Day 3 :
San Bortolo Hospital, Italy
Keynote: The hypothesis of endovascular occlusion of the internal mammary arteries to treat patients suffering from refractory angina
Time : 08:30-09:05
Marco Picichè completed his Graduation in Medicine from University of Florence in 1995 and Cardiac Surgery Residency at Tor Vergata University of Rome in 2000, both summa cum laude. He held regular teaching appointments at the University of Montpellier-School of Medicine; obtained certification by the French board in Cardiac Surgery (Paris, 2007); earned his Research Master’s in Surgical Science (Paris, 2007) and; received a University Diploma in Vascular Surgery (Paris, 2007). In Canada, he authored a research project on the occlusion of the internal mammary arteries as an alternative method of myocardial blood supply. In September 2011, he received PhD degree in Therapeutic Innovations from Paris-Sud University. He is the Editor in Chief of the book: “Dawn and Evolution of Cardiac Procedures: Research Avenues in Cardiac Surgery and Interventional Cardiology” (Springer-Verlag publishing house, September 2012). He patented a new surgical instrument. Currently, he is a Cardiac Surgeon in Italy.
There is evidence that an ischemic stimulus may cause the internal mammary arteries (IMAs) to develop important collateral branches. In Leriche syndrome, the IMAs may be the main source of blood supply for the lower limbs. Communication is also possible between the IMAs and the native coronary arteries. This has been demonstrated by angiography in living patients. Postmortem angiography in patients with ischemic heart disease has demonstrated such connections in 12% of cadavers. The Vineberg operation of the 1940s was based on the plastic potential of the IMAs. It consisted of IMA implantation into the left ventricular wall. Another example of the IMAs’ potential for collateralization may be seen following imperfect coronary surgery, where blood flow is impeded by stenosis at the IMA-to-coronary artery anastomotic site, and eventually by graft occlusion in its middle-distal portion. In such a case new branches may arise from the IMAs and direct toward the heart within a few days, weeks or months of surgery. These observations suggest that IMAs exhibit a significant potential for plasticity that may be induced under hypoxic conditions and/or in the presence of an obstruction to anterograde flow. Before the advent of cardiopulmonary bypass, some authors believed that surgical ligation of the IMAs produced an increased blood supply to the myocardium through natural and pre-existing anastomotic channels. Currently, not all patients suffering from ischemic heart disease benefit from conventional myocardial revascularization techniques (no-option patients) and it is in this context that the concept of IMA occlusion has been promoted again since 2010. In man, transitory and mid-term angioplasty balloon ITA occlusion increases the collateral flow index and fractional flow reserve by means of a functional ischemia-reducing extra-cardiac coronary artery supply, via natural ipsilateral ITA bypasses. This new achievement reinforces the recent hypothesis that endovascular embolization/plug occlusion of the IMAs might be considered for otherwise untreatable patients.
Figure 1: The principle of occlusion of the internal mammary artery (From Glover et al. Experiences of myocardial revascularization by division of the internal mammary arteries. Section on Cardiovascular Disease, 1958)
1. M Picichè, J G Kingma, P Voisine, F Dagenais and E Fadel (2010) Angiogenesis and surgical or endovascular enhancement of noncoronary collateral circulation: a new research Field J Thorac Cardiovasc Surg 139:1675–1676.
2. M Stoller, S F de Marchi and C Seiler (2014). The function of natural internal mammary-tocoronary artery bypasses and its effect on myocardial ischemia, Circulation 129:2645–2652.
3. Stoller M and Seiler C (2017) Effect of permanent right internal mammary artery closure on coronary collateral function and myocardial ischemia Circ Cardiovasc Interv; 10 DOI: 10.1161/CIRCINTERVENTIONS.116.004990.
4. Picichè M (2016) Embolization of the internal thoracic arteries in refractory angina. International Journal of Cardiology 212:310
5. Picichè M (2017) Letter by Picichè Regarding Article, “Effect of permanent right internal mammary artery closure on coronary collateral function and myocardial ischemia” Circ Cardiovasc Interv; 10:e005777.
Kilgore Leadership Services, LLC & THEO Executive Group, LLC, USA
Time : 09:05-09:40
John W Kilgore is a board certified invasive Cardiologist and Internist with over 30 years of extremely successful clinical practice in a private and teaching hospital setting in the United States. In addition, he is an ordained Anglican priest having served bi-vocationally for 15 years in the United States and Europe. As a clinician, scientist, humanitarian, and philanthropist, he also worked extensively in hospital administration having been the Director of Cardiovascular Services for a National Catholic Health Care System. He is currently working in leadership advisory assisting hospital CEO’s and their teams in adapting to their environment. His attention to patient care and satisfaction has resulted in studying at such eminent institutions as the Harvard University and Ritz Carlton Executive Leadership programs, and has studied such noteworthy companies as Starbucks, Apple, and Enterprise Leasing. This presentation helps translate the lessons of service industries to health care. In addition to his MD and BS, he holds a Master’s Degree in Public Health, and a Certificate of Anglican studies.
Medical education around the world is deservedly good at educating practitioners in the science and technological aspects of medical care of patients. What is often inadequate, however, is education in the art of medicine and the human aspects of caring for patients in their hour of need. As a result, far too many patients feel insufficiently valued by the health care system, and its practitioners may be practicing more of the science of medicine than the art. Data show that feeling valued and understanding one’s illness contribute to improved compliance, less stress, and better outcomes. The hospitality industry (hotels, restaurants, and travel companies), on the other hand, is particularly adept at satisfying expectations, developing loyalty, and measuring happiness of customers. This methodological approach to customer satisfaction and brand loyalty (witness Apple, Starbucks, and Ritz Carlton) is clearly a good business. The case can be made that such an approach would also be good for patient care and medical practice, with less stress, greater personal health involvement, and improved compliance of patients. This eminent and seasoned clinician, with extensive experience in medical administration, has studied the methods of the hospitality industry and, in this presentation, applies the principles of that service industry to the art and science of practicing medicine. Your medical practice, clinic, and hospital will benefit from this translation of study of human behaviour across disciplines and industries. Careful attention to patients and their families as human beings in need will result in greater satisfaction, better health, and improved outcomes for patients and doctors.
1. An Epidemiological Analysis and Description of Health Parameters and Mortality of the University of Missouri-Columbia Medical Centre Neonate Population with Other Populations - Thesis for Master’s Degree.
2. At The Table - Tent Makers in the 21st Century. The Living Church April 2017.
3. So, What Did the Doctor Say? A Translation of ‘Doctor Speak’ to ‘Understandable’ Book Manuscript in process.
4. The Slinky Eﬀect, Leadership, and Teams. Article submitted for publication.
5. Extensive Public Speaking and media Engagements in healthcare, philanthropy and the church.
Center for Healthcare and Organizational Research, USA
Keynote: Examining risk factors associated with worldwide sudden cardiac death rates in children and adults
Time : 09:40-10:15
Damien Byas is currently serving as an Associate Faculty Member in a Master of Public Health (MPH) program; President of North American Scientific Committee on Cardiovascular Health; a part-time public health researcher, Senior Research Fellow, and an Adjunct Professor for an MPH program.
Statement of the Problem: Physical inactivity, diabetes, diets high in fats and cholesterol, and obesity are all considered as poor health conditions which serve as significant gateway factors which may lead to heart disease and possibly cardiac death. In 2012 worldwide (World Health Federation, 2016), there were more than 17.3 million cardiac related deaths. Cardiovascular diseases were the main cause of death in almost all Organization for Economic Co-operation and Development (OECD) countries, and accounted for 35% of all deaths in 2009 (OECD, 2011). This study examined specific identifiable risk factors which may be associated with sudden cardiac death rates in children and adult populations using the Kids´ Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ, 2016).
Orientation: A large randomly drawn sample (N=422,599) of boys (n=198,960) and girls (n=223,639) ages 4 to 12, was examined in this research study to test for the association between risk factors which may be associated with heart disease prevalence. The Pearson Chi Square test was applied to measure for significant variable relationships in this research study. Methodology & Theoretical Orientation: The Pearson chi square test was applied to measure for significant variable relationships in this research study.
Findings: The results of this study found that there was a statistically significant association between cardiovascular disease prevalence and identifiable risk factors in children and adult groups (p<.05). Other significant associations were also found as a result of the Chi square analysis.
Conclusion & Significance: Recommendations are made to implement more effective strategies for health promotion and disease prevention, health education, cultural competence training for healthcare professionals, improve healthcare quality, and economic development.
1. Byas D K, Gillespie J, Talbert P Y and Kinnard J (2016) Examining the association between healthcare quality and health status among American children. Journal of the National Society of Allied Health, Fall/Winter 2016 edition. 13(1): 25-29.
2. Byas D (2011) Developing strategies to reduce children’s health care disparities. Internet Journal of Healthcare Administration 7(2).