Abstracts - SA Heart Congress 2016

Index of abstracts: alphabetical listing of first authors

Optimizing outcome and quality of life for mesenteric ischemia patients by improving diagnostic and treatment strategies

With this thesis we have shown that outcome for mesenteric ischemia patients has improved over time. The main reasons for this are the introduction of minimally invasive treatment options and increased awareness of the disease. Both have let to more organ-sparing strategies and enhancement of quality of life. Timely diagnosis is still very difficult. Although many researchers have tried to find a biomarker or combination of biomarkers to aid in the diagnostic process of AMI patients, we have shown that the use of biomarkers in the diagnostic process of AMI is insufficiently substantiated. The actual diagnosis of AMI can currently only be made on the basis of a high index of suspicion followed by a multislice CTA. To save bowel and reduce morbidity and mortality, prompt revascularization is essential before assessment of bowel with possible resection should be performed. We have shown that endovascular treatment (EVT) has replaced open surgical revascularization as primary treatment strategy with antegrade (PMAS) as the first and retrograde (ROMS) as the second option. Although EVT has a lower primary patency, the less invasive character and concomitant lower morbidity and mortality is favourable for these cachectic and severely ill patients. While great progress has been made in treatment options in the field of atherosclerotic mesenteric ischemia for years, the raison d'être of the median arcuate ligament syndrome (MALS) is still a huge point of discussion. With our comprehensive systematic review, we have shown that (endoscopic) coeliac artery release (e)CAR gives a sustainable symptom relief of 68% in adults and 82% in paediatric patients. These results were the basis for our application to the Dutch National Health Institute, who have appointed us €1,3M for our blinded, randomised controlled trial comparing (e)CAR with a sham operation in patients suspected of MALS. It is estimated that the CARoSO trial will end the debate, whether MALS really does exist and if (e)CAR is a cost-effective treatment for these patients. <br/

Characterisation and modulation of the intracellular inflammatory signalling pathways activated during surgery with cardiopulmonary bypass

Surgery with cardiopulmonary bypass (CPB) is associated with post-operative complications due to systemic inflammation. However, the intracellular signalling pathways that promote inflammation in cardiac surgery with CPB are uncertain. The studies presented in this thesis were designed to illuminate these molecular mechanisms, thereby informing the development of novel anti-inflammatory strategies. This was addressed through a clinical trial to determine the effects of CPB on inflammatory signalling in leukocytes (Chapter 4). In this study, the induction of reactive oxygen species (ROS) and the activation of NF-κB and p38 MAP kinase within leukocytes was compared in patients exposed to miniaturised CPB (mCPB; an optimised form of CPB designed to attenuate systemic inflammatory activation) or conventional CPB (cCPB). Twenty-six patients undergoing surgical revascularisation for advanced coronary artery disease were randomised to undergo surgery with either cCPB or mCPB. Blood samples were collected pre-operatively and at various times after the initiation of CPB and analysed by intracellular staining and flow cytometry for intracellular markers of activation. p38 MAP kinase phosphorylation in granulocytes was enhanced in patients receiving cCPB compared to mCPB (p<0.05). Levels of ROS in lymphocytes were elevated in cCPB compared to mCPB (p<0.01) whereas ROS levels in granulocytes and monocytes were similar between groups. NF-κB phosphorylation in leukocyte sub-sets, leukocyte tissue migration as well as conventional markers of inflammation were comparable between the investigative groups. A porcine model was also established to study the signalling pathways that promote systemic inflammation in response to cardiac surgery with CPB under well-controlled experimental conditions. The influence of sulforaphane, an anti-inflammatory compound derived from green vegetables, on inflammation and injury in response to CPB was also studied. It was observed that pre-treatment of animals with sulforaphane reduced p38 MAP kinase (p<0.05) and NF-κB (p<0.05) phosphorylation in leukocytes exposed to CPB and protected porcine kidneys from exhibiting histological features of early injury. A small clinical study demonstrated biologically significant levels of sulforaphane could be determined in plasma, with lower levels of p38 MAP kinase (p<0.01) and attenuated ROS (p<0.01) in the early stages following consumption. In conclusion, systemic inflammatory responses following CPB were associated with activation of p38 MAP kinase and NF-κB pathways in circulating leukocytes in both porcine and clinical studies. Inflammatory responses to CPB can be reduced by miniaturisation of the CPB circuit and pharmacologically using sulforaphane.Open Acces

High-Risk Percutaneous Intervention in the Drug-Eluting Stent Era

High-risk Intervention in the Drug-eluting stent era The use of drug-eluting stents in high-risk interventions, including those undertaken to treat the left main coronary artery (Chapter 2), multivessel disease (Chapter 14) or on-going ST-segment elevation myocardial infarction (Chapters 11 and 12) appeared overall beneficial in comparison with traditional metallic stents. In particular, the use of drug eluting stents was associated to a remarkable decrease in late loss (Chapter 3) which ultimately resulted in lower need for re- intervention (Chapter 2), while no clear effect on death and myocardial infarction was observed. The safety profile of these new coronary devices appeared overall consistent with what has been reported in the pivotal trials focusing on selected patient/lesion subsets (Chapters 2, 3, 7, 8, 12, 14, 15, 16). The incidence of possible or confirmed acute, sub-acute or late thrombosis was low in this high-risk subset of patients patients undergoing treatment for left main coronary artery disease (Chapters 2, 3, 7, 8, 12, 14, 15, 16) and importantly we could not confirm previous concerns regarding the potential association between intimal hyperplasia and sudden death in patients undergoing treatment for left main coronary artery disease (Chapters 7 and 8)

New Technologies for the Treatment of Coronary and Structural Heart Diseases

There has been significant progress in the field of interventional cardiology, from the development of newer devices to newer applications of technology, resulting in improved cardiovascular outcomes. The goal of this Special Issue is to update practicing clinicians and provide a comprehensive collection of original articles, reviews, and editorials. To this end, we invited state-of-the-art reviews, including reviews of new technology and therapeutics, as well as original research in this area to be considered for inclusion in this issue. Examples include the history and evolution of interventional techniques, reviews of specific devices and technologies for coronary artery disease (i.e., stent technology, atherectomy devices, coronary physiology, intracoronary imaging, and robotics), structural heart diseases (i.e., ASD: atrial septal defect; LAAC: left atrial appendage closure; MC: MitraClip; PFO: patent foramen ovale; TAVI: transcatheter aortic valve implantation), advances in the management of challenging coronary anatomy, new biomarkers of cardiovascular disease (noncoding RNAs, etc.), and interventional techniques in the management of heart failure, peripheral arterial diseases, and pulmonary embolism. This Special Issue presents the most recent advances in the field of coronary and structural heart diseases as well as their implications for future patient care

Cirugía robótica en patología quirúrgica benigna y maligna (urología, cirugía general y digestiva, cirugía cardiotorácica, ginecología, endocrinología, oftalmología y cirugía de cabeza y cuello). Capítulo I: cirugía cardiotorácica, endocrina, oftalmológica y cirugía de cabeza y cuello

Cirurgia robòtica; Tècniques quirúrgiques; InnovacióCirugía robótica; Técnicas quirúrgicas; InnovaciónRobotic surgery; Surgical techniques; InnovationAquest estudi té l’objectiu de determinar si la cirurgia assistida per robot, quan aquesta és el tractament indicat en una sèrie de patologies benignes o malignes, ha de ser incorporada en la cartera comuna bàsica de serveis assistencials del SNS i, per tant, convertir-se en una tecnologia finançada a través de fons públics. Per fer-ho s’ha avaluat l’eficàcia o l’efectivitat, la seguretat i l’eficiència de la cirurgia assistida per robot en comparació amb la cirurgia oberta o endoscòpica en un grup d’indicacions de patologia benigna o maligna en les especialitats de cirurgia cardiotoràcica, endocrina, oftalmològica, de cap i coll.El estudio tiene el objetivo de determinar si la cirugía asistida por robot, cuando la cirugía es el tratamiento indicado en una serie de patologías benignas o malignas, debe ser incorporada en la cartera común básica de servicios asistenciales del SNS y, por tanto, convertirse en una tecnología financiada a través de fondos públicos. Para ello se ha evaluado la eficacia o la efectividad, la seguridad y la eficiencia de la cirugía asistida por robot en comparación con la cirugía abierta o endoscópica en un grupo de indicaciones de patología benigna o maligna en las especialidades de cirugía cardiotorácica, endocrina, oftalmológica y de cabeza y cuello.The aim of the report is to determine whether robot-assisted surgery —when surgery is the indicated treatment for a series of benign or malignant pathologies— should be included in the basic common portfolio of the SNS healthcare services and thus become a publicly funded technology. To this end, the efficacy or effectiveness, safety and efficiency of robot-assisted surgery has been evaluated in comparison with open or endoscopic surgery in a group of indications of benign or malignant pathology in the specialities of cardiothoracic surgery, endocrine surgery, ophthalmological surgery, head and neck surgery