Day 1 :
Hospital Zambrano-Hellion, Mexico
Time : 10:00-10:45
Ovidio A. Garcia Villarreal is a cardiac surgeon dedicated to the private practice, retired from the social medicine. Surgery. He has been working on the mitral, aortic and tricuspid reconstruction for more than 25 years. He has been spearheading in the field of Cardiac arrhythmia surgery, particularly in atrial fibrillation surgery (Cox-maze procedure) as well as in aortic valve sparing operations in Mexico. He has executed national surgical models for valvular heart reconstruction and maze procedure. He has been also dedicated to clinical research, with more than 50 international publications in PubMed. Editor-in-Chief of the journal Cirugia Cardiaca en Mexico, and analyst in more than 15 international journals. He is active member of the Mexican Society of Cardiac Surgery, Society of Thoracic Surgeons, European Association of Cardiothoracic Surgery, amongst others.
Background. Pulmonary vein (PV) isolation has been the cornerstone in the treatment of atrial fibrillation (AF). Many doubts exist about permanent total disconnection of the PV after catheter-based techniques. Surgical division of the PV is the most convincing technique to avoid any further reconnection. We believe this way is the clearest one to investigate how effective PV isolation alone is in the treatment for atrial fibrillation.
Material and methods. From 1998 to 2010, we operated on 120 adult patients having rheumatic mitral valve disease and concomitant AF. All of them had long-standing persistent AF (> 1 year of duration). PV isolation was performed surgically by means of cut-and-sew in all these cases of mitral valve surgery. All patients were analyzed at 3 months, 6 months, 1 year, and once yearly after operation. Registers were recorded arising from Holter and echocardiographic study during the follow-up to 7 years.
Results. Follow up completed at 93 % for seven years. There was only 1 operative death (0.8%), and 7 more along the follow-up. The endpoint was free from any AF, flutter or atrial tachyarrhythmia. Any type of tachyarrhythmia was present at 39%, 47%, 63%, 68%, and 70% at 3 months, 1 year, 3 years, 5 years, and 7 years. The odds ratio for AF recurrence at 7 years was 2.33 (95% CI, 1.46-3.71; p < 0.001). Left atrial size > 6.5 cm in diameter was directly related to AF recurrence at 7 years after surgery (odds ratio= 8.25 [95 % CI, 2.84-24.25; p < 0.001).
Conclusions. By dividing PV surgically, there is no doubt about definitive and complete PV disconnection. Surgical isolation of the PV is not enough to eliminate long-standing persistent AF. More complex procedures such as maze procedure should be considered to treat surgically the AF, especially long-standing persistent AF.
Soochow University , China
Xiao-Hua Wang has completed her PhD majored in immunology from Soochow University. She has been the director of Medical Nursing over ten years. She has published more than 30 papers in impact journals and has been serving as a reviewer of some journals.
Aim: The aim of the study was to explore the impact of anxiety and/or depression on prognosis among CAD patients with stent implantation and to find an intervention to improve symptoms of anxiety and depression for this kind of patients. The specific objectives include: 1) to explore the impact of anxiety and depression on MACEs in Chinese CAD patients after stent implantation; (2) to confirm the effectiveness of a six weeks, one-on-one, face-to-face combined with phone-delivered multiform mindfulness-based stress reduction (mMBSR) on the improvement of anxiety, depression, and stress in Chinese CAD patients with stent implantation.
Methods: Part 1: The impact of anxiety and depression on cardiovascular events of patients with coronary artery stent implantation. Patients who were diagnosed CAD for the first time and met the established criteria were recruited from the First and Second Affiliated Hospital of Soochow University, the Affiliated Hospital of Jiangnan University and the Affiliated Hospital of Nantong University between June 2015 and May 2016.
Part -2: The effectiveness of mMBSR on anxiety and depression in CAD patients with coronary artery stent implantation: A randomized controlled trial. 70 patients who met the established criteria were recruited within 1-4 days after coronary stent implantation from the First Affiliated Hospital of Soochow University between 22 June 2016 and 4 January 2017 and were randomized equally to experimental or control group. Patients in experimental group received a six-weeks, one-on-one, face-to-face combined with phone-delivered MBSR intervention, while patients in control group received routine care. The levels of anxiety, depression, stress and mindfulness were compared between the two groups before and after intervention. The mediating role of mindfulness in the effects of MBSR on improvement of anxiety, depression and stress was analyzed.
Results: Part 1: A total of 328 copies of the initial questionnaire were collected. Among those collected, 19 were excluded, and the remaining 309 were considered valid; the effective recovery rate was 94.21 %. 100 patients (32.36%) had anxiety, 80 (25.89%) had depression, and 56 (18.12%) had anxiety combined with depression. Part 2. 5 patients who practiced mindfulness exercise less than 80% of required in the experimental group were treated as withdrawal. 4 patients in the control group refused to cooperate and did not complete the questionnaires at final. We finally analyzed the data of patients who completed the intervention and questionnaires, with 30 in experimental and 31 in control group.
Conclusion : The prevalence rates of anxiety and depression are high in CAD patients with stent implantation. The occurrence of MACEs still poses clinical problems in CAD patients after stent implantation. Depression is an independent predictor of MACEs. The symptom of anxiety combined with depression increases the risk of MACEs significantly. Although anxiety is associated with MACEs, it has no additional value in the case of co-occurring depression.
Kazan State Medical University, Russia
Liutsiia Feiskhanova is an Associate Professor of department of hospital therapy of Kazan State Medical University, Russia. She has published more than 25 articles in reputed journals. Her interests: cardiology, arrhythmology, rheumatology.
The risk of cardiovascular pathology in rheumatoid arthritis (RA) is 1.5-2 times higher than in the population. This increased risk is based on systemic chronic inflammation, which is the hallmark of rheumatoid arthritis. Framingham scale and SCORE are insufficiently reliable for assessment of cardiovascular risk in patients with RA, because they have the value of the presence of rheumatoid factor and long-lasting increase of ESR. Cardiovascular risk is correlated with the presence of rheumatoid factor, antibodies to cyclic citrullinated peptide, activity and duration of the disease. Dyslipidemia develops earlier than in the population. Proinflammatory cytokines are involved in atherosclerosis and myocardial fibrosis. Sudden cardiac death occurs in 2 times more often in people with RA, than in the population. The greatest contribution to the development of sudden cardiac death is made by ventricular arrhythmias. Patients with RA have a tendency to develop myocarditis and fibrosis, which leads to diastolic dysfunction. According to our data, the diastolic dysfunction correlates with the degree of activity of the disease (p<0.05). Pericardial damage is a common occurrence in rheumatic diseases. In our study the pericardial effusion is found in about 30% of cases according to echocardiography, but specialists often find it difficult and see this picture as an increase of myocardial mass, which in the calculation of parameters indicates the presence of eccentric hypertrophy. Given the fact that RA is the most common rheumatic disease, it needs the special attention to cardiovascular pathology that increases the risk of fatal consequences in patients with RA.