Day 2 :
Keynote Forum
Roland Hetzer
Medical Director of Herzzentrum Cottbus
Keynote: Progress in the treatment of end-stage heart failure
Time : 09:00-09:40
Biography:
Prof. Dr. Roland Hetzer has completed his cardiothoracic surgery training in Hannover Medical School, Germany and in Stanford University, California. He performed the first heart transplantation in Hannover in 1983 and the first pediatric heart transplantation in Germany in 1985. As the Medical Director and Chairman in Deutsches Herzzentrum Berlin from January 1986 to September 2014, he and his team performed more than 1900 heart transplantations and more than 2300 implantations of mechanical circulatory support systems. He has made numerous original contributions in the field of cardiothoracic and vascular surgery particularly in surgical treatment of end-stage heart failure and valve surgery. Presently, he still serves as the Medical Director of Herzzentrum Cottbus and sees his private patients in Cardio Centrum Berlin.
Abstract:
Heart failure has a rapidly increasing incidence in both men and women and is the most prominent heart disease in the elderly. This is due to the successful treatment of acute heart disease which later on turns into chronic failure. Whereas pharmaceutical and electrophysiological concepts have been constantly improved, end-stage heart failure has been approached by various surgical procedures.
The majority of cases depends on ischemic heart disease which we described as LOCIMAN (Left heart failure, Occlusion of the Coronary artery, Incompetence of Mitral valve and Left ventricular Aneurysm or Akinesia). It appears to be mandatory to evaluate the relative contribution of these components to heart failure and the relative importance of surgical procedures (coronary bypass, mitral valve repair and aneurysmectomy) for cardiac improvement.
These procedures play a major role in less than profound heart failure. In such cases, various external support procedures were introduced which mostly have been abandoned as well as the partial ventricular resection procedure (Batista).
Neither external restraint procedures have not fulfilled the expectations nor myocardial regeneration and stem cell application.
Heart transplantation is now a well-established treatment for end-stage heart failure, enabling a high degree of physical rehabilitation and a mean survival time of 12 to 14 years. Some of our patients are now living for more than 30 years after transplantation. However, heart transplantation is an option offered to only few patients due to limited availability of donor organs.
Mechanical circulatory support systems have achieved clinical application during the last 30 years. Between 1987 and 2014, more than 2300 ventricular assist devices have been implanted in Berlin to keep patients alive, after which there were three options: bridge to transplantation, bridge to myocardial recovery in myocarditis and in cardiomyopathy, first demonstrated by pump explantation and long-term stability in Berlin in 1995, and as permanent implants.
Originally these ventricular assist devices were extracoporeal connected to large driving units. Thereafter, electrical pulsatile systems were introduced; however, these were noisy and bulky. In 1998, the author implanted the first rotary blood pump with continuous flow (MicroMed DeBakey) worldwide. Such systems, which are small and silent, have become the standard in now 90% of cases. These pumps also qualify for long-term use (up to 10 years). They are developed to support the left ventricle; however, they can be also implanted in the right ventricle when necessary. Moreover these systems are very useful in elderly patients.
Pulsatile extracorporeal systems, i.e. Berlin Heart EXCOR Pediatric, are the only one available for end-stage heart failure in infants and young children.
Complete myocardial recovery has been observed with ventricular assist device support in acute myocarditis and even in dilative cardiomyopathy.
The only available total artificial heart is the CardioWest pneumatic system. However, there are some experimental total artificial heart developmental projects going on in Germany, in France and in USA.
Keynote Forum
Robert Skalik
Wrocław Medical University, Poland
Keynote: Adaptive physiology or cardiovascular dysfunction - how to optimize diagnostic management in athletes?
Time : 09:30-10:20
Biography:
Robert Skalik is a Consultant in Cardiology at two hospitals (Regional General Hospital, Krotoszyn and Leszno Medical Centre “Ventriculus”, Leszno, Poland) and outpatient Cardiology Clinics in WrocÅ‚aw. He is an academic Teacher in Department of Physiology, Medical University of WrocÅ‚aw, Poland, former Consultant in Cardiology and Echocardiography, Department of Cardiac Surgery and Cardiology, Medical University of WrocÅ‚aw. He completed his PhD in Echocardiography at Medical University of WrocÅ‚aw, Poland. He completed his internship in Department of Cardiology, Free University of Amsterdam, Netherlands. He was a Lecturer at Post-graduate School of Cardiology, University of Perugia, Italy. He is a member of editorial and review boards for medical journals: Clinical and Medical Investigations, Journal of Cardiovascular Disorders, SRL Cardiology, Annals of Cardiology and Cardiovascular Diseases, Reviewer of International Journal of Cardiology, Expert Review of Cardiovascular Therapy, Reviewer of research projects on Cardiovascular Medicine and Physiology co-funded by European Commission, Author of 107 published reports.
Abstract:
Athletic training presents a burden on the cardiovascular system and can pose a significant risk in athletes with undetected heart anomaly. Asymptomatic or symptomatic heart abnormality in athletes usually includes ventricular systolic or diastolic dysfunction caused by myocarditis, ischaemia, and hypertensive, hypertrophic or dilated cardiomyopathy. Nonetheless, other cardiac pathologies such as congenital or acquired heart dysfunction and valve defects can also contribute to cardiovascular fatalities in athletes. A growing interest in sports activities raises concerns regarding the safety of exercise in athletes with various cardiovascular anomalies. In recreational sports, the incidence of sudden cardiac death and cardiovascular comorbidities is higher than expected and may even increase as more and older individuals participate in organized sports. The risk of unrecognized symptomatic or asymptomatic left ventricle remodeling with subsequent heart dysfunction or heart failure in athletes increases with age. Moreover, a greater number of patients with a history of cancer treated with cardiotoxic therapy seek participation in sports. Equipped with an improved diagnostic and treatment armamentarium, and faced with a growing number of “at risks” participants, sports cardiologists will be increasingly faced with the dilemma of qualifying this population for exercise. The various aspects of cardiac hypertrophy, their relevance for understanding the differential diagnostic process, pathophysiologic mechanisms of cardiovascular dysfunction in athletes and whole array of diagnostic tools used in the specific group including ECG, cardiopulmonary exercise testing and advanced imaging techniques are discussed.
References:
- Robert Skalik. Screening of athletes : an electrocardiogram is not enough Herz 2015
- Robert Skalik. Qualifying athletes for exercisee-J.Cardiol.Pract. 2014
- Robert Skalik, Branko Furst. Heart failure in athletes: pathophysiology and diagnostic management. e-Journal of Cardiol.Pract. 2017
- Robert Skalik, Anna Janocha, LudmiÅ‚a Borodulin-Nadzieja, Anna Goździk, RafaÅ‚ PorÄ™ba, Dariusz BiaÅ‚y, Arkadiusz Derkacz, Marta Obremska, Ireneusz CaÅ‚kosiÅ„ski. The effect of different exercise protocols on leptin levels and regional left ventricular diastolic heart function among professional swimmers - a comparison with untrained subjects: a Doppler tissue imaging study Med.Sport.(Kraków) 2006
- Dariusz Biały, Arkadiusz Derkacz, Halina Nowosad, Robert Skalik, Edyta Marszałek, Rafał Poręba, Marcin Protasiewicz, Zdzisław Zagrobelny. Electrocardiography and echocardiography in athletic heart imaging, Biol.Sport. 2003