Conference Schedule

Day1: May 24, 2018

Keynote Forum

Biography

Carlin S. Long, MD, is a UCSF Professor of Medicine and Director of the Center for Prevention of Heart and Vascular Disease. Dr. Long earned his MD at the University of Texas Southwestern Medical School. Dr. Long received his Internal Medicine and Cardiology training at the University of California San Francisco where he stayed as faculty member until 1998 when he joined the faculty of the University of Colorado.  Dr Longs research is focused on understanding the role of pro-inflammatory molecules in the transition from compensated to decompensated myocardial failure. He is particularly interested in how cells in the heart “speak” to one another in normal and abnormal growth with a particular interest on the cardiac fibroblast which initiates the process of repair within the heart muscle both in response to injuries such as heart attack, but also that seen in long-standing high blood pressure and certain valvular diseases.

 

Abstract

 

Cardiac fibroblasts serve important roles in cardiac structure and intercellular communication in both normal and injured myocardium.  While infiltrating immune-inflammatory cells are the primary initiators of the early phase of the response to injury, cardiac fibroblasts are the principal resident tissue cell involved throughout the process of wound healing. Two critical aspects of cardiac fibroblast phenotype in response to injury are well recognized. First, the transition into the myofibroblast phenotype, so named due to their expression of contractile proteins, like smooth muscle alpha-actin which contribute to wound contracture. The myofibroblast is the primary source of collagen deposition which may persist for long periods of time following resolution of injury and scar maturation. Second, the physiologic resolution of the wound healing response requires the myofibroblast to inactivate these functions and return to the quiescent basal state. It is presumed that termination occurs by apoptosis, although the regulatory mechanisms remain undefined. Thus physiologically appropriate functions of cardiac fibroblasts require profound phenotypic transitions, and termination of the activated phenotype. Studying hepatic fibrosis, David Brenner used a unique transgenic reagent which simultaneously express the red fluorescent protein (RFP) under control of the alpha smooth muscle actin (aSMA) promoter and the green fluorescence protein (EGFP) under the control of collagen a1 (I) promoter. We took advantage of these animals to study these phenotypic transitions both in vivo and in vitro. For the in vitro studies we have used an automated program of “counting” red, green and yellow (red+green) cells and have subjected these cells to high-throughput screening in the presence of chemical libraries and candidates found to have the most promise with this approach in vivo. We believe this represents a unique approach for defining therapeutic approaches to studying pathologic fibrosis with great potential.

Biography

Having obtained a PhD in Medicine in 1978, Dr Simon Allen specialised in internal medicine. For years, he worked at and subsequently headed a hospital’s cardio-vascular department, and treated patients with various internal diseases, including cardio and renal diseases. He authored many scientific articles in peer-reviewed journals on metabolic disorders, including obesity, arthritis, renal, cardio-vascular and gastroenterological diseases. He lectured doctors pursuing higher medical qualifications. He then devoted two decades to pioneering medical research into various chronic internal diseases. He established Fine Treatment in Oxford, UK, authored The Origin of Diseases Theory, invented and patented therapeutic Dr Allen’s Devices as effective tools of non-invasive Thermobalancing therapy.

 

Abstract

10-year long patient observations have demonstrated that the therapeutic Dr. Allen’s Device relieves angina pain and discomfort in the chest area when used as a supporting tool in the treatment of coronary heart disease. Considering its efficacy in the treatment of other internal organs, it is suggested that Thermobalancing therapy with Dr Allen’s Device might improve blood circulation in the capillaries of the heart tissue, helping to prevent formation of coronary artery plaque and helping to dissolve coronary artery plaque, and thereby strengthen the cardiac muscle. The device may aid recovery after a heart attack. The Origin of Diseases theory shows that certain physiological processes at the capillary level around the affected coronary artery may become pathological, leading to the development of plaque and coronary heart disease and, consequently, to the deterioration of the function of this vital organ. Comprising a wax-based thermo-element, and when applied to the skin, Dr Allen’s Device accumulates the naturally emitted body heat and uses this energy to help to stimulate blood circulation at the capillary level that helps to ease troubling symptoms, and may dissolve plaque and improve the condition of the heart muscle over time.

 

Biography

Marco Picichè (MD, Ph.D.) graduated with a degree in medicine from the University of Florence in 1995 and completed his cardiac surgery residency at the Tor Vergata University of Rome in 2000, both summa cum laude. He has worked as an assistant at Saint Luc Hospital, Catholic University of Louvain, Brussels (1999–2001), as a clinic head/hospital assistant at the universities of Clermont-Ferrand (2003–2004) and Montpellier (2004–2007). He held regular teaching appointments at the university of Montpellier school of medicine, obtained certification by the French Board in cardiac surgery (Paris, 2007), earned his research master in surgical science (Paris, 2007). In Canada he authored a research project on ‘‘Noncoronary collateral circulation,’’ at Québec Heart & Lung Institute, Laval University. In September 2011 he received a doctor of philosophy (Ph.D.) in therapeutic innovations from Paris-Sud University. He is the Editor in Chief of the book : « Dawn and evolution of cardiac procedures : research avenues in cardiac surgery and interventional cardiology » (Springer-Verlag publishing house). Currently he is a consultant cardiac surgeon in Italy.

 

Abstract

Coronary artery bypass grafting remains the gold standard  for the treatment of patients with severe coronary disease. Although percutaneous coronary interventions are the first treatment for single or two vessels disease, when coronary disease involves three vessels, especially in diabetic patients, surgery remains the best option.   Coronary artery bypass surgery is endorsed by the excellent, well-documented, long-term results that follow complete revascularization and the use of mammary artery grafts. However, there is an endless  debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass surgery. The off-pump literature is divided into an early, enthusiastic   phase with results favoring off-pump surgery, an intermediate phase with conflicting results, and a current phase, with publications on leading journals favoring on-pump surgery.  Nowadays, most centers perform on pump surgery, limiting off-pump surgery to a single anastomosis on the left anterior descending artery in single vessel disease. Herein, an extensive review of surgical techniques in coronary surgery is presented. 

 

Tracks

  • Cardiac Remodeling|Pediatric Cardiology |Cardiac Medications | Advanced Devices Used to treat Cardiac Diseases | Cardiovascular Disease |
Location: Armstrong
Speaker

Lemin Zheng,

Peking University, China

Chair

Biography

Rachad Mounir Shoucri has a BSc in Electrical Engineering from Alexandria University, Egypt, a MSc in Optical Physics and a PhD in Theoretical Physics from Laval University, Québec, Canada. After graduation in 1975 he worked for five years at the Hôpital du Saint-Sacrement and the Institut de Cardiologie de Québec where he developed his current interest in mathematical physiology and the application of mathematics in cardiology. Since 1981 he is with the Department of Mathematics and Computer Science of the Royal Military College of Canada, Kingston, Ontario, where he is now Emeritus Professor.

Abstract

The theory of large elastic deformation was applied to the myocardium in a way to obtain a mathematical expression for the pressure-volume relation (PVR) as well as for the end-systolic pressure-volume relation (ESPVR) in the heart ventricles. Several relations between the ejection fraction (EF) and the parameters describing the ESPVR have been derived. A relation between EF and percentage of heart failure (HF) has been extended in a way to obtain new relations between percentage of HF and the parameters describing the ESPVR, these relations give new insight into the problem of heart failure with preserved ejection fraction (HFpEF). Non-invasive application of the results of this study in routine clinical work is possible when ratios of pressures in the heart ventricles are calculated. Applications to clinical data published in the medical literature give consistent results, they show the possibility to classify the state of the ventricles into normal state, mildly depressed state, severely depressed state. Results show that bivariate (or multivariate) analysis of data give better classification for the purpose of clinical diagnosis.  

Biography

Dr Howie (Hao) Tran, MD, is board-certified cardiologist who specializes in treating patients with end-stage or advanced heart failure. He cares for patients who require heart transplants and mechanical circulatory support devices, including ventricular assist devices (VADs) and percutaneous ventricular assist devices (PVADs).As an assistant professor in the Division of Cardiovascular Medicine, Dr. Tran instructs students, residents and fellows at UC San Diego School of Medicine.He has lectured and coauthored numerous journal articles on advanced therapies in heart failure and the use of VADs. His work has appeared in Journal of the American College of Cardiology and Circulation: Heart Failure.Dr. Tran did his medical training in advanced heart failure, mechanical circulatory support and transplant cardiology at UC San Diego School of Medicine. He completed a general cardiology fellowship at the Warren Alpert Medical School of Brown University, where he also completed a residency in internal medicine. Dr. Tran earned his medical degree from Drexel University College of Medicine in Philadelphia. He is board-certified in internal medicine, cardiovascular disease and advanced heart failure and transplant cardiology. 

Abstract

Patients with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels 1–2 who either have or are at risk for right ventricular failure face significant morbidity and mortality after continuous flow left ventricular assist device (CF-LVAD) implantation. Currently, the options for biventricular support are limited the Total Artificial Heart (TAH; CardioWest, Syncardia, Tuscon, AZ) or biventricular assist device (BiVAD), which uses bulky extracorporeal or implantable displacement pumps. We describe a successful series based on an innovative approach for biventricular support in consecutive INTERMACS levels 1–2 patients utilizing a HeartWare Ventricular Assist Device (HVAD; HeartWare, Framingham, MA) in a left ventricular (LV-HVAD) and a right atrial (RA-HVAD) configuration. From June 2014 through May 2016, 11 consecutive INTERMACS levels 1–2 patients with evidence of biventricular failure underwent implantation of a CF LVAD (10 LV-HVAD and 1 HeartMate II LVAD, Thoratec, Pleasanton, CA) and RA-HVAD pumps. A total of 4,314 BiVAD support days were accumulated in our case series. Seven patients have undergone orthotopic heart transplant, whereas 3 are ambulatory and are either waiting transplant or reconsideration for transplantation. There is one mortality in this case series, which was due to an intracranial bleed from supratherapeutic anticoagulation. Two other patients experienced hemorrhagic strokes, but without neurologic sequelae, whereas no patients have experienced ischemic strokes. There were two episodes of gastrointestinal bleeding. This is the largest series to date involving this approach with outcomes superior to those previously described in patients receiving biventricular support. We conclude this novel therapy is a viable alternative to current practices in the management of biventricular failure.

 

Biography

Dr. Joyce Akwe completed her residency training and a chief resident year at Morehouse School of Medicine in 2010. After that, she joined the Medical Staff at the Atlanta VA Medical Center. She also joined faculty at Emory University School of Medicine in 2010. Currently, Dr. Joyce Akwe is an Associate Professor of Medicine at the Emory University School of Medicine. She is the Assistant Chief of Hospital Medicine at the Atlanta VA Medical Center. Her interests are in Quality Improvement in medicine, Medical Education and Medical Simulation. She is the lead for Simulation at the Atlanta VA medical Center. She has completed and published more than 60 peer reviewed articles, abstracts or book chapters. She has created several evidence based order sets for the Atlanta VAMC. She is the clerkship director for Morehouse School of Medicine internal medicine clerkship rotation at the Atlanta VA Medical Center.

 

Abstract

The time from cardiac arrest to the administration of CPR and defibrillation greatly influence the outcome of in-patient cardiac arrest. Both the time to defibrillation and the start of CPR could be influenced by several factors. In order to cut down on these barriers to a successful code, we administered pre-code readiness training to the hospital staff with various background and level of responsibilities The goal of our program was to reduce the response time to in-hospital cardiac arrest by focusing on the factors which have been reported to increase the response time such as lack of a vascular access, equipment malfunction or even discrepancies in alerting hospital-wide resuscitation response. Twelve questions were prepared to address the main aspects that could reduce the time to defibrillation and contribute to the success of a code.  A total of 125 volunteers were trained.  First they completed the 12 question questionnaire. Next, they completed training on how they could assist in preparing a deteriorating patient or a patient at high risk of having a cardiac arrest. Lastly, they were placed in a simulated patient room and a real life situation was simulated.Prior to the training, 968 answers to these questions were correct. After the training, 1484 answers were correct (Value is < 0.00001). The difference in the correct answers before and after the training was statistically significant for each of the questions. Too much valuable time is wasted at the beginning of a code. The hypothesis is that recognizing a patient at a high risk of having a cardiac arrest and preparing the patient and his environment to a cardiac arrest may lead to a better outcome. This training program covered the most common aspects that could contribute to rapid intervention and consequently a successful code.

 

Biography

Lemin Zheng has completed his PhD in 2005 from Cleveland Clinic/Cleveland State University in Clinical/Bioanalytical Chemistry. Currently, he is the lab director and professor in Institute of Cardiovascular Sciences, Peking University (China), Key Laboratory of Molecular Cardiovascular Science of Ministry of Education. His main field of research is lipoprotein, lipids, vascular function and bio-material. He has published more than 60 papers in reputed journals, such as the Journal of Clinical Investigation, Clin. Cancer Res., Advanced Functional Materials, Nanoscale, ACS APPL MATER INTERFACES, Free Radical Biology and Medicine, JAHA, International Journal of Cardiology, BBA-Molecular and Cell Biology of Lipids, JBC, Nature Structural & Molecular Biology, ATVB, Int. J Cancer, Cardiovasc Diabetol, Journal of Translational Medicine, AJP...... He has more than 1600 SCI citation. He has been served as an editorial board member of Cardiovascular & Hematological Disorders - Drug Targets, and Lipid & Cardiovascular Research. He has a U.S. patent.

Abstract

Metabolomics has been increasingly recognized as an enabling technique with the potential to identify key metabolomic features in an attempt to understand the pathophysiology and differentiate different stages of Coronary heart disease (CHD).We performed comprehensive metabolomic analysis in human plasma from 28 human subjects with stable angina (SA), myocardial infarction (MI), and healthy control (HC). Subsequent analysis demonstrated a uniquely altered metabolic profile in these CHD: a total of 18, 37 and 36 differential metabolites were identified to distinguish SA from HC, MI from SA, and MI from HC groups respectively. Among these metabolites, glycerophospholipid (GPL) metabolism emerged as the most significantly disturbed pathway. We used a targeted metabolomic approach to systematically analyze GPL, oxidized phospholipid (oxPL), and downstream metabolites derived from polyunsaturated fatty acids (PUFAs), such as arachidonic acid and linoleic acid. Surprisingly, lipids associated with lipid peroxidation (LPO) pathways including oxidized PL and isoprostanes, isomers of prostaglandins, were significantly elevated in plasma of MI patients comparing to HC and SA, consistent with the notion that oxidative stress-induced LPO is a prominent feature in CHD. Optical coherence tomography (OCT) has been considered as the ideal tool for the evaluation of atherosclerotic plaques. Circulating trimethylamine-N-oxide (TMAO), which is a metabolite of the dietary lipid phosphatidylcholine by gut microbiota, has recently been linked to elevated CHD risk. A total of 26 patients with CAD were recruited to assess coronary plaque using OCT and measure plasma TMAO level. According to plaque rupture status, patients were divided into plaque rupture group (n = 12) and non-plaque rupture group (n = 14). Plasma TMAO level was significantly higher in patients with plaque rupture than in those with non-plaque rupture (8.6 ± 4.8 μmol/L vs 4.2 ± 2.4 μmol/L, p = 0.011). In conclusion, circulating TMAO level may reflect coronary plaque vulnerability and progression.

Biography

Dr. Fumihiro Tomoda is a Professor of Fukui Health Science University. He belongs to Japanese Society of Internal Medicine, Japanese Society of Nephrology, Japanese Society of Hypertension, Japanese Society for Dialysis Therapy and Japanese Circulatory Society. Currently, he is also in the position of Editor-In-Chief for the Journal of “Insights in Blood Pressure”. He got Specialist in clinical nephrology and cardiology, Medicine Doctor's degree (Ph.D., Thesis: systemic and renal hemodynamics in essential hypertension) and several awards at Toyama Medical and Pharmaceutical University. His researches focus on sympatho-adrenal system and its association with cardiovascular risk factors such as cardiovascular structural remodeling, platelet activation, hemorheologic abnormalities and metabolic disorder in hypertension.

Abstract

In essential hypertensives (EHT), the complication of metabolic syndrome (Mets) enhance sympatho-adrenal system and its responsiveness to stress. Although sympatho-adrenal activation can reduce insulin sensitivity, the influences of acute stress on insulin sensitivity remains to be elucidated in EHT when complicated with Mets. In this study, therefore, the effects of mental arithmetic stress (10-minute serial subtraction of 7 from 1000) on insulin sensitivity were compared between 39 EHT with Mets and 51 EHT without Mets. Before stress, fasting blood glucose (FBS), fasting plasma insulin (PI) and homeostasis model assessment of insulin resistance (HOMA-IR, i.e., index of insulin resistance) were higher in EHT with Mets than in EHT without Mets, although blood pressure, pulse rate and plasma levels of noradrenaline (PNA) and adrenalin (PAD) did not differ between both groups. Arithmetic stress increased blood pressure and pulse rate to the similar extent in both groups. Although stress increased PNA and PAD in the two groups, the increase of PNA induced by stress was greater in EHT with Mets than in EHT without Mets. FBS did not change following stress in either group. Contrary, IR and HOMA-IR increased after stress in both groups. Furthermore, the increases of IR and HOMA-IR induced by stress were more pronounced in EHT with Mets (1.76±1.22 to 2.10±1.30) comparted with EHT without Mets (0.97±0.60 to 0.99±0.54) (group×stress interaction: p< 0.05). In EHT complicated with Mets, metal arithmetic stress aggravated insulin resistance concomitantly with the exaggerated activation of sympathetic nervous system.

Biography

Mingguo Xu has completed his PhD at the age of 28 years from Sun Yat-Sen  University and postdoctoral studies from The Johns Hopkins Hospital. He is the director of pediatric department in ShenZhen Children’s Hospital. He is talented in pediatric cardiology, including interventional therapy of congenital heart disease and the basic research of Kawasaki disease. He has published more than 11 papers in reputed journals.

Abstract

      Ventricular septal defect (VSD) is a common congenital heart disease in children. There are two methods to treat VSD in China, surgical operations and interventional operations using occluders produced in China. In our department, we have treated  1500 cases using occluders produced in China  from 2005 to 2017. The technique successful rate is higher than 99.8ï¼…. The rate of complications is less than 1ï¼…. The complications include heart block, occluder transposition,  femoral arteriovenous fistula and thrombosis in femoral artery and vein. We followed up these cases after the operation, which showed that the long-term effects are definite.  There is no case to be death because of the procedure. We concluded that children with VSD can be cured with interventional therapy using occluders produced in China with satisfactory results. 

Biography

Mikhaylov Vladimir was born on March 21, 1959 in Uglich, Yaroslavl province, Russia. In1982- has finished the Ryazan medical institute named after I.P. Pavlov.  1997 – 2000 - Head of Moscow Scientific-Practical Center of laser Medicine. 2000 – 2006 -General director of Scientific medical laser Center, Moscow.  Since 2006 - private practices on family medicine in Moscow. 2013- Physician Contract with Eternity Medicine Institute, Dubai 1988- protected a degree of  Ph.D. - Formation dublical anastomosis in surgery of intestinum and pancreas (Diploma – МД â„– 030634, Moscow, 01.07.1988). 1994 - received a degree  Sci.D.  - Use of low- level of laser radiation in treatment of oncology diseases (Diploma – Др  â„– 002389, Moscow, 29.07.1994, â„– 36д/5). 2009 - Has been recognized as an International Medical Laser Specialist at class: Hon-IMeLas, Number: H-0017,  Congress ISLSM, WFSLMS, Tokyo, November 27, 2009.In 1996 - was elected by the member International Advisory Board on the 1st. Congress of the World Association on Laser Therapy (WALT) in Jrusalem, Israel. In 1998 - was elected the Representative of the WALT in Russia and East Europe on the 2nd. Congress of the World Association on Laser Therapy (WALT) in USA. In 1999 was selected in Board of directors (EMLA), direction – oncology and angiology in Vienna, Austria. In 2000 - is selected by a member of editorial board of the “Laser Therapy”. In 2001- President  of the VIIIth Congress of European medical laser association (EMLA), Moscow, Russia. In 2002 - is selected by in Task Force in IIId Congress of World Association for Laser Therapy (WALT), Tokyo Japan.2016 - Prof. Ming-Chien Kao AWARD (for the paper contributed to the journal LASER THERAPY(Vol.24-1, Jan.2015 issue).

 

 

Abstract

The mortality from the diseases due to the affection of vessels came out now on the first place. The use of the Intravenous laser blood irradiation (ILBI) within the last 30 years showed its high efficiency in a treatment of diseases of vessels and heart, and other system diseases. Therefore ILBI as the method of the system impact on the blood system, allows to lower  the lethality and to increase the life expectancy.The lasers used for treatment of various diseases, the waves having length of 630-640 nanometers are the most effective for the direct impact on the blood and the vascular wall. The energy of the waves of this length is absorbed by oxygen, improves the microcirculation in tissues, changes the viscosity of the blood and affects the wall of vessels.

 

 

Biography

Mikhaylov Vladimir was born on March 21, 1959 in Uglich, Yaroslavl province, Russia. In1982- has finished the Ryazan medical institute named after I.P. Pavlov.  1997 – 2000 - Head of Moscow Scientific-Practical Center of laser Medicine. 2000 – 2006 -General director of Scientific medical laser Center, Moscow.  Since 2006 - private practices on family medicine in Moscow. 2013- Physician Contract with Eternity Medicine Institute, Dubai1988- protected a degree of  Ph.D. - Formation dublical anastomosis in surgery of intestinum and pancreas (Diploma – МД â„– 030634, Moscow, 01.07.1988). 1994 - received a degree  Sci.D.  - Use of low- level of laser radiation in treatment of oncology diseases (Diploma – Др  â„– 002389, Moscow, 29.07.1994, â„– 36д/5). 2009 - Has been recognized as an International Medical Laser Specialist at class: Hon-IMeLas, Number: H-0017,  Congress ISLSM, WFSLMS, Tokyo, November 27, 2009. In 1996 - was elected by the member International Advisory Board on the 1st. Congress of the World Association on Laser Therapy (WALT) in Jrusalem, Israel. In 1998 - was elected the Representative of the WALT in Russia and East Europe on the 2nd. Congress of the World Association on Laser Therapy (WALT) in USA. In 1999 was selected in Board of directors (EMLA), direction – oncology and angiology in Vienna, Austria. In 2000 - is selected by a member of editorial board of the “Laser Therapy”. In 2001- President  of the VIIIth Congress of European medical laser association (EMLA), Moscow, Russia. In 2002 - is selected by in Task Force in IIId Congress of World Association for Laser Therapy (WALT), Tokyo Japan.2016 - Prof. Ming-Chien Kao AWARD (for the paper contributed to the journal LASER THERAPY(Vol.24-1, Jan.2015 issue).

 

 

Abstract

The main role in transportation of blood to the capillary bed is played by the artery, the power of the heart is only 0,49 -0,027 % of the power needed to transport blood to the capillary bed. The vascular pump is regulated by the frequency of contractions of the heart muscle and is tightly synchronized with the work of the heart.The rapid spread of the pulse wave causes a suction effect. Following the reduction of the vessel wall, the blood is just drawn from the aorta and large arteries to the smaller vessels down to the capillary bed. Systematic irregularities in the vascular pump cause increased pressure in arteries located above the lesion and lead to the development of hypertension and can be a starting point in the development of various diseases of the cardiovascular system and other body systems. These illnesses may be both local and systemic, depending on the size and the location of pathological changes in the vascular wall.

 

Biography

After completing his MBBS and MS in General Surgery, he did his Mch in CVTS from Seth GS Medical College, Mumbai in 2008. He later joined Narayana Hrudayalaya, Bangalore in 2008, which a 1000 bedded hospital executing close to 600 open heart surgeries in a month.He worked as a Fellow in Adult Cardiothoracic department in Royal Melbourne Hospital, Australia, which is the second largest Cardiothoracic unit in the whole of Australia. After working in Australia for 2 years he rejoined Narayana Hrudayalaya, as Consultant Cardiothoracic Surgeon in 2012 and worked there till 2015. He has independently performed about 1000 open heart surgeries, consisting of Coronary Artery bypass surgeries and Valve Replacements. His area of interest is Coronary Artery bypass, especially Total Arterial Revascularization. He joined Aster CMI Hospital in Feb 2016 as Consultant Cardiothoracic Surgeon.

 

Abstract

Statement of the problem: In India 2.78 million deaths are due to cardiovascular diseases of which 50% are due to CAD. Peculiarities of CAD patterns in Indian patients younger age at presentation, high incidence of double vessel disease (DVD) and triple vessel disease (TVD) , diffuse involvement, distal disease and significant left ventricular (LV) dysfunction at presentation. Length of significant stenosis > 20 mm, multiple significant stenosis (> 70% narrowing) in the same artery separated by segment of apparently normal vessel and significant narrowing involving the whole length of coronary artery.We in our institute perform Off Pump Coronary Artery Bypass (OPCAB), use left internal mammary artery (LIMA) and veins as conduits to perform the surgery. Once the conduits are harvested, we heparinize with I.V. Heparin 3 mg/Kg given to achieve an ACT >300. Using the octopus as stabilizer, we perform an endartrectomy of the left anterior descending (LAD) first and then use a vein patch to cover the defect. LIMA is then used to anastomose the LAD on the vein patch. Veins are used to bypass the Left Circumflex (LCX) and right coronary artery (RCA), as deemed appropriate. The proximal ends of the vein grafts are anastomosed to Ascending Aorta with side clamp and heart beating. Intraop we start Lomodex infusion 20ml/hr which is continued for 24 hours and the inotropes used are Adrenaline and Dobutamine as and when necessary. Postoperatively aspirin 75mg is given and Heparin infusion started after 6hours to maintain activated clotting time (ACT) of around 150 for 24 hours. Patients are usually extubated after 4 hours provided they are hemodynamically stable. Anticoagulation by Acitrom is commenced orally from day 1 to maintain an INR of 2 for 3 months.Out of the 20 patients in last 18months outcomes have been excellent with no in-hospital mortality or cerebrovascular incidents. Off pump CABG (Coronary Artery Bypass Grafting) with coronary end-arterectomy offers a good solution to the problem of diffuse coronary artery disease.Off pump CABG (Coronary Artery Bypass Grafting) with coronary end-arterectomy offers a good solution to the problem of diffuse coronary artery disease.


 

Biography

Weimei Ou has completed her Master degree from Peking University and pursuing PhD at Geriatrics Department, Peking University First Hospital, Peking University. She has published 4 papers in reputed journals and has been serving as a Peer Reviewer of several journals. She has participated in translating two professional English books into Chinese. She is enthusiastic about scientific research and has actively taken part in many academic activities, such as academic speech contest, workshop, and conference and so on. She is the Vice Minister of Inline Ministry, a department of Graduate Student Union.

Abstract

Aspirin is the most widely used antiplatelet agent, however, some patients exhibit “resistance” to aspirin, termed “high on-aspirin platelet reactivity (HAPR)”. It has been reported HAPR significantly increased risk of ischemic events. Several studies have used expression profiling of blood RNA by microarray to identify novel biomarkers and potential therapeutic targets for HAPR patients. However, evidence in Chinese patients is still lacking in this area. Our study on 34 RNA-sequenced peripheral blood samples from elderly patients with coronary artery disease (CAD) on regular aspirin treatment, 18 of them had recurrent cardiovascular events (CVE) while the other 16 were stable. A total of 56751 transcripts were analyzed by an unpaired t-test (p<0.05) and further filtered for a fold-change of >1.5 between two groups, yielding 39 differentially expressed transcripts (DET). Among the 39 DETs, we selected 7 transcripts to further validate in a large-scale patients (n=88) using real time quantitative PCR. The mean age of these 88 patients was 75.60±9.99 years old. Among them, HAPR patients showed no significant differences in terms of co-morbidities and combined drugs, while the relative expression of lysophosphatidic acid receptor 3 (LPAR3) was significantly decreasing when compared with low on-aspirin platelet reactivity (LAPR) patients (p=0.022). The area under ROC curve was 0.759 for LPAR3 to diagnose HAPR (p=0.011). Logistic regression analysis showed low-density lipoprotein cholesterol (LDL-C) was independent risk factor for HAPR (HR=5.066, p=0.013), while β-blocker might be protective factor for HAPR (HR=0.215, p=0.019). In conclusion, our study investigated circulating transcripts associated with HAPR in Chinese elderly patients with CAD and demonstrated that LPAR3 might be potential biomarker for HAPR. Nevertheless, larger-scale and long-term studies are still needed.