage therapy of arrhythmia and structural heart disease is indicated whether symptomatic or asymptomatic and cyanotic or acyanotic.

Avinash Yashwant Pawar

D Y Patil Hospital, India

Title: Corelation of pulmonary capillary wedge pressure calculated by Echo Doppler with invasive measurement by Swan-Ganz catheter in post CABG patients

Time : 14:40-15:05

Speaker
Biography:

Avinash Pawar is currently working as a Senior Resident in the Department of Cardiology at D.Y. Patil Hospital, Navi Mumbai. He has keen interest in clinical and interventional cardiology.

 

Abstract:

Introduction: The evaluation of cardiac function, pulmonary and therapeutic implications. The Swan-Ganz catheter can be placed bedside but it is also not free of complications. The flow propagation velocity of early mitral inflow measured by conventional Doppler and the displacement of the mitral annulus measured by Tissue Doppler has been shown to accurately reflect Pulmonary Capillary Wedge Pressure (PCWP) in cardiac patients.

Objectives: To study the correlation of PCWP calculated by Echo Doppler with invasive measurement by Swan-Ganz catheter in post Coronary Artery Bypass Graft (CABG) patients.

Method: 35 patients, who were diagnosed as multi-vessel coronary artery disease on coronary angiography and underwent elective coronary artery bypass grafting, were selected for this study. Each of the patients included in the study underwent pulmonary artery catheter (Swan-Ganz) placement before the surgery for hemodynamic measurement. Measurement of PCWP by Echo Doppler study and pulmonary artery catheter done simultaneously after transferring the patient in ICU and when patients are hemodynamically stable and on necessary post-operative medical management.

Results: In our present study, there was no statistically significant correlation between peak E wave velocities and measured PCWP by Swan-Ganz catheter (r=0.311, p=0.069). The relationship between E/Ea ratio and measured PCWP by Swan-Ganz catheter was the strongest (P<0.001) of all Echo Doppler variables determined. We found that if E/Ea ratio is <8, it indicates normal pulmonary capillary wedge pressure (<12 mm of Hg) and if E/Ea ratio >15 indicates raised pulmonary capillary wedge pressure (>15 mm of Hg). The E/FPV ratio >2 for predicting an elevated PCWP (>15 mm of Hg) in post CABG patients had good sensitivity (96%) and specificity (89%). It should be determined in conjugation with E/Ea ratio for the assessment of both diastolic function and filling pressures. Pulmonary capillary wedge pressure determined by different echocardiographic equations using different variables like E/Ea ratio, E/FPV ratio, FPV and IVRT had significant positive correlation with measured PCWP by Swan-Ganz catheter.

Conclusion: Echocardiography can be used as a bedside method of estimating and monitoring PCWP. Thereby, it will make follow up of patients with congestive heart failure more comfortable and less expensive. In addition, echocardiographic technique can be applied easily for the outdoor patients for rough estimation of PCWP.

Ezzeldin A Mostafa

Ain Shams University Hospital, Egypt

Title: Bileaflet mechanical valves: They are not the same

Time : 15:35-16:00

Speaker
Biography:

Ezzeldin A Mostafa is an Emeritus Professor and Past HOD of Cardiovascular and Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt. He is the Ex-Managing Director of Cardiac Surgery Academy, Ain-Shams University, Cairo, Egypt. He has Bachelor’s degree from Faculty of Medicine, Ain-Shams University (1976), MSc in General Surgery and then in Cardiology and Vascular Diseases (MCVD), and then his PhD (MD) in Thoracic and cardiovascular surgery (1984) and lastly MBA from ESLSCA (2010). He is a Member of the Society of Thoracic Surgery; the European Association of Cardio-Thoracic Surgery; the World Society of Pediatric Cardiology and Cardiac Surgery and the Egyptian Society of Cardio-Thoracic Surgery (ESCTS), etc. His major interests are neonatal and pediatric cardiac surgery, mitral and aortic valve repair, Ebstein’s repair, dysrhythmia and maze surgery and health management by information system.

 

Abstract:

Background: Continuous effort is still provided in designing optimal artificial heart valves with better hemodynamic function and reduced thromboembolic potential. The question is do we have moved forward toward this goal or not.

Method: A prospective, randomized comparative study was done on 360 patients scheduled for elective mitral valve replacement. Patients were grouped into On-X group (n=180) who received On-X mechanical valve and St-Jude Medical prosthetic valve, SJM (n=180) who received St Jude mechanical valve. Echocardiographic and clinical assessments were performed for all patients at 6 and 12 months follow up period.

Results: Rheumatic heart disease was the most common cause of valve affection (94.2%). Early mortality was 6.4%. The mean followup time was 3.11±2.44 years. No structural or non-structural valvular dysfunction and no thrombo embolism cases were encountered. Late valve thrombosis was 1.9%/patient year in On-X group and 2.1%/patient year in SJM group. The mean Effective Orifice Area (EOA) was higher in on-X group (2.0±0.3 cm2) than in SJM group (1.9±0.2 cm2), (P value≥0.05). The mean Indexed effective orifice area, EOAI was higher in On-X group (1.1±0.1 cm2/m2) than in SJM group (1.0±0.1 cm2/m2), (P value=0.034), especially significant in small valve size (25 mm) where it was 1.09±0.21 cm2/m2 in On-X group and 0.93±0.12 cm2/m2 in SJM group, (P value=0.02).

Conclusion: On-X and St Jude prosthetic valves have a comparable hemodynamic performance in mitral position. However, On-X prosthesis might have a forwardstep on the way of design technology that may allow better function in terms of EOA and Effective Orifice Area (EOAI) especially in smaller valve size.