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Thomas Jefferson University Hospital, USA
Michael P. Savage is the Ralph J. Roberts Professor of Cardiology at Thomas Jefferson University and Director of the Cardiac Catheterization Laboratory at the Thomas Jefferson University Hospital in Philadelphia. He was instrumental in the formation of the recently opened Jefferson Angioplasty Center as a second-opinion center for high-risk patients with complex cardiovascular disease. The Jefferson team under Dr. Savage has pioneered many advances in interventional cardiology and was at the forefront of clinical research in the development of coronary stents that have revolutionized the treatment of heart disease. Dr. Savage's research continues to advance the care of cardiac patients by perfecting techniques for less invasive alternatives to heart surgery. His work includes over 230 publications of original research, book chapters, and abstracts. He has lectured nationally and internationally on a variety of cardiac disease topics and is an editorial consultant for numerous journals. He has received multiple honors for patient care, research, and teaching. Dr. Savage is a Fellow of the American College of Cardiology, the Society of Cardiac Angiography and Interventions, and the American College of Physicians..
Background: Saphenous vein grafts (SVG) are the most common conduit used in coronary artery bypass surgery. However, within a decade from surgery approximately 50% of SVG will develop significant disease. Percutaneous coronary intervention (PCI) of diseased SVG is associated with a high risk of distal embolization, no-reflow, periprocedural myocardial infarction (MI), and late restenosis [1,2]. This review examines the evolutionary advances and current status of PCI for this challenging problem. Role of Stents: The preeminent role of coronary stenting for SVG disease was established by the SAVED trial . Compared to balloon angioplasty, bare metal stents resulted in improved procedural and angiographic outcomes. At 240 days, event-free survival was significantly higher in the stent group (73 vs. 58%, p=0.04). The role of drug-eluting stents (DES) remained uncertain initially due to the mixed results of smaller randomized trials. The superiority of DES was solidified by the 610 patient ISAR-CABG trial which demonstrated fewer cardiac events at 1 year with DES (15.4 vs. 22.1%, p=0.03) . Optimal duration of dual antiplatelet therapy after SVG stenting has not been established. However, late and very late stent thrombosis occur more frequently in SVG. Distal Embolization: SVG intervention is fraught with a high risk of ischemic complications due to distal embolization. In the landmark SAFER trial, use of a distal protection device (DPD) resulted in a 42% relative reduction in early cardiac events . Despite the evidence of clinical benefit and guideline class I recommendation, DPD are used in <25% of SVG PCI. Delivery of filter devices can be technically challenging in complex SVG and this likely contributes to the reticence of some operators to use them. We have recently reported the value of simple adjunct techniques to facilitate the successful deployment of DPD in SVG . No-Reflow: The development of no-reflow during PCI is a significant risk factor for MI and death. DPD have reduced but not eliminated no-reflow, which is a complex phenomenon involving both debris embolization and microvascular spasm. A variety of vasodilating drugs have been used to treat no-reflow including calcium channel blockers, adenosine, and nitroprusside. In the largest series of patients treated with drug therapy for no-reflow, intracoronary nicardipine was found to be over 98% successful in reversing no-reflow during PCI . It has been suggested that pretreatment with intracoronary nicardipine or other vasodilating agents may reduce the incidence of SVG no-reflow . In current practice, we utilize the apparent synergistic effect of prophylactic intracoronary nicardipine and distal protection filters in vein graft PCI. Compared to use of DPD alone, the combination of drug + device is associated with significantly fewer periprocedural death/MI (10 vs. 1%, p<0.01) . Conclusion: Significant technical and procedural advances have improved the outcome of high risk SVG intervention
New York Medical College, USA
Keynote: List of 13 possible causes of Atrial Fibrillation (AF) by leading institute do not include Lyme Disease. However, in majority of ECGs of AF, we often find various degree of Borrelia Burgdorferi (BB) infection of the heart with increase in ANP & Cardiac Troponin I from analysis of ECGs. It is possible to detect & treat these abnormalities before AF develops
Yoshiaki Omura received Oncological Residency training at Cancer Institute of Columbia University & Doctor of Science Degree through research on Pharmaco-Electro-Physiology of Single Cardiac Cells in-vivo and in-vitro from Columbia University. He researched EMF Resonance phenomenon between 2 identical molecules for non-invasive detection of molecules, at Graduate Experimental Physics Dept., Columbia University, for which he received U.S. patent. He is also the creator of Bi-Digital O-Ring Test. He published over 270 original research articles, many chapters, & 9 books. He is currently Adjunct Prof. of Family & Community Medicine, New York Medical College; President & Prof. of Int’l College of Acupuncture & Electro-Therapeutics, NY; Editor in Chief, Acupuncture & Electro-Therapeutics Research, Int’l Journal of Integrative Medicine, (indexed by 17 major int’l Indexing Periodicals); Formerly, he was also Adjunct Prof. or Visiting Prof. in Universities in USA, France, Italy, Ukraine, Japan, Korea, & China
According to the currently available lists of possible causes of Atrial Fibrillation (A.F.), none of them mention Lyme Disease, Borrelia Burgdorferi (B.B.) infection. Using very high sensitivity of Electromagnetic Field (EMF) Resonance Phenomenon between 2 identical molecules with identical weight, we can detect almost any molecules or infection including B.B. Spirochete infection non-invasively from chest wall or recoded electrocardiograms (ECGs). The B.B. infections are often found in ECGs corresponding to SA-node area, right atrium, left atrium, etc. This non-invasive, sensitive method of detecting different molecules or specific cancer tissues was given US Patent in 1993. When we examine ECG of A.F., we found in majority of recoded ECGs, various degrees of B.B. infection exist at SA-node area, right atrium and left atrium. However, small degree of B.B. infection such as less than 1000ng we do not find A.F. When degree of infection increased over 2000 or 3000ng and only when ANP (Atrial Natriuretic Peptide) significantly increased over 150~200ng at where B.B. infection is significantly increased, they often develop A.F. When there was A.F, due to B.B. there was always very significant increase in ANP & Cardiac Troponin I (while in normal heart ANP is less than 10ng) and increased Cardiac Troponin I with decrease in Vitamin D3 & Taurine. It is well known that ANP is released from atrial muscle and it has function of reducing blood pressure as well as increasing excretion of sodium from kidney. Our study indicates significantly high percentage of various degrees of B.B. infection were detected in ECG showing presence of A.F. Therefore, even when the patient does not have A.F. by non-invasively examining the degree of infection of Borrelia Burgdorferi Spirochete & abnormal increased ANP at atriums, we may be able to prevent development of atrial fibrillation since it indicates high probability of development of atrial fibrillation. For eliminating B.B. infection of heart, commonly used Doxycycline often have some problem for various reasons, more effective result can be obtained by combined use of optimal doses of Vitamin D3 or Taurine & Amoxicillin average 3 times a day, since Vitamin D3 was found to have excellent urinary excreting effect of virus, bacteria, & fungi as one of 7 unique beneficial effects.