Day 2 :
University Hospital Marburg, Germany
Time : 10:00-10:40
He started his career as a resident at the University Hospital in Giessen in 1978. In 1990 he became a full professor for cardiovascular surgery at the University in Bonn and vice chairman of the respective department. In 1989 and 1990 he spent two semesters at the Carolinas Heart Institute in Charlotte/NC as a research and clinical fellow. Since 1994,He is working at the University Hospital in Marburg as a full professor for cardiovascular surgery and director of the department. Between 2001 and 2011 he also held the position of the vice medical director and since 2006 the medical director of the University Hospital in Marburg. The main specialties within cardiovascular surgery are laser- and arrhythmia surgery, endovascular procedures including TAVI´s and endovascular reconstructions of the aortic arch and reconstructive surgery of the coronaries. As the chairman of the board of "Medical Network Hessen" he is an official representative of the State of Hessen in the field of clinical medicine and medical education.
In an elderly population, many patients are suffering from multiple cardiovascular problems at different locations. Age and multimorbidity are limits for conventional open heart surgery. New hybrid interventions are offering tailored treatment options also for this growing group of patients:Patients with cerebrovascular disease and status post stroke are frequently also suffering from degenerative aortic valve disease. One such tailored hybrid procedure consists of a typical endarterectomy of the affected carotid artery, mostly under local anesthesia, followed by a catheterbased aortic valve replacement via a vascular graft anastomosed to the patients common carotid artery, which contains the necessary ports for the TAVI and avoids major interferences with carotid flow. We have performed this procedure in 4 patients, among them one with a bilateral endarterectomy. All of them were discharged home without new neurologic pathologies. This procedure will be demonstrated in detail.
Many elderly patients are referred to us for a TAVI procedure but preoperative investigations reveal further significant cardiac pathologies such as coronary artery disease with severe left main or diffuse triple vessel involvement, further valvular disease or even congenital defects. In a novel hybrid approach, we address the other pathologies in the typical open fashion and finally insert a TAVI valve under direct vision via a small mini aortotomy. So the aortic valve replacement does add no more than 10 minutes to the cross clamp time and such, even complex operations may be performed in very old and multimorbid patients with a reasonable risk, as demonstrated in already more than 20 patients.
St. George’s University of London, UK
Keynote: CD4+CD28null T lymphocytes from patients with myocardial infarction have distinct gene signatures, phenotype and function compared to conventional CD4+CD28+ T cells
Time : 10:40-11:30
Ingrid Dumitriu is a Reader (Associate Professor) in Cardiovascular Immunology at St. George’s, University of London, London UK. She leads the Cardiovascular Immunology research group and has an MD degree and a PhD in Immunology. Her research focuses on the role of inflammation and immune cells in atherosclerosis and other cardiovascular diseases. Dr Dumitriu is a nucleus member of the European Society of Cardiology (ESC) Working Group on Atherosclerosis and Vascular Biology. She is also a member of the ESC, European Atherosclerosis Society, British Society for Immunology, and ESC Working Group on Peripheral Circulation.
We have previously shown that CD4+CD28null (CD28null) T cells are a unique T lymphocyte subset with pro-inflammatory and cytolytic function. CD28null T cells increase in the circulation and atherosclerotic plaques of myocardial infarction (MI) patients. CD28null T cells accumulate preferentially in unstable atherosclerotic plaques and promote atherosclerotic plaque rupture via release of their cytotoxic cargo and lysis of endothelial and vascular smooth muscle cells. MI patients with high CD28null T cell numbers have increased risk of recurrent severe coronary events and unfavourable prognosis. The precise mechanisms that regulate the inflammatory and cytolytic functions of CD28null T cells in MI remain elusive. We performed whole genome transcriptome analysis of CD28null and conventional CD28+ T cells from MI patients to identify differences in gene signatures between these two lymphocyte subsets. We found that CD28null T cells from MI patients had marked differences in gene programmes compared to conventional CD28+ T cells. Functional enrichment pathway analysis revealed the natural killer cell mediated cytotoxicity and chemokine signalling pathways as the most significantly up-regulated. We provide data confirming these changes at protein level and demonstrating their impact on the function of CD28null T lymphocytes. Our novel findings reveal that the distinct phenotypic and functional properties of CD28null T cells are regulated at transcriptional level and identify novel molecular targets to modulate the deleterious function of this cell subset in MI patients.