1
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Keller LS, Nuche J, Avvedimento M, Real C, Farjat-Pasos J, Paradis JM, DeLarochellière R, Poulin A, Kalavrouziotis D, Dumont E, Galhardo A, Mengi S, Mohammadi S, Rodés-Cabau J. Angina in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Rev Esp Cardiol (Engl Ed) 2023; 76:991-1002. [PMID: 37137426 DOI: 10.1016/j.rec.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the prevalence, clinical characteristics, and outcomes of patients with angina undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. METHODS A total of 1687 consecutive patients with severe aortic stenosis undergoing TAVR at our center were included and classified according to patient-reported angina symptoms prior to the TAVR procedure. Baseline, procedural and follow-up data were collected in a dedicated database. RESULTS A total of 497 patients (29%) had angina prior to the TAVR procedure. Patients with angina at baseline showed a worse New York Heart Association (NYHA) functional class (NYHA class> II: 69% vs 63%; P=.017), a higher rate of coronary artery disease (74% vs 56%; P <.001), and a lower rate of complete revascularization (70% vs 79%; P <.001). Angina at baseline had no impact on all-cause mortality (HR, 1.02; 95%CI, 0.71-1.48; P=.898) and cardiovascular mortality (HR, 1.2; 95%CI, 0.69-2.11; P=.517) at 1 year. However, persistent angina at 30 days post-TAVR was associated with increased all-cause mortality (HR, 4.86; 95%CI, 1.71-13.8; P=.003) and cardiovascular mortality (HR, 20.7; 95%CI, 3.50-122.6; P=.001) at 1-year follow-up. CONCLUSIONS More than one-fourth of patients with severe aortic stenosis undergoing TAVR had angina prior to the procedure. Angina at baseline did not appear to be a sign of a more advanced valvular disease and had no prognostic impact; however, persistent angina at 30 days post-TAVR was associated with worse clinical outcomes.
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Affiliation(s)
- Lukas S Keller
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Carlos Real
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Julio Farjat-Pasos
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Anthony Poulin
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Attilio Galhardo
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siddhartha Mengi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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2
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Nuche J, Keller LS, Rodés-Cabau J. Reply to Francisco-Pascual and Rivas-Gándara-Syncope in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. Can J Cardiol 2023; 39:910-911. [PMID: 37030517 DOI: 10.1016/j.cjca.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023] Open
Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Lukas S Keller
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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3
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Keller LS, Nuche J, Mesnier J, Farjat-Pasos J, Paradis JM, De Larochellière R, Mohammadi S, Kalavrouziotis D, Dumont E, Philippon F, Rodés-Cabau J. Syncope in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. Can J Cardiol 2023; 39:901-908. [PMID: 36806689 DOI: 10.1016/j.cjca.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND No data exist on the clinical and prognostic significance of syncope in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. METHODS A total of 1705 consecutive patients with severe aortic stenosis undergoing TAVR in a tertiary university centre between 2007 and 2021 were included and classified according to the presence of syncope before the TAVR procedure. Baseline, procedural, and follow-up data were collected prospectively in a dedicated database. RESULTS A total of 115 patients (7%) presented with syncope before the TAVR procedure. Of these, 15 patients (13%) showed arrhythmic episodes as the probable cause of the syncope, and all of them had pacemakers implanted at a median of 13 (6 to 53) days before the TAVR procedure. Patients with syncope were older (82 ± 8 years vs 80 ± 8 years, P = 0.001) and had a higher rate of pacemaker implantation before the TAVR procedure (27% vs 14%, P < 0.001), with no differences between groups regarding the severity of aortic stenosis (transvalvular gradient, valve area). There were no differences between groups in 30-day (adjusted hazard ratio [HR], 1.28; 95% confidence interval [CI], 0.46-3.60) and 1-year (adjusted HR, 0.71; 95% CI, 0.0.35-1.45) mortality following TAVR. CONCLUSIONS Syncope was not associated with a more advanced valvular disease and had no significant prognostic impact on patients undergoing TAVR. However, arrhythmias and conduction-system disturbances were more common in patients with previous syncope and might play a relevant role in the pathogenesis of syncope in patients with aortic stenosis.
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Affiliation(s)
- Lukas S Keller
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jorge Nuche
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jules Mesnier
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Julio Farjat-Pasos
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jean-Michel Paradis
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | - Siamak Mohammadi
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | - Eric Dumont
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - François Philippon
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Josep Rodés-Cabau
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
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Mangner N, Brinkert M, Keller LS, Moriyama N, Hagemeyer D, Haussig S, Crusius L, Kobza R, Abdel-Wahab M, Laine M, Stortecky S, Pilgrim T, Nietlispach F, Ruschitzka F, Thiele H, Toggweiler S, Linke A. Continued non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists during transcatheter aortic valve implantation. EUROINTERVENTION 2023; 18:e1066-e1076. [PMID: 36440479 PMCID: PMC9909456 DOI: 10.4244/eij-d-22-00521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND One-third of patients undergoing transcatheter aortic valve implantation (TAVI) have an indication for long-term oral anticoagulation (OAC). AIMS We aimed to investigate whether continued non-vitamin K antagonist oral anticoagulant (NOAC) therapy compared with continued vitamin K antagonist (VKA) therapy during TAVI is equally safe and effective. Methods: Consecutive patients on OAC with either NOAC or VKA undergoing transfemoral TAVI at five European centres were enrolled. The primary outcome measure was a composite of major/life-threatening bleeding, stroke, and all-cause mortality at 30 days. RESULTS In total, 584 patients underwent TAVI under continued OAC with 294 (50.3%) patients receiving VKA and 290 (49.7%) patients receiving NOAC. At 30 days, the composite primary outcome had occurred in 51 (17.3%) versus 36 (12.4%) patients with continued VKA and with continued NOAC, respectively (odds ratio [OR] 0.68, 95% confidence interval [CI]: 0.43-1.07; p=0.092). Rates of major/life-threatening bleeding (OR 0.87, 95% CI: 0.52-1.47; p=0.606) and stroke (OR 1.02, 95% CI: 0.29-3.59; p=0.974) were not different between groups. In a multivariate Cox regression analysis, continued NOAC, compared with continued VKA, was associated with a lower risk for all-cause 1-year mortality (hazard ratio [HR] 0.61, 95% CI: 0.37-0.98; p=0.043). The analysis of the propensity score-matched cohort revealed similar results. CONCLUSIONS Continued NOAC compared with continued VKA during TAVI led to comparable outcomes with regard to the composite outcome measure indicating that continued OAC with both drugs is feasible. These hypothesis-generating results need to be confirmed by a dedicated randomised controlled trial.
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Affiliation(s)
- Norman Mangner
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Miriam Brinkert
- Division of Cardiology, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Lukas S Keller
- Quebec Heart and Lung Institute, Laval University, Quebec, QC, Canada
| | - Noriaki Moriyama
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
- Division of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Daniel Hagemeyer
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Stephan Haussig
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Stefan Stortecky
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- CardioVascular Center Zürich, Hirslanden Klinik im Park, Zürich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
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5
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Degtiarova G, Mikulicic F, Vontobel J, Garefa C, Keller LS, Boehm R, Ciancone D, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Post-hoc motion correction for coronary computed tomography angiography without additional radiation dose - Improved image quality and interpretability for “free”. Imaging 2022. [DOI: 10.1556/1647.2022.00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractObjectiveTo evaluate the impact of a motion-correction (MC) algorithm, applicable post-hoc and not dependent on extended padding, on the image quality and interpretability of coronary computed tomography angiography (CCTA).MethodsNinety consecutive patients undergoing CCTA on a latest-generation 256-slice CT device were prospectively included. CCTA was performed with prospective electrocardiogram-triggering and the shortest possible acquisition window (without padding) at 75% of the R-R-interval. All datasets were reconstructed without and with MC of the coronaries. The latter exploits the minimal padding inherent in cardiac CT scans with this device due to data acquisition also during the short time interval needed for the tube to reach target currents and voltage (“free” multiphase). Two blinded readers independently assessed image quality on a 4-point Likert scale for all segments.ResultsA total of 1,030 coronary segments were evaluated. Application of MC both with automatic and manual coronary centerline tracking resulted in a significant improvement in image quality as compared to the standard reconstruction without MC (mean Likert score 3.67 [3.50;3.81] vs 3.58 [3.40;3.73], P = 0.005, and 3.7 [3.55;3.82] vs 3.58 [3.40;3.73], P < 0.001, respectively). Furthermore, MC significantly reduced the proportion of non-evaluable segments and patients with at least one non-evaluable coronary segment from 2% to as low as 0.3%, and from 14% to as low as 3%. Reduction of motion artifacts was predominantly observed in the right coronary artery.ConclusionsA post-hoc device-specific MC algorithm improves image quality and interpretability of prospectively electrocardiogram-triggered CCTA and reduces the proportion of non-evaluable scans without any additional radiation dose exposure.
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Affiliation(s)
- Ganna Degtiarova
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Chrysoula Garefa
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Lukas S. Keller
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Reto Boehm
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Domenico Ciancone
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Aju P. Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Philipp A. Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Ronny R. Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
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6
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Sager R, Keller LS, Stehli J, Jakob P, Michel J, Kasel M, Templin C, Stähli BE. Association of N-terminal pro-B-type natriuretic peptide with mortality in elderly (≥80 years) patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 100:535-543. [PMID: 36040724 DOI: 10.1002/ccd.30365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the prognostication of patients ≥80 years of age undergoing percutaneous coronary intervention (PCI). BACKGROUND Elderly patients with coronary artery disease in need of PCI represent a growing patient population. Advanced risk prediction in this frail and comorbid patient population is important. METHODS A total of 460 consecutive patients ≥80 years of age undergoing PCI for acute (ACS) or chronic coronary syndromes (CCS) at the University Hospital Zurich, Switzerland, between January 2016 and December 2018 and with available baseline NT-proBNP levels were included in the analysis. Patients were stratified according to baseline NT-proBNP levels. The primary endpoint was all-cause mortality at a median follow-up of 33 (interquartile range: 3-392) days. RESULTS Median baseline NT-proBNP levels were 1411 (457-3984) ng/L. All-cause mortality was 7.8% in the lowest and 27.8% in the highest NT-proBNP quartile group (p < 0.001). In patients with ACS, all-cause mortality was 4.8% and 30.4% in the lowest and the highest NT-proBNP quartile (p < 0.001), and corresponding rates in patients with CCS were 11.1% and 22.2% (p = 0.38). In multivariable Cox regression analysis, baseline NT-proBNP levels were independently associated with an increased risk of all-cause mortality (adjusted hazard ratio: 1.00, 95% confidence interval: 1.00-1.00, p = 0.04). CONCLUSIONS Baseline NT-proBNP levels were identified as independent predictor of mortality in elderly (≥80 years) patients undergoing PCI. Hence, baseline NT-proBNP allows for the identification of a high-risk elderly patient subset.
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Affiliation(s)
- Raphael Sager
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Lukas S Keller
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Jakob
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jonathan Michel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Markus Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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7
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Abstract
PURPOSE OF REVIEW This review intends to give an up-to-date overview of the current state of evidence in the treatment of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR), focusing on percutaneous coronary interventions (PCI) pre-TAVR. RECENT FINDINGS The recently published ACTIVATION trial is the 1st randomized trial comparing coronary revascularization (PCI) versus medical treatment in patients with significant CAD undergoing TAVR. With the caveat of several major limitations of the trial, the results of this study raised the question about the appropriateness of the common practice to routinely revascularize coronary stenosis before TAVR. Aortic valve stenosis is the most common valvular heart disease among the elderly and it often co-occurs with CAD. TAVR is increasingly considered an alternative to surgical aortic valve replacement not only in the elderly population but also in younger and lower-risk patients. The impact of co-existing CAD on clinical outcomes as well as the optimal timing of PCI in TAVR candidates is still unclear and the subject of ongoing randomized trials. Meanwhile, it is common practice in many centers to routinely perform invasive coronary angiography and PCI for significant coronary disease as part of the TAVR workup. While computed tomography angiography has emerged as a possible alternative to the invasive coronary angiography in patients with low pre-test probability for CAD, the value of functional invasive assessment of coronary lesions in the pre-TAVR setting has still to be clarified. Also, there is an increasing interest in the clinical relevance and optimal management of the potentially challenging coronary access post-TAVR, requiring further research.
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Affiliation(s)
- Lukas S Keller
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Vassili Panagides
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jules Mesnier
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Jorge Nuche
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada
| | - Josep Rodés-Cabau
- Québec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec, G1V 4G5, Canada.
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8
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Brinkert M, Mangner N, Moriyama N, Keller LS, Hagemeyer D, Crusius L, Lehnick D, Kobza R, Abdel-Wahab M, Laine M, Stortecky S, Pilgrim T, Nietlispach F, Ruschitzka F, Thiele H, Linke A, Toggweiler S. Safety and Efficacy of Transcatheter Aortic Valve Replacement With Continuation of Vitamin K Antagonists or Direct Oral Anticoagulants. JACC Cardiovasc Interv 2020; 14:135-144. [PMID: 33358653 DOI: 10.1016/j.jcin.2020.09.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study investigated whether transcatheter aortic valve replacement (TAVR) with peri-procedural continuation of oral anticoagulation is equally safe and efficacious as TAVR with peri-procedural interruption of anticoagulation. BACKGROUND A significant proportion of patients undergoing TAVR have an indication for long-term oral anticoagulation. The optimal peri-procedural management of such patients is unknown. METHODS Consecutive patients on oral anticoagulation who underwent transfemoral TAVR at 5 European centers were enrolled. Oral anticoagulation was either stopped 2 to 4 days before TAVR or continued throughout the procedure. Primary safety outcome was major bleeding. Secondary efficacy endpoints included vascular complications, stroke, and mortality. RESULTS Of 4,459 patients, 584 patients were treated with continuation of anticoagulation and 733 with interruption of anticoagulation. At 30 days, major or life-threatening bleedings occurred in 66 (11.3%) versus 105 (14.3%; odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.61 to 1.21; p = 0.39) and major vascular complications in 64 (11.0%) versus 90 (12.3%; OR: 0.89; CI: 0.62 to 1.27; p = 0.52) of patients with continuation and with interruption of anticoagulation, respectively. Transfusion of packed red blood cells was less often required in patients with continuation of anticoagulation (80 [13.7%] vs. 130 [17.7%]; OR: 0.59; 95% CI: 0.42 to 0.81; p = 0.001). Kaplan-Meier estimates of survival at 12 months were 85.3% in patients with continuation of anticoagulation and 84.0% in patients with interruption of anticoagulation (hazard ratio: 0.90; 95% CI: 0.73 to 1.12; p = 0.36). CONCLUSIONS Continuation of oral anticoagulation throughout TAVR did not increase bleeding or vascular complication rates. Moreover, packed red blood cell transfusions were less often required in patients with continuation of oral anticoagulation.
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Affiliation(s)
- Miriam Brinkert
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Norman Mangner
- Heart Center Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Noriaki Moriyama
- Division of Cardiology of the Helsinki University Central Hospital, Helsinki, Finland
| | - Lukas S Keller
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hagemeyer
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Lisa Crusius
- Heart Center Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Dirk Lehnick
- Clinical Trial Unit, Biostatistics and Methodology, University Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Mika Laine
- Division of Cardiology of the Helsinki University Central Hospital, Helsinki, Finland
| | - Stefan Stortecky
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; CardioVascularCenter Zurich, Hirslanden Clinic im Park, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Axel Linke
- Heart Center Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
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9
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Armijo G, Tang GH, Kooistra N, Ferreira-Neto AN, Toggweiler S, Amat-Santos IJ, Keller LS, Urena M, Ahmad H, Tafur Soto J, Muñoz-Garcia E, Regueiro A, Leenders GE, Tirado-Conte G, Sengupta A, McInerney A, Couture T, Cuevas Herreros O, Rodriguez-Gabella T, Kini A, Ahmed M, Zaid S, Gonzalo N, Nuñez-Gil IJ, Muñoz-Garcia AJ, Jimenez-Quevedo P, Fernández-Ortiz A, Himbert D, Nietlispach F, Stella P, Dangas GD, Escaned J, Macaya C, Rodés-Cabau J, Nombela-Franco L. Third-Generation Balloon and Self-Expandable Valves for Aortic Stenosis in Large and Extra-Large Aortic Annuli From the TAVR-LARGE Registry. Circ Cardiovasc Interv 2020; 13:e009047. [DOI: 10.1161/circinterventions.120.009047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Currently, 2 third-generation transcatheter valves, 29-mm Sapien-3 and 34-mm Evolut-R (ER), are indicated for large sized aortic annuli. We analyzed short and 1-year performance of these valves in patients with large (area ≥575 mm
2
or perimeter ≥85 mm) and extra-large (≥683 mm
2
or ≥94.2 mm) aortic annuli undergoing transcatheter aortic valve replacement.
Methods:
A total of 833 patients across 12 centers with symptomatic aortic stenosis and large aortic annuli underwent transcatheter aortic valve replacement with 29-mm Sapien-3 (n=640) or 34-mm ER (n=193). Clinical, anatomic, and procedural characteristics were collected, and Valve Academic Research Consortium-2 outcomes were reported.
Results:
Median aortic annulus area and perimeter were 617 mm
2
(591–657) and 89.1 mm (87.0–92.1), respectively (704 mm
2
[689–743] and 96.0 mm [94.5–97.9] in the subgroup of 124 patients with extra-large annuli). Overall device success was 94.3% (Sapien-3, 95.8% and ER, 89.3%;
P
=0.001), with a higher rate of significant paravalvular leak (
P
=0.004), second valve implantation (
P
=0.013), and valve embolization (
P
=0.009) in the ER group. Thirty-day and 1-year mortality was 2.4% and 9.2%, respectively, without differences between groups. Valve hemodynamics were excellent (mean gradient, 8.8±3.6 mm Hg; 3.3% rate of moderate-severe paravalvular leak) in the extra-large annulus, without differences compared with the large annulus group.
Conclusions:
In patients with large and extra-large aortic annuli, transcatheter aortic valve replacement using 29-mm Sapien-3 and 34-mm ER is safe and feasible. Observed differences in clinical outcomes and hemodynamic performance may guide valve choice in this cohort of patients undergoing transcatheter aortic valve replacement.
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Affiliation(s)
- Germán Armijo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Nynke Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Alfredo Nunes Ferreira-Neto
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Switzerland (S.T.)
| | - Ignacio J. Amat-Santos
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Lukas S. Keller
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Marina Urena
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Hasan Ahmad
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Jose Tafur Soto
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Erika Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Spain (A.R.)
| | - Geert E. Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Gabriela Tirado-Conte
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Aditya Sengupta
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Angela McInerney
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Thomas Couture
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Oscar Cuevas Herreros
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Tania Rodriguez-Gabella
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Mohammed Ahmed
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Nieves Gonzalo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Ivan J. Nuñez-Gil
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio J. Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Pilar Jimenez-Quevedo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio Fernández-Ortiz
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Dominique Himbert
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Fabian Nietlispach
- Department of Cardiology, Universitz Hospital Zurich and Hirslanden Klinik Im Park, Zurich, Switzerland (F.N.)
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - George D. Dangas
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Javier Escaned
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Carlos Macaya
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Luis Nombela-Franco
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
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10
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Langfritz M, Shahin M, Nietlispach F, Taramasso M, Denegri A, Moccetti M, Pedrazzini G, Moccetti T, Keller LS, Ruschitzka F, Maisano F, Obeid S. Baseline Predictors of Renal Failure in Transcatheter Aortic Valve Implantation. J Invasive Cardiol 2019; 31:E289-E297. [PMID: 31567117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) post transcatheter aortic valve implantation (TAVI) is associated with worsened short- and long-term outcomes. We sought to identify significant baseline predictors of AKI and establish a high-risk group within patients enrolled in the multicenter SWISS-TAVI cohort. METHODS AND RESULTS A total of 526 patients who underwent TAVI were included in our analysis. Patients on hemodialysis were excluded. Within the first week after valve implantation, fifty patients (9.5%) developed AKI. There was a significantly higher prevalence of diabetes mellitus in the AKI group (45% vs 28%; P=.02). The odds ratio (OR) for patients suffering from diabetes mellitus who developed AKI was 1.9 after multivariable binary regression analysis (95% confidence interval, 1.018-3.553; P=.04). Chronic kidney disease (CKD) stage ≥4 was more prevalent in the AKI group (26% vs 14%; P=.04). Every 1 mg/dL creatinine above normal level at baseline increased AKI risk by a factor of 1.6 (OR, 1.605; 95% CI, 1.111-2.319; P=.01). Age, gender, body mass index, history of dyslipidemia, and history of hypertension were similar between the groups. In the diabetic population of 155 patients (29.5%), AKI developed in 22 patients (14.2%), compared with the non-diabetic population of 370 patients (70.5%), where AKI developed in 27 patients (7.3%). In the diabetic population, an elevation by 1 mg/dL in baseline creatinine was an independent predictor of developing kidney injury (OR, 2.061; 95% CI, 1.154-3.683; P=.02, while in non-diabetic patients, neither baseline glomerular filtration rate, CKD grade, STS score, EuroScore II, ACEF score, nor procedural contrast usage were predictors of AKI. CONCLUSION Diabetics with CKD stage ≥4 (as defined by the Kidney Disease: Improving Global Outcomes criteria) constitute a high-risk group for developing AKI after TAVI. In this high-risk subgroup, baseline creatinine in combination with amount of contrast agent used were strong risk factors for developing AKI. AKI in non-diabetics was less predictable by baseline characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Slayman Obeid
- University Heart Center, University Hospital, Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
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11
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Brinkert M, Keller LS, Moriyama N, Cuculi F, Bossard M, Lehnick D, Kobza R, Laine M, Nietlispach F, Toggweiler S. Safety and Efficacy of Transcatheter Aortic Valve Replacement With Continuation of Oral Anticoagulation. J Am Coll Cardiol 2019; 73:2004-2005. [DOI: 10.1016/j.jacc.2018.11.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/11/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
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12
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Keller LS, Keller DI. [Not Available]. Praxis (Bern 1994) 2017; 106:1291-1293. [PMID: 29137543 DOI: 10.1024/1661-8157/a002817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Wir berichten über eine unklare Synkope eines 21-jährigen Patienten. Als Ursache der Synkope fanden sich bilaterale zentrale Lungenembolien als thrombembolische Komplikation eines grossen, rechtsseitigen Vorhofmyxoms.
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Affiliation(s)
- Lukas S Keller
- 1 Interdisziplinäres Notfallzentrum, Kantonsspital Baden
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Treloar AF, Schabdach DG, Sansing S, Keller LS. Superovulation of New Zealand white rabbits by continuous infusion of follicle-stimulating hormone, using a micro-osmotic pump. Lab Anim Sci 1997; 47:313-6. [PMID: 9241636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A successful method for superovulation of rabbits, which is more time effective than current protocols, has been established and consistently yields large numbers of fertilized ova. Subcutaneous microosmotic pumps were used to administer follicle-stimulating hormone (FSH) over a 3-day period to mature ovarian follicles. The amount of FSH administered was based on baseline serum FSH concentration in unmated New Zealand White does; as determined by radioimmunoassay. Treatment with FSH was followed by intravenous administration of human chorionic gonadotropin (hCG) to enhance ovulation. Hormonally primed does were then mated to mature, fertile bucks. Ova were collected 18 to 20 h after mating. This procedure resulted in an average yield of 37 ova/doe, with a 72.3% fertilization rate. These results were consistent with those published for superovulation using multiple subcutaneous injections of FSH. This method provided a consistent high yield of fertilized ova per doe and required only a simple surgical procedure.
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Affiliation(s)
- A F Treloar
- Department of Veterinary Sciences, Bristol-Myers Squibb Company, Pharmaceutical Research Institute, Wallingford, Connecticut 06492-7660, USA
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Callahan BM, Hutchinson KA, Armstrong AL, Keller LS. A comparison of four methods for sterilizing surgical instruments for rodent surgery. Contemp Top Lab Anim Sci 1995; 34:57-60. [PMID: 16457569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- B M Callahan
- Bristol-Myers Squibb Company, Wallingford, CT 06492, USA
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Treloar AE, Keller LS. A centralized transgenic core facility within a laboratory animal resources program. Contemp Top Lab Anim Sci 1994; 33:52-5. [PMID: 16466210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- A E Treloar
- Department of Veterinary Sciences, Bristol-Myers Squibb Pharmaceutical Research Institute, Wallingford, CT 06492-7660, USA
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Abstract
Madison lung carcinoma (M109), a murine tumor of spontaneous origin, appears to be non-immunogenic, according to 2 commonly employed tests for tumor immunogenicity. However, C.parvum-induced immunopotentiation during the growth of M109 tumor results in post-excision anti-tumor immunity to M109 tumor implants. The C.parvum-potentiated post-excision immunity to M109 is tumor-specific and T-cell-dependent. T cells from mice whose progressive M109 tumors have been excised are capable, on passive transfer, of inhibiting adoptive immunotherapy of T-cell-deficient recipients by spleen cells from mice immunized with an admixture of M109 cells and C.parvum. The data are interpreted as evidence supporting the hypothesis that the apparent lack of anti-tumor immunity in this tumor model is not due to the absence of tumor-associated antigens. We suggest that, instead, in this model the balance between the effector and suppressor arms of the immune response favors tumor-induced immunosuppression, resulting in a magnitude of anti-tumor immunity insufficient for detection by commonly employed tests for tumor immunogenicity. Our study shows that shifting the balance in favor of the effector arm by means of immunopotentiation results in a measurable immune response to an apparently non-immunogenic tumor.
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Affiliation(s)
- I Bursuker
- Bristol-Myers Squibb Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Wallingford, CT 06492
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Keller LS, McDermott S, Alt-White A. Effects of computerized nurse careplanning on selected health care effectiveness measures. Proc Annu Symp Comput Appl Med Care 1991:38-42. [PMID: 1807627 PMCID: PMC2247491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A computerized nurse careplanning system (CNCP) was implemented on two nursing units of the Veterans' Affairs Medical Center, Washington, DC. This pretest, post-test experimental study sought to determine the effects of implementing this system on selected nursing care activities and associated patient outcomes. Effects on outcomes of job satisfaction, use of careplanning and competency of staff nurses were also examined. The sample consists of four medical nursing wards with registered nurses (n = 40) and patients (n = 160 as subjects). Data collection included nurse questionnaires, patient interviews and chart reviews. Results of the multiple regression analyses will be summarized here. Plans for further enhancement of CNCP will be discussed.
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Affiliation(s)
- L S Keller
- University of Maryland, School of Nursing
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Abstract
The effect of several anaesthetic agents on the gray short-tailed opossum (Monodelphis domestica) was investigated. Pentobarbitone sodium at a dose of 50 mg/kg sedated the animals but did not produce analgesia or anaesthesia. A combination of ketamine hydrochloride and xylazine at 40 mg/kg and 5 mg/kg, respectively, sedated the animals, but anaesthetic levels were not attained. Halothane was most effective in producing anaesthesia in Monodelphis domestica. Hypothermia was a major side effect with all three anaesthetic regimes.
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Affiliation(s)
- L S Keller
- Department of Comparative Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033
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Abstract
Cystic ovaries were found at necropsy in 54 of 71 (76%) female guinea pigs between 18 and 60 months of age. Histologic appearance and location of the cysts within the ovary were consistent with cystic rete ovarii. Microscopic appearance of the large ovarian cysts suggested reproductive performance in these guinea pigs should be compromised. Breeding records indicated that fertility was markedly reduced in affected females over fifteen months of age. Cystic endometrial hyperplasia, mucometra, endometritis in appropriate placental tissue, or fibroleiomyomas were seen in 21 of 54 (39%) guinea pigs with cystic ovaries, but in only one of 17 (6%) guinea pigs without cystic ovaries.
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Pruitt RH, Keller LS, Hale SL. Mastering distractions that mar home visits. Nurs Health Care 1987; 8:345-7. [PMID: 3648526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Butcher JN, Keller LS, Bacon SF. Current developments and future directions in computerized personality assessment. J Consult Clin Psychol 1985. [PMID: 3841357 DOI: 10.1037//0022-006x.53.6.803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
This article deals with the question of whether offspring of social drinkers would show, to a lesser degree, some of the behavioral characteristics of infants with fetal alcohol syndrome. Another question concerned individual differences in "temperament."
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