Day 2 :
Keynote Forum
Roland Hetzer
Former Medical Director, German Heart Institute Berlin, Germany
Keynote: End-stage Heart Failure
Time : 09:00-09:25
Biography:
Roland Hetzer has completed his cardiothoracic surgery training in Hannover Medical School, Germany and in Stanford University, California. He performed thernfirst heart transplantation in Hannover in 1983 and the first pediatric heart transplantation in Germany in 1985. As the Medical Director and Chairman in DeutschesrnHerzzentrum Berlin from January 1986 to September 2014, he and his team performed more than 1900 heart transplantations and more than 2300 implantationsrnof mechanical circulatory support systems. He has made numerous original contributions in the field of cardiothoracic and vascular surgery particularly in surgicalrntreatment of end-stage heart failure and valve surgery. Presently, he still serves as the Medical Director of Herzzentrum Cottbus and sees his private patients inrnCardio Centrum Berlin.
Abstract:
Heart failure has a rapidly increasing incidence in both men and women and is the most prominent heart disease in thernelderly. This is due to the successful treatment of acute heart disease which later on turns into chronic failure. Whereasrnpharmaceutical and electrophysiological concepts have been constantly improved, end-stage heart failure has been approachedrnby various surgical procedures. The majority of cases depends on ischemic heart disease which we described as LOCIMAN (Leftrnheart failure, Occlusion of the Coronary artery, Incompetence of Mitral valve and Left ventricular Aneurysm or Akinesia), Itrnappears to be mandatory to evaluate the relative contribution of these components to heart failure and the relative importancernof surgical procedures (coronary bypass, mitral valve repair and aneurysmectomy) for cardiac improvement. These proceduresrnplay a major role in less than profound heart failure. In such cases, various external support procedures were introduced whichrnmostly have been abandoned as well as the partial ventricular resection procedure (Batista). Heart transplantation is now a wellestablishedrntreatment for end-stage heart failure, enabling a high degree of physical rehabilitation and a mean survival time ofrn12 to 14years. Some of our patients are now living for more than 30 years after transplantation. However, heart transplantationrnis an option offered to only few patients due to limited availability of donor organs. Mechanical circulatory support systemsrnhave achieved clinical application during the last 30 years. Between 1987 and 2014, more than 2300 ventricular assist devicesrnhave been implanted in Berlin to keep patients alive, after which there were three options: bridge to transplantation, bridge tornmyocardial recovery in myocarditis and in cardiomyopathy, first demonstrated by pump explantation and long-term stabilityrnin Berlin in 1995, and as permanent implants. Originally these ventricular assist devices were extracoporeal connected tornlarge driving units. Thereafter, electrical pulsatile systems were introduced; however, these were noisy and bulky. In 1998, thernauthor implanted the first rotary blood pump with continuous flow (MicroMed DeBakey) worldwide. Such systems, which arernsmall and silent, have become the standard in now 90% of cases. These pumps also qualify for long-term use (up to 10 years).rnThey are developed to support the left ventricle; however, they can be also implanted in the right ventricle when necessary.rnMoreover these systems are very useful in elderly patients. Pulsatile extracorporeal systems, i.e. Berlin Heart EXCOR Pediatric,rnare the only one available for end-stage heart failure in infants and young children. The only available total artificial heart isrnthe CardioWest pneumatic system. However, there are some experimental total artificial heart developmental projects goingrnon in Germany, in France and in USA.
Keynote Forum
Ada Yonath
Weizmann Institute of Science, Israel
Keynote: Towards control of resistance to antibiotics
Time : 14:15-15:00
Biography:
Ada Yonath is focusing on protein biosynthesis and the antibiotics hampering it. In the seventies she established the first structural-biology laboratory in Israel.rnShe is the Director of Kimmelman Center for Biomolecular-Structure. During 1986-2004 she also headed Max-Planck-Research-Unit for Ribosome Structure inrnHamburg. Among others, she is a member of US-National-Academy-of-Sciences; Israel Academy; German Science Academy; PontificiaAccademia-delle-Scienzern(Vatican). She holds honorary doctorates from Oslo, NYU, Mount-Sinai, Oxford, Cambridge, Hamburg, Berlin-Technical, Patras, De-La-Salle, Xiamen, Lodzrnuniversities. Her awards include the Israel Prize; Louisa-Gross-Horwitz Prize; Linus-Pauling Gold Medal; Wolf-Prize; UNESCO/L’Oreal Award; Albert-EinsteinrnWorld Award for Excellence; and Nobel Prize for Chemistry.
Abstract:
Resistance to antibiotics and the spread of antibiotics metabolites are severe problems in contemporary medicine and ecology.rnStructures of complexes of eubacterial-ribosomes with antibiotics paralyzing them illuminated common pathways in inhibitory-actions, synergism, differentiation and resistance. Recent structures of ribosomes from a multi-resistant pathogensrnidentified features that can account for species-specific diversity in infectious-diseases susceptibility. These may lead to designrnof environmental-friendly degradable antibiotics, which will also be species-specific antibiotics-drugs, thus the basis for srnrevolution in the antibiotics field, which its current preference for wide-spectrum drugs. Thus, reducing resistance while protecting the environment and preserving the microbiome.
Keynote Forum
Béla Merkely
Past President of the Hungarian Society of Cardiology
Heart and Vascular Center, Semmelweis University, Hungary
Keynote: Cardiac Resynchronisation: State of the Art
Time : 09:00 - 09:30
Biography:
He is the Chairman of the Heart and Vascular Center, Semmelweis University, Budapest, Hungary. President of the Clinical Center and Vice Rector of the Semmelweis University. Councillor and Member of the Board of the European Society of Cardiology. Chair of the National Cardiac Societies Committee of EHRA. President of the Hungarian Association of Cardiovascular Intervention. Honorary President of the Hungarian Heart Rhythm Association. Past President of the Hungarian Society of Cardiology.
Abstract:
rnCardiac resynchronization therapy (CRT) has become the gold standard device therapy in chronic heart failure patients on optimal medical therapy with ventricular dyssynchrony and reduced ejection fraction. According to the ESC guidelines, CRT is most effective in patients with wide QRS (120-150 msec), left bundle branch block, non-ischemic etiology and female gender. CRT indication is growing across Europe, but CRT penetration is insufficient, thus CRT needs exerts CRT implantations. To compensate, both the numbers of CRT implanting centers and the overall CRT implantations increase rapidly in European countries. In 2013 a total of 51 274 CRT devices were implanted in 1701 national European centers.rnCRT is cost-effective, reduces mortality and morbidity, however non-response to CRT is still the biggest problem. Recent studies have showed no advantage of CRT in patients with narrow QRS or non-left bundle branch block pattern in ECG. Etiology of heart failure has a pivotal role, it has been shown that CRT with implantable cardioverter defibrillator (CRT-D) might be beneficial in patients with ischemic etiology, but not in non-ischemic patients. Device optimization is crucial, physiologic atrioventricular delay (<120 msec), and optimal electrode position (in a postero-lateral vein far away from the scar) reduces mortality. Electroanatomic mapping with right to left ventricular interlead sensed electrical delay measurement improves pacing conditions. Quadripolar lead configuration could avoid phrenic nerve stimulation. Novel implantation techniques have been developed, such as transseptal endocardial lead placement or coronary sinus lead stabilization with stent implantation.rn