Day 1 :
Keynote Forum
Daan Dohmen
FocusCura, Netherlands
Keynote: cVitals “Telemonitoring-as-a-service†concept for patients with COPD, heartfailure and/ or severe hypertension showing impressive outcomes leading to full reimbursement by mayor insurers in the netherlands
Biography:
Daan Dohmen is an Entrepreneur as well as Scientist. After his Master’s in Industrial Engineering with specialization in Management of Medicine and his PhD on implementing e-health at the University of Twente, he founded FocusCura. He is formally appointed as Councillor of the Dutch Council for Healthcare and Society, which advises the Dutch Government (Ministry of Health) and Parliament. Also, more recently, he joined the Board of the Dutch Patient Association for people with cardiovascular diseases in the Netherlands.
Abstract:
In Netherlands, both COPD and cardiovascular diseases are amongst the major drivers of overcrowded emergency rooms and increase of healthcare expenditure. Telemonitoring is seen as an important means to reduce the burden for chronic patients as well as to prevent EMR visits, hospital admissions and outpatient clinic visits; but large-scale implementations and reimbursement by insurers are scarce. Therefore, in 2016 mayor insurers in the Netherlands started reimbursing cVitals telemonitoring as a service concept in two important value-based healthcare projects. The first concept, ‘Heartguard’, focused on patients with heart failure and severe hypertension and was carried out in specialized focus-clinics of cardiology center in Netherlands. The second concept, ‘In Sight’, was carried out in the Slingeland Hospital together with homecare organization with sincere focus on patients with COPD and heart failure. In both concepts, patients are enrolled in a special cVitals telemonitoring as a service program which guides the patients through their individualized regimen, doing measurements at home such as blood pressure, weight and heart rate and sending them to their cardiologists. If any of the measurements deviates from the normal and/or the system finds an increased risk based on data-analysis, the health care provider receives an alert which can be followed by a video consultation intervention. Home or outpatient clinic visits only are done when needed. The services are contracted by mayor insurers in Netherlands using special reimbursement contracts, based on the foundation of value-based-healthcare and Triple Aim. The first results show that patients, who are using the service, need fewer interactions with their care professionals, outpatient clinic visits are reduced while patients are reporting significantly higher PROMS (EQ-5D, PAM-13). Also, less admissions and EMR visits are registered. Patients with the ‘Heartguard’ service showed an average decrease in blood pressure from 157/89 mmHg to 132/84 mmHg whereas 64% of patients with resistant hypertension gained control of their blood pressure within 3-6 months. These patients were referred by their general practitioners after various medicines failed to lower their blood pressure.
Keynote Forum
Ovidio Alberto Garcia Villarreal
Hospital Zambrano-Hellion, Mexico
Keynote: Mitral valve repair in denegerative disease: Towards excellence, 100% of effectiveness!
Biography:
Ovidio A García Villarreal is the Founder and present President of the Mexican College of Cardiovascular and Thoracic Surgery. He is the immediate past President of the Mexican Society of Cardiac Surgery. He is a Cardiac Surgeon retired from the social medicine, now focused exclusively on private practice in Monterrey, México. He is member of the Mexican Society of Cardiac Surgery, Mexican College of Cardiovascular and Thoracic Surgery, Society of Thoracic Surgeons, European Association of Cardiothoracic Surgery, and of the National Association of Cardiologists of Mexico. He has published more than 50 articles indexed in PubMed, and many others in non-indexed journals. He is the Founder and present Editor-in-Chief of Cirugía Cardiaca en México, official journal of the Mexican Society of Cardiac Surgery since 2015.
He is Reviewer in many prestigious international journals, as Annals of Thoracic Surgery, European Journal of Cardio-thoracic Surgery, Arch. Cardiol. Mex., and many other open access journals. He is the Precursor and the highest extensive experienced in the field of atrial fibrillation surgery (maze procedure), mitral valve repair, and aortic valve sparing-operations (David procedure, Yacoub procedure) in México. He was awarded with the National Prize in Surgery 2000 “Fernando Montes de Oca” from the Mexican Academy of Surgery, the highest prize for surgery in México.
Abstract:
Mitral regurgitation (MR) can be addressed by means of “French Correction” principles described by Carpentier. Remodelling on a frame plays a central role in this strategy. The annuloplasty ring forces leaflet coaptation, distributes evenly all the tensional forces in the repair. Moreover, it avoids any further annulus dilation. It has been demonstrated that the lack of the annuloplasty ring is one of the most powerful predictors for failure after MVR (mitral valve repair). Edge-to-Edge technique is the basis of the MitraClip therapy. Hence, it is not the exception to this rule. Several studies have made very clear that, in this context, the longer the follow-up, the higher the recurrence of the MR after MVR. This is especially true after 10 years follow-up. With this framework, the fact that constantly calls our attention is why the annuloplasty ring is not taken into consideration at the moment to install the MitraClip device. Rules do not become different depending on a given specific surgical or percutaneous approach. The answer has become more than evident by the surgical group. When analyzing the trials concerning the MitraClip, follow-ups are not long enough in order to get strong conclusions about ringless MitraClip. EVEREST-II trial is a 5-year follow-up. However, the achieved results could not be reproduced by others. Current indication based on the current approval device in USA is exclusively on the primary/degenerative MR patients with high-risk for operation with no adequate response to optimal medical therapy. The main indication in Europe for MitraClip is functional MR; in USA as well as Europe, current indication for this kind of procedure is IIb, level of recommendation B or C, respectively. COAPT trial has been designed to test the MitraClip usefulness in functional MR. Results are still on the way. Nevertheless, rules do not change at all. Restrictive annuloplasty is the most common technique to address the functional MR. Even though there is an overoptimistic belief about MitraClip all alone could be sufficient in order to treat MR; everything seems to indicate just the opposite. Annuloplasty with a ring is an absolute must. Cardioband or Millipede IRIS can offer some solution to cope with all these shortcomings.
Keynote Forum
Mikhail Y Rudenko
Russian New University, Russia
Keynote: Practical results of non-invasive measurement of hemodynamic parameters: Blood volumes and metabolism data: Oxygen, lactate and phosphocreatine ( SPECIAL SESSION )
Biography:
Rudenko M Yu has been engaged in research in the field of Physiology and Medicine, as well as Medical Equipment Engineering since 1979. From 1980 to 1989, he was engaged in Space Medicine. He has supervised the development of methods and instruments for detecting the psycho-physiological state of spacecraft human operators. In 1990, he has established a private educational institution “The Institute of Chinese medicine”, till 1998, 17 professors of traditional Chinese medicine (TCM) from China worked in this institute. He has excellently mastered the theory and practice of TCM. He wrote several books on TCM and eastern philosophy. He has created an educational course for western doctors. In 1991, he took an active part in foundation of a private educational institution “Russian New University “in Moscow and currently 25000 students study there. At the university, he headed the Scientific School of Hemodynamic Studies of Cardiovascular System. In the process of his research 9 laws of physiology were revealed. He is a member of ESC W.G. on e-cardiology, ID439666. He takes active part in the W.G. conferences and meetings
Abstract:
Aim: The aim of the present study is to expand diagnostic capabilities in cardiology using the new theory of cardiometry.
Materials & Methods: Non-invasive measurement of blood volumes in each cardiac cycle and parameters of cardiac muscle metabolism upon digital processing of an ECG alone allows monitoring of any changes in the cardiovascular system performance. No additional examination is required. The procedure takes only 20 seconds.
Conclusions: Using the theory of cardiometry in practice allows you: (1) to determine heart life expectancy in an individual with an accuracy up to several hours; (2) to evaluate efficacy of the selected medication and (3) to effectively use the method in sports.
Biography
Rudenko M Yu has been engaged in research in the field of Physiology and Medicine, as well as Medical Equipment Engineering since 1979. From 1980 to 1989, he was engaged in Space Medicine. He has supervised the development of methods and instruments for detecting the psycho-physiological state of spacecraft human operators. In 1990, he has established a private educational institution “The Institute of Chinese medicine”, till 1998, 17 professors of traditional Chinese medicine (TCM) from China worked in this institute. He has excellently mastered the theory and practice of TCM. He wrote several books on TCM and eastern philosophy. He has created an educational course for western doctors. In 1991, he took an active part in foundation of a private educational institution “Russian New University “in Moscow and currently 25000 students study there. At the university, he headed the Scientific School of Hemodynamic Studies of Cardiovascular System. In the process of his research 9 laws of physiology were revealed. He is a member of ESC W.G. on e-cardiology, ID439666. He takes active part in the W.G. conferences and meetings.
- Cardiovascular Disease | Heart Disease & Failure | Angiography & Interventional Cardiology | Cardiac Nursing | Heart Diagnosis | Cardiac Surgery | Cardiovascular Disease | Cardio-Oncology
Location: Pluto
Chair
Ovidio Alberto Garcia Villarreal
Hospital Zambrano-Hellion, Mexico
Co-Chair
Mikhail Y Rudenko
Russian New University, Russia
Session Introduction
Ovidio Alberto Garcia Villarreal
Hospital Zambrano-Hellion, Mexico
Title: Mitraclip therapy: Rules do not change, Annuloplasty ring is a must
Biography:
Ovidio A García Villarreal is the Founder and present President of the Mexican College of Cardiovascular and Thoracic Surgery. He is the immediate past President of the Mexican Society of Cardiac Surgery. He is a Cardiac Surgeon retired from the social medicine, now focused exclusively on private practice in Monterrey, México.
He is member of the Mexican Society of Cardiac Surgery, Mexican College of Cardiovascular and Thoracic Surgery, Society of Thoracic Surgeons, European Association of Cardiothoracic Surgery, and of the National Association of Cardiologists of Mexico. He has published more than 50 articles indexed in PubMed, and many others in non-indexed journals. He is the Founder and present Editor-in-Chief of Cirugía Cardiaca en México, official journal of the Mexican Society of Cardiac Surgery since 2015. He is Reviewer in many prestigious international journals, as Annals of Thoracic Surgery, European Journal of Cardio-thoracic Surgery, Arch. Cardiol. Mex., and many other open access journals. He is the Precursor and the highest extensive experienced in the field of atrial fibrillation surgery (maze procedure), mitral valve repair, and aortic valve sparing-operations (David procedure, Yacoub procedure) in México. He was awarded with the National Prize in Surgery 2000 “Fernando Montes de Oca” from the Mexican Academy of Surgery, the highest prize for surgery in México.
Abstract:
Mitral regurgitation (MR) can be addressed by means of “French Correction” principles described by Carpentier. Remodelling on a frame plays a central role in this strategy. The annuloplasty ring forces leaflet coaptation, distributes evenly all the tensional forces in the repair. Moreover, it avoids any further annulus dilation. It has been demonstrated that the lack of the annuloplasty ring is one of the most powerful predictors for failure after MVR (mitral valve repair). Edge-to-Edge technique is the basis of the MitraClip therapy. Hence, it is not the exception to this rule. Several studies have made very clear that, in this context, the longer the follow-up, the higher the recurrence of the MR after MVR. This is especially true after 10 years follow-up. With this framework, the fact that constantly calls our attention is why the annuloplasty ring is not taken into consideration at the moment to install the MitraClip device. Rules do not become different depending on a given specific surgical or percutaneous approach. The answer has become more than evident by the surgical group. When analyzing the trials concerning the MitraClip, follow-ups are not long enough in order to get strong conclusions about ringles MitraClip.
EVEREST-II trial is a 5-year follow-up. However, the achieved results could not be reproduced by others. Current indication based on the current approval device in USA is exclusively on the primary/degenerative MR patients with high-risk for operation with no adequate response to optimal medical therapy. The main indication in Europe for MitraClip is functional MR; in USA as well as Europe, current indication for this kind of procedure is IIb, level of recommendation B or C, respectively. COAPT trial has been designed to test the MitraClip usefulness in functional MR. Results are still on the way. Nevertheless, rules do not change at all. Restrictive annuloplasty is the most common technique to address the functional MR. Even though there is an overoptimistic belief about MitraClip all alone could be sufficient in order to treat MR; everything seems to indicate just the opposite. Annuloplasty with a ring is an absolute must. Cardioband or Millipede IRIS can offer some solution to cope with all these shortcomings
Nikolaos Bourmpoulis
Red Cross Hospital Athens, Greece
Title: Paradoxical embolism PFO: Easy to occlude; Effective?
Biography:
Nikolaos Bourmpoulis is the Director of Catheterization Laboratory in the Department of Interventional Cardiology, Korgialenio - Benakio Red Cross Hospital Athens, Greece.
Abstract:
Patent foramen ovale (PFO) has been considered as the main cause of paradoxical embolism in the absence of open communication between left and right circulation. On the other hand, PFO itself, with its slow flow between the atrial septum primum and secundum can form thrombus which potentially can be the source of emboli to systematic circulation. Three randomized, open label trials, Gore REDUCE (closure device versus antiplatelet therapy alone compared to the combination of both), CLOSE (closure devise or anticoagulants versus antiplatelet therapy to prevent recurrence of stroke), and RESPECT (closure device versus standard treatment) showed that the risk of stroke was lower with patent foramen ovale closure than with medical treatment alone.
Despite the speculations for these trials and their limitations, it seems that in the near future the treatment of cryptogenic stroke is going to change, a fact that will be probably reflected to the guidelines. The more aggressive approach of interventional cardiologists will balance the more conservative approach of neurologists and will give new fields for investigation, answering questions as how urgently must we intervene after the first stroke to prevent subclinical strokes shown by MRI, or if there is field for primary prevention when a PFO is diagnosed before a paradoxical embolism.
Dolina Gencheva
Medical University of Plovdiv, Bulgaria
Title: Diffi culties in the treatment of a 12-old patient with familial hypercholesterolemia and the inclusion of a PCSK 9-inhibitor
Biography:
Dolina Gencheva has completed her Graduation in Medicine in 2014 at Medical University, Plovdiv, Bulgaria and is currently specializing in the field of Cardiology at the University Hospital Sv. Georgi-Plovdiv. She is the first author of one article, published in a referenced medical journal, co-author of several other journals with impact factors.
Abstract:
The case report concerns a 12 year old boy with genetically diagnosed compound heterozygous form of familial hypercholesterolemia, who first presented with xanthomas on both knees and elbows and a family history of early coronary artery disease and sudden cardiac death. Before the initiation of lipid lowering treatment at the age of 11, the patient’s level of total and LDL cholesterol were 18 mmol/l and 15 mmol/l, respectively. Over the course of several months, the treatment with a statin and a cholesterol absorption inhibitor achieved a 50% decrease of LDL cholesterol level without reaching the absolute recommended target of 3.5 mmol/l. Additional tests of the boy showed initial fibro-degenerative changes of his mitral valve annulus and aortic valve, while his intima media thickness and cardio-pulmonary test were normal. Considering the high risk of early onset atherosclerosis and cardiovascular mortality as well as the unavailability of LDL-apheresis, the patient’s case was reviewed by a national committee, consisting of a cardiologist, a pediatrician and an endocrinologist and approved for adjuvant treatment with a PCSK 9-inhibitor with the consent of his parent.=
Samer Ellahham
Cleveland Clinic, United Arab Emirates
Title: Reducing Door to- Balloon time for acute ST elevation myocardial infarction in primary percutaneous intervention: The role of lean six sigma improvement
Biography:
Abstract: