Day 1 :
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada
Time : 10:15-10:45
Louis P. Perrault received his medical degree from University of Montreal in 1986. He completed 3 years of training in basic science research in Paris under the supervision of Professor Paul VanHoutte at Université Louis-Pasteur and obtained a doctor degree (PhD) in fundamental research in 1997. He is the current president for the CSCS.Dr. Perrault is a local Principal Investigator for the Cardiothoracic Surgical Trials Network (CTSNet) for the NIH/CIHR since 2007. He is also an investigator of the FRSQ (Fonds de la Recherche en Santé du Québec). Dr. Perrault has authored and co-authored more than 250 articles in peer-reviewed publications including New England Journal of Medicine, J Chir Thorac Cardio-Vasc, Circulation and J Heart Lung Transplant. His areas of clinical expertise include: Coronary Artery Bypass Grafting Surgery (CABG), valve surgery and heart transplantation ,endothelial dysfunction in left ventricular hypertrophy, pulmonary hypertension following CPB, stem cells therapy and heart transplantation.
To address the clinical consequences related to chest tube clogging, a novel chest drainage apparatus, the PleuraFlow Active Tube Clearance System (Clear Catheter Systems, Bend, OR), was developed. The aim of this world's first clinical experience study was to follow clinicians using the PleuraFlow system to assess usability issues and potential areas of improvement in the heart surgery setting.A user preference study was conducted to assess how specified users (surgeons, nurses, and intensive care physicians) used the PleuraFlow system to achieve specified goals in an efficient manner. Data were collected from patient charts and by a questionnaire that they had filled.All the surgeons (n = 7) noted that the device was not any more difficult to insert than a conventional chest tube and was easy to assemble and use. There were no reports of malfunction or complications related to the installation or use of the system. A majority, 77% (24/31), of nurses felt that the device was more time efficient than stripping, milking, or tapping the chest tubes to keep them open. A majority (16/19, 84%) of the PleuraFlow chest tubes and guide tubes were removed together in one piece within 1 day of surgery (on postoperative day 1).rnOverall, the physicians and nurses rated the PleuraFlow system positively for its ability to be incorporated into the postoperative workflow of managing the drainage of patients after heart surgery. This device may be useful to allow caregivers to be certain that chest tubes are functioning in the early hours after surgery, when active bleeding is resolving and when complications from undrained blood can ensue.
Cardiac Surgeon University Hospital of Besancon – France
Keynote: Early Detection of Asymptomatic Bypass Graft Abnormalities Using a Cardiac Troponin I Ratio Following Coronary Artery Bypass Surgery
Time : 10:45-11:15
Prof. Sidney Chocron is head of department of cardiac surgery in Besancon (France). He has published more than 100 papers in reputed journals. His research Interests Cardiovascular surgeries,Myocardial revascularization.He built internet websites with techniques of surgical myocardial revascularization using only the two mammary arteries (http://www.chirurgie-cardiaque-besancon.org/learncabg) and other surgical videos (http://www.chirurgie-cardiaque-besancon.org/index.php?xlpage=interventions).
rnTo identify the best cardiac Troponin I (cTnI) ratio to detect asymptomatic graft or anastomoses anomalies after myocardial revascularization.Patients with a rising cTnI profile, based on measurements at 6 and 12 hours (cTnI 12 hours : 6 hours ratio >1) after the last anastomosis in off-pump surgery or after cardiopulmonary bypass in on-pump surgery, underwent a coronary angiogram, despite an uncomplicated postoperative course and absence of electrocardiogram changes. The optimal threshold value for the ratio was determined using a receiving operator characteristic (ROC) curve.rnFrom April 2005 to May 2011, among 1693 patients undergoing isolated coronary artery bypass graft (CABG), 29 (1.7%) had a cTnI ratio >1 and underwent postoperative angiography. Twenty abnormalities were observed in 16 patients (55%). In the anastomoses, there were four occlusions and four stenosis. In the grafts, there were 12 stenosis: two of the Y graft anastomosis, two dissections, five hematomas and three kinking. TIMI flow grade based on results of the Thrombolysis In Myocardial Infarction trial was 3 in six patients, 1 in five, and 0 in five. In the 16 patients with lesions, the cTnI ratio was 2.1 ± 1.4 versus 1.4 ± 0.3 in patients with no lesions (p = 0.09). A ratio of 1.3 (p = 0.003) was determined by ROC curve analysis as having the greatest discriminant capacity, with associated sensitivity of 87.5% and specificity of 62%.A cTnI 12 hours : 6 hours ratio >1.3 may be indicative of these abnormalities. Early identification of these anomalies may avoid adverse outcomes. rn
Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg. Sweden
Keynote: Restenosis after percutaneous coronary intervention (PCI): Experiences from the perspective of patients
Time : 11:15-11:45
Annika Odell has completed a Master of Science in Health Care Science in Nursing 2006. PhD, 2014, at the Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg. With Tite: “Aspects on Revascularisation for coronary artery disease- from a patient, health care provider and societal perspective”. She is Head of the research unit, the development unit and the Tobacco preventive unit at the department of Cardiology at Sahlgrenska University Hospital, GöteborgrnPublications in American Journalof Cardiology, Cardiology and European Journal of Cardiovascular Nursing.
PCI has been established as an effective treatment for coronary artery disease. Restenosis is a recurrence of a significant narrowing in the treated vessel. Although a part of the investigative and research funding is invested in the prevention and resolving the restenosis problem, little is known about its clinical significance apart from further revascularisation.The intention of this study was to clarify the patients perspective of what it means to suffer from documented restenosis after PCI.Patients interviewed had undergone PCI. Data collection and analysis was done simultaneously according to Grounded Theory methodology and continued until new interviews provided no additional information."Living with uncertainty" was identified as the core category, and the central focus in the data explains what it means to patients' to suffer from restenosis. The core category was further illuminated in four additional categories labelled "fighting for access to care", "moderating health threats", "trying to understand" and "controlling relatives anxiety".Patients' perceptions of illness and illness-related events, such as symptoms, diagnosis, treatment and prognosis, are considerably affected by uncertainty. This infiltrates their struggle to acquire the care needed, their endeavour to comprehend and moderate health threats, and caring for their family.