The Experts below are selected from a list of 201 Experts worldwide ranked by ideXlab platform
Pierre E Dupont - One of the best experts on this subject based on the ideXlab platform.
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percutaneous intracardiac beating Heart surgery using metal mems tissue approximation tools
The International Journal of Robotics Research, 2012Co-Authors: Andrew Gosline, Nikolay V Vasilyev, Evan J Butler, Christopher R Folk, Adam L Cohen, Rich Chen, Nora Lang, Pedro J Del Nido, Pierre E DupontAbstract:Achieving superior outcomes through the use of robots in medical applications requires an integrated approach to the design of the robot, tooling and the procedure itself. In this paper, this approach is applied to develop a robotic technique for closing abnormal communication between the atria of the Heart. The goal is to achieve the efficacy of surgical closure as performed on a stopped, open Heart with the reduced risk and trauma of a beating-Heart Catheter-based procedure. In the proposed approach, a concentric tube robot is used to percutaneously access the right atrium and deploy a tissue approximation device. The device is constructed using a metal microelectromechanical system (MEMS) fabrication process and is designed to both fit the manipulation capabilities of the robot as well as to reproduce the beneficial features of surgical closure by suture. The effectiveness of the approach is demonstrated through ex vivo and in vivo experiments.
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percutaneous intracardiac beating Heart surgery using metal mems tissue approximation tools
The International Journal of Robotics Research, 2012Co-Authors: Andrew Gosline, Nikolay V Vasilyev, Evan J Butler, Christopher R Folk, Adam L Cohen, Nora Lang, Richard T Chen, Pedro J Del Nido, Pierre E DupontAbstract:Achieving superior outcomes through the use of robots in medical applications requires an integrated approach to the design of the robot, tooling and the procedure itself. In this paper, this approach is applied to develop a robotic technique for closing abnormal communication between the atria of the Heart. The goal is to achieve the efficacy of surgical closure as performed on a stopped, open Heart with the reduced risk and trauma of a beating-Heart Catheter-based procedure. In the proposed approach, a concentric tube robot is used to percutaneously access the right atrium and deploy a tissue approximation device. The device is constructed using a metal microelectromechanical system (MEMS) fabrication process and is designed to both fit the manipulation capabilities of the robot as well as to reproduce the beneficial features of surgical closure by suture. The effectiveness of the approach is demonstrated through ex vivo and in vivo experiments.
Michael Buerke - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of the novel dual acting fiia fxa inhibitor ep217609c101 unfractionated heparin enoxaparin and fondaparinux in preventing cardiac Catheter thrombosis
Journal of Thrombosis and Thrombolysis, 2014Co-Authors: Anja Kaeberich, Baerbel Hauroeder, Uwe Raaz, Alexander Vogt, Lars Maedgefessel, E Neuhart, C Krezel, Ludovic Drouget, Michael BuerkeAbstract:Efficient and safe anticoagulation is crucial in patients requiring percutaneous coronary intervention (PCI) or extracorporeal circulation during cardiac surgery. Although new anticoagulant strategies have emerged for PCI as alternatives to the established treatment with heparins, the development of new anticoagulants with an improved efficacy/safety ratio is still necessary. Our study compared the efficacy of the novel, dual-acting, neutralizable FIIa/FXa-inhibitor EP217609C101 (EP) at 2, 1.2, 0.9, and 0.6 μg/ml to unfractionated heparin (UFH), enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis under in vitro conditions. Blood drawn by venepunction from healthy male volunteers (n = 10) pretreated with 500 mg aspirin orally was treated with the anticoagulant to test and continuously circulated through a cardiac Catheter for 60 min or until the Catheter became blocked by thrombotic debris. Anticoagulant efficacy was assessed by thrombus weight, electron microscopic features of the developing thrombi, and laboratory parameters. Whereas UFH, enoxaparin, EP 2, and EP 1.2 μg/ml secured maximum circulation times, statistically significant premature Catheter occlusions were observed for EP 0.9, EP 0.6 μg/ml, and fondaparinux. The UFH group and both high-dose concentrations of EP showed significantly lower thrombus weights than the low-dose concentrations of EP and fondaparinux, (p ≤ 0.05). On electron microscopic analysis of the thrombotic debris no differences were observed in erythrocyte deposition between UFH, enoxaparin, and all EP concentrations tested. A significant reduction in fibrin deposition was achieved by UFH and EP 2 μg/ml but no significant differences in platelet deposition were found, except for a significant reduction for EP 0.6 μg/ml. Our in vitro study showed that EP217609C101 is a promising new drug that is dose-dependently superior to classical (UFH, enoxaparin) and newer (fondaparinux) drugs in preventing Heart Catheter thrombosis.
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In vitro comparison of the novel, dual-acting FIIa/FXa-inhibitor EP217609C101, unfractionated heparin, enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis.
Journal of thrombosis and thrombolysis, 2013Co-Authors: Anja Kaeberich, Michael Buerke, Baerbel Hauroeder, Uwe Raaz, Alexander Vogt, Lars Maedgefessel, E Neuhart, C Krezel, Ludovic Drouget, Karl WerdanAbstract:Efficient and safe anticoagulation is crucial in patients requiring percutaneous coronary intervention (PCI) or extracorporeal circulation during cardiac surgery. Although new anticoagulant strategies have emerged for PCI as alternatives to the established treatment with heparins, the development of new anticoagulants with an improved efficacy/safety ratio is still necessary. Our study compared the efficacy of the novel, dual-acting, neutralizable FIIa/FXa-inhibitor EP217609C101 (EP) at 2, 1.2, 0.9, and 0.6 μg/ml to unfractionated heparin (UFH), enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis under in vitro conditions. Blood drawn by venepunction from healthy male volunteers (n = 10) pretreated with 500 mg aspirin orally was treated with the anticoagulant to test and continuously circulated through a cardiac Catheter for 60 min or until the Catheter became blocked by thrombotic debris. Anticoagulant efficacy was assessed by thrombus weight, electron microscopic features of the developing thrombi, and laboratory parameters. Whereas UFH, enoxaparin, EP 2, and EP 1.2 μg/ml secured maximum circulation times, statistically significant premature Catheter occlusions were observed for EP 0.9, EP 0.6 μg/ml, and fondaparinux. The UFH group and both high-dose concentrations of EP showed significantly lower thrombus weights than the low-dose concentrations of EP and fondaparinux, (p ≤ 0.05). On electron microscopic analysis of the thrombotic debris no differences were observed in erythrocyte deposition between UFH, enoxaparin, and all EP concentrations tested. A significant reduction in fibrin deposition was achieved by UFH and EP 2 μg/ml but no significant differences in platelet deposition were found, except for a significant reduction for EP 0.6 μg/ml. Our in vitro study showed that EP217609C101 is a promising new drug that is dose-dependently superior to classical (UFH, enoxaparin) and newer (fondaparinux) drugs in preventing Heart Catheter thrombosis.
Uwe Raaz - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of the novel dual acting fiia fxa inhibitor ep217609c101 unfractionated heparin enoxaparin and fondaparinux in preventing cardiac Catheter thrombosis
Journal of Thrombosis and Thrombolysis, 2014Co-Authors: Anja Kaeberich, Baerbel Hauroeder, Uwe Raaz, Alexander Vogt, Lars Maedgefessel, E Neuhart, C Krezel, Ludovic Drouget, Michael BuerkeAbstract:Efficient and safe anticoagulation is crucial in patients requiring percutaneous coronary intervention (PCI) or extracorporeal circulation during cardiac surgery. Although new anticoagulant strategies have emerged for PCI as alternatives to the established treatment with heparins, the development of new anticoagulants with an improved efficacy/safety ratio is still necessary. Our study compared the efficacy of the novel, dual-acting, neutralizable FIIa/FXa-inhibitor EP217609C101 (EP) at 2, 1.2, 0.9, and 0.6 μg/ml to unfractionated heparin (UFH), enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis under in vitro conditions. Blood drawn by venepunction from healthy male volunteers (n = 10) pretreated with 500 mg aspirin orally was treated with the anticoagulant to test and continuously circulated through a cardiac Catheter for 60 min or until the Catheter became blocked by thrombotic debris. Anticoagulant efficacy was assessed by thrombus weight, electron microscopic features of the developing thrombi, and laboratory parameters. Whereas UFH, enoxaparin, EP 2, and EP 1.2 μg/ml secured maximum circulation times, statistically significant premature Catheter occlusions were observed for EP 0.9, EP 0.6 μg/ml, and fondaparinux. The UFH group and both high-dose concentrations of EP showed significantly lower thrombus weights than the low-dose concentrations of EP and fondaparinux, (p ≤ 0.05). On electron microscopic analysis of the thrombotic debris no differences were observed in erythrocyte deposition between UFH, enoxaparin, and all EP concentrations tested. A significant reduction in fibrin deposition was achieved by UFH and EP 2 μg/ml but no significant differences in platelet deposition were found, except for a significant reduction for EP 0.6 μg/ml. Our in vitro study showed that EP217609C101 is a promising new drug that is dose-dependently superior to classical (UFH, enoxaparin) and newer (fondaparinux) drugs in preventing Heart Catheter thrombosis.
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In vitro comparison of the novel, dual-acting FIIa/FXa-inhibitor EP217609C101, unfractionated heparin, enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis.
Journal of thrombosis and thrombolysis, 2013Co-Authors: Anja Kaeberich, Michael Buerke, Baerbel Hauroeder, Uwe Raaz, Alexander Vogt, Lars Maedgefessel, E Neuhart, C Krezel, Ludovic Drouget, Karl WerdanAbstract:Efficient and safe anticoagulation is crucial in patients requiring percutaneous coronary intervention (PCI) or extracorporeal circulation during cardiac surgery. Although new anticoagulant strategies have emerged for PCI as alternatives to the established treatment with heparins, the development of new anticoagulants with an improved efficacy/safety ratio is still necessary. Our study compared the efficacy of the novel, dual-acting, neutralizable FIIa/FXa-inhibitor EP217609C101 (EP) at 2, 1.2, 0.9, and 0.6 μg/ml to unfractionated heparin (UFH), enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis under in vitro conditions. Blood drawn by venepunction from healthy male volunteers (n = 10) pretreated with 500 mg aspirin orally was treated with the anticoagulant to test and continuously circulated through a cardiac Catheter for 60 min or until the Catheter became blocked by thrombotic debris. Anticoagulant efficacy was assessed by thrombus weight, electron microscopic features of the developing thrombi, and laboratory parameters. Whereas UFH, enoxaparin, EP 2, and EP 1.2 μg/ml secured maximum circulation times, statistically significant premature Catheter occlusions were observed for EP 0.9, EP 0.6 μg/ml, and fondaparinux. The UFH group and both high-dose concentrations of EP showed significantly lower thrombus weights than the low-dose concentrations of EP and fondaparinux, (p ≤ 0.05). On electron microscopic analysis of the thrombotic debris no differences were observed in erythrocyte deposition between UFH, enoxaparin, and all EP concentrations tested. A significant reduction in fibrin deposition was achieved by UFH and EP 2 μg/ml but no significant differences in platelet deposition were found, except for a significant reduction for EP 0.6 μg/ml. Our in vitro study showed that EP217609C101 is a promising new drug that is dose-dependently superior to classical (UFH, enoxaparin) and newer (fondaparinux) drugs in preventing Heart Catheter thrombosis.
Anja Kaeberich - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of the novel dual acting fiia fxa inhibitor ep217609c101 unfractionated heparin enoxaparin and fondaparinux in preventing cardiac Catheter thrombosis
Journal of Thrombosis and Thrombolysis, 2014Co-Authors: Anja Kaeberich, Baerbel Hauroeder, Uwe Raaz, Alexander Vogt, Lars Maedgefessel, E Neuhart, C Krezel, Ludovic Drouget, Michael BuerkeAbstract:Efficient and safe anticoagulation is crucial in patients requiring percutaneous coronary intervention (PCI) or extracorporeal circulation during cardiac surgery. Although new anticoagulant strategies have emerged for PCI as alternatives to the established treatment with heparins, the development of new anticoagulants with an improved efficacy/safety ratio is still necessary. Our study compared the efficacy of the novel, dual-acting, neutralizable FIIa/FXa-inhibitor EP217609C101 (EP) at 2, 1.2, 0.9, and 0.6 μg/ml to unfractionated heparin (UFH), enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis under in vitro conditions. Blood drawn by venepunction from healthy male volunteers (n = 10) pretreated with 500 mg aspirin orally was treated with the anticoagulant to test and continuously circulated through a cardiac Catheter for 60 min or until the Catheter became blocked by thrombotic debris. Anticoagulant efficacy was assessed by thrombus weight, electron microscopic features of the developing thrombi, and laboratory parameters. Whereas UFH, enoxaparin, EP 2, and EP 1.2 μg/ml secured maximum circulation times, statistically significant premature Catheter occlusions were observed for EP 0.9, EP 0.6 μg/ml, and fondaparinux. The UFH group and both high-dose concentrations of EP showed significantly lower thrombus weights than the low-dose concentrations of EP and fondaparinux, (p ≤ 0.05). On electron microscopic analysis of the thrombotic debris no differences were observed in erythrocyte deposition between UFH, enoxaparin, and all EP concentrations tested. A significant reduction in fibrin deposition was achieved by UFH and EP 2 μg/ml but no significant differences in platelet deposition were found, except for a significant reduction for EP 0.6 μg/ml. Our in vitro study showed that EP217609C101 is a promising new drug that is dose-dependently superior to classical (UFH, enoxaparin) and newer (fondaparinux) drugs in preventing Heart Catheter thrombosis.
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In vitro comparison of the novel, dual-acting FIIa/FXa-inhibitor EP217609C101, unfractionated heparin, enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis.
Journal of thrombosis and thrombolysis, 2013Co-Authors: Anja Kaeberich, Michael Buerke, Baerbel Hauroeder, Uwe Raaz, Alexander Vogt, Lars Maedgefessel, E Neuhart, C Krezel, Ludovic Drouget, Karl WerdanAbstract:Efficient and safe anticoagulation is crucial in patients requiring percutaneous coronary intervention (PCI) or extracorporeal circulation during cardiac surgery. Although new anticoagulant strategies have emerged for PCI as alternatives to the established treatment with heparins, the development of new anticoagulants with an improved efficacy/safety ratio is still necessary. Our study compared the efficacy of the novel, dual-acting, neutralizable FIIa/FXa-inhibitor EP217609C101 (EP) at 2, 1.2, 0.9, and 0.6 μg/ml to unfractionated heparin (UFH), enoxaparin, and fondaparinux in preventing cardiac Catheter thrombosis under in vitro conditions. Blood drawn by venepunction from healthy male volunteers (n = 10) pretreated with 500 mg aspirin orally was treated with the anticoagulant to test and continuously circulated through a cardiac Catheter for 60 min or until the Catheter became blocked by thrombotic debris. Anticoagulant efficacy was assessed by thrombus weight, electron microscopic features of the developing thrombi, and laboratory parameters. Whereas UFH, enoxaparin, EP 2, and EP 1.2 μg/ml secured maximum circulation times, statistically significant premature Catheter occlusions were observed for EP 0.9, EP 0.6 μg/ml, and fondaparinux. The UFH group and both high-dose concentrations of EP showed significantly lower thrombus weights than the low-dose concentrations of EP and fondaparinux, (p ≤ 0.05). On electron microscopic analysis of the thrombotic debris no differences were observed in erythrocyte deposition between UFH, enoxaparin, and all EP concentrations tested. A significant reduction in fibrin deposition was achieved by UFH and EP 2 μg/ml but no significant differences in platelet deposition were found, except for a significant reduction for EP 0.6 μg/ml. Our in vitro study showed that EP217609C101 is a promising new drug that is dose-dependently superior to classical (UFH, enoxaparin) and newer (fondaparinux) drugs in preventing Heart Catheter thrombosis.
Wendy Stevens - One of the best experts on this subject based on the ideXlab platform.
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epidemiology and disease characteristics of systemic sclerosis related pulmonary arterial hypertension results from a real life screening programme
Arthritis Research & Therapy, 2017Co-Authors: Kathleen Morrisroe, Wendy Stevens, J Sahhar, Mandana Nikpour, Candice Rabusa, Susanna M ProudmanAbstract:Pulmonary arterial hypertension (PAH) is the leading cause of death in systemic sclerosis (SSc). Annual screening with echocardiogram (ECHO) is recommended. We present the methodological aspects of a PAH screening programme in a large Australian SSc cohort, the epidemiology of SSc-PAH in this cohort, and an evaluation of factors influencing physician adherence to PAH screening guidelines. Patient characteristics and results of PAH screening were determined in all patients enrolled in a SSc longitudinal cohort study. Adherence to PAH screening guidelines was assessed by a survey of Australian rheumatologists. Summary statistics, chi-square tests, univariate and multivariable logistic regression were used to determine the associations of risk factors with PAH. Among 1636 patients with SSc, 194 (11.9%) had PAH proven by right-Heart Catheter. Of these, 160 were detected by screening. The annual incidence of PAH was 1.4%. Patients with PAH diagnosed on subsequent screens, compared with patients in whom PAH was diagnosed on first screen, were more likely to have diffuse SSc (p = 0.03), be in a better World Health Organisation (WHO) Functional Class at PAH diagnosis (p = 0.01) and have less advanced PAH evidenced by higher mean six-minute walk distance (p = 0.03), lower mean pulmonary arterial pressure (p = 0.009), lower mean pulmonary vascular resistance (p = 0.006) and fewer non-trivial pericardial effusions (p = 0.03). Adherence to annual PAH screening using an ECHO-based algorithm was poor among Australian rheumatologists, with less than half screening their patients with SSc of more than ten years disease duration. PAH is a common complication of SSc. Physician adherence to PAH screening recommendations remains poor. Identifying modifiable barriers to screening may improve adherence and ultimately patient outcomes.
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FRI0261 Anti-phospholipid antibodies in systemic sclerosis: Prevalence and clinical correlations
Annals of the Rheumatic Diseases, 2013Co-Authors: Kathleen Morrisroe, Susanna M Proudman, Wendy Stevens, J. Byron, Vivek Thakkar, Owen A Moore, Mandana NikpourAbstract:Background Anti-phospholipid antibodies (APLA) are typically associated with thrombosis in systemic lupus erythematosus and anti-phospholipid syndrome. However, little is know about the clinical associations of these antibodies in systemic sclerosis (SSc). Objectives We sought to determine the prevalence and correlates of APLA in a large cohort of patients with SSc. Methods Patients participating in the Australian Scleroderma Cohort Study who fulfilled the ACR or Medsger criteria for SSc, were tested for APLA (anti-cardiolipin IgM [ACA IgM], anti-cardiolipin IgG [ACA IgG] and anti-beta2 glycoprotein antibodies [Anti-β 2 GP]) using commercial ELISA assays at each annual visit. APLA and various clinical manifestations were defined as present ever from SSc diagnosis. Chi-square and unadjusted logistic regression were used to identify and quantify clinical associations of APLA in SSc. Results One or more types of APLA were present in 226 (24.0%) of 940 patients included in the study. There were no patients with lupus anticoagulant. Type and titre of APLA are summarized in Table 1. Moderate to high titre ACA IgG were associated with right Heart Catheter-diagnosed pulmonary arterial hypertension (PAH) (odds ratio 1.6, 95% CI: 1.03-2.52, p=0.038). Both ACA IgM (odds ratio 2.04, 95% CI: 1.4-3.0, p Conclusions Anti-phospholipid antibodies are found in 24% of patients with SSc, but in most cases the titres are low ( Disclosure of Interest None Declared
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n terminal pro brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis a case control study
Arthritis Research & Therapy, 2012Co-Authors: Vivek Thakkar, Wendy Stevens, J. Byron, Owen A Moore, David L Prior, Danny Liew, Karen Patterson, Pravin Hissaria, Janet RoddyAbstract:Pulmonary arterial hypertension is a major cause of mortality in systemic sclerosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) has emerged as a candidate biomarker that may enable the early detection of systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH). The objective of our study was to incorporate NT-proBNP into a screening algorithm for SSc-PAH that could potentially replace transthoracic echocardiography (TTE) as a more convenient and less costly "first tier" test. NT-proBNP levels were measured in patients from four clinical groups: a group with right Heart Catheter (RHC)-diagnosed SSc-PAH before commencement of therapy for PAH; a group at high risk of SSc-PAH based on TTE; a group with interstitial lung disease; and systemic sclerosis (SSc) controls with no cardiopulmonary complications. NT-proBNP levels were compared by using ANOVA and correlated with other clinical variables by using simple and multiple linear regression. ROC curve analyses were performed to determine the optimal cut point for NT-proBNP and other clinical variables in prediction of PAH. NT-proBNP was highest in the PAH group compared with other groups (P < 0.0001), and higher in the risk group compared with controls (P < 0.0001). NT-proBNP was positively correlated with systolic pulmonary artery pressure (PAP) on TTE (P < 0.0001), and mean PAP (P = 0.013), pulmonary vascular resistance (P = 0.005), and mean right atrial pressure (P = 0.006) on RHC. A composite model wherein patients screened positive if NT-proBNP was ≥ 209.8 pg/ml, and/or DLCOcorr was < 70.3% with FVC/DLCOcorr ≥ 1.82, had a sensitivity of 100% and specificity of 77.8% for SSc-PAH. We have proposed a screening algorithm for SSc-PAH, incorporating NT-proBNP level and PFTs. This model has high sensitivity and specificity for SSc-PAH and, if positive, should lead to TTE and confirmatory testing for PAH. This screening algorithm must be validated prospectively.
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pulmonary arterial hypertension in systemic sclerosis the need for early detection and treatment
Internal Medicine Journal, 2007Co-Authors: Susanna M Proudman, Wendy Stevens, J Sahhar, David S CelermajerAbstract:Pulmonary arterial hypertension (PAH) is an important cause of mortality in systemic sclerosis (SSc). The symptoms are non-specific and can be ascribed to other features of the disease, so it is often underrecognized until the late stages. Earlier treatment with new agents is associated with better treatment outcomes. The aim of this article is to develop evidence-based guidelines for screening for PAH and interstitial lung disease (ILD) in SSc. PAH occurs in up to 27% of patients with SSc. Abnormal pulmonary function, particularly a disproportionate fall in carbon monoxide diffusing capacity (DLCO), can identify patients in the early stages of PAH, prompting further investigation in high-risk patients (limited SSc of >10 years' duration, symptoms and/or signs of PAH, DLCO 45 mmHg on echocardiography). Right Heart Catheter remains the diagnostic gold standard. An algorithm for screening with regular pulmonary function tests for the early detection of PAH and ILD in SSc is proposed.
