Day 3 :
Keynote Forum
Marco Picichè
San Bortolo Hospital, Italy
Keynote: Heart failure: cannulation strategies of Extracorporeal Membrane Oxygenation (ECMO)
Time : 10:00-10:40
Biography:
Marco Picichè graduated with a degree in medicine from the University of Florence in 1995 and completed his cardiac surgery residency at the Tor Vergata University of Rome in 2000, both summa cum laude. He held regular teaching appointments at the university of Montpellier school of medicine, obtained certification by the French Board in cardiac surgery (Paris, 2007), earned his research master in surgical science (Paris, 2007), and received a university diploma in vascular surgery (Paris, 2007). In Canada he authored a research project on the occlusion of the internal mammary arteries as an alternative method of myocardial blood supply (2008, Laval University). In May 2009 he had the honor of opening the 44th Congress of the European Society for Surgical Research with a lecture on ‘‘The history of surgical research.’’ In September 2011 he received a doctor of philosophy (Ph.D.) in therapeutic innovations from Paris-Sud University. He is the Editor in Chief of the book: « Dawn and evolution of cardiac procedures: research avenues in cardiac surgery and interventional cardiology » (Springer-Verlag publishing house, September 2012). He patented a new surgical instrument. Currently he is a cardiac surgeon in Italy.
Abstract:
ECMO (Extracorporeal Membrane Oxygenator) combines a centrifugal pump with a hollow fiber or membrane oxygenator and provides hemodynamic improvement and cardiac and respiratory support with up to 6 l/min nonpulsatile flow. ECMO can be used in a central configuration with the outflow from the distal ascending aorta and inflow from the right atrium, or in a peripheral configuration, involving femoral or subclavian artery and femoral vein. The central approach is generally used following unsuccessful weaning from cardiopulmonary bypass. Peripheral cannulation is generally used for acute cardiac or respiratory failure from nonsurgical causes. Usually, peripheral cannulation is performed percutaneously using the Seldinger technique. Cannulas range from 17 to 21 Fr for arterial cannulation and from 25 to 29 Fr for venous cannulation. Perfusion of the lower limb must be achieved using a 6 Fr cannula inserted into the superficial femoral artery. Otherwise, an 8 mm Dacron graft may be sutured to the femoral or subclavian artery and the outflow cannula inserted inside. This allows the perfusion of the limb. One disadvantage of the peripheral cannulation is the inability to effectively decompress the left ventricle if there is a total absence of left ventricular function. Therefore, a transseptal drainage or venting from the left ventricle or left atrium or pulmonary artery must be instituted. Herein, the different cannulation strategies of ECMO are discussed.
Keynote Forum
Imre Janszky
Norwegian University of Science and Technology, Norway
Keynote: Weight and weight change and risk of acute myocardial infarction and heart failure – the HUNT Study
Biography:
Imre Janszky has an MD and a PhD degree from Semmelweis Medical University, Budapest, Hungary and from Karolinska Institutet, Stockholm, Sweden, respectively. He is currently working at the Department of Public Health and General Practice/Norwegian University of Science and Technology as professor in epidemiology. His main focus of research is on risk and prognostic factors for cardiovascular diseases but he also has interest in other areas including epidemiology of psychiatric and neurologic disorders and epidemiologic methods.
Abstract:
To delineate the association of weight with cardiovascular health throughout adulthood. We conducted a population-based prospective cohort study of 26 097 community-dwelling individuals who were followed for 11.4 years with measurements of cardiovascular risk factors and common chronic disorders. Body weight and height were directly measured at baseline in 1995–1997 as they had been 10 and 30 years prior to baseline. From these measurements, we estimated average body mass index (BMI) over time and calculated weight change. Resulted in the association of average BMI with acute myocardial infarction (AMI) became weaker with adjustment for the most recent BMI measurement, whilst this adjustment had a more limited effect on associations with heart failure (HF) risk. For example, the multi-adjusted hazard ratios for AMI in a comparison of individuals with average BMI until baseline ≥35 kg m−2 and between 18.5 and 22.4 kg m−2 decreased from 1.75 [95% confidence interval (CI) 1.04–2.95] to 1.32 (0.73–2.40). The corresponding numbers for HF were 3.12 (1.85–5.27) and 2.95 (1.53–5.71), respectively. The associations between weight change and risk of AMI and HF were U-shaped, with stable weight showing the lowest risk. Sustained overweight or obesity over time is associated with increased risk of HF, even after adjustment for the most recent BMI. For AMI risk, the most recent BMI appears to be the most important. Weight change also increases risks for both outcomes beyond the effects of BMI. Our results suggest that a global epidemic of obesity is likely to increase the incidence of HF, even if BMI in middle age can be controlled.