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Published in: Current Heart Failure Reports 2/2013

01-06-2013 | Management of Heart Failure (T.E. Meyer, Section Editor)

Defining the Role for Percutaneous Mechanical Circulatory Support Devices for Medically Refractory Heart Failure

Authors: Navin K. Kapur, Marwan F. Jumean

Published in: Current Heart Failure Reports | Issue 2/2013

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Abstract

Despite significant advances in the management of heart failure, short-term mortality due to advanced heart failure and cardiogenic shock remains high. Developed over the past few decades, percutaneous circulatory support devices offer a rapid and effective approach to slow the downward spiral of hemodynamic instability in patients presenting with decompensated heart failure until a more definitive strategy is pursued or patients recover. This review will discuss the goals of percutaneous circulatory support, the types of devices currently available, and the most recent clinical datasets examining the utility of these devices.
Literature
1.
go back to reference Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2008;101:1016–22.PubMedCrossRef Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2008;101:1016–22.PubMedCrossRef
2.
go back to reference Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–e215.PubMedCrossRef Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–e215.PubMedCrossRef
4.
go back to reference Bregman D, Nichols AB, Weiss MB, Powers ER, Martin EC, Casarella WJ. Percutaneous intraaortic balloon insertion. Am J Cardiol. 1980;46:261–4.PubMedCrossRef Bregman D, Nichols AB, Weiss MB, Powers ER, Martin EC, Casarella WJ. Percutaneous intraaortic balloon insertion. Am J Cardiol. 1980;46:261–4.PubMedCrossRef
5.
go back to reference Henriques JP, Remmelink M, Baan Jr J, van der Schaaf RJ, Vis MM, Koch KT, et al. Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover Lp 2.5. Am J Cardiol. 2006;97:990–2.PubMedCrossRef Henriques JP, Remmelink M, Baan Jr J, van der Schaaf RJ, Vis MM, Koch KT, et al. Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover Lp 2.5. Am J Cardiol. 2006;97:990–2.PubMedCrossRef
6.
go back to reference Sjauw KD, Remmelink M, Baan Jr J, Lam K, Engstrom AE, van der Schaaf RJ, et al. Left ventricular unloading in acute ST-segment elevation myocardial infarction patients is safe and feasible and provides acute and sustained left ventricular recovery. J Am Coll Cardiol. 2008;51:1044–6.PubMedCrossRef Sjauw KD, Remmelink M, Baan Jr J, Lam K, Engstrom AE, van der Schaaf RJ, et al. Left ventricular unloading in acute ST-segment elevation myocardial infarction patients is safe and feasible and provides acute and sustained left ventricular recovery. J Am Coll Cardiol. 2008;51:1044–6.PubMedCrossRef
8.
go back to reference Thiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation. 2001;104:2917–22.PubMedCrossRef Thiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation. 2001;104:2917–22.PubMedCrossRef
9.
go back to reference Extracorporeal Life Support Organization (ELSO). ECLS registry report, international summary. Ann Arbor: ELSO; 2009. Extracorporeal Life Support Organization (ELSO). ECLS registry report, international summary. Ann Arbor: ELSO; 2009.
10.
go back to reference Koeckert MS, Jorde UP, Naka Y, Moses JW, Takayama H. Impella LP 2.5 for left ventricular unloading during venoarterial extracorporeal membrane oxygenation support. J Card Surg. 2011;26(6):666–8.PubMedCrossRef Koeckert MS, Jorde UP, Naka Y, Moses JW, Takayama H. Impella LP 2.5 for left ventricular unloading during venoarterial extracorporeal membrane oxygenation support. J Card Surg. 2011;26(6):666–8.PubMedCrossRef
11.
go back to reference Kantrowitz A, Tionneland S, Freed PS, Phillips SJ, Butner AN, Sherman Jr JL. Initial clinical experience with intra-aortic balloon pumping in cardiogenic shock. JAMA. 1968;203:135–40. Kantrowitz A, Tionneland S, Freed PS, Phillips SJ, Butner AN, Sherman Jr JL. Initial clinical experience with intra-aortic balloon pumping in cardiogenic shock. JAMA. 1968;203:135–40.
12.
go back to reference •• Patel MR, Smalling RW, Thiele H, Barnhart HX, Zhou Y, Chandra P, et al. Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial. JAMA. 2011;306(12):1329–37. A recent clinical trial reporting no obvious short-term benefit to pre-reperfusion deployment of an IABP in AMI; however, did identify a trend toward long-term benefit.PubMedCrossRef •• Patel MR, Smalling RW, Thiele H, Barnhart HX, Zhou Y, Chandra P, et al. Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial. JAMA. 2011;306(12):1329–37. A recent clinical trial reporting no obvious short-term benefit to pre-reperfusion deployment of an IABP in AMI; however, did identify a trend toward long-term benefit.PubMedCrossRef
13.
go back to reference •• Perera D, Stables R, Clayton T, De Silva K, Lumley M, Clack L. Long-term mortality data from the balloon-pump assisted coronary intervention study (BCIS-1): a randomized controlled trial of elective balloon counterpulsation during high risk PCI. Circulation. 2012 Dec 6 (Epub ahead of print). A recent analysis of the BCIS-1 study showing a statistically significant improvement in mortality with elective IABP insertion during high risk coronary intervention. •• Perera D, Stables R, Clayton T, De Silva K, Lumley M, Clack L. Long-term mortality data from the balloon-pump assisted coronary intervention study (BCIS-1): a randomized controlled trial of elective balloon counterpulsation during high risk PCI. Circulation. 2012 Dec 6 (Epub ahead of print). A recent analysis of the BCIS-1 study showing a statistically significant improvement in mortality with elective IABP insertion during high risk coronary intervention.
14.
go back to reference Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–96.PubMedCrossRef Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–96.PubMedCrossRef
15.
go back to reference Sjauw KD, Konorza T, Erbel R, Danna PL, Viecca M, Minden HH, et al. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol. 2009;54(25):2430–4.PubMedCrossRef Sjauw KD, Konorza T, Erbel R, Danna PL, Viecca M, Minden HH, et al. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol. 2009;54(25):2430–4.PubMedCrossRef
16.
go back to reference Maini B, Naidu SS, Mulukutla S, Kleiman N, Schreiber T, Wohns D, et al. Real-world use of the Impella 2.5 circulatory support system in complex high-risk percutaneous coronary intervention: the USpella registry. Catheter Cardiovasc Interv. 2012;80(5):717–25.PubMedCrossRef Maini B, Naidu SS, Mulukutla S, Kleiman N, Schreiber T, Wohns D, et al. Real-world use of the Impella 2.5 circulatory support system in complex high-risk percutaneous coronary intervention: the USpella registry. Catheter Cardiovasc Interv. 2012;80(5):717–25.PubMedCrossRef
17.
go back to reference Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intraaortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52:1584–8.PubMedCrossRef Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intraaortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52:1584–8.PubMedCrossRef
18.
go back to reference O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, et al. Prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II Study. Circulation. 2012;126(14):1717–27.PubMedCrossRef O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, et al. Prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II Study. Circulation. 2012;126(14):1717–27.PubMedCrossRef
19.
go back to reference Griffith BP, Anderson MB, Samuels LE, Pae WE Jr, Naka Y, Frazier OH. The RECOVER I: a multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support. J Thorac Cardiovasc Surg. 2012 Mar 9 Epub ahead of print. Griffith BP, Anderson MB, Samuels LE, Pae WE Jr, Naka Y, Frazier OH. The RECOVER I: a multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support. J Thorac Cardiovasc Surg. 2012 Mar 9 Epub ahead of print.
20.
go back to reference Burkhoff D, Cohen H, Brunckhorst C, O’Neill WW. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006;152:e1–8.PubMedCrossRef Burkhoff D, Cohen H, Brunckhorst C, O’Neill WW. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006;152:e1–8.PubMedCrossRef
21.
go back to reference Thiele H, Sick P, Boudriot E, Diederich KW, Hamecht R, Niebauer J, et al. Randomized comparison of intra-aortic balloon support versus a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26:1276–83.PubMedCrossRef Thiele H, Sick P, Boudriot E, Diederich KW, Hamecht R, Niebauer J, et al. Randomized comparison of intra-aortic balloon support versus a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26:1276–83.PubMedCrossRef
22.
go back to reference •• Kar B, Gregoric ID, Basra SS, Idelchik GM, Loyalka P. The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol. 2011;57:688–96. Largest reported series of TandemHeart Implants for patients with cardiogenic shock in a single center.PubMedCrossRef •• Kar B, Gregoric ID, Basra SS, Idelchik GM, Loyalka P. The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol. 2011;57:688–96. Largest reported series of TandemHeart Implants for patients with cardiogenic shock in a single center.PubMedCrossRef
23.
go back to reference Sanborn TA, Sleeper LA, Bates ER, Jacobs AK, Boland J, French JK, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol. 2000;36:1123–9.PubMedCrossRef Sanborn TA, Sleeper LA, Bates ER, Jacobs AK, Boland J, French JK, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol. 2000;36:1123–9.PubMedCrossRef
24.
go back to reference •• Cheng JM, den Uil CA, Hoeks SE, van der Ent M, Jewbali LS, van Domburg RT, et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30(17):2102–8. A rare meta-analysis of studies comparing percutaneous mechanical support devices in patients with cardiogenic shock, which showed significant hemodynamic benefit, but no improvement in short-term mortality with percutaneous circulatory support devices when compared to IABP.PubMedCrossRef •• Cheng JM, den Uil CA, Hoeks SE, van der Ent M, Jewbali LS, van Domburg RT, et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30(17):2102–8. A rare meta-analysis of studies comparing percutaneous mechanical support devices in patients with cardiogenic shock, which showed significant hemodynamic benefit, but no improvement in short-term mortality with percutaneous circulatory support devices when compared to IABP.PubMedCrossRef
25.
go back to reference Combes A, Leprince P, Luyt CE, et al. Outcomes and longterm quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008;36(5):1404–11.PubMedCrossRef Combes A, Leprince P, Luyt CE, et al. Outcomes and longterm quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008;36(5):1404–11.PubMedCrossRef
26.
go back to reference Ghio S, Gavazzi A, Campana C, Inserra C, Klersy C, Sebastiani R, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol. 2001;37:183–8.PubMedCrossRef Ghio S, Gavazzi A, Campana C, Inserra C, Klersy C, Sebastiani R, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol. 2001;37:183–8.PubMedCrossRef
27.
go back to reference Zehender M, Kasper W, Kauder E, Schinthaler M, Geibel A, Olschewski M, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med. 1993;328:981–8.PubMedCrossRef Zehender M, Kasper W, Kauder E, Schinthaler M, Geibel A, Olschewski M, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med. 1993;328:981–8.PubMedCrossRef
28.
go back to reference Jacobs AK, Leopold JA, Bates E, Mendes LA, Sleeper LA, White H, et al. Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry. J Am Coll Cardiol. 2003;41:1273–9.PubMedCrossRef Jacobs AK, Leopold JA, Bates E, Mendes LA, Sleeper LA, White H, et al. Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry. J Am Coll Cardiol. 2003;41:1273–9.PubMedCrossRef
29.
go back to reference Budweiser S, Jörres RA, Riedl T, Heinemann F, Hitzl AP, Windisch W, et al. Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation. Chest. 2007;131(6):1650–8.PubMedCrossRef Budweiser S, Jörres RA, Riedl T, Heinemann F, Hitzl AP, Windisch W, et al. Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation. Chest. 2007;131(6):1650–8.PubMedCrossRef
30.
go back to reference Benza RL, Miller DP, Gomberg-Maitland M, Frantz RP, Foreman AJ, Coffey CS, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation. 2010;122:164–72.PubMedCrossRef Benza RL, Miller DP, Gomberg-Maitland M, Frantz RP, Foreman AJ, Coffey CS, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation. 2010;122:164–72.PubMedCrossRef
31.
go back to reference Haddad F, Peterson T, Fuh E, Kudelko KT, de Jesus Perez V, Skhiri M, et al. Characteristics and outcome after hospitalization for acute right heart failure in patients with pulmonary arterial hypertension. Circ Heart Fail. 2011;4:692–9.PubMedCrossRef Haddad F, Peterson T, Fuh E, Kudelko KT, de Jesus Perez V, Skhiri M, et al. Characteristics and outcome after hospitalization for acute right heart failure in patients with pulmonary arterial hypertension. Circ Heart Fail. 2011;4:692–9.PubMedCrossRef
32.
go back to reference Apostolakis S, Konstantinides S. The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management. Cardiology. 2012;121(4):263–73.PubMedCrossRef Apostolakis S, Konstantinides S. The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management. Cardiology. 2012;121(4):263–73.PubMedCrossRef
33.
go back to reference Sanchez O, Planquette B, Roux A, Gosset-Woimant M, Meyer G. Triaging in pulmonary embolism. Semin Respir Crit Care Med. 2012;33:156–62.PubMedCrossRef Sanchez O, Planquette B, Roux A, Gosset-Woimant M, Meyer G. Triaging in pulmonary embolism. Semin Respir Crit Care Med. 2012;33:156–62.PubMedCrossRef
34.
35.
go back to reference Takagaki M, Wurzer C, Wade R, Lee R, Malaisrie SC, McCarthy PM, et al. Successful conversion of TandemHeart left ventricular assist device to right ventricular assist device after implantation of a HeartMate XVE. Ann Thorac Surg. 2008;86:1677–9.PubMedCrossRef Takagaki M, Wurzer C, Wade R, Lee R, Malaisrie SC, McCarthy PM, et al. Successful conversion of TandemHeart left ventricular assist device to right ventricular assist device after implantation of a HeartMate XVE. Ann Thorac Surg. 2008;86:1677–9.PubMedCrossRef
36.
37.
go back to reference Nordhaug D, Steensrud T, Muller S, Husnes KV, Myrmel T. Intraaortic balloon pumping improves hemodynamics and right ventricular efficiency in acute ischemic right ventricular failure. Ann Thorac Surg. 2004;78(4):1426–32.PubMedCrossRef Nordhaug D, Steensrud T, Muller S, Husnes KV, Myrmel T. Intraaortic balloon pumping improves hemodynamics and right ventricular efficiency in acute ischemic right ventricular failure. Ann Thorac Surg. 2004;78(4):1426–32.PubMedCrossRef
38.
go back to reference Atiemo AD, Conte JV, Heldman AW. Resuscitation and recovery from acute right ventricular failure using a percutaneous right ventricular assist device. Catheter Cardiovasc Interv. 2006;68(1):78–82.PubMedCrossRef Atiemo AD, Conte JV, Heldman AW. Resuscitation and recovery from acute right ventricular failure using a percutaneous right ventricular assist device. Catheter Cardiovasc Interv. 2006;68(1):78–82.PubMedCrossRef
39.
go back to reference Takayama H, Naka Y, Kodali SK, Vincent JA, Addonizio LJ, Jorde UP, et al. A novel approach to percutaneous right-ventricular mechanical support. Eur J Cardiothorac Surg. 2012;41(2):423–6.PubMedCrossRef Takayama H, Naka Y, Kodali SK, Vincent JA, Addonizio LJ, Jorde UP, et al. A novel approach to percutaneous right-ventricular mechanical support. Eur J Cardiothorac Surg. 2012;41(2):423–6.PubMedCrossRef
40.
go back to reference Loor G, Khani-Hanjani A, Gonzalez-Stawinski GV. Use of RotaFlow (MAQUET) for temporary right ventricular support during implantation of HeartMate II left ventricular assist device. ASAIO J. 2012;58(3):275–7.PubMedCrossRef Loor G, Khani-Hanjani A, Gonzalez-Stawinski GV. Use of RotaFlow (MAQUET) for temporary right ventricular support during implantation of HeartMate II left ventricular assist device. ASAIO J. 2012;58(3):275–7.PubMedCrossRef
41.
go back to reference •• Kapur NK, Paruchuri V, Korabathina R, Al-Mohammdi R, Mudd JO, Prutkin J, et al. Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. J Heart Lung Transplant. 2011;30(12):1360–7. A single center study exploring use of the the TH-RVAD in medically refractory RV failure.PubMedCrossRef •• Kapur NK, Paruchuri V, Korabathina R, Al-Mohammdi R, Mudd JO, Prutkin J, et al. Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. J Heart Lung Transplant. 2011;30(12):1360–7. A single center study exploring use of the the TH-RVAD in medically refractory RV failure.PubMedCrossRef
42.
go back to reference Kapur NK, Paruchuri V, Jagannathan A, Finley J, Chakrabarti AK, Steinberg D, et al. Mechanical circulatory support for right ventricular failure: The TandemHeart in RIght VEntricular support (THRIVE) Registry. 32nd IHSLT 2012 Annual Meeting Kapur NK, Paruchuri V, Jagannathan A, Finley J, Chakrabarti AK, Steinberg D, et al. Mechanical circulatory support for right ventricular failure: The TandemHeart in RIght VEntricular support (THRIVE) Registry. 32nd IHSLT 2012 Annual Meeting
43.
go back to reference Stevenson LW, Pagani FD, Young JB, Jessup M, Miller L, Kormos RL, et al. INTERMACS profiles in advanced heart failure: the current picture. J Heart Lung Transplant 2009;28(6):535–41. Stevenson LW, Pagani FD, Young JB, Jessup M, Miller L, Kormos RL, et al. INTERMACS profiles in advanced heart failure: the current picture. J Heart Lung Transplant 2009;28(6):535–41.
Metadata
Title
Defining the Role for Percutaneous Mechanical Circulatory Support Devices for Medically Refractory Heart Failure
Authors
Navin K. Kapur
Marwan F. Jumean
Publication date
01-06-2013
Publisher
Current Science Inc.
Published in
Current Heart Failure Reports / Issue 2/2013
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-013-0132-1

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