Day 1 :
Thomas Jefferson University,USA
Louis Samuels is professor surgery at Thomas Jefferson University in Philadelphia Pennsylvania. His Medical School, General Surgery and Cardiothoracic Surgery training were completed at Hahnemann University in Philadelphia Pennsylvania. Dr. Samuels has published over 100 peer-reviewed manuscripts on a variety of topics in Cardiothoracic Surgery, most notably in the field of artificial heart technologies and the management of acute and chronic heart failure. In the past fifteen years, Dr. Samuels has also taken interest in Beating Heart Coronary Artery Bypass Grafting (CABG) and has performed over 1000 of these procedures including totally off-pump (i.e. OP-CAB) and Pump-Assisted CABG (i.e. PAD-CAB). Dr. Samuels maintains a busy clinical practice and continues to be involved with clinical research as well as serving on various committees related to the oversight of ongoing and prospective clinical trials
BACKGROUND: The techniques utilized to accomplish Coronary Artery Bypass Grafting (CABG) include the traditional use of cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest to totally Off-Pump (i.e. OP-CAB) without CPB. The purpose of this report is to describe a hybrid approach—Pump-Assisted Direct CABG (PAD-CAB)-- with the aid of CPB without aortic cross-clamping and cardioplegic arrest.
METHODS: Between November 2003 and December 2016, 317 PAD-CAB procedures were performed by the author/surgeon. The PAD-CAB procedures were achieved with standard CPB via sternotomy under normothermic conditions with the mean arterial pressures (MAP) kept between 60 and 80 mmHg. Outcome measures included hospital mortality and specific major adverse events (MAE) benchmarked against the Society of Thoracic Surgeons (STS) database. The number of bypass grafts, status of the case, specific patient factors, and postoperative length of stay (LOS) were also assessed.
RESULTS: There were 238 male (75%) and 79 (25%) female patients. The mean age was 67 years (range: 38 to 92 years). The mean ejection fraction (EF) was 50% (range: 0 to 75%) with 66 cases (21%) having an EF < 40%. Two hundred seventy-seven cases (87.4%) were non-emergent with forty cases (12.6%) classified as emergent/salvage. The average of number of bypass grafts was 3.24 (range: 1 to 5). The postoperative LOS averaged 7.5 days with a median of 6 days. There were two hospital deaths (0.65%). Major Adverse Events were: 1 deep SWI (0.32%), 3 CVAs (0.95%), and 5 POBs (1.58%).
CONCLUSIONS: PAD-CAB is a safe and effective operation with outcomes that are equivalent or superior to the outcomes reported in the STS registry for CABG. The PAD-CAB technique takes advantage of the circulatory stability achieved with CPB assistance and eliminates the potential risks associated with aortic cross-clamping and cardioplegic arrest.
Garber,Spanish Society of Regenerative Medicine and Cell Therapy (SEMERETEC), Spain
Garber has over 32 years of experience in Internal Medicine and Cardiology, in addition to training, research, and development expertise in Regenerative Medicine. Over the past 12 years, he has made a significant contribution to stem cell research, specializing in the exploration and development of stem cell therapies for cardiac disorders, osteoarthritis, and neurological and autoimmune diseases. Formerly the Director of American Medical Information Group, he now serves as the Medical Director of Regenerative Medicine Madrid and the President of the Spanish Society of Regenerative Medicine and Cell Therapy (SEMERETEC). He also teaches a Master’s degree program in Regenerative Medicine and edits a number of scholarly journals on the subject.
The primary cause of death among chronic diseases worldwide is ischemic cardiovascular diseases, such as stroke and myocardial infarction. Recent evidence indicates that adult Mesenchymal stem cells therapy aimed at restoring organ function, and cardiovascular repair represent promising strategies to treat cardiovascular diseases, and have been recognized as one of the potential therapeutic agents, following several tests in animal models and clinical trials. In the process, various sources of mesenchymal stem cells have been identified which help in cardiac regeneration by either revitalizing the cardiac stem cells or revascularizing the heart. Although mesenchymal cell therapy has achieved considerable admiration and promising therapeutic strategy is the priming of therapeutic MSCs with stem cell modulators before transplantation. therapeutic efficacy of MSCs in vitro or in vivo from cell priming to tissue engineering strategies, for use
some challenges still remain that need to be overcome in order to establish it as a successful technique, questions going on: Which specific types of stem cells are likely to be most effective?, Can heart cells divide, and, if so, can we develop strategies to stimulate the growth and differentiation of the cardiac cells left in the injured heart to promote recovery of tissue mass and function?
Nobody knows at the time being what will be the best therapy for our patients.”,“We may need different cells for different patients and different cells for drug discovery or tissue engineering.” Which cell(s) will ultimately prove to be useful in patients is a matter of opinion.
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