2^nd World Heart Congress May 14-16, 2018 Tokyo, Japan

Biography:

Wenhua Ling has completed his PhD from University of Eastern Finland and Postdoctoral studies from McGill University. He is the Director of Institute of Preventing Medicine of Sun Yat-sen University, China. He has published more than 180 papers in SCI journals.

Abstract:

Fetuin-A possess multiple roles in regulating cardiovascular disease. The present study was designed to evaluate the association of circulating fetuin-A with cardiovascular disease (CVD) and all-cause mortality. We measured plasma fetuin-A in 1620 patients using an enzyme-linked immune-sorbent assay kit. The patients were members of the Guangdong coronary artery disease (CAD) cohort and were recruited between October 2008 and December 2011. Cox regression models were used to estimate the association between plasma fetuin-A and the risk of mortality. A total of 206 deaths were recorded during a median follow-up of 5.9 years, 146 of whom died from CVD. The hazard ratios (HRs) for the second and third tertiles of the fetuin-A levels (using the first tertile as a reference) were 0.65 (95% confidence interval [CI] 0.44, 0.96) and 0.51 (95% CI 0.33, 0.78) for CVD mortality (P=0.005) and 0.65 (95% CI 0.47, 0.91) and 0.48 (95% CI 0.33, 0.70) for all-cause mortality (P<0.001), respectively. Lower plasma fetuin-A levels were associated with an increased risk of all-cause and CVD mortality in patients with CAD independently of traditional CVD risk

Biography:

Jenny-Lynn V Juhuri has completed her Medical Technology degree from University of Santo Tomas, Philippines and her Medicine degree from University of Santo Tomas Faculty of Medicine and Surgery.

Abstract:

Congenital coronary artery fistulas are rare cardiac defects. A fistula associated with other cardiac anomalies, like valvular heart disease, is an extremely rare condition. We report a young symptomatic patient who presented with a continuous murmur heard along second right intercostal space and a systolic murmur at the apex on clinical examination. Chest x-ray showed left ventricular prominence and transthoracic echocardiography with Doppler studies showed right coronary fistula draining into the right atrium and moderate mitral regurgitation. She is being followed up with medical management at the outpatient department. We recommend coronary angiography with cardiac catheterization and if patient will give her consent, surgical repair of the fistula with possible mitral valve surgery is recommended. We conclude that diagnosis of coronary artery fistula should be considered when patient presents with continuous murmur. A non-invasive test, like transthoracic echocardiography with Doppler studies, can demonstrate dilated coronary arteries and their receiving chambers or vessels.

Biography:

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German board certified Cardiac Surgeon with a subspecialization in Pediatric Cardiac Surgery. She was the Junior Consultant of the Congenital Heart Surgery at the University Hospital Erlangen, Germany (2006-2008), Research Fellowship at the Children's Hospital Boston, USA (2008-2009) and was the Director of Pediatric Cardiac Surgery in Mainz, Germany (2009-2011). She has also worked as Senior Consultant in Children Heart Center in Linz, Austria and since 2014 she is Senior Consultant at the University Hospital Munich, Germany and University Lecture 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: Due to an increasing waiting time for available donor organs in pediatric heart transplantation (pHTx) ABO-incompatible HTx (HTxi) may be a satisfying option and probably an unpreventable one. There is an immunological window of tolerance during the human embryonic development which persists into the time of infancy. It has the potential of developing natural antibodies to ABO-antigens. This process plays a significant role in ABOi organ transplantation and could maintain long-term tolerance to a certain degree in the setting of HTxi.

Methods: This systematic review and meta-analyses aims at providing an overview of the reported outcome of infants and small children with end stage heart failure after undergoing a HTx. A systematic literature search for publications reporting the outcome after pHTx published between 2001 and 2017 was conducted. Studies written in English with a study size of more than 10 patients were included. The primary outcome was mortality at HTx-listing and one year after ABO-compatible HTx (HTxc) or HTxi. Exploratory data analysis of four studies was analyzed. Two types of model (fixed effect model and random effect model) were represented. Primary outcome measure was all cause mortality or delisting on the HTx list.

Results: Total mortality on HTx list in all groups was: I2=89.9%, 95% CI=64%, 99.3%. Delisted from HTx list because of recovering or worsening of clinical status before HTx: I2=72.6%, 95% CI=16.8%, 97.5%. HTxc: I2=99%, 95% CI=97.3%, 99.8. 12 months survival after HTx was: I2=87.5%, 95% CI=56.1%, 99.1%. 86% of the patients survived 12 months after HTx in average with a 95% confidence interval of 0.84, 0.88.

Conclusion: HTxi is a good option with similar results compared to HTxc in infants. It might avoid the long waiting time and minimizes the risk of death on the waiting list. However, long-term results are yet to be determined, as well as complications and risks. Aspects such as renal function, infections, graft vasculopathy, the risk for malignancy and chronic rejection after HTxi remain to be examined closely.

Biography:

Hong Ju Shin is currently the Clinical Associate Professor at Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital. He also has the Membership at various societies such as The Asian Society for Cardiovascular Surgery, The Korean Society for Thoracic and Cardiovascular Surgery, The Korean Society of Circulation, The Korean Pediatric Heart Society and The Korean Medical Association.

Abstract:

A 23-year-old female patient with a history of pulmonary valvectomy for pulmonary stenosis at 2 years of age underwent pulmonary valve repair, which consisted of remnant cusp extension using a fresh pericardium and commissural resuspension. An immediate postoperative computed tomographic scan showed full movement of the extended anterior cusp during systole, yet flail motion during diastole. However, follow-up magnetic resonance imaging at 10 months postoperatively revealed a small amount of pulmonary flow regurgitation (2.0%).

Biography:

Martina Cebova has completed her PhD from Commenius University in Slovakia and Postdoctoral studies from Maine Medical Center Research Institute in USA. She has continued to work at the Institute of Normal and Pathological Physiology of Slovak Academy of Sciences as a Junior Scientist and since 2016 she is a Scientific Secretary of the institute. She has published in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

High mobility group box 1 (HMGB1) is a non-histone chromosomal protein associated with various pathological conditions such as cardiovascular disease, cancer and ischemia/reperfusion injury. The aim of the study was to evaluate the effects of HMGB1 protein on biochemical and morphological parameters after experimental myocardial infarction (MI). 12-week-old Wistar-Kyoto (WKY) male rats used for the study were divided into following groups: shame operated WKY without MI, WKY with MI, WKY + IM+ anti-HMGB1 protein. In vivo model of experimental MI was induced by ligation of the left descending coronary artery and lasted 20 min. Before reperfusion anti HMGB1 protein was administrated I.V. Animals survived 7 days after MI. NOS activity was determined by conversion of ³[H] Arginine to ³[H] Citrulline in the aorta and ischemic, border and non-ischemic region of the heart. NFÒ¡B expression was determined by Western blot. For morphological parameters, the hearts were processed by TTC-staining procedure. Cytokine levels were determined in the plasma. Concentration of CD was measured spectrophotometrically. Anti-HMGB1 protein increased NOS activity in both ischemic and border part of the heart, as well as in the aorta. It significantly decreased NFÒ¡B expression in MI part of the heart, TNF-alpha and IL-6 level in plasma. Simultaneously, anti-HMGB1 protein decreased MI part as well as border region of the heart. Considering the results, HMGB1 protein is a promising molecule for reduction the negative effects of the myocardium infarction, as well as a promising agent for the treatment of cardiovascular diseases.

Biography:

Punitha Arasaratnam became Member of the Royal College of Physicians in United Kingdom in 2008 and is a certified Cardiologist practicing in Singapore. She has completed a 2 year Fellowship in Advanced Multimodality Cardiac Imaging in Nuclear/PET, CT and MRI in Canada.

Abstract:

A 33 year old Asian woman, non-smoker with prior coronary artery bypass graft presented on the 10/1/2017 with central chest pain and shortness of breath. ECG showed anterior ST elevation myocardial infarction. An emergency cath showed native triple vessel disease, atretic left internal mammary artery graft, ostial SVG-OM (saphenous venous graft-obtuse marginal) 60% stenosis and SVG-RCA (right coronary artery) graft was patent. The native left main (LM), proximal left anterior descending (LAD) and the ramus intermedius (RI) was stented. On the 16/2/2017, she complained of chest pain and a repeat cath showed edge stenosis 70% of the proximal LAD stent with mid-distal LAD showing diffuse 60-70% disease and fractional flow reserve was 0.62 on hyperemia. The LM and RI stents were patent. The ostial SVG-RCA graft was occluded. She underwent balloon angioplasty (POBA) of the LAD and stenting of the SVG-RCA lesion. She complained of frequent episodes of chest pain and a nuclear myocardial perfusion scan showed significant ischemia in the left circumflex (LCx) artery territory. On the 3/8/2017, she underwent a POBA to a 100% in-stent restenosis to the RI. Computed tomography of the thoracic aorta showed eccentric wall thickening and moderate-severe narrowing in the proximal left subclavian artery suggestive of Takayasu’s arteritis. She was referred to the rheumatologist and commenced on oral prednisolone and methotrexate. This case illustrates a rare cause of recurrent angina in a young woman, albeit an LDL of 1.1 mmol/l. An early index of suspicion may have prevented the multiple coronary interventions.

Biography:

Satoru Takeno has completed his graduation from Akita University School of Medicine in 2001. After receiving training for General Pediatrics and Pediatric Cardiology, he completed his Postgraduate study at Mahidol University, Thailand. He is an Assistant Professor at Kindai University, where he engages in pediatric electrophysiology and catheter ablation.

Abstract:

The incidence of atrioventricular nodal reentrant tachycardia (AVNRT) is relatively uncommon during infancy, and increases with age. A possible reason for the tendency is explained by the immaturity of the atrioventricular node (AV node) in children. Histologically, it has been speculated that the right-sided nodal extension, which extends posteriorly along with the tricuspid valve from the compact AV node, acted as the anatomic substrate for the slow pathway during tachycardia attack. Several past studies revealed the growth-related changes in the length of the right-sided nodal extension, which supported the hypothesis of the relationship between the length of the right-sided nodal extension and the likelihood of AVNRT attack. Meanwhile, the role of left-sided nodal extension in the development of AVNRT has not been fully understood. A previous histological study reported that there was little correlation between growth and the length of left-sided nodal extension, contrary to the right-sided nodal extension. Several case reports of successful left-sided ablation for AVNRT that could not be ablated with the right-sided approach indicated the possibility of involvement of the left-sided nodal extension in some forms of AVNRT attack. In this presentation, I will discuss the conduction characteristics of both the left and the right-sided nodal extensions and their roles in the development of AVNRT attack.

Biography:

Carola Y Forster has a convincing track record in neurophysiology with a strong focus on the dysfunctions of the blood-brain barrier (BBB). A significant aspect of her research is related to regulation of gene expression at the BBB, specifically by non-coding RNA, particular microRNA, to offer pharmacological solutions to the observed BBB alterations. For this, she systematically studies the mechanisms from gene regulation, through transcription, to protein degradation and cellular morphology, linking basic science with clinical aspects. After years of experience in research, evaluation, teaching and administration both in hospital and education institutions, she developed different in vitro and in vivo models of cerebrovascular disease and established recently a division of computational model to further strengthen this area of research.

Michiaki Nagai has completed his graduation from the Jichi Medical University School of Medicine and has been engaged in the cardiovascular medicine. Using volumetric analysis in MR SPGR imaging, he has been investigating the fields for target hypertensive organ damages including the relationships among hypertension, blood pressure variability, brain atrophy, cognitive impairment and central autonomic nervous system including the insular cortex. He was engaged in the Interventional Cardiology at Hiroshima City Asa Hospital as the Vice Director. He won the Japanese Society of Hypertension Award in the International Society of Hypertension 2006, the Young Investigator’s Award in the 8th Japanese Neurocardiology Workshop 2007 and Young Scientist Award in the second annual scientific forum of clinical hypertension of the Japanese Society of Hypertension 2013.

Abstract:

In recent years, greater attention has been placed on the impact of biological sex and hormonal status in regards to a predisposition for cardiovascular disease (CVD) and response to therapy. Women generally have a lower risk for developing CVD compared to men of similar age but this protection is lost during menopause, suggesting the importance of sex steroid hormone signaling. Although estrogens are viewed as female sex hormones and androgens are viewed as male sex hormones, estrogen and androgen signaling govern a multitude of physiological processes in both women and men. Our biomedical research thus focuses on the protective role of estrogen in the vasculature and pathophysiology of cardiovascular disorders of public health significance, such as heart failure, stress-induced cardiomyopathy (e.g. Takotsubo syndrome) and ischemic stroke as a frequent comorbidity. We will present a set of experiments implementing estrogen receptor beta mediated pathways of cardio-protection and pilot experiments relating estrogen receptor status, endothelial dysfunction and stroke susceptibility potentially contributing to the pathophysiology of Takotsubo syndrome.

Biography:

Qais Alefan has completed his PhD from Universiti Sains Malaysia. He is an Assistant Professor at the Faculty of Pharmacy, Jordan University of Science and Technology. He has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

The prevalence of hypertension in Jordan is very high, approaching 32%. Controlling of blood pressure can be achieved by using antihypertensive medications and adherence to lifestyle changes. This study aimed to identify factors correlating with hypertensive patients' compliance with lifestyle recommendations in north of Jordan. A cross sectional survey and face to face interview methods were used to collect the data from 1000 adult Jordanian patients (>18 years old) who have been diagnosed with hypertension for at least 1 month; on medical treatment and attending hypertensive clinic in King Abdullah University Hospital from (October 2016-December 2016). The questionnaire was developed based on previous literature and with the help of experts in the field of hypertension. Data analysis was conducted using the SPSS Version 23. In this study, only 23% of the patients were fully compliant with healthy lifestyle behaviors. About 95% were knowledgeable on hypertension, and 86% of the patients had positive beliefs about the management protocols of their disease. Gender, physician counseling on a healthy lifestyle, patients’ beliefs about hypertension management, and their knowledge on hypertension and its management, have an independent effect on compliance with lifestyle recommendations. Despite the high level of patients' knowledge about hypertension disease, and the positive beliefs regarding hypertension management, the rate of compliance with lifestyle recommendations was low. Receiving counseling from physicians about healthy lifestyle and self-care, being informed about hypertension and its management and having positive beliefs about managing this disease are significant predictors of patients’ compliance with lifestyle recommendations.

Biography:

Nazim Megherbi is a Cardiologist at the Frantz Fanon Hospital University, Blida, Algeria.

Abstract:

Introduction & Aim: Diabetes is an independent risk factor for cardiovascular disease affecting men and women. We have tried to identify the peculiarities of coronary artery disease in women with diabetes, paying particular attention to the detection of myocardial ischemia in accordance with the recommendations of the European Society of Cardiology and the findings of coronary angiography.

Methods: Our study is a descriptive, mono-centric, retrospective study of a series of 328 consecutive women received in our department during the year 2016 and candidates for coronary angiography preceded by an evaluation in accordance with the recommendations of the European Cardiology Society of 2013 in the management of stable coronary artery disease, or in the course of an acute coronary syndrome. Our work aims to compare the coronary lesions according to the diabetes and of the pretest screening in the management of the stable coronary artery disease. The secondary objective is to compare coronary lesions in woman according to diabetes.

Results: Of the 328 patients, 199 (61%) were diabetic. The average age was 62±9.32 years for diabetic patients versus 56±8.13 years for those who were not. The prevalence of all risk factors was significantly higher in patients with diabetes. Stable chronic angina was the main coronary angiography pattern (59% stable Angor, 34% NSTEMI, 7% STEMI). Despite a nearly similar screening of myocardial ischemia via the pretest probability for both groups, diabetes was more associated with the presence of coronary lesions (63% vs. 29%, p<0.001), persistent significance after elimination of confounding factors. The same was true for the positivity of myocardial scintigraphy and its angiographic translation (63% vs. 30%, p<0.001). Tri-troncular coronary lesion was more frequent in diabetics (38% vs. 21%, p<0.001), whereas non-diabetic patients had more mono-troncular lesions (57% vs. 30%, p<0.001).

Conclusion: Insufficiency in the management of women’s coronary artery disease is often related to a deceptive symptomatology that can go in the direction of the false positive but also the false negative, especially when associated with diabetes known to provide atypical symptoms. The diabetes is not taken into consideration in pretest probability screening of coronary artery disease but should be considered, it would be associated with more coronary artery disease at the coronary angiography for the same evaluation comparing to women who are not diabetic.

Biography:

Will be updated soon.

Abstract:

Background: Multiple Valve Surgery (MVS) is still of choice for advanced rheumatic heart disease (RHD), which has been associated with reported poor early and late outcomes. We review our experience and results after MVS.

Methods: Between 2007 and 2017: 162 patients (53%men, 47%women), with mean age of 37.5 years (16- 67Y), underwent MVS for isolated advanced RHD. Criteria for selecting patients: New York Heart Association (NYHA) class III or IV, Cardiomegaly, lower left ventricular ejection fraction (LVEF), severe pulmonary hypertension and or right ventricular dysfunction, Valvular disease with deterioration of more than one vital function. All patients received replacement procedures in mitral and aortic position (155 mechanical, 7 bioprosthetic), with concomitant De Vega tricuspide annuloplasty (129 patients), tricuspide annuloplasty ring (11 patients) and or other complex tricuspide plasty procedures. The mean cardiopulmonary bypass time: 135 min (75 - 240min), Mean cross-clamping time: 67min (45 - 120min).

Results: The 30-day hospital mortality was 17.2% (n =28), 30 patients had postoperative complications : Low Cardiac output syndrome(12), 6 Infections (1 mediastinitis, 5 Pneumonia), 5 Acute kidney failure (Dialysis: 1 case), 7 Transient atrioventricular Block, 5 transient tachyarrythmias, 3 Neurologic events (2 Stroke, 1 Coma),  4 Right sided Heart failures.

Follow-up 3- 58 months after surgery: The freedom from thromboembolism and anticoagulation-related hemorrhage was 81 %. Of the 125 patients still alive, 98 were in NYHA class I and II.

Conclusion: Surgery of advance multiple valves disease has a significant high morbidity and mortality rates.  Results may be improved by early surgical treatment before NYHA class IV or deterioration of LVEF occurs.

Biography:

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German board certified Cardiac Surgeon with a subspecialization in Pediatric Cardiac Surgery. She was the Junior Consultant of the Congenital Heart Surgery at the University Hospital Erlangen, Germany (2006-2008), Research Fellowship at the Children's Hospital Boston, USA (2008-2009) and was the Director of Pediatric Cardiac Surgery in Mainz, Germany (2009-2011). She has also worked as Senior Consultant in Children Heart Center in Linz, Austria and since 2014 she is Senior Consultant at the University Hospital Munich, Germany and University Lecture 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 & Aim: 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: 18 heart transplantations on children (nine female, nine male) were performed from 1988 to 2015. The range of age was between 0 days and 3 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). 14 children (78%) had 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%). 15 (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 a re-transplantation. The median time patients spent at intensive care unit was 17 days (min: 1 day; max: 121 days). They were respirated for 7 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 and 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 is possible. These results were comparable to those of the ISHLT registry in pediatrics.

Biography:

Ioan A Gutiu has expertise in study of atherosclerosis risk factors in cardiovascular disease especial in inflammation contribution, pathogenic interventions of non-traditional risk factors such as dental state, magnesium, uric acid, etc. all with possible therapeutically consequences.

Abstract:

Statement of the Problem: The role of inflammation in atherosclerosis pathogenesis is now re-discussed especially by new therapeutic search (darapladib, methotrexate, colchicines, for example) and by new extensive studies of diverse inflammation markers (such as interleukine-6, C reactive protein, etc.). But influence of possible association of inflammation markers (IM) on atherosclerosis risk factors in cardiovascular disease (CVD) is less studied. We analyzed the effects of the concomitant presence of five clinical current used inflammatory markers (serum fibrinogen -sF, Leukocytes-sL, BSR, C-reactive protein-CRP and number of tooth loss-TL, as index of chronic persistent gum inflammation such as parodontitis or parodontosis) on atherosclerosis risk factors (ARF) in CVD.

Methodology: This is a cross-sectional study of 1331 patients with CVD. From these only 27 have all 5 IM present (only about 2%) and only 17 (1.3%) have no IM present. We compared these two groups of patients for the incidence of a great number of ARF (such as cholesterol, triglycerides, smoking, obesity, arterial hypertension, etc.).

Findings: From all ARF analyzed we found that only 5 differ significantly between the group with all IM present and the group with no IM: Age (61.2±-10.7 versus 51.1±-12.8 years, P<0.001), systolic arterial pressure (173.4±-27.5 versus 155.4±-25.7 mmHg, P<0.0033), serum glucose (118.7±-30.3 versus 97.1±-23.02 mg/dl, P<0.010), HDL-Cholesterol (37.1±-10.6 versus 47.7±-12.9, P<0.006), platelets number (287.2±-66.5 versus 287.2±-76.8, P<0.009). The rest of ARF do not differ significantly between the two groups.

Conclusion & Significance: Association of IM (an inflammatory load) in CVD is found in a small number of more aged patients. In this group a number of ARF differs significantly compared with the patients with no IM. These findings underline the role of inflammation level (load) in CVD patients Interpretation of these results and possible therapeutic consequences are discussed.

Biography:

Ogus Akkus is a Teaching Faculty at the Mustafa Kemal University, Turkey.

Abstract:

Aim: Due to disturbing symptoms and catastrophic outcomes, aneurysms require more attention and closer follow-up. We aimed to evaluate whether ischemia modified albumin (IMA) values are increase in patients with aortic aneurysm and predictive to differentiate those patients.

Methods: Our study population consisted of patients with aortic aneurysm (n=57) and age-matched control subjects (control group) (n=58).

Results: The high sensitive C reactive protein (hsCRP), IMA, low-density lipoprotein (LDL) and total cholesterol levels were significantly higher in aneurysm group than the control group (p<0.05 for all). High-density lipoprotein (HDL) cholesterol level was significantly lower in the aneurysm group (p<0.05). LDL, total cholesterol, hsCRP and IMA levels were significantly correlated with maximum aortic diameter (r=0.210, p=0.024, r=0.469, p<0.001, r=0.472, p<0.001 and r=0.698, p<0.001, respectively). The cut-off value of IMA obtained by ROC curve analysis was 0.48 for prediction of aortic aneurysm (sensitivity: 100.0%, specificity: 100.0%).

Conclusion: Low IMA levels may be a useful marker in excluding an aortic aneurysm with a high sensitivity and specificity, preferably when aneurysm considered as low probability and in patients without any ischemic event ever.

Biography:

Jeko Madjarov is board certified in General, Vascular/Endovascular and Cardiothoracic Surgery. His clinical interests include adult cardiac and thoracic surgery, aortic surgery, including complex/endovascular aortic repair and minimally invasive coronary and thoracic surgery. He is a key Member of the complex lead extraction program in the Department of Cardiac Electrophysiology. He has several patents in the field of diagnosis and treatment of cardiac arrhythmias, endovascular treatment of aortic disease, and complex chest wall reconstruction. He has received his Medical degree from Sofia Medical University, Bulgaria, and completed a Cardiac Surgery Residency at St. Ekaterina University Hospital, Sofia, Bulgaria. He has completed General Surgery residencies at Yale-New Haven Hospital, New Haven, CT and Baystate Medical Center/Tufts University School of Medicine, Springfield, MA. He has then completed Fellowships in Vascular/Endovascular Surgery and Cardiovascular/Thoracic Surgery at Carolinas Medical Center, Charlotte, NC. He has authored more than 20 publications.

Abstract:

Introduction & Aim: Both experimental and clinical data have demonstrated a high risk of ventricular arrhythmia in the early post-myocardial infarction (MI) phase. The indications for implantable cardioverter-defibrillator (ICD) have rapidly expanded over the past ten years in acute MI. However there are many factors may prohibit transvenous ICD lead placement. The aim of this study was to evaluate the impact of extra-pericardial placement of ICD leads for treating ventricular arrhythmia. In one porcine model the effectiveness of this treatment was studied by creating acute MI in the LAD territory.

Methods: In vivo studies were performed in 9 female Yorkshire pigs (weight 46.2±6.1 kg). After mini-thoracotomy or completely minimal invasive procedure the first custommade bipolar pacing lead were sutured to the subcutaneous tissue of the left ventricle (LV) and the second to extra-pericardium at the level of the right atrial appendage without opening pericardium. The ICD generator was placed into pocket below xyphoid process. In one porcine model an acute MI was created by proximal ligation of left anterior descending artery that resulted in spontaneous ventricular fibrillation which was successfully detected and treated by the device.

Results: All ICD systems had acceptable defibrillation thresholds with energy tested at 27J and 37J. There were no increase impedance between the coil and generator. There were no inappropriate discharges. Two Porcine models successfully converted VF to the sinus rhythm at 27J and 7 converted to sinus rhythm at 37J. Mean R-wave amplitude (9.6 mV), mean pacing impedance (1030 ohms), mean threshold (5.0v @ 1.0ms) and first shock efficacy (78%).

Conclusion: Extra-pericardial placement of ICD leads in acute myocardial infarction has demonstrated good performance with stable defibrillator energy and impedance. This new technology can overcome the potential limitations of the currently available intravenous and sub q devices. We are also going to discuss novel electrophysiology approaches of extra-pericardial electrophysiology.

Biography:

Xuan Kai Koe has completed his graduation from The University of Manchester, UK. He subsequently went into foundation training at Lancashire Teaching Hospital for 2 years and then went into core medical training at Manchester Royal Infirmary for a year. Currently he is at Lancashire Teaching Hospital, completing his final year of core medical training. He has also obtained his Membership of Royal College of Physician (MRCP, London) in 2017.

Abstract:

A 56 year-old lady was referred to cardiologist with one month history of intermittent sharp chest pain, shortness of breath and palpitations. She has never smoked, drinks minimal amount of alcohol and has no history of recreational drug use. She has a past medical history of Raynaud’s syndrome and anxiety. Clinical examination noted heart rate regular, 65 beats per minute, blood pressure 120/70 mmHg, normal heart sounds, clear chest and no pedal edema. ECG showed sinus rhythm at 61bpm with biphasic T wave in leads V1, V2, V3 and T wave inversion in leads V4, V5. 24-hour ECG noted ventricular ectopics. No pauses, heart blocks or arrhythmias were noted. Echocardiogram demonstrated an echogenic mass at the apical septal region, LVEF 55%, no valvular abnormalities. She was referred on for a cardiac MRI which demonstrated an apical septal mass with central heterogeneity (on enhancement) suggesting necrosis or fluid content. A full body CT and PET scan showed no primary or secondary disease elsewhere. The case was then referred on for discussion at the multidisciplinary team (MDT) meeting of regional tertiary heart center involving cardiothoracic surgeons, cardiologists and radiologists. The outcome was that this is likely a fibroma and surgery should not be contemplated due to the position of the tumor making this technically challenging. It was decided that a biopsy will not be pursued and that this patient will be observed regularly. Repeat echocardiogram 4 months after initial presentation noted similar findings to previous echo, demonstrating no change in size of the mass. Cardiac MRI repeated at 6 months from initial presentation confirmed that the septal mass size remained unchanged. One year after initial presentation echocardiogram showed similar findings to previous echocardiograms. She was put on 6-monthly surveillance with echocardiogram and yearly cardiac MRI. At present she is clinically stable.

Biography:

Hong Ju Shin is currently the Clinical Associate Professor at Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital. He also has the Membership at various societies such as The Asian Society for Cardiovascular Surgery, The Korean Society for Thoracic and Cardiovascular Surgery, The Korean Society of Circulation, The Korean Pediatric Heart Society and The Korean Medical Association.

Abstract:

Introduction & Aim: There is no concrete predictor of the change of pulmonary arterial pressure after surgical closure of an atrial septal defect (ASD) in patients with pulmonary arterial hypertension (PAH). The aim of this study was to investigate the role of preoperative room air arterial oxygen saturation (SaO₂) (arterial blood gas data) as a predictor of postoperative PAH.

Methods: The medical records of 36 patients [>20 years, mean pulmonary arterial pressure (mPAP) ≥25 mmHg] who underwent surgical closure of an ASD between March 2004 and January 2014 were retrospectively reviewed.

Results: The median age was 47 years (range, 24.6-65.9 years) and mPAP was 38±14 mmHg. The mean pulmonary vascular resistance (Rp) was 3.9±4.2 Wood units, and fenestration was performed in 12 (33%) patients. Only 1 patient received anti-PAH medication preoperatively. The median follow-up period was 4 years (range, 0-10 years). There were two hospital deaths, one of which was related to PAH. At the last follow-up, PAH (estimated tricuspid regurgitation velocity >3 m/s) existed in 7 patients (19%) and 10 patients (28%) were receiving anti-PAH medications (considered as clinical PAH). Univariate analysis for persistent clinical PAH revealed that mPAP, Qp/Qs, Rp, room air arterial oxygen saturation and postoperative functional class were significant risk factors. Only SaO₂ remained a significant risk factor in multivariate analysis (P=0.03).

Conclusion: Preoperative room air SaO₂ is a useful predictor of persistent PAH in adult patients undergoing surgical closure of an ASD.

Biography:

Jinlin Wu has completed his PhD from Peking Union Medical College, China. He is a young Cardiovascular Researcher, currently doing Residency training in Fuwai Hospital, China.

Abstract:

Objective: To investigate the predictive value of plasma D-dimer for in-hospital mortality in patients with type A acute aortic dissection (AAD).

Methods: We prospectively observed 133 consecutive suspected patients admitted in emergency department of our hospital from February 2015 to January 2016 and all of them were diagnosed as AAD with CTA. They were divided into two set of groups: (1) In-hospital mortality group, n=l9 and Survival group, n=l14 and (2) D-dimer≥20 ug/ml group, n=36 and D-dimer<20 ug/ml group, n=97. Plasma D-dimer level was measured at admission in all patients, and the predictive value of D-dimer for in-hospital mortality was determined by uni- and multivariate Cox regression analysis.

Results: The patients were at the mean age of (52.0±10.7) years, with the in-hospital stay of (12±10) days. The total in-hospital mortality was 14.3% (19/133). Compared with Survival group, the in-hospital mortality group presented higher D-dimer level, P<0.05. D-dimer≥20 ug/ml group had a higher mortality than that of D-dimer<20 ug/ml group, P<0.001. The univariate Cox regression analysis indicated that the group with plasma D-dimer≥20 ug/ml had higher risk of in-hospital death (HR 4.845, 95% CI 1.840-12.76, P=0.001). With adjusted age, systolic blood pressure, platelet counts and the intervals from pain to admission, the D-dimer≥20 ug/ml was the independent predictor for in-hospital mortality (HR 3.399, 95% CI 1.252-9.229, P=0.016). When surgery was added to the multivariate Cox regression analysis, however, D-dimer≥20 ug/ml was no longer related to in-hospital mortality (HR 1.185, 95% CI 0.354-3.968, P=0.783), while platelet counts at admission is related to in-hospital mortality (HR 0.987; 95% CI 0.977-0.998; P=0.021) in such case.

Conclusion: Before surgical intervention, a higher D-dimer level at admission indicates an increased risk of in-hospital mortality in patients with type A AAD and platelet counts at admission could be considered as a reference index.

Biography:

Mary Shibuya is an experienced native English Medical Editor/Writer of 32 years living in Japan with a background in Chemistry and Allergy Research at Mayo Clinic (Rochester, MN). For 23 years she was the Language Editor of the Internal Medicine Journal, published by the Japanese Society of Internal Medicine. She attended various medical/scientific congresses as Press (interviews, transcription, summarizing). She also enjoys lecturing on scientific medical writing in English to graduate schools and pharmaceutical companies. She strives to encourage ESL doctors/researchers to publish in English.

Abstract:

In the world of medical writing, it is the facts that are to be well represented. In presenting the facts however, a great amount of background information is often necessary to orientate the audience. Unfortunately there is a tendency to use lengthy sentences, which sometimes become upwards of three lines long. Consequently the reader becomes lost in the multitude of words. Therefore, clear and concise sentences are imperative to achieve the best understanding. This seminar will highlight the easiest ways to cut unnecessary components and to avoid awkward paragraph composition. Also, the use of punctual aids will be reviewed as they are extremely useful tools to improve text readability. Further, a useful final draft checklist and resource materials will be provided.

Biography:

M Jakovljevic has completed her graduation from the School of Medicine in Zagreb. In 1980 she has completed her specialization in Internal Medicine at the Department for Heart and Blood Vessel Diseases, Zagreb University Hospital Centre. She subsequently completed a program in Cardiology and Clinical Pharmacology in 1980. In 1979, she defended her Master’s thesis and in 1982 she has completed her Doctorate in Medical Sciences at the University of Zagreb in the field of cardiology.

Abstract:

Introduction & Aim: Some of the main goals of treatment in patients with heart failure (HF) is improving the quality of life and functional capability. The aim of the study is to assess the effect of complementary supportive therapy (CST) on the quality of life and functional capability in patients with heart failure and reduced ejection fraction (HFrEF).

Methods: We investigated 33 patients with left ventricular dilatation (LVIDd >60 mm) and reduced ejection fraction (EF<40%) in 76 CST periods. Prior to each CST period, therapy was optimized (OMT) during one month. Complementary supportive therapy (CST) consists of a 10 day session. In addition to OMT, the patients were treated with carnitine, co-enzyme Q-10, L-arginin, vitamin B, vitamin E, vitamin C, selenium while lying for 30 minutes inside a pulsating electromagnetic field (up to 30 microteslas with individual frequency settings) and inhaling 02. Before and after each CST period they were asked to evaluate the quality of life using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the visual analogue scale and EF, LVIDd and NYHA class were determined. Statistical analysis of the CST was based on the t-test, Spearman’s rank correlation coefficient and Wilcox’s signed-ranks test. The median monitoring period was 60 months (ranging 11-122).

Results: After administering the complementary supportive therapy, a statistically significant

Improvement (p<0.05) was noticed in the particular items of the MLHFQ, in emotional and physical dimensions. The values of VAS and EF increased whereas NYHA and LVIDd decreased significantly (p<0.001).

Conclusion: CST significantly improved the quality of life and functional capacity of patients with HFrEF.

Biography:

Abstract:

INTRODUCTION

Literatures indicate an underutilized level of cardiac rehabilitation (CR) referral and participation worldwide. Only one-third of eligible coronary heart disease (CHD) patients after coronary revascularization would attend CR. In western countries, CR referral rate of CHD patient was around 40% and the 36% -80% of MI patients would attend CR. The data in Asian countries was much more unsatisfied, compared with that in western. By 2014, the CR participation rate of CHD patient in China was only 14.3%. In Hong Kong, 21% of post-MI patients participated in phase II CR in 2005. Factors associated with conventional CR non-participation include female, elderly, low education, lack of transport, busy working schedule, low financial support or lack of insurance, and preference of self exercise in the literature. To improve the adherence and effects of CR, eHealth and mHealth are adopted to enhance healthy lifestyle modification and medical therapy; to improve self-care management and quality of life; and potentially to decrease the risk of recurrent events.

AIM

To identify the program care characteristics and to evaluate the effectiveness of eHealth or mHealth application in CR for post PCI patients.

METHODS

Keywords of “coronary heart disease (CHD), myocardial infarction (MI) or ischeamic heart disease (IHD)” and “percutaneous coronary intervention (PCI) or coronary intervention” and “eHealth”, “mHealth”, “mobile”, “Smartphone” or “technology” and “telerehab*”, “cardiac rehab*” or “secondary prevention” were used. Databases of CINAHL, Medline, EMBASE, Cochrane Library, Joanna Bridge Institute, PsychINFO, and Social Work Abstracts were searched. Studies published in English between 2006 and 2016 were included.

Eligible studies were assessed according to the following PICOS.

1). Population/ participants (P): adult patients with the diagnosis of CHD and underwent PCI or other coronary intervention;

2). Intervention (I): CR or any component of CR delivered through eHealth/ mHealth;

3). Comparison (C): comparisons with usual care or conventional CR;

4). Outcomes (O): Patient’s clinical outcomes, such as physical, psychological and social indicators, mortality and adverse events, and economical outcomes, e.g. health care utility;

5). Study (S): experimental studies.

RESULTS

Sixty-four studies were found following the searching strategy and nine studies were identified according to the PICOS. Overall, 69% (n=9) of the studies were published between 2010 to 2015.

Two fifths of them (n=5, 40%) were conducted in Europe and nearly one thirds of them (n=4, 30%) were in North America. Study sample size varied from 39 to 11,862, with the study duration ranging from 4-week to 6-month. To appraise the quality of the nine reviewed studies, “Quality Assessment Tool for Quantitative Studies” was used. For the global rating quality, 44% (n=4) of the studies were rated as strong and 56% (n=5) were moderate.

Internet-based, mobile-based and smartphone-based CR had been tested against conventional CR. In general, the alternative CR programs covered comprehensive components on exercise, medication, diet, CHD risk factor control, and healthy behavior change.

Commonly, the stydies lacked a theory to underpinned their study design. All the reviewed studies assessed the outcomes of exercise capacity/ frequency of physical activity and majority of them (88%, n=8) achieved significant improvements in the alternative CR group. Six studies (66%) improved the anxiety/ depression level and QoL/ health-related quality of life. Five studies (55%) reported physiological outcomes improvements, including blood pressure, heart rate, body mass index, lipid profile, fasting blood glucose and some studies achieved significant improvements. However, limited studies (n=2) measured medication adherence.

Among those electronic CR programs achieving significant effects in promoting physical exercise, QoL, medication and diet adherence, and cardiovascular risk factors control, they commonly applied interaction with patients via text message and self-monitor in personal health outcomes. Four studies (45%) applied smart-phone based interventions and 80% of the outcomes achieved significant improvements while 5 studies (55%) were internet plus mobile-phone based but reported improvements in 57% of the outcomes. The literatures also indicated better assessability and convenience in mobile or smartphone-based CR programs, compared with internet-based design. Limited studies applied any health behaviour change theory to guide the development of the alternative CR.

CONCLUSION

A theoretical framework underpinned, smartphone-based intervention is indicated to support post PCI patients engaging in CR, particularly for Chinese population. To maximize the effects of CR on patient outcomes and reducing unnecessary health care utility, mCR program is recommended to motivate and help the post PCI patients adhere to their medical therapy, physical and diet recommendation. Also, patients’ self-care skills and self-efficacy on managing their life-long illness could also be measured in future studies.

Biography:

Ahmed F Elmahrouk has completed his MD in Cardiothoracic Surgery from Tanta University in 2005 after having a Fellowship in Leiden University Hospital in Netherlands. He has worked as an Associate Professor of Cardiothoracic Surgery in Tanta University, Egypt. He is currently working as a Pediatric Cardiac Surgeon in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia.

Abstract:

Background: The increasing complexity of congenital cardiac surgery has resulted in the increased use of extracorporeal membrane oxygenation (ECMO) support for children who cannot be weaned from cardiopulmonary bypass (CPB). In single ventricle morphology, many challenges were reported to worsen the outcome with ECMO. Single ventricle was exposed more to volume overload, besides the imbalance between systemic and pulmonary circulation with decreasing coronary perfusion due to diastolic run-off into the pulmonary circulation. The purpose of this research was to compare the outcome in children with uni-ventricular repair underwent ECMO support, versus children with biventricular repair.

Methods: The hospital records of all patients with CHD who required ECMO after a cardiac surgical procedure between January 2001 and December 2016, were retrospectively reviewed. Various outcomes were reported and tested for any association with hospital death. Children were divided into two groups, Group A: Children with uni-ventricular repair (51 children) and Group B: Children with biventricular repair (62 children).

Results: A total of 113 children required ECMO for cardiopulmonary support after congenital cardiac surgery; 88 (77.9%) were placed on ECMO in the operating room. Median age of the patients was three months (range, 4 days-15 years) and median weight was 3.5 kg (range, 2.2-42.5). 42 (37.2%) survived to hospital discharge. In children with single-ventricle physiology, survival to discharge was 37.3% (19/51 patients) and for biventricular physiology it was 37.1% (23/62 patients). There was no difference in hospital survival between both groups. Univariate analysis revealed that number of days on ECMO support, renal failure and stroke as risk factors for hospital mortality, while age and cross-clamp time were found to be statistically non-significant.

Conclusion: Satisfactory results can be achieved in pediatric patients by using ECMO support for postoperative cardiac and pulmonary failure refractory to medical management. The outcome in children with biventricular hearts is not superior the uni-ventricular ones. Prolonged ECMO support, renal failure and stroke are risk of mortality.

Biography:

Murat Kibar has his expertise in diagnoses and evaluation to animals with heart disease. His Doctoral thesis was about Doppler echocardiographic examination of atrio-ventricular valves in dogs. He has done investigations about effects of some drugs in dogs with heart failure. He has completed his Post-doctoral research in Austria, Israel and USA. He has got 28 articles in journals indexed by SCI and SCI Expanded and 28 articles in other national journals and published 4 books.

Abstract:

Statement of the Problem: Diastolic dysfunction is common in cardiac disease and contributes to the signs and symptoms of heart failure. Doppler echocardiography has become the non-invasive technique of choice for evaluating diastolic function. Doppler tissue echocardiography (DTE), a new application recently developed for clinical use, has made possible the acquisition of myocardial wall and mitral annular velocities online during examination. However, investigations in dogs with diastolic dysfunction are scared. The aim of this study was to explore the feasibility and the diagnostic value of conventional Doppler parameters of transmitral inflows and Doppler tissue echocardiography parameters of septal annulus motion for the assessment of diastolic dysfunction in dogs with cardiac failure.

Methodology & Theoretical Orientation: 31 consecutive patients (age 4.0-14.5 years; mean (SD) age, 10.25 (3) years; body weight 2.7-30.0 kg; mean (SD) weight, 8.65 (5.6) kg; 17 male, 14 female) with normal and diastolic dysfunction were studied prospectively. Mitral inflow and DTE signals were recorded in all patients. The LV diastolic mitral flow patterns were divided into normal diastolic flow pattern (group 1), delayed relaxation pattern (group 2), pseudonormal flow pattern (group 3) and restrictive pattern (group 4).

Findings: In our study population, 17 patients had normal mitral inflow variables (E/A ratio>1 and Dt<109 m). The other 7 patients were classified as having abnormal mitral inflow pattern (E’>8 cm/s, E’/A’>1). Early diastolic annular velocity (E’) was lower in group 3 (PN) than in group 1. Eight patients had delayed relaxation (E/A ratio<1, Dt>109 ms and E’<8 cm/s). Additionally, six patients had a restrictive pattern in our study (E/A>2 and E’<8 cm/s). In the PN group, a significant reduction in E’/A’ (0.71±0.10, P<0.01) and a significant increase in A’ (10.35±3.60 cm/s, P<0.01) and E/E’ (14.32±3.50, P<0.05) were detected. E’ velocity was lower in group 1 than in group 3 (9.02±2.90 cm/s vs. 7.46±2.17 cm/s, P=ns). When the combination of A’>7.6 cm/s and E’/A’<1 was used as a cut point, PN could be identified with a sensitivity of 90% and a specificity of 88%.

Conclusion & Significance: In conclusion, the combination of Doppler tissue echocardiography of the mitral septal annulus and mitral inflow patterns by conventional Doppler indices provides better estimates of diastolic dysfunction in dogs.

Biography:

Debbie Lynn A Udarbe has completed her graduation in the Internal Medicine Residency program from the Angeles University Foundation Medical Center in Angeles City, Philippines. She is currently on Cardiology Fellowship training and also serving as the Chief Fellow in the same institution.

Abstract:

A middle-aged male with long standing hypertension and diabetes was initially managed as a case of acute coronary syndrome when he presented with exertional dyspnea and intermittent angina. Cardiovascular examination revealed a blood pressure of 130/70 mmHg, normal cardiac rate and regular rhythm, a grade 3/5 systolic ejection murmur loudest at the Erb’s point, a grade 2/3 early diastolic blowing murmur at the left parasternal border and a grade 2/5 holosystolic murmur at the apex. Basilar rales were appreciated. A short-axis view of the great vessels on transthoracic echocardiography revealed an aortic valve with four equally-sized cusps. The presence of marginal calcifications and partial fusion resulted in some restriction in opening during systole, which was confirmed by detection of a significant gradient across the valve. Diastolic malcoaptation was also evident, particularly at the central area, leading to substantial regurgitation. The electrocardiogram showed sinus rhythm with left ventricular hypertrophy. Meanwhile, chest radiography revealed pulmonary congestion and cardiomegaly with left ventricular prominence. A coronary angiogram was performed which demonstrated non-significant coronary artery disease. This case highlights the importance of the prompt use and subsequent correlation of echocardiography with the comprehensive clinical history, physical examination and sound physician judgment in the approach to even the most uncommon cardiac diseases. Discovering them incidentally during surgery or autopsy is now a thing in the past. The quadricuspid aortic valve is a rare congenital anomaly with a reported prevalence range of only about 0.013-0.043% and requires surgical intervention in more than half of cases in adulthood due to worsening aortic regurgitation. Previously, it could only be discovered during surgery, aortography, or autopsy. Needless to say, echocardiography is an accessible imaging tool to promptly recognize a quadricuspid aortic valve and its associated lesions.

Biography:

Abstract:

Aim: The aim of this study was to investigate whether nighttime surgery contributes to higher in-hospital mortality in patients with acute type A aortic dissection.

Methods: All patients with acute type A aortic dissection who underwent surgery at Fuwai Hospital from 2010 to 2015 were included in the present study. Depending on the surgery start and end time, patients were divided in daytime and nighttime groups. Propensity matching analysis was used to compare in-hospital mortality and post-operative complications among these groups.

Results: A total of 698 patients with acute type A aortic dissection underwent surgery. Among these, 321 patients underwent nighttime surgery (45.98%), while 377 patients underwent daytime surgery (54.02%). The operation time, cardiopulmonary bypass time, and aortic cross clamp time showed statistical differences between the two groups (P<0.01). There was a significant difference between daytime group and nighttime group in in-hospital mortality (6.42% versus 12.08%, P<0.05). The nighttime group had higher incidence rate of re-intubation, continuous renal replacement therapy compared with daytime group (P<0.05). Furthermore, patients who underwent nighttime surgery showed significantly higher adjusted in-hospital mortality than patients who underwent daytime surgery (odds ratio 2.13, 95% confidence interval 1.19 to 3.81, P=0.01).

Conclusion: Patients with acute type A aortic dissection who suffered from some serious medical conditions were more likely to die in the hospital if they underwent emergency nighttime surgery.

Biography:

Dr. Elizabeth Mathew is an Acute Care Nurse Practitioner with Doctorate in Nursing Practice recently graduated from Brandman University, Irvine California. Elizabeth is migrated to USA in 2006 from India as a Registered Nurse worked in Cardiology and Cardiothoracic Surgery department with Citrus Valley Medical Center Intercommunity Hospital in Covina, California. She also has experience in cardiac Cathlab, EP lab, and actively involved in research in the past. She has been participating in staff development and educational programs in concurrence with education department at the organization and received several honors and recognition for her exceptional work. This project was completed as a part of DNP curriculum affiliated with Citrus Valley Medical Center.

Abstract:

Background: Premature clopidogrel discontinuation is the single most crucial culprit of stent thrombosis (40.8%) with a mortality rate >25%. Dual antiplatelet therapy with aspirin and P2Y12 antagonist are a critical component of treatment following PCI to prevent stent thrombosis and related life-threatening complications. Patients with poor medication adherence to antiplatelet therapy are at high risk for stent thrombosis and recurrent coronary events and often experience the worse outcomes.

Aim: Implement a multidisciplinary teaching and post discharge motivational phone calls to post PCI patients to improve antiplatelet therapy medication adherence and prescription filling behaviors to reduce acute and sub-acute stent thrombosis.

Methods: The team enrolled 34 participants who underwent PCI from June 2017 to October 2017. A multidisciplinary teaching implemented to the participants post PCI by an interdisciplinary team along with motivational phone calls within 24 hours and 30-days post discharge to evaluate medication adherence and prescription filling behaviors.

Results: A paired sample test is used to assess pre and post intervention showed a significant increase in patient’s medication adherence (t=15.14, p=<0.001) and prescription filling behavior (t=-16.82, p=<0.001), no stent thrombosis reported in 30 days, 91.7% of participants filled prescription on time.

Conclusion: A multidisciplinary teaching and follow-up phone calls after discharge in post PCI patients will significantly improve patient’s antiplatelet medication adherence and prescription filling behaviors consequently reduce acute and sub-acute coronary stent thrombosis.