Day 1 :
President, North American Scientific Committee on Cardiovascular Health, USA
Keynote: An Examination of Identifiable Risk Factors and Health Outcomes Associated with Cardiovascular Health in Children and Adults
Time : 09:30-10:20
Damien Byas, PhD, is an Epidemiologist and Professor of Public Health at American Public Health Association. He is an International Public Health Delegate and President of North American Scientific Committee on Cardiovascular Health.
Statement of the Problem: The World Health Organization (2017) recently reported that “worldwide, at least 2.8 million people die each year as a result of being overweight or obese, and an estimated 35.8 million (2.3%) of global Disability-adjusted life years (DALYs) are caused by both cardiovascular wellness and overweight or obesity. The purpose of this study was examine identifiable risk factors and disease outcomes which may be associated with cardiovascular health in children and adult populations.
Methodology & Theoretical Orientation: This study examined inpatient pediatric patients using the Kids´ Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ, 2014;2016). A large randomly drawn sample (N = 524,581) of boys (n = 244,553) and girls (n = 280,028) ages 5 to 12, was examined in this research study to test for the association between cardiovascular health and disease related outcomes. Additionally, a small adult sample of adults ages 19 to 55 (N = 143), enrolled in an undergraduate level city college program, were assessed to determine if there was a relationship between Cardiovascular Health and associated risk factors and other health. The Pearson Chi Square test was applied to measure for significant variable associations in this research study in addition to the application of the Cramer’s V analysis to examine for strength of variable associations. A multiple regression analysis was applied to determine if obesity prevalence and type 2 diabetes risk were significant predictors of cardiovascular health in adult groups. Findings: The research found that there were significant associations between cardiovascular health and health outcomes in children (p < .001) and that the factors of obesity and type 2 diabetes risk were significant predictors for cardiovascular health in adults (p < .05).
Conclusion & Significance: The outcome of this research study provides support for improved efforts to develop more effective strategies to promote positive healthy lifestyles in adults and children’s populations.
President- Latvian Association for Pediatric Cardiologists, Latvia
Keynote: Effectiveness of autologous bone marrow-derived mononuclear cells delivery in wide spectrum of pathologies
Time : 10:20-11:10
Aris Lacis, cardiac surgeon, professor, MD, PhD graduated Riga Medical Institute in 1961. General and thoracic surgeon in P. Stradina University Hospital in Riga (1964–1969). Thoracic and cardiac surgeon in the Latvian Centre for Cardiovascular Surgery (1969–1994). Since 1994 until 2012 – the head of Pediatric Cardiology and Cardiac Surgery Clinic in University Children’s Hospital, Riga; since 2012 – a consulting professor of this Clinic. Vicepresident of Latvian Society for Cardiovascular Surgery. President of Latvian Association for Pediatric Cardiologists. Author of 395 scientific publications, 3 monographs and 13 patents. Investigator in more than 10 clinical trials including cardiosurgical procedures performed under deep hypothermia, hybrid procedures etc. In May 2009 have been used transcutan intramyocardial delivery techniques for treatment (idiopathic dilated cardiomyopathia) the first 3 months aged patient in the world with autologous bone marrow derived progenitor cells. In November 2010 the first patient with end stage pulmonary hypertension received intrapulmonary implantation autologous stem cells.
The promising field of regenerative medicine is working to restore structure and function of damaged tissues and organs. The adult heart represents an attractive candidate for cell-based technologies. While there is a wealth of preclinical and clinical data showing the safety, feasibility and efficacy of stem cells in adults with acute myocardial infarction and heart failure, less is known about possible implementation of stem cell therapy in infants and children with heart failure due to dilated cardiomyopathy and pulmonary arterial hypertension. The challenges facing cardiac stem cell therapy are multiple. There are uncertainties around the destiny of stem cells after their injection into the blood stream. In particular, it regards migration and homing of implanted cells in the target tissues. As yet unclear is the possible role of sympathetic nervous system in the context of osteoreflexotherapy. There is still no definitive answer to the question on which is the preferred type of stem cells to be used for transplantation in different settings. Since 2008, when we first used autologous bone marrow-derived mononuclear cells (BM-MNCs) in patient with acute myocardial infarction, we have investigated the use of stem cells not only for myocardial regeneration in adults and pediatric patients, but also in adult patients with diabetes mellitus and osteoarthritis. The objective is to determine the role of BM-MNCs in management of wide spectrum of pathologies, including critically ill pediatric patients, adult patients with acute myocardial infarction and heart failure and adult patients with osteoarthritis. Two patients (9 and 15 years old) with trisomy 21 and severe pulmonary arterial hypertension due to uncorrected large ventricular septal defects received imtra-pulmonary BM-MNCs implantation. Radionuclide scintigraphy showed improvement of lungs vascularization during 36 months follow-up. Seven patients (4 months–17 years) with dilated idiopathic cardiomyopathy received intra-myocardial BM-MNCs injections. During follow-up (up to 7 years), we observed improvement of left ventricular ejection fraction (LVEF), decrease of left ventricular end diastolic dimension by echocardiography and cardio-thoracic index at chest X-ray exams, reduction of serum brain-natriuretic peptide serum levels and decrease of the stage of heart failure from stage IV to stage I, by NYHA classification. No peri-procedural harmful side effects were observed. We performed BM-MNCs intracoronary infusion in 101 adult patients with acute myocardial infarction with reduced LVEF and in 14 patients with chronic heart failure. Our results showed statistically significant improvement in LVEF at 12 months. We also infused BM-MNCs to the pancreas directly via branches of splenic artery or superior pancreaticoduodenal artery we have performed single intra-articular BM-MNCs injections in 70 patients with knee or hip joint osteoarthritis (stage II–III). No adverse effects after the BM-MNC injection were observed. Preliminary analysis showed decrease in pain and other symptoms and statistically significant improvement by clinical scoring system using different questionnaires. The results are promising and we suggest that BM-MNCs might be used for the stabilization of the adult and pediatric patients to improve symptoms and outcomes or serve as a bridge for heart or lung transplantation or delay joint replacement surgery. It also could be recommended in cases if other more traditional treatment options fail or are contraindicated.
- Heart Diseases & Failure |Cardiac and Cardiovascular Research|Diabetes, Obesity & Stroke | Cardiac Pharmacology
Location: Meeting Room 2
Center for Healthcare and Organizational Research, USA
Childrenís Clinical University Hospital, Latvia
Sun Yat-sen University, China
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.
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
Philippine Heart Center, Philippines
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.
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.
Congenital Heart Surgery Munich, Germany
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.
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.
Korea University Ansan Hospital, Republic of Korea
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.
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%).
Center of Experimental Medicine Slovak Academy of Sciences, Slovak Republic
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.
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. NF“°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 NF“°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.
Ng Teng Fong General Hospital, Singapore
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.
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.
Kindai University School of Medicine, Japan
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.
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.
University of Wurzburg, Germany Hiroshima City Asa Hospital, Japan
Title: Estrogen Receptor-Beta activation: A novel approach to prevent ischemic brain damage as a comorbidity of heart failure
Time : 15:25-16:10
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.
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.
Jordan University of Science and Technology, Jordan
Title: Factors associated with hypertensive patients' compliance with recommended lifestyle behaviors in north of Jordan
Time : 16:30-16:55
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.
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.
Frantz Fanon Hospital University, Algeria
Time : 16:55-17:20
Nazim Megherbi is a Cardiologist at the Frantz Fanon Hospital University, Blida, Algeria.
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.
Will be updated soon.
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.