Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short- and long-term results in ischemic cardiomyopathy

array:24 ["pii" => "S1807593222029167" "issn" => "18075932" "doi" => "10.1590/S1807-59322010001000004" "estado" => "S300" "fechaPublicacion" => "2010-01-01" "aid" => "2916" "copyright" => "CLINICS" "copyrightAnyo" => "2010" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2010;65:947-52" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S1807593222029179" "issn" => "18075932" "doi" => "10.1590/S1807-59322010001000005" "estado" => "S300" "fechaPublicacion" => "2010-01-01" "aid" => "2917" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2010;65:953-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Clinical Science" "titulo" => "Tomographic assessment of the spine in children with spondylocostal dysotosis syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "953" "paginaFinal" => "959" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig3-cln_65p953" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 671 "Ancho" => 523 "Tamanyo" => 42560 ] ] "descripcion" => array:1 [ "en" => "A 3 D reconstruction CT scan showed skull asymmetry in a 14-year-old patient (deformational plagiocephaly) without synostosis. A 3D reconstruction CT scan of the endocranial base showed asymmetric 3D position of the external acoustic meatus. The asymmetry is more marked in the middle and the posterior cranial fossa while the anterior cranial fossa was slightly asymmetric." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ali Al Kaissi, Klaus Klaushofer, Franz Grill" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Ali Al" "apellidos" => "Kaissi" ] 1 => array:2 [ "nombre" => "Klaus" "apellidos" => "Klaushofer" ] 2 => array:2 [ "nombre" => "Franz" "apellidos" => "Grill" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029179?idApp=UINPBA00004N" "url" => "/18075932/0000006500000010/v1_202212010724/S1807593222029179/v1_202212010724/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222029155" "issn" => "18075932" "doi" => "10.1590/S1807-59322010001000003" "estado" => "S300" "fechaPublicacion" => "2010-01-01" "aid" => "2915" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2010;65:941-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Clinical Science" "titulo" => "The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "941" "paginaFinal" => "946" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig2-cln_65p941" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 250 "Ancho" => 478 "Tamanyo" => 15461 ] ] "descripcion" => array:1 [ "en" => "Average changes in heart rate. Pre: preinduction, Post:postinduction, Pex: post-extubation" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dilsen Ornek, Seyhan Metin, Serpil Deren, Canan Un, Mustafa Metin, Bayazit Dikmen, Nermin Gogus" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Dilsen" "apellidos" => "Ornek" ] 1 => array:2 [ "nombre" => "Seyhan" "apellidos" => "Metin" ] 2 => array:2 [ "nombre" => "Serpil" "apellidos" => "Deren" ] 3 => array:2 [ "nombre" => "Canan" "apellidos" => "Un" ] 4 => array:2 [ "nombre" => "Mustafa" "apellidos" => "Metin" ] 5 => array:2 [ "nombre" => "Bayazit" "apellidos" => "Dikmen" ] 6 => array:2 [ "nombre" => "Nermin" "apellidos" => "Gogus" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029155?idApp=UINPBA00004N" "url" => "/18075932/0000006500000010/v1_202212010724/S1807593222029155/v1_202212010724/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Clinical Science" "titulo" => "Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short- and long-term results in ischemic cardiomyopathy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "947" "paginaFinal" => "952" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Vicente Serrano, José A F Ramires, Alexandre de Matos Soeiro, Luiz Antônio M César, Whady A Hueb, Luiz A Dallan, Fábio B Jatene, Noedir A G Stolff" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Carlos Vicente" "apellidos" => "Serrano" "sufijo" => "Jr" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "I" "identificador" => "af1-cln_65p947" ] ] ] 1 => array:3 [ "nombre" => "José A F" "apellidos" => "Ramires" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "II" "identificador" => "af2-cln_65p947" ] ] ] 2 => array:4 [ "nombre" => "Alexandre" "apellidos" => "de Matos Soeiro" "email" => array:1 [ 0 => "alexandre.soeiro@bol.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "I" "identificador" => "af1-cln_65p947" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "c1-cln_65p947" ] ] ] 3 => array:3 [ "nombre" => "Luiz Antônio M" "apellidos" => "César" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "II" "identificador" => "af2-cln_65p947" ] ] ] 4 => array:3 [ "nombre" => "Whady A" "apellidos" => "Hueb" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "II" "identificador" => "af2-cln_65p947" ] ] ] 5 => array:3 [ "nombre" => "Luiz A" "apellidos" => "Dallan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "III" "identificador" => "af3-cln_65p947" ] ] ] 6 => array:3 [ "nombre" => "Fábio B" "apellidos" => "Jatene" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "III" "identificador" => "af3-cln_65p947" ] ] ] 7 => array:3 [ "nombre" => "Noedir A G" "apellidos" => "Stolff" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "III" "identificador" => "af3-cln_65p947" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Unidade Clínica de Coronariopatias Agudas, São Paulo, SP, Brazil" "etiqueta" => "I" "identificador" => "af1-cln_65p947" ] 1 => array:3 [ "entidad" => "Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cardiopneumologia, São Paulo, SP, Brazil" "etiqueta" => "II" "identificador" => "af2-cln_65p947" ] 2 => array:3 [ "entidad" => "Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Cardíaca, São Paulo/SP, Brazil" "etiqueta" => "III" "identificador" => "af3-cln_65p947" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "c1-cln_65p947" "etiqueta" => "*" "correspondencia" => "Tel.: 55 11 3067-7427" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig3-cln_65p947" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 247 "Ancho" => 446 "Tamanyo" => 16988 ] ] "descripcion" => array:1 [ "en" => "Incidence of congestive heart failure after surgery according to functional class (New York Heart Association classification). ∗p<0.01 vs. baseline." ] ] ] "textoCompleto" => "INTRODUCTIONThe term ischemic cardiomyopathy (ICM) is used to describe the clinical picture and pathological findings in patients with congestive heart failure secondary to ischemic heart disease. Manifestations of congestive heart failure are common in patients with coronary artery disease. They may be the dominant feature in those who have sustained prior myocardial infarctions with ischemic areas replaced by fibrous tissue, with disappearance or reduction of angina symptoms. The three most common causes of congestive heart failure in this setting are left ventricular aneurysm, mitral regurgitation due to dilatation of the mitral annulus and/or papillary muscle ischemic dysfunction, and an inadequate quantity of normally contracting myocardium.<a class="elsevierStyleCrossRefs" href="#bib1">1,2</a> ICM can also result from myocardial hibernation, which is characterized as a situation of reduced regional contractile function distal to a coronary artery stenosis from which the individual recovers after removal of the coronary stenosis.<a class="elsevierStyleCrossRef" href="#bib3">3</a>Patients who have untreated infarct-related ventricular aneurysms that compromise 20% to 25% of the left ventricular area develop progressive global ventricular dilatation. The rationale for congestive heart failure among ventricular aneurysms is that the fraction of blood that enters the region of the aneurysms causes an overload state, and severe global dilatation of the heart ensues over time.<a class="elsevierStyleCrossRef" href="#bib3">3</a> The surgical treatment of left ventricular dysfunction has evolved gradually. Initially, it was demonstrated that patients with large ventricular aneurysms and severe cardiac failure improved with resection of the ventricular aneurysm.<a class="elsevierStyleCrossRef" href="#bib3">3</a> Surgical therapy of ventricular aneurysms evolved further with the intracavitary patch techniques of Jatene,<a class="elsevierStyleCrossRef" href="#bib2">2</a> Dor,<a class="elsevierStyleCrossRef" href="#bib1">1</a> and Cooley<a class="elsevierStyleCrossRef" href="#bib4">4</a> that have yielded excellent surgical and functional results. However, the clinical and survival benefits of aneurysmectomy when severe left ventricular dysfunction is present remained controversial until the STICH trial in 2009, the results of which showed no reduction in the rate of death or hospitalization for cardiac causes in patients submitted to aneurysmectomy.<a class="elsevierStyleCrossRef" href="#bib5">5</a> Therefore, the objective of this study was to describe the short- and long-term functional results after aneurysmectomy surgery in ICM and to identify predictors of a favorable outcome.METHODS AND MATERIALPatient populationBetween June 1992 and December 1995, 169 consecutive patients with ischemic heart disease underwent aneurysmectomy surgery at our institution. Prior to data collection, this study was approval by the ethics committee. Baseline clinical characteristics of patients are shown in <a class="elsevierStyleCrossRef" href="#t1-cln_65p947">Table 1</a>. The three-year follow-up period was completed in 2001 by means of telephone contact or office visits. Follow-up consisted of obtaining information about the functional class of congestive heart failure (New York Heart Association), angina (Canadian Cardiovascular Society [CCS]), and survival data using a medical questionnaire.<elsevierMultimedia ident="t1-cln_65p947"></elsevierMultimedia>Coronary angiography was conducted with all patients. In addition, the number of diseased coronary vessels (lumen narrowing ≥ 70%) was assessed. Global left ventricular ejection fraction (LVEF) was also measured by contrasted ventriculography. Left ventricular dysfunction was characterized by an ejection fraction ≤ 30%. Left ventricular aneurysm was defined as a zone of paradoxical systolic expansion (dyskinetic) or as an akinetic myocardial zone well delimited from the surrounding cardiac silhouette. Viability data were obtained by echocardiographic stress test or thallium scintigraphy for all patients. Baseline coronary angiography and ventriculography data are shown in <a class="elsevierStyleCrossRef" href="#t2-cln_65p947">Table 2</a>. The indication for surgery was left ventricular failure, refractory to medical therapy, in the presence of an anatomic left ventricular aneurysm and concomitant coronary stenosis suitable for coronary artery bypass grafting (CABG).<elsevierMultimedia ident="t2-cln_65p947"></elsevierMultimedia>Operative proceduresWith the patient supported on normothermic cardiopulmonary bypass, the heart was carefully examined to confirm the extension excise portion of a nonfunctioning wall previously analyzed by echocardiography or ventriculography. Once thinning of the nonfunctioning area was confirmed, a small incision was made. Any clot present was carefully removed. With the unloaded heart opened and beating, the surrounding wall was palpated, and its ability to contract (regional wall thickening) was reliably assessed. All thinned nonfunctioning portions of the wall were considered for resection.Excision was planned to remove as much nonfunctioning wall as possible while restoring ventricular size and shape toward normal conditions as described by Jatene.<a class="elsevierStyleCrossRef" href="#bib2">2</a> In many cases, the excised specimen was composed of a mixture of infarcted and viable muscle. In addition, repair sutures were often placed through relatively thick areas of myocardium. Sutures were positioned further apart on the tissue edges than on the felt strips so that the length of the incision was plicated in the closure to help to restore the shape of the ventricle toward normal conditions.In most patients with an anterior aneurysm, scarring of the septum was observed. However, only in cases in which a major portion of the septum was both scarred and thinned was a septoplasty performed, as previously described. The anterior edge of the patch was incorporated into the ventricular closure. Once ventricular repair was completed, bypass grafting was carried out when indicated. Retrograde cardioplegia and antegrade cardioplegia or infusion down a right graft were utilized to protect the left and right ventricle, respectively. Complete revascularization was performed in all patients according to the noninvasive test performed.In this study, a total of 290 grafts were accomplished, providing a grafts/patient ratio of 1.8±0.4 (see <a class="elsevierStyleCrossRef" href="#t3-cln_65p947">Table 3</a>). Nine patients with left anterior descending artery lesion did not receive any kind of graft. Intraoperative transesophageal echocardiography was conducted to confirm mitral insufficiency. If confirmed, both a left atriotomy and a left ventriculotomy through the aneurysm were performed. If the mitral valve was so severely diseased that it could not be repaired, a prosthetic mitral valve was implanted. After completion of the myocardial revascularization and mitral valve surgery, attention was directed toward the repair of the ventricular aneurysm. Mitral repair/replacement was done in 13 cases.<elsevierMultimedia ident="t3-cln_65p947"></elsevierMultimedia>Statistical analysisSpearman's rank test was used for correlations, whereas multiple regression analysis was utilized to assess the potential associations. The cumulative probability of events was determined using the Kaplan-Meier method, and differences in the distribution of events during the three-year study period were evaluated with the log-rank test. A p-value ≤ 0.05 was considered to be statistically significant.RESULTSEarly post-operative careSeven (4.1%) patients died in the hospital due to cardiac causes. Results of univariate analyses demonstrated that angina was associated with a decreased risk of hospital mortality (p = 0.04), whereas prolonged duration of cardiopulmonary bypass was associated with an increased risk of hospital mortality (p = 0.03). When entered into the multivariate analysis, none of the variables examined proved to be predictive. Specific features in the postoperative treatment in the intensive care unit are shown in <a class="elsevierStyleCrossRef" href="#t4-cln_65p947">Table 4</a>. Significant differences occurred between patients who survived and patients who died during hospitalization.<elsevierMultimedia ident="t4-cln_65p947"></elsevierMultimedia>Late clinical follow-upOf the initial 169 patients, contrast ventriculography (for LVEF determination) was repeated on 133 (79%) patients at 6 months, 90 (53%) patients at 12 months, and 75 (44%) patients at 36 months. The initial LVEF of 22±5% increased significantly to 40±3% at 6 months and 45±6% and 45±7% at 12 and 36 months, respectively (see <a class="elsevierStyleCrossRef" href="#fig1-cln_65p947">Figure 1</a>). After three years of follow-up, we had information about 83% (140) of patients included in study. Ten (6.3%) late casualties were recorded during the follow-up period. Actuarial survival was 91.1%, 90.5%, and 89.2% at one, two, and three years, respectively (see <a class="elsevierStyleCrossRef" href="#fig2-cln_65p947">Figure 2A</a>). Actuarial survival rates based on baseline characteristics are shown in <a class="elsevierStyleCrossRef" href="#fig2-cln_65p947">Figures 2B, 2C, and 2D</a>.<elsevierMultimedia ident="fig1-cln_65p947"></elsevierMultimedia><elsevierMultimedia ident="fig2-cln_65p947"></elsevierMultimedia>There was a successful functional outcome of myocardial revascularization as evidenced by a significant improvement in congestive heart failure NYHA class, gated LVEF ex/rest ratio by radioisotopic ventriculography performed at 2 and 36 months, and contrast ventriculography. Congestive heart failure classes I, II, III, and IV were observed in 81 (56%), 42 (29%), 16 (10%), and 8 (5%) operative survivors at follow-up, respectively (see <a class="elsevierStyleCrossRef" href="#fig3-cln_65p947">Figure 3</a>). Angina classes (CCS) I/II and III/IV were observed in 54% and 16% of patients, respectively, at three-year follow-up. In 30% of patients, we did not observe angina.<elsevierMultimedia ident="fig3-cln_65p947"></elsevierMultimedia>Several variables were identified as correlates of recurrent heart failure. In particular, lower LVEF, presentation with congestive heart failure, and need for preoperative IABP were associated with a greater likelihood of recurrent heart failure, whereas higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.055), and higher number of grafts (p = 0.01) were predictive of improvement in congestive heart failure class at follow-up.DISCUSSIONThese data suggest that, among patients with severe left ventricular dysfunction, aneurysmectomy results in favorable short- and long-term functional and clinical outcomes, which lead to satisfactory survival rates. Selection of appropriate surgical candidates and extensive use of concomitant revascularization substantially improves survival rates. Currently, aneurysmectomy is considered to be a prominent surgical technique of left ventricular reconstruction for either dyskinetic or akinetic left ventricular segments in patients with ICM. Dyskinetic/akinetic left ventricular segments almost exclusively involve the left ventricle, most commonly the anterior or apical segments. For the detection of left ventricular dyskinetic/akinetic segments, biplane left ventriculography is a precise method that is available for outlining left ventricular segments, assessing septal motion, and determining the quantity of functioning residual myocardium.<a class="elsevierStyleCrossRef" href="#bib4">4</a> Nevertheless, other noninvasive methods, such as magnetic resonance imaging, that were unavailable at the time of the study are gaining popularity. Aneurysmectomy associated with concomitant CABG improves ventricular function in patients with severe coronary artery disease and severe left ventricular dysfunction.Functional outcomeFew clinical series have focused on the functional outcome after myocardial revascularization in ICM. Most researchers have verified that short- and long-term survival rates after surgery are acceptable. The disclosure of short-term progress in left ventricular systolic performance has generally been viewed as an indicator of successful functional effect.<a class="elsevierStyleCrossRefs" href="#bib6">6,7</a> Contrary to this hypothesis, present evidence suggests that an increase in left ventricular ejection fraction is not accompanied by clinical improvement.<a class="elsevierStyleCrossRef" href="#bib6">6</a> These findings have significant implications because clinical management of congestive heart failure has also produced significant progress in terms of both survival and control of symptoms.<a class="elsevierStyleCrossRef" href="#bib7">7</a> Thus, the preference of the most advantageous therapeutic modality for a specific patient with ischemic left ventricular dysfunction must be well thought out. Merely considering survival may be inadequate to distinguish among therapeutic options.For the most part, congestive heart failure is accountable for the satisfactorily low occurrence of symptoms late after surgery. Estimates of recurrent heart failure are well described and differ broadly from other studies of patients with ICM, ranging from 28% to 63%.<a class="elsevierStyleCrossRef" href="#bib7">7</a> The current findings are consistent with those of previous studies. It is possible that the cases of recurrent heart failure point to the unyielding development in the direction of left ventricular dysfunction.<a class="elsevierStyleCrossRef" href="#bib7">7</a> Determination of left ventricular ejection fraction by echocardiogram is reasonable to reveal the relationship between left ventricular systolic function and congestive heart failure late after revascularization.Predicting the recurrence or appearance of the symptoms of congestive heart failure has immeasurable relevance in terms of patient selection. The present study linked the greater possibility of heart failure at follow-up after aneurysmectomy with female sex, history of congestive heart failure, lower ejection fraction, and need for preoperative IABP support. In addition, history of angina, use of the left internal thoracic artery, and number of bypass grafts were inversely related to recurrence of congestive heart failure.The importance of demographic characteristics before surgery is quite obvious, even though a relation with recurrent heart failure has not been previously described. In fact, lower ejection fraction has frequently been associated with unfavorable long-term outcomes after revascularization in ICM, as have history of congestive heart failure and female sex.<a class="elsevierStyleCrossRef" href="#bib7">7</a> The requirement for preoperative IABP may predict which patients will have more severe left ventricular failure. Assessment of known evidence is problematic because not many researchers have investigated the recurrence of congestive heart failure in large clinical trials.Whereas the clinical variables per se have an influence on patient selection, the operative variables examined in this study have applicable management connotations. Evidence suggests that more widespread exploitation of left internal thoracic artery grafts and complete myocardial revascularization can diminish the recurrence of congestive failure in the short- and long-term following surgery. This finding is consistent with inferences made by previous researchers regarding the overall revascularization patients.<a class="elsevierStyleCrossRefs" href="#bib7">7-20</a> Failure to previously demonstrate an association on ICM between the sort of graft for bypass and long-term coronary events by other investigators may be related to the decreased application of the left internal thoracic artery (i.e., between 20% and 35% when informed).<a class="elsevierStyleCrossRef" href="#bib7">7</a> The rationale for not employing the left thoracic artery in the past in patients with ICM was due to apprehension about complications related to advanced age, urgency of revascularization, and reserved anxiety about long-term prognosis.<a class="elsevierStyleCrossRef" href="#bib16">16</a> However, the findings of this study and other recent studies<a class="elsevierStyleCrossRefs" href="#bib16">16,17,19-23</a> suggest that there is little cause for concern. Thus, patients with ICM should be managed with a left internal thoracic artery graft when revascularization is selected therapy.<a class="elsevierStyleCrossRef" href="#bib15">15</a>SurvivalCoronary artery bypass grafting has advanced into a secure therapy approach for selected patients with ischemic left ventricular failure. The present study demonstrated that myocardial revascularization can currently be accessible to patients with ICM at a low operative hazard (as low as 2%) and with a reasonable long-term follow-up. Assessment of survival estimates after coronary artery bypass grafting with previously published series presents some limitations.<a class="elsevierStyleCrossRef" href="#bib15">15</a> In particular, patient selection principles are not consistent among the various clinical reports with regard to the values of left ventricular ejection fraction and the inclusion of patients with acute myocardial infarction, left ventricular aneurysm, or valve disease who require surgical management.<a class="elsevierStyleCrossRef" href="#bib5">5</a> Despite these limitations, a surgical mortality rate varying from 2% to 10% has been reported for a considerable number of consecutive patients.<a class="elsevierStyleCrossRefs" href="#bib6">6,7,14,16,17,19,20,22</a>Consistent with previously reported actuarial 5-year survival rates between 64% and 73%,<a class="elsevierStyleCrossRefs" href="#bib16">16,17,19,20,22</a> the long-term outcomes after myocardial revascularization were also satisfactory in the present study. Progress in perioperative management of patients with end-stage ischemic heart disease<a class="elsevierStyleCrossRef" href="#bib6">6</a> has been instrumental in transitioning bypass grafting from a high-risk neglected alternative to transplantation<a class="elsevierStyleCrossRefs" href="#bib6">6,7</a> to a low-risk routine modality. However, the constant evolution throughout the last decade of time of patient selection criteria by means of prospective laboratory investigation and of retrospective risk stratification has played an even more important role in this transition.<a class="elsevierStyleCrossRefs" href="#bib6">6,22</a>Consequently, reviews of large clinical series, such as the current one, have been conducted to isolate preoperative variables that may predict the outcome of revascularization. Analysis of previous studies shows that a sequence of patient characteristics, including advanced age, female sex, lower ejection fraction, comorbid conditions, urgency of operation, and reoperation, may be linked to increased operative risk.<a class="elsevierStyleCrossRefs" href="#bib6">6,18,24-32</a> In the present study, both late overall and late cardiac mortality were associated with lower ejection fraction, fewer bypass grafts, and longer duration of cardiopulmonary bypass.The association between preoperative left ventricular function and short- and long-term survival is instinctive because it describes the severity of ischemic left ventricular failure.<a class="elsevierStyleCrossRef" href="#bib14">14</a> The number of bypass grafts in the present series highlights the completeness of the revascularization because two thirds of patients had two- and three-vessel disease. Accordingly, the finding of an inverse relationship between the number of grafts and mortality is consistent with the results of Luciani and colleagues,<a class="elsevierStyleCrossRef" href="#bib3">3</a> who reported that complete myocardial revascularization was inversely linked to mortality. Complete revascularization of the myocardium has vast prognostic implications for survival.<a class="elsevierStyleCrossRef" href="#bib6">6</a> In addition, the role of the length of cardiopulmonary bypass in predicting morbi-mortality must also be considered. This additional aspect emphasizes the magnitude of ischemic heart disease, where prolonged circulatory assistance may be mandatory to wean a deteriorating heart from bypass.<a class="elsevierStyleCrossRef" href="#bib3">3</a>Recently, the Surgical Treatment for Isquemic Heart Failure (STICH) trial studied surgical ventricular reconstruction added to CABG in 1,000 patients with heart failure (LVEF of 35% or less) caused by coronary artery disease.<a class="elsevierStyleCrossRef" href="#bib5">5</a> The patients were randomly selected to undergo CABG alone or CABG with surgical ventricular reconstruction; the median follow-up was 48 months. The findings of this study showed that adding surgical ventricular reconstruction to CABG reduced the left ventricular volume compared to CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes.<a class="elsevierStyleCrossRef" href="#bib5">5</a>LimitationsThe present study was retrospective and not randomized, similar to previous studies of myocardial revascularization in patients with ICM. Modifying medical practice by increasing the period of cardioplegia, myocardial viability evaluation, and use of the left internal thoracic artery, might have had an influential role in our findings unlike previously published work. Late follow-up echocardiographic and coronary angiographic studies were not executed in all patients. It is difficult to determine if poor functional outcome is a result of complications related to myocardial revascularization and/or progressing ICM. This limitation is present in most of the previously published papers on this topic. Other colleagues have proposed the Specific Activity Scale, which has better consistency with exercise treadmill presentation than NYHA or CCS.<a class="elsevierStyleCrossRefs" href="#bib3">3,33</a> Nevertheless, NYHA and CCS continue to be the main scoring practices used, and their application is acceptable if clinical series are to be matched up to. All data were obtained before 2001, which may modify some results because of the development of new technologies and surgical methods after this period.CONCLUSIONThe findings of this study suggest that aneurysmectomy among patients with severe LV dysfunction results in short- and long-term favorable outcome function and survival. In addition to the enduring relief from angina, most of the patients experienced improvements in congestive heart failure at long-term follow-up. Selection of appropriate surgical candidates may substantially improve survival among these patients." "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "xpalclavsec1581294" "titulo" => "KEYWORDS" ] 1 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 2 => array:3 [ "identificador" => "cesec20" "titulo" => "METHODS AND MATERIAL" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "cesec30" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "cesec40" "titulo" => "Patient population" ] 1 => array:2 [ "identificador" => "cesec50" "titulo" => "Operative procedures" ] 2 => array:2 [ "identificador" => "cesec60" "titulo" => "Statistical analysis" ] ] ] ] ] 3 => array:3 [ "identificador" => "cesec70" "titulo" => "RESULTS" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "cesec80" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "cesec90" "titulo" => "Early post-operative care" ] 1 => array:2 [ "identificador" => "cesec100" "titulo" => "Late clinical follow-up" ] ] ] ] ] 4 => array:3 [ "identificador" => "cesec110" "titulo" => "DISCUSSION" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "cesec120" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "cesec130" "titulo" => "Functional outcome" ] 1 => array:2 [ "identificador" => "cesec140" "titulo" => "Survival" ] 2 => array:2 [ "identificador" => "cesec150" "titulo" => "Limitations" ] ] ] ] ] 5 => array:2 [ "identificador" => "cesec160" "titulo" => "CONCLUSION" ] 6 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-05-10" "fechaAceptado" => "2010-07-07" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "KEYWORDS" "identificador" => "xpalclavsec1581294" "palabras" => array:5 [ 0 => "Myocardial revascularization" 1 => "Ventricular dysfunction" 2 => "Ischemic cardiomyopathy" 3 => "Cardiac surgery" 4 => "Aneurysmectomy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "INTRODUCTION:The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes. METHODS AND MATERIAL:Patients (n = 169) with angiographic left ventricular ejection fraction of 22±5% underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95% of the patients. RESULTS:Cumulative in-hospital and 36-month mortalities were 7% and 15%, respectively. These respective rates varied according to preoperative parameters: CHF class I-II, 4% and 13%; CHF class III-IV, 8% and 16%; LVEF<20%, 12% and 26%; LVEF 21-30%, 2% and 6%; gated LVEF exercise/rest >5%, <1% and 4%; and gated LVEF exercise/rest ≤5%, 17% and 38%. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow-up based on the results of a multivariate analysis. After three years of follow-up, 84% of the patients were in class I/II, LVEF was 45±7%, and gated LVEF ex/rest ratio was 13% higher (p<0.01) compared to the beginning of the study. CONCLUSIONS:These data suggest that aneurysmectomy among patients with severe LV dysfunction result in short- and long-term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "ceabs10" "titulo" => "INTRODUCTION:" ] 1 => array:2 [ "identificador" => "ceabs20" "titulo" => "METHODS AND MATERIAL:" ] 2 => array:2 [ "identificador" => "ceabs30" "titulo" => "RESULTS:" ] 3 => array:2 [ "identificador" => "ceabs40" "titulo" => "CONCLUSIONS:" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig1-cln_65p947" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 259 "Ancho" => 420 "Tamanyo" => 8872 ] ] "descripcion" => array:1 [ "en" => "Left ventricular ejection fraction (LVEF) determined by contrast ventriculogram." ] ] 1 => array:7 [ "identificador" => "fig2-cln_65p947" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 436 "Ancho" => 661 "Tamanyo" => 35237 ] ] "descripcion" => array:1 [ "en" => "Cumulative mortality: A, global; B, according to baseline congestive heart failure New York Heart Association classification (CHF NYHF); C, according to baseline left ventricular ejection fraction (LVEF); D, according to baseline gated left ventricular ejection fraction (LVEF) exercise (ex)/rest ratio." ] ] 2 => array:7 [ "identificador" => "fig3-cln_65p947" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 247 "Ancho" => 446 "Tamanyo" => 16988 ] ] "descripcion" => array:1 [ "en" => "Incidence of congestive heart failure after surgery according to functional class (New York Heart Association classification). ∗p<0.01 vs. baseline." ] ] 3 => array:7 [ "identificador" => "t1-cln_65p947" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic, n (percentage) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">111 (66%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Age (in years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">61±9 (range: 31-78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">76 (45%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Smokers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">75 (44%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Total cholesterol > 240 mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">64 (38%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">59 (35%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Months since myocardial infarction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">9.4±6.2 (range; 1.5-32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Functional class (CHF NYHA)<a class="elsevierStyleCrossRef" href="#tfn1-cln_65p947">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">16 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">53 (31%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">59 (35%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">41 (25%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Electrocardiographic Findings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Sinus rhythm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">135 (80%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">84 (20%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Left anterior divisional block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">81 (48%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Left bundle branch block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">53 (31%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">First degree atrioventricular block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">38 (22%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Third degree atrioventricular block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">6 (4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tfn1-cln_65p947" "etiqueta" => "a" "nota" => "CHF NYHA, congestive heart failure according to the New York Heart Association." ] ] ] "descripcion" => array:1 [ "en" => "Baseline clinical characteristics of the study population (n = 169)." ] ] 4 => array:7 [ "identificador" => "t2-cln_65p947" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Lesion on left anterior descending artery (LADA) n(%)<a class="elsevierStyleCrossRef" href="#tfn2-cln_65p947">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Occlusion of LADA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">87 (51%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Critical stenosis of LADA (70-99%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">52 (31%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">< 70% stenosis of LADA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">30 (18%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Type of lesion n(%)<a class="elsevierStyleCrossRef" href="#tfn3-cln_65p947">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Uniarterial lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">51 (30%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Biarterial lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">62 (37%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Triarterial lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">56 (33%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Left ventricular ejection mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">22±5% (range: 11-30) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tfn2-cln_65p947" "etiqueta" => "a" "nota" => "Between lesions on LADA: p<0.0001." ] 1 => array:3 [ "identificador" => "tfn3-cln_65p947" "etiqueta" => "b" "nota" => "Between types of lesion: p = 0.58. Note: Left ventricular ejection fraction measured by contrasted ventriculography. Data expressed as number or percentage." ] ] ] "descripcion" => array:1 [ "en" => "Baseline angiographic data of the study population (n = 169)." ] ] 5 => array:7 [ "identificador" => "t3-cln_65p947" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">All grafts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="bottom">290 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Left internal thoracic artery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="bottom">132 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Right internal thoracic artery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="bottom">46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Radial artery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="bottom">32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Safena vein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="bottom">80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Grafts/ patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="bottom">1.8 ± 0,4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Mitral valve replacement/repair \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="bottom">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Surgical treatment." ] ] 6 => array:7 [ "identificador" => "t4-cln_65p947" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Between patients who survived and patients who died during hospitalization: ap<0.0001, bp<0.01, cp = 0.001.∗ = more than 24 hours after surgery. Mean±SD." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Total (n = 169) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Survived (n = 158, 93%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Died (n = 11, 7%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Intensive care unit (in days)a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">16±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">12±3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">19±3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Hospital stay (in days)a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">27±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">15±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">33±5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Need of vasoactive agents, n(%)a ∗ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">109 (64%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">98 (62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">11 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Need of mechanical ventilation n(%)b ∗ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">3.4±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.8±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">4.8±0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Acute renal failure n(%)a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">19 (11%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">8 (5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">11 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Urinary or respiratory tract infection n(%)c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">11 (7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">31 (20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">8 (73%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Post-surgical in-hospital data." ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgery for left ventricular aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ V Dor \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1097/00001573-199012000-00009" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Cardiol" "fecha" => "1990" "volumen" => "5" "paginaInicial" => "773" "paginaFinal" => "780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10149333" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1097/00001573-199012000-00009" "WWW" => array:1 [ "link" => "10.1097/00001573-199012000-00009" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular aneurysmectomy: resection or reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ AD Jatene \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1985" "volumen" => "89" "paginaInicial" => "321" "paginaFinal" => "331" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3974267" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ GB Luciani \n \t\t\t\t\t\t\t\t """ 1 => """ G Montalbano \n \t\t\t\t\t\t\t\t """ 2 => """ G Casali \n \t\t\t\t\t\t\t\t """ 3 => """ A Mazzucco \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thor Cardiovasc Surg" "fecha" => "2000" "volumen" => "120" "paginaInicial" => "478" "paginaFinal" => "489" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "10.1067/mtc.2000.108692" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular aneurysms: pathophysiologic observations and standard resection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ JL Cox \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Sem Thorac Cardiovasc Surg" "fecha" => "1997" "volumen" => "9" "paginaInicial" => "113" "paginaFinal" => "122" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary bypass surgery with or without surgical ventricular reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ RH Jones \n \t\t\t\t\t\t\t\t """ 1 => """ EJ Velazquez \n \t\t\t\t\t\t\t\t """ 2 => """ RE Michler \n \t\t\t\t\t\t\t\t """ 3 => """ G Sopko \n \t\t\t\t\t\t\t\t """ 4 => """ JK Oh \n \t\t\t\t\t\t\t\t """ 5 => """ CM O'Connor \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "360" "paginaInicial" => "1705" "paginaFinal" => "1717" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "10.1056/NEJMoa0900559" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventricular aneurysm after myocardial infarction: surgical excision with use of temporary cardiopulmonary bypass" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ DA Cooley \n \t\t\t\t\t\t\t\t """ 1 => """ HA Collins \n \t\t\t\t\t\t\t\t """ 2 => """ GC Morris \n \t\t\t\t\t\t\t\t """ 3 => """ DW Chapman \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "1958" "volumen" => "167" "paginaInicial" => "557" "paginaFinal" => "560" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular aneurysm: a new surgical approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ V Dor \n \t\t\t\t\t\t\t\t """ 1 => """ M Saab \n \t\t\t\t\t\t\t\t """ 2 => """ P Coste \n \t\t\t\t\t\t\t\t """ 3 => """ M Kornaszewska \n \t\t\t\t\t\t\t\t """ 4 => """ F Montiglio \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1989" "volumen" => "37" "paginaInicial" => "11" "paginaFinal" => "19" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "10.1055/s-2007-1013899" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventricular endoaneurysmorraphy: results of an improved method of repair" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ DA Cooley \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Tex Heart Inst J" "fecha" => "1989" "volumen" => "16" "paginaInicial" => "72" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15227216" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of biplane angiography for the measurement of left ventricular volume in man" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ HT Dodge \n \t\t\t\t\t\t\t\t """ 1 => """ H Sandler \n \t\t\t\t\t\t\t\t """ 2 => """ DH Ballew \n \t\t\t\t\t\t\t\t """ 3 => """ JD Lord \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Heart J" "fecha" => "1960" "volumen" => "60" "paginaInicial" => "762" "paginaFinal" => "776" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "10.1016/0002-8703(60)90359-8" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial viability assessment in ischemic cardiomyopathy: benefits of coronary revascularization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ GD Dreyfus \n \t\t\t\t\t\t\t\t """ 1 => """ D Duboc \n \t\t\t\t\t\t\t\t """ 2 => """ A Blasco \n \t\t\t\t\t\t\t\t """ 3 => """ F Vigoni \n \t\t\t\t\t\t\t\t """ 4 => """ C Dubois \n \t\t\t\t\t\t\t\t """ 5 => """ D Brodaty \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/0003-4975(94)90091-4" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1994" "volumen" => "57" "paginaInicial" => "1402" "paginaFinal" => "1408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8010780" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/0003-4975(94)90091-4" "WWW" => array:1 [ "link" => "10.1016/0003-4975(94)90091-4" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional status" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ JA Elefteriades \n \t\t\t\t\t\t\t\t """ 1 => """ G Tolis \n \t\t\t\t\t\t\t\t """ 2 => """ E Levi \n \t\t\t\t\t\t\t\t """ 3 => """ LK Mills \n \t\t\t\t\t\t\t\t """ 4 => """ BL Zaret \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/0735-1097(93)90551-b" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1993" "volumen" => "22" "paginaInicial" => "1411" "paginaFinal" => "1417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8227799" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/0735-1097(93)90551-b" "WWW" => array:1 [ "link" => "10.1016/0735-1097(93)90551-B" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ JJ Bax \n \t\t\t\t\t\t\t\t """ 1 => """ D Poldermans \n \t\t\t\t\t\t\t\t """ 2 => """ A Elhendy \n \t\t\t\t\t\t\t\t """ 3 => """ JH Cornel \n \t\t\t\t\t\t\t\t """ 4 => """ E Boersma \n \t\t\t\t\t\t\t\t """ 5 => """ R Rambaldi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/s0735-1097(99)00157-6" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1999" "volumen" => "34" "paginaInicial" => "163" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10400006" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/s0735-1097(99)00157-6" "WWW" => array:1 [ "link" => "10.1016/S0735-1097(99)00157-6" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ The SOLVD Investigators \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1056/NEJM199108013250501" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1991" "volumen" => "325" "paginaInicial" => "293" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2057034" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1056/NEJM199108013250501" "WWW" => array:1 [ "link" => "10.1056/NEJM199108013250501" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ A Yamaguchi \n \t\t\t\t\t\t\t\t """ 1 => """ T Ino \n \t\t\t\t\t\t\t\t """ 2 => """ H Adachi \n \t\t\t\t\t\t\t\t """ 3 => """ S Murata \n \t\t\t\t\t\t\t\t """ 4 => """ H Kamio \n \t\t\t\t\t\t\t\t """ 5 => """ M Okada \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1997" "volumen" => "65" "paginaInicial" => "434" "paginaFinal" => "438" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "10.1016/S0003-4975(97)01155-7" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ GB Luciani \n \t\t\t\t\t\t\t\t """ 1 => """ G Montalbano \n \t\t\t\t\t\t\t\t """ 2 => """ G Casali \n \t\t\t\t\t\t\t\t """ 3 => """ A Mazzucco \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1067/mtc.2000.108692" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2000" "volumen" => "120" "paginaInicial" => "478" "paginaFinal" => "489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10962408" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1067/mtc.2000.108692" "WWW" => array:1 [ "link" => "10.1067/mtc.2000.108692" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elective vs non-elective radial artery grafts: comparing midterm results through 64-slice computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ R Rocha-e-Silva \n \t\t\t\t\t\t\t\t """ 1 => """ TSG Santos \n \t\t\t\t\t\t\t\t """ 2 => """ CE Rochite \n \t\t\t\t\t\t\t\t """ 3 => """ JA Rocha-Filho \n \t\t\t\t\t\t\t\t """ 4 => """ AP Mansur \n \t\t\t\t\t\t\t\t """ 5 => """ J Fabri Jr \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s1807-59322007000600012" "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2007" "volumen" => "62" "paginaInicial" => "725" "paginaFinal" => "730" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18209915" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary revascularization with the left internal thoracic artery and radial artery. Comparison of short-term clinical evolution between electve and emergency surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ R Rocha-e-Silva \n \t\t\t\t\t\t\t\t """ 1 => """ AP Mansur \n \t\t\t\t\t\t\t\t """ 2 => """ J Fabri Jr \n \t\t\t\t\t\t\t\t """ 3 => """ RB Ramos \n \t\t\t\t\t\t\t\t """ 4 => """ CECC Filho \n \t\t\t\t\t\t\t\t """ 5 => """ LAO Dallan \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clinics" "fecha" => "2005" "volumen" => "60" "paginaInicial" => "227" "paginaFinal" => "232" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of invasive therapies in enderly patients with acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ JC Nicolau \n \t\t\t\t\t\t\t\t """ 1 => """ PA Lemos \n \t\t\t\t\t\t\t\t """ 2 => """ M Wajngarten \n \t\t\t\t\t\t\t\t """ 3 => """ RR Giraldez \n \t\t\t\t\t\t\t\t """ 4 => """ CV Serrano Jr \n \t\t\t\t\t\t\t\t """ 5 => """ EE Martinez \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1590/s1807-59322009000600010" "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "553" "paginaFinal" => "560" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19578659" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1590/s1807-59322009000600010" "WWW" => array:1 [ "link" => "10.1590/S1807-59322009000600010" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term follow-up of patients indergone coronary artery bypass grafting with exclusive use of arterial grafts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ AA Abdouni \n \t\t\t\t\t\t\t\t """ 1 => """ LAF Lisboa \n \t\t\t\t\t\t\t\t """ 2 => """ LB Puig \n \t\t\t\t\t\t\t\t """ 3 => """ CE Tossuniam \n \t\t\t\t\t\t\t\t """ 4 => """ LAO Dallan \n \t\t\t\t\t\t\t\t """ 5 => """ FB Jatene \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Bras Cir Cardiovasc" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "494" "paginaFinal" => "500" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "10.1590/S0102-76382008000400007" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical myocardial revascularization of patients with ischemic cardiomyopath and severe left ventricuar disfnction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ AL Hovnanian \n \t\t\t\t\t\t\t\t """ 1 => """ AM Soeiro \n \t\t\t\t\t\t\t\t """ 2 => """ CV Serrano Jr \n \t\t\t\t\t\t\t\t """ 3 => """ SA Oliveira \n \t\t\t\t\t\t\t\t """ 4 => """ FB Jatene \n \t\t\t\t\t\t\t\t """ 5 => """ NAG Stolg \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1590/S1807-59322010000100002" "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2010" "volumen" => "65" "paginaInicial" => "3" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20126339" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1590/S1807-59322010000100002" "WWW" => array:1 [ "link" => "10.1590/S1807-59322010000100002" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of completeness of revascularization during long-term follow-up after coronary artery operations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ E Jones \n \t\t\t\t\t\t\t\t """ 1 => """ WS Weintraub \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1996" "volumen" => "62" "paginaInicial" => "401" "paginaFinal" => "409" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary artery bypass grafting in patients with an ejection fraction of twenty or less" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ TK Kaul \n \t\t\t\t\t\t\t\t """ 1 => """ AK Agnihotri \n \t\t\t\t\t\t\t\t """ 2 => """ BL Fields \n \t\t\t\t\t\t\t\t """ 3 => """ LS Riggins \n \t\t\t\t\t\t\t\t """ 4 => """ DA Wyatt \n \t\t\t\t\t\t\t\t """ 5 => """ CR Jones \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/s0022-5223(96)70377-x" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1996" "volumen" => "111" "paginaInicial" => "1001" "paginaFinal" => "1012" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8622298" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/s0022-5223(96)70377-x" "WWW" => array:1 [ "link" => "10.1016/S0022-5223(96)70377-X" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Managemento of heart failure. III. The role of myocardial revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ DW Baker \n \t\t\t\t\t\t\t\t """ 1 => """ R Jones \n \t\t\t\t\t\t\t\t """ 2 => """ J Hodges \n \t\t\t\t\t\t\t\t """ 3 => """ BM Massie \n \t\t\t\t\t\t\t\t """ 4 => """ MA Kostam \n \t\t\t\t\t\t\t\t """ 5 => """ EA Rose \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1001/jama.272.19.1528" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "1994" "volumen" => "272" "paginaInicial" => "1528" "paginaFinal" => "1534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7966846" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1001/jama.272.19.1528" "WWW" => array:1 [ "link" => "10.1001/jama.272.19.1528" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary artery bypass grafting in patients with poor left ventricular function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ ST Christakis \n \t\t\t\t\t\t\t\t """ 1 => """ RD Weisel \n \t\t\t\t\t\t\t\t """ 2 => """ SE Fremes \n \t\t\t\t\t\t\t\t """ 3 => """ J Ivanov \n \t\t\t\t\t\t\t\t """ 4 => """ T David \n \t\t\t\t\t\t\t\t """ 5 => """ BS Goldman \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1992" "volumen" => "103" "paginaInicial" => "1083" "paginaFinal" => "1092" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1597972" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting survival after coronary revascularization for ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ SE Langenburg \n \t\t\t\t\t\t\t\t """ 1 => """ SA Buchanan \n \t\t\t\t\t\t\t\t """ 2 => """ LH Blackbourne \n \t\t\t\t\t\t\t\t """ 3 => """ RP Scheri \n \t\t\t\t\t\t\t\t """ 4 => """ KN Sinclair \n \t\t\t\t\t\t\t\t """ 5 => """ J Martinez \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/0003-4975(95)00755-A" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1995" "volumen" => "60" "paginaInicial" => "1193" "paginaFinal" => "1197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8526598" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/0003-4975(95)00755-A" "WWW" => array:1 [ "link" => "10.1016/0003-4975(95)00755-A" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protection in the failing heart" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ IL Kron \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/s0003-4975(99)01021-8" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1999" "volumen" => "68" "paginaInicial" => "1971" "paginaFinal" => "1973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10585113" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/s0003-4975(99)01021-8" "WWW" => array:1 [ "link" => "10.1016/S0003-4975(99)01021-8" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-risk reparative surgery: a neglected alternative to heart transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ JA Sanchez \n \t\t\t\t\t\t\t\t """ 1 => """ CR Smith \n \t\t\t\t\t\t\t\t """ 2 => """ RE Drusin \n \t\t\t\t\t\t\t\t """ 3 => """ DS Reison \n \t\t\t\t\t\t\t\t """ 4 => """ JR Malm \n \t\t\t\t\t\t\t\t """ 5 => """ EA Rose \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.82.1.302" "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "1990" "volumen" => "82" "numero" => "Suppl 4" "paginaInicial" => "302" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2194698" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-risk heart surgery in the heart transplant candidate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ BM Blakeman \n \t\t\t\t\t\t\t\t """ 1 => """ R Pifarre \n \t\t\t\t\t\t\t\t """ 2 => """ H Sullivan \n \t\t\t\t\t\t\t\t """ 3 => """ MR Costanzo-Nordin \n \t\t\t\t\t\t\t\t """ 4 => """ MJ Zucker \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "1990" "volumen" => "9" "paginaInicial" => "468" "paginaFinal" => "472" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of operative risk for coronary bypass operations in patients with left ventricular dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ TM Yau \n \t\t\t\t\t\t\t\t """ 1 => """ PW Fedak \n \t\t\t\t\t\t\t\t """ 2 => """ RD Weisel \n \t\t\t\t\t\t\t\t """ 3 => """ C Teng \n \t\t\t\t\t\t\t\t """ 4 => """ J Ivanov \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/S0022-5223(99)70094-2" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1999" "volumen" => "118" "paginaInicial" => "1006" "paginaFinal" => "1013" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10595971" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/S0022-5223(99)70094-2" "WWW" => array:1 [ "link" => "10.1016/S0022-5223(99)70094-2" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ MF Di Carli \n \t\t\t\t\t\t\t\t """ 1 => """ J Maddahi \n \t\t\t\t\t\t\t\t """ 2 => """ S Rokhsar \n \t\t\t\t\t\t\t\t """ 3 => """ HR Schelbert \n \t\t\t\t\t\t\t\t """ 4 => """ D Bianco-Batlles \n \t\t\t\t\t\t\t\t """ 5 => """ RC Brunken \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/S0022-5223(98)70052-2" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1998" "volumen" => "116" "paginaInicial" => "997" "paginaFinal" => "1004" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9832692" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/S0022-5223(98)70052-2" "WWW" => array:1 [ "link" => "10.1016/S0022-5223(98)70052-2" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of completeness of revascularization during long-term follow-up after coronary artery operations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ E Jones \n \t\t\t\t\t\t\t\t """ 1 => """ WS Weintraub \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1996" "volumen" => "62" "paginaInicial" => "401" "paginaFinal" => "409" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Degree of risk related to procedures performed in conjunction with surgca myocardial revascularization in octogenarians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ JCR Iglezias \n \t\t\t\t\t\t\t\t """ 1 => """ LAO Dallan \n \t\t\t\t\t\t\t\t """ 2 => """ A Louenção Jr \n \t\t\t\t\t\t\t\t """ 3 => """ AL Celullare \n \t\t\t\t\t\t\t\t """ 4 => """ R Pereira \n \t\t\t\t\t\t\t\t """ 5 => """ NAG Stolf \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clinics" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "387" "paginaFinal" => "392" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "10.1590/S1807-59322009000500003" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative reproducibility and validity of systems foe assessing cardiovascular functional class: advantages of a new specific activity scale" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ L Goldman \n \t\t\t\t\t\t\t\t """ 1 => """ B Hashimoto \n \t\t\t\t\t\t\t\t """ 2 => """ EF Cook \n \t\t\t\t\t\t\t\t """ 3 => """ A Loscalzo \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.64.6.1227" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1981" "volumen" => "64" "paginaInicial" => "1227" "paginaFinal" => "1234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7296795" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006500000010/v1_202212010724/S1807593222029167/v1_202212010724/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006500000010/v1_202212010724/S1807593222029167/v1_202212010724/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029167?idApp=UINPBA00004N"]

Statistics

Clinical Science

Carlos Vicente Serrano JrI, José A F RamiresII, Alexandre de Matos SoeiroI,

Corresponding author

alexandre.soeiro@bol.com.br

Tel.: 55 11 3067-7427

, Luiz Antônio M CésarII, Whady A HuebII, Luiz A DallanIII, Fábio B JateneIII, Noedir A G StolffIII

I Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Unidade Clínica de Coronariopatias Agudas, São Paulo, SP, Brazil

II Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cardiopneumologia, São Paulo, SP, Brazil

III Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Departamento de Cirurgia Cardíaca, São Paulo/SP, Brazil

Read

834

Times
was read the article

274

Total PDF

560

Total HTML

Share statistics

 array:24 [
  "pii" => "S1807593222029167"
  "issn" => "18075932"
  "doi" => "10.1590/S1807-59322010001000004"
  "estado" => "S300"
  "fechaPublicacion" => "2010-01-01"
  "aid" => "2916"
  "copyright" => "CLINICS"
  "copyrightAnyo" => "2010"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
  "subdocumento" => "fla"
  "cita" => "Clinics. 2010;65:947-52"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1807593222029179"
    "issn" => "18075932"
    "doi" => "10.1590/S1807-59322010001000005"
    "estado" => "S300"
    "fechaPublicacion" => "2010-01-01"
    "aid" => "2917"
    "copyright" => "CLINICS"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
    "subdocumento" => "fla"
    "cita" => "Clinics. 2010;65:953-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Science</span>"
      "titulo" => "Tomographic assessment of the spine in children with spondylocostal dysotosis syndrome"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "953"
          "paginaFinal" => "959"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig3-cln_65p953"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 671
              "Ancho" => 523
              "Tamanyo" => 42560
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">A 3 D reconstruction CT scan showed skull asymmetry in a 14-year-old patient &#40;deformational plagiocephaly&#41; without synostosis&#46; A 3D reconstruction CT scan of the endocranial base showed asymmetric 3D position of the external acoustic meatus&#46; The asymmetry is more marked in the middle and the posterior cranial fossa while the anterior cranial fossa was slightly asymmetric&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ali Al Kaissi, Klaus Klaushofer, Franz Grill"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Ali Al"
              "apellidos" => "Kaissi"
            ]
            1 => array:2 [
              "nombre" => "Klaus"
              "apellidos" => "Klaushofer"
            ]
            2 => array:2 [
              "nombre" => "Franz"
              "apellidos" => "Grill"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029179?idApp=UINPBA00004N"
    "url" => "/18075932/0000006500000010/v1_202212010724/S1807593222029179/v1_202212010724/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1807593222029155"
    "issn" => "18075932"
    "doi" => "10.1590/S1807-59322010001000003"
    "estado" => "S300"
    "fechaPublicacion" => "2010-01-01"
    "aid" => "2915"
    "copyright" => "CLINICS"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
    "subdocumento" => "fla"
    "cita" => "Clinics. 2010;65:941-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Science</span>"
      "titulo" => "The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "941"
          "paginaFinal" => "946"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig2-cln_65p941"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 250
              "Ancho" => 478
              "Tamanyo" => 15461
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Average changes in heart rate&#46;</p> <p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Pre&#58; preinduction&#44; Post&#58;postinduction&#44; Pex&#58; post-extubation</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Dilsen Ornek, Seyhan Metin, Serpil Deren, Canan Un, Mustafa Metin, Bayazit Dikmen, Nermin Gogus"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Dilsen"
              "apellidos" => "Ornek"
            ]
            1 => array:2 [
              "nombre" => "Seyhan"
              "apellidos" => "Metin"
            ]
            2 => array:2 [
              "nombre" => "Serpil"
              "apellidos" => "Deren"
            ]
            3 => array:2 [
              "nombre" => "Canan"
              "apellidos" => "Un"
            ]
            4 => array:2 [
              "nombre" => "Mustafa"
              "apellidos" => "Metin"
            ]
            5 => array:2 [
              "nombre" => "Bayazit"
              "apellidos" => "Dikmen"
            ]
            6 => array:2 [
              "nombre" => "Nermin"
              "apellidos" => "Gogus"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029155?idApp=UINPBA00004N"
    "url" => "/18075932/0000006500000010/v1_202212010724/S1807593222029155/v1_202212010724/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Clinical Science</span>"
    "titulo" => "Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction&#58; favorable short- and long-term results in ischemic cardiomyopathy"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "947"
        "paginaFinal" => "952"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Carlos Vicente Serrano, Jos&#233; A F Ramires, Alexandre de Matos Soeiro, Luiz Ant&#244;nio M C&#233;sar, Whady A Hueb, Luiz A Dallan, F&#225;bio B Jatene, Noedir A G Stolff"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Carlos Vicente"
            "apellidos" => "Serrano"
            "sufijo" => "Jr"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "af1-cln_65p947"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jos&#233; A F"
            "apellidos" => "Ramires"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">II</span>"
                "identificador" => "af2-cln_65p947"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Alexandre"
            "apellidos" => "de Matos Soeiro"
            "email" => array:1 [
              0 => "alexandre.soeiro@bol.com.br"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "af1-cln_65p947"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "c1-cln_65p947"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Luiz Ant&#244;nio M"
            "apellidos" => "C&#233;sar"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">II</span>"
                "identificador" => "af2-cln_65p947"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Whady A"
            "apellidos" => "Hueb"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">II</span>"
                "identificador" => "af2-cln_65p947"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Luiz A"
            "apellidos" => "Dallan"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">III</span>"
                "identificador" => "af3-cln_65p947"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "F&#225;bio B"
            "apellidos" => "Jatene"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">III</span>"
                "identificador" => "af3-cln_65p947"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Noedir A G"
            "apellidos" => "Stolff"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">III</span>"
                "identificador" => "af3-cln_65p947"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Hospital das Cl&#237;nicas&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; Unidade Cl&#237;nica de Coronariopatias Agudas&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "I"
            "identificador" => "af1-cln_65p947"
          ]
          1 => array:3 [
            "entidad" => "Instituto do Cora&#231;&#227;o&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; Departamento de Cardiopneumologia&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "II"
            "identificador" => "af2-cln_65p947"
          ]
          2 => array:3 [
            "entidad" => "Instituto do Cora&#231;&#227;o&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; Departamento de Cirurgia Card&#237;aca&#44; S&#227;o Paulo&#47;SP&#44; Brazil"
            "etiqueta" => "III"
            "identificador" => "af3-cln_65p947"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "c1-cln_65p947"
            "etiqueta" => "&#42;"
            "correspondencia" => "Tel&#46;&#58; 55 11 3067-7427"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig3-cln_65p947"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 247
            "Ancho" => 446
            "Tamanyo" => 16988
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Incidence of congestive heart failure after surgery according to functional class &#40;New York Heart Association classification&#41;&#46; &#8727;<span class="elsevierStyleItalic">p</span>&#60;0&#46;01 vs&#46; baseline&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">The term ischemic cardiomyopathy &#40;ICM&#41; is used to describe the clinical picture and pathological findings in patients with congestive heart failure secondary to ischemic heart disease&#46; Manifestations of congestive heart failure are common in patients with coronary artery disease&#46; They may be the dominant feature in those who have sustained prior myocardial infarctions with ischemic areas replaced by fibrous tissue&#44; with disappearance or reduction of angina symptoms&#46; The three most common causes of congestive heart failure in this setting are left ventricular aneurysm&#44; mitral regurgitation due to dilatation of the mitral annulus and&#47;or papillary muscle ischemic dysfunction&#44; and an inadequate quantity of normally contracting myocardium&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2</a> ICM can also result from myocardial hibernation&#44; which is characterized as a situation of reduced regional contractile function distal to a coronary artery stenosis from which the individual recovers after removal of the coronary stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Patients who have untreated infarct-related ventricular aneurysms that compromise 20&#37; to 25&#37; of the left ventricular area develop progressive global ventricular dilatation&#46; The rationale for congestive heart failure among ventricular aneurysms is that the fraction of blood that enters the region of the aneurysms causes an overload state&#44; and severe global dilatation of the heart ensues over time&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> The surgical treatment of left ventricular dysfunction has evolved gradually&#46; Initially&#44; it was demonstrated that patients with large ventricular aneurysms and severe cardiac failure improved with resection of the ventricular aneurysm&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> Surgical therapy of ventricular aneurysms evolved further with the intracavitary patch techniques of Jatene&#44;<a class="elsevierStyleCrossRef" href="#bib2">2</a> Dor&#44;<a class="elsevierStyleCrossRef" href="#bib1">1</a> and Cooley<a class="elsevierStyleCrossRef" href="#bib4">4</a> that have yielded excellent surgical and functional results&#46; However&#44; the clinical and survival benefits of aneurysmectomy when severe left ventricular dysfunction is present remained controversial until the STICH trial in 2009&#44; the results of which showed no reduction in the rate of death or hospitalization for cardiac causes in patients submitted to aneurysmectomy&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Therefore&#44; the objective of this study was to describe the short- and long-term functional results after aneurysmectomy surgery in ICM and to identify predictors of a favorable outcome&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">METHODS AND MATERIAL</span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Patient population</span><p id="para30" class="elsevierStylePara elsevierViewall">Between June 1992 and December 1995&#44; 169 consecutive patients with ischemic heart disease underwent aneurysmectomy surgery at our institution&#46; Prior to data collection&#44; this study was approval by the ethics committee&#46; Baseline clinical characteristics of patients are shown in <a class="elsevierStyleCrossRef" href="#t1-cln_65p947">Table 1</a>&#46; The three-year follow-up period was completed in 2001 by means of telephone contact or office visits&#46; Follow-up consisted of obtaining information about the functional class of congestive heart failure &#40;New York Heart Association&#41;&#44; angina &#40;Canadian Cardiovascular Society &#91;CCS&#93;&#41;&#44; and survival data using a medical questionnaire&#46;</p><elsevierMultimedia ident="t1-cln_65p947"></elsevierMultimedia><p id="para40" class="elsevierStylePara elsevierViewall">Coronary angiography was conducted with all patients&#46; In addition&#44; the number of diseased coronary vessels &#40;lumen narrowing &#8805; 70&#37;&#41; was assessed&#46; Global left ventricular ejection fraction &#40;LVEF&#41; was also measured by contrasted ventriculography&#46; Left ventricular dysfunction was characterized by an ejection fraction &#8804; 30&#37;&#46; Left ventricular aneurysm was defined as a zone of paradoxical systolic expansion &#40;dyskinetic&#41; or as an akinetic myocardial zone well delimited from the surrounding cardiac silhouette&#46; Viability data were obtained by echocardiographic stress test or thallium scintigraphy for all patients&#46; Baseline coronary angiography and ventriculography data are shown in <a class="elsevierStyleCrossRef" href="#t2-cln_65p947">Table 2</a>&#46; The indication for surgery was left ventricular failure&#44; refractory to medical therapy&#44; in the presence of an anatomic left ventricular aneurysm and concomitant coronary stenosis suitable for coronary artery bypass grafting &#40;CABG&#41;&#46;</p><elsevierMultimedia ident="t2-cln_65p947"></elsevierMultimedia></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Operative procedures</span><p id="para50" class="elsevierStylePara elsevierViewall">With the patient supported on normothermic cardiopulmonary bypass&#44; the heart was carefully examined to confirm the extension excise portion of a nonfunctioning wall previously analyzed by echocardiography or ventriculography&#46; Once thinning of the nonfunctioning area was confirmed&#44; a small incision was made&#46; Any clot present was carefully removed&#46; With the unloaded heart opened and beating&#44; the surrounding wall was palpated&#44; and its ability to contract &#40;regional wall thickening&#41; was reliably assessed&#46; All thinned nonfunctioning portions of the wall were considered for resection&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">Excision was planned to remove as much nonfunctioning wall as possible while restoring ventricular size and shape toward normal conditions as described by Jatene&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> In many cases&#44; the excised specimen was composed of a mixture of infarcted and viable muscle&#46; In addition&#44; repair sutures were often placed through relatively thick areas of myocardium&#46; Sutures were positioned further apart on the tissue edges than on the felt strips so that the length of the incision was plicated in the closure to help to restore the shape of the ventricle toward normal conditions&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">In most patients with an anterior aneurysm&#44; scarring of the septum was observed&#46; However&#44; only in cases in which a major portion of the septum was both scarred and thinned was a septoplasty performed&#44; as previously described&#46; The anterior edge of the patch was incorporated into the ventricular closure&#46; Once ventricular repair was completed&#44; bypass grafting was carried out when indicated&#46; Retrograde cardioplegia and antegrade cardioplegia or infusion down a right graft were utilized to protect the left and right ventricle&#44; respectively&#46; Complete revascularization was performed in all patients according to the noninvasive test performed&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">In this study&#44; a total of 290 grafts were accomplished&#44; providing a grafts&#47;patient ratio of 1&#46;8&#177;0&#46;4 &#40;see <a class="elsevierStyleCrossRef" href="#t3-cln_65p947">Table 3</a>&#41;&#46; Nine patients with left anterior descending artery lesion did not receive any kind of graft&#46; Intraoperative transesophageal echocardiography was conducted to confirm mitral insufficiency&#46; If confirmed&#44; both a left atriotomy and a left ventriculotomy through the aneurysm were performed&#46; If the mitral valve was so severely diseased that it could not be repaired&#44; a prosthetic mitral valve was implanted&#46; After completion of the myocardial revascularization and mitral valve surgery&#44; attention was directed toward the repair of the ventricular aneurysm&#46; Mitral repair&#47;replacement was done in 13 cases&#46;</p><elsevierMultimedia ident="t3-cln_65p947"></elsevierMultimedia></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">Statistical analysis</span><p id="para90" class="elsevierStylePara elsevierViewall">Spearman&#39;s rank test was used for correlations&#44; whereas multiple regression analysis was utilized to assess the potential associations&#46; The cumulative probability of events was determined using the Kaplan-Meier method&#44; and differences in the distribution of events during the three-year study period were evaluated with the log-rank test&#46; A <span class="elsevierStyleItalic">p</span>-value &#8804; 0&#46;05 was considered to be statistically significant&#46;</p></span></span></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">RESULTS</span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">Early post-operative care</span><p id="para100" class="elsevierStylePara elsevierViewall">Seven &#40;4&#46;1&#37;&#41; patients died in the hospital due to cardiac causes&#46; Results of univariate analyses demonstrated that angina was associated with a decreased risk of hospital mortality &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;04&#41;&#44; whereas prolonged duration of cardiopulmonary bypass was associated with an increased risk of hospital mortality &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;03&#41;&#46; When entered into the multivariate analysis&#44; none of the variables examined proved to be predictive&#46; Specific features in the postoperative treatment in the intensive care unit are shown in <a class="elsevierStyleCrossRef" href="#t4-cln_65p947">Table 4</a>&#46; Significant differences occurred between patients who survived and patients who died during hospitalization&#46;</p><elsevierMultimedia ident="t4-cln_65p947"></elsevierMultimedia></span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">Late clinical follow-up</span><p id="para110" class="elsevierStylePara elsevierViewall">Of the initial 169 patients&#44; contrast ventriculography &#40;for LVEF determination&#41; was repeated on 133 &#40;79&#37;&#41; patients at 6 months&#44; 90 &#40;53&#37;&#41; patients at 12 months&#44; and 75 &#40;44&#37;&#41; patients at 36 months&#46; The initial LVEF of 22&#177;5&#37; increased significantly to 40&#177;3&#37; at 6 months and 45&#177;6&#37; and 45&#177;7&#37; at 12 and 36 months&#44; respectively &#40;see <a class="elsevierStyleCrossRef" href="#fig1-cln_65p947">Figure 1</a>&#41;&#46; After three years of follow-up&#44; we had information about 83&#37; &#40;140&#41; of patients included in study&#46; Ten &#40;6&#46;3&#37;&#41; late casualties were recorded during the follow-up period&#46; Actuarial survival was 91&#46;1&#37;&#44; 90&#46;5&#37;&#44; and 89&#46;2&#37; at one&#44; two&#44; and three years&#44; respectively &#40;see <a class="elsevierStyleCrossRef" href="#fig2-cln_65p947">Figure 2A</a>&#41;&#46; Actuarial survival rates based on baseline characteristics are shown in <a class="elsevierStyleCrossRef" href="#fig2-cln_65p947">Figures 2B&#44; 2C&#44; and 2D</a>&#46;</p><elsevierMultimedia ident="fig1-cln_65p947"></elsevierMultimedia><elsevierMultimedia ident="fig2-cln_65p947"></elsevierMultimedia><p id="para120" class="elsevierStylePara elsevierViewall">There was a successful functional outcome of myocardial revascularization as evidenced by a significant improvement in congestive heart failure NYHA class&#44; gated LVEF ex&#47;rest ratio by radioisotopic ventriculography performed at 2 and 36 months&#44; and contrast ventriculography&#46; Congestive heart failure classes I&#44; II&#44; III&#44; and IV were observed in 81 &#40;56&#37;&#41;&#44; 42 &#40;29&#37;&#41;&#44; 16 &#40;10&#37;&#41;&#44; and 8 &#40;5&#37;&#41; operative survivors at follow-up&#44; respectively &#40;see <a class="elsevierStyleCrossRef" href="#fig3-cln_65p947">Figure 3</a>&#41;&#46; Angina classes &#40;CCS&#41; I&#47;II and III&#47;IV were observed in 54&#37; and 16&#37; of patients&#44; respectively&#44; at three-year follow-up&#46; In 30&#37; of patients&#44; we did not observe angina&#46;</p><elsevierMultimedia ident="fig3-cln_65p947"></elsevierMultimedia><p id="para130" class="elsevierStylePara elsevierViewall">Several variables were identified as correlates of recurrent heart failure&#46; In particular&#44; lower LVEF&#44; presentation with congestive heart failure&#44; and need for preoperative IABP were associated with a greater likelihood of recurrent heart failure&#44; whereas higher LVEF ex&#47;rest ratio &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;01&#41;&#44; male sex &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;055&#41;&#44; and higher number of grafts &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;01&#41; were predictive of improvement in congestive heart failure class at follow-up&#46;</p></span></span></span><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">DISCUSSION</span><p id="para140" class="elsevierStylePara elsevierViewall">These data suggest that&#44; among patients with severe left ventricular dysfunction&#44; aneurysmectomy results in favorable short- and long-term functional and clinical outcomes&#44; which lead to satisfactory survival rates&#46; Selection of appropriate surgical candidates and extensive use of concomitant revascularization substantially improves survival rates&#46; Currently&#44; aneurysmectomy is considered to be a prominent surgical technique of left ventricular reconstruction for either dyskinetic or akinetic left ventricular segments in patients with ICM&#46; Dyskinetic&#47;akinetic left ventricular segments almost exclusively involve the left ventricle&#44; most commonly the anterior or apical segments&#46; For the detection of left ventricular dyskinetic&#47;akinetic segments&#44; biplane left ventriculography is a precise method that is available for outlining left ventricular segments&#44; assessing septal motion&#44; and determining the quantity of functioning residual myocardium&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a> Nevertheless&#44; other noninvasive methods&#44; such as magnetic resonance imaging&#44; that were unavailable at the time of the study are gaining popularity&#46; Aneurysmectomy associated with concomitant CABG improves ventricular function in patients with severe coronary artery disease and severe left ventricular dysfunction&#46;</p><span id="cesec120" class="elsevierStyleSection elsevierViewall"><span id="cesec130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle150">Functional outcome</span><p id="para150" class="elsevierStylePara elsevierViewall">Few clinical series have focused on the functional outcome after myocardial revascularization in ICM&#46; Most researchers have verified that short- and long-term survival rates after surgery are acceptable&#46; The disclosure of short-term progress in left ventricular systolic performance has generally been viewed as an indicator of successful functional effect&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;7</a> Contrary to this hypothesis&#44; present evidence suggests that an increase in left ventricular ejection fraction is not accompanied by clinical improvement&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a> These findings have significant implications because clinical management of congestive heart failure has also produced significant progress in terms of both survival and control of symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> Thus&#44; the preference of the most advantageous therapeutic modality for a specific patient with ischemic left ventricular dysfunction must be well thought out&#46; Merely considering survival may be inadequate to distinguish among therapeutic options&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">For the most part&#44; congestive heart failure is accountable for the satisfactorily low occurrence of symptoms late after surgery&#46; Estimates of recurrent heart failure are well described and differ broadly from other studies of patients with ICM&#44; ranging from 28&#37; to 63&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> The current findings are consistent with those of previous studies&#46; It is possible that the cases of recurrent heart failure point to the unyielding development in the direction of left ventricular dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> Determination of left ventricular ejection fraction by echocardiogram is reasonable to reveal the relationship between left ventricular systolic function and congestive heart failure late after revascularization&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">Predicting the recurrence or appearance of the symptoms of congestive heart failure has immeasurable relevance in terms of patient selection&#46; The present study linked the greater possibility of heart failure at follow-up after aneurysmectomy with female sex&#44; history of congestive heart failure&#44; lower ejection fraction&#44; and need for preoperative IABP support&#46; In addition&#44; history of angina&#44; use of the left internal thoracic artery&#44; and number of bypass grafts were inversely related to recurrence of congestive heart failure&#46;</p><p id="para180" class="elsevierStylePara elsevierViewall">The importance of demographic characteristics before surgery is quite obvious&#44; even though a relation with recurrent heart failure has not been previously described&#46; In fact&#44; lower ejection fraction has frequently been associated with unfavorable long-term outcomes after revascularization in ICM&#44; as have history of congestive heart failure and female sex&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> The requirement for preoperative IABP may predict which patients will have more severe left ventricular failure&#46; Assessment of known evidence is problematic because not many researchers have investigated the recurrence of congestive heart failure in large clinical trials&#46;</p><p id="para190" class="elsevierStylePara elsevierViewall">Whereas the clinical variables <span class="elsevierStyleItalic">per se</span> have an influence on patient selection&#44; the operative variables examined in this study have applicable management connotations&#46; Evidence suggests that more widespread exploitation of left internal thoracic artery grafts and complete myocardial revascularization can diminish the recurrence of congestive failure in the short- and long-term following surgery&#46; This finding is consistent with inferences made by previous researchers regarding the overall revascularization patients&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7-20</a> Failure to previously demonstrate an association on ICM between the sort of graft for bypass and long-term coronary events by other investigators may be related to the decreased application of the left internal thoracic artery &#40;i&#46;e&#46;&#44; between 20&#37; and 35&#37; when informed&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> The rationale for not employing the left thoracic artery in the past in patients with ICM was due to apprehension about complications related to advanced age&#44; urgency of revascularization&#44; and reserved anxiety about long-term prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib16">16</a> However&#44; the findings of this study and other recent studies<a class="elsevierStyleCrossRefs" href="#bib16">16&#44;17&#44;19-23</a> suggest that there is little cause for concern&#46; Thus&#44; patients with ICM should be managed with a left internal thoracic artery graft when revascularization is selected therapy&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a></p></span><span id="cesec140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle160">Survival</span><p id="para200" class="elsevierStylePara elsevierViewall">Coronary artery bypass grafting has advanced into a secure therapy approach for selected patients with ischemic left ventricular failure&#46; The present study demonstrated that myocardial revascularization can currently be accessible to patients with ICM at a low operative hazard &#40;as low as 2&#37;&#41; and with a reasonable long-term follow-up&#46; Assessment of survival estimates after coronary artery bypass grafting with previously published series presents some limitations&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a> In particular&#44; patient selection principles are not consistent among the various clinical reports with regard to the values of left ventricular ejection fraction and the inclusion of patients with acute myocardial infarction&#44; left ventricular aneurysm&#44; or valve disease who require surgical management&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Despite these limitations&#44; a surgical mortality rate varying from 2&#37; to 10&#37; has been reported for a considerable number of consecutive patients&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;7&#44;14&#44;16&#44;17&#44;19&#44;20&#44;22</a></p><p id="para210" class="elsevierStylePara elsevierViewall">Consistent with previously reported actuarial 5-year survival rates between 64&#37; and 73&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib16">16&#44;17&#44;19&#44;20&#44;22</a> the long-term outcomes after myocardial revascularization were also satisfactory in the present study&#46; Progress in perioperative management of patients with end-stage ischemic heart disease<a class="elsevierStyleCrossRef" href="#bib6">6</a> has been instrumental in transitioning bypass grafting from a high-risk neglected alternative to transplantation<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;7</a> to a low-risk routine modality&#46; However&#44; the constant evolution throughout the last decade of time of patient selection criteria by means of prospective laboratory investigation and of retrospective risk stratification has played an even more important role in this transition&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;22</a></p><p id="para220" class="elsevierStylePara elsevierViewall">Consequently&#44; reviews of large clinical series&#44; such as the current one&#44; have been conducted to isolate preoperative variables that may predict the outcome of revascularization&#46; Analysis of previous studies shows that a sequence of patient characteristics&#44; including advanced age&#44; female sex&#44; lower ejection fraction&#44; comorbid conditions&#44; urgency of operation&#44; and reoperation&#44; may be linked to increased operative risk&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;18&#44;24-32</a> In the present study&#44; both late overall and late cardiac mortality were associated with lower ejection fraction&#44; fewer bypass grafts&#44; and longer duration of cardiopulmonary bypass&#46;</p><p id="para230" class="elsevierStylePara elsevierViewall">The association between preoperative left ventricular function and short- and long-term survival is instinctive because it describes the severity of ischemic left ventricular failure&#46;<a class="elsevierStyleCrossRef" href="#bib14">14</a> The number of bypass grafts in the present series highlights the completeness of the revascularization because two thirds of patients had two- and three-vessel disease&#46; Accordingly&#44; the finding of an inverse relationship between the number of grafts and mortality is consistent with the results of Luciani and colleagues&#44;<a class="elsevierStyleCrossRef" href="#bib3">3</a> who reported that complete myocardial revascularization was inversely linked to mortality&#46; Complete revascularization of the myocardium has vast prognostic implications for survival&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a> In addition&#44; the role of the length of cardiopulmonary bypass in predicting morbi-mortality must also be considered&#46; This additional aspect emphasizes the magnitude of ischemic heart disease&#44; where prolonged circulatory assistance may be mandatory to wean a deteriorating heart from bypass&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a></p><p id="para240" class="elsevierStylePara elsevierViewall">Recently&#44; the Surgical Treatment for Isquemic Heart Failure &#40;STICH&#41; trial studied surgical ventricular reconstruction added to CABG in 1&#44;000 patients with heart failure &#40;LVEF of 35&#37; or less&#41; caused by coronary artery disease&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> The patients were randomly selected to undergo CABG alone or CABG with surgical ventricular reconstruction&#59; the median follow-up was 48 months&#46; The findings of this study showed that adding surgical ventricular reconstruction to CABG reduced the left ventricular volume compared to CABG alone&#46; However&#44; this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a></p></span><span id="cesec150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle170">Limitations</span><p id="para250" class="elsevierStylePara elsevierViewall">The present study was retrospective and not randomized&#44; similar to previous studies of myocardial revascularization in patients with ICM&#46; Modifying medical practice by increasing the period of cardioplegia&#44; myocardial viability evaluation&#44; and use of the left internal thoracic artery&#44; might have had an influential role in our findings unlike previously published work&#46; Late follow-up echocardiographic and coronary angiographic studies were not executed in all patients&#46; It is difficult to determine if poor functional outcome is a result of complications related to myocardial revascularization and&#47;or progressing ICM&#46; This limitation is present in most of the previously published papers on this topic&#46; Other colleagues have proposed the Specific Activity Scale&#44; which has better consistency with exercise treadmill presentation than NYHA or CCS&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;33</a> Nevertheless&#44; NYHA and CCS continue to be the main scoring practices used&#44; and their application is acceptable if clinical series are to be matched up to&#46; All data were obtained before 2001&#44; which may modify some results because of the development of new technologies and surgical methods after this period&#46;</p></span></span></span><span id="cesec160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle180">CONCLUSION</span><p id="para260" class="elsevierStylePara elsevierViewall">The findings of this study suggest that aneurysmectomy among patients with severe LV dysfunction results in short- and long-term favorable outcome function and survival&#46; In addition to the enduring relief from angina&#44; most of the patients experienced improvements in congestive heart failure at long-term follow-up&#46; Selection of appropriate surgical candidates may substantially improve survival among these patients&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:7 [
        0 => array:2 [
          "identificador" => "xpalclavsec1581294"
          "titulo" => "KEYWORDS"
        ]
        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
        ]
        2 => array:3 [
          "identificador" => "cesec20"
          "titulo" => "METHODS AND MATERIAL"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "cesec30"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "cesec40"
                  "titulo" => "Patient population"
                ]
                1 => array:2 [
                  "identificador" => "cesec50"
                  "titulo" => "Operative procedures"
                ]
                2 => array:2 [
                  "identificador" => "cesec60"
                  "titulo" => "Statistical analysis"
                ]
              ]
            ]
          ]
        ]
        3 => array:3 [
          "identificador" => "cesec70"
          "titulo" => "RESULTS"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "cesec80"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "cesec90"
                  "titulo" => "Early post-operative care"
                ]
                1 => array:2 [
                  "identificador" => "cesec100"
                  "titulo" => "Late clinical follow-up"
                ]
              ]
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "cesec110"
          "titulo" => "DISCUSSION"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "cesec120"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "cesec130"
                  "titulo" => "Functional outcome"
                ]
                1 => array:2 [
                  "identificador" => "cesec140"
                  "titulo" => "Survival"
                ]
                2 => array:2 [
                  "identificador" => "cesec150"
                  "titulo" => "Limitations"
                ]
              ]
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "cesec160"
          "titulo" => "CONCLUSION"
        ]
        6 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-05-10"
    "fechaAceptado" => "2010-07-07"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec1581294"
          "palabras" => array:5 [
            0 => "Myocardial revascularization"
            1 => "Ventricular dysfunction"
            2 => "Ischemic cardiomyopathy"
            3 => "Cardiac surgery"
            4 => "Aneurysmectomy"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION&#58;</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study was to &#40;1&#41; identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and &#40;2&#41; identify predictors of favorable outcomes&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS AND MATERIAL&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">Patients &#40;n &#61; 169&#41; with angiographic left ventricular ejection fraction of 22&#177;5&#37; underwent aneurysm surgery and were prospectively followed for three years&#46; Prior to surgery&#44; 40&#37; and 60&#37; of the patients were in congestive heart failure NYHA class I&#47;II and III&#47;IV&#44; respectively&#46; Concomitant revascularization was performed on 95&#37; of the patients&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara110" class="elsevierStyleSimplePara elsevierViewall">Cumulative in-hospital and 36-month mortalities were 7&#37; and 15&#37;&#44; respectively&#46; These respective rates varied according to preoperative parameters&#58; CHF class I-II&#44; 4&#37; and 13&#37;&#59; CHF class III-IV&#44; 8&#37; and 16&#37;&#59; LVEF&#60;20&#37;&#44; 12&#37; and 26&#37;&#59; LVEF 21-30&#37;&#44; 2&#37; and 6&#37;&#59; gated LVEF exercise&#47;rest &#62;5&#37;&#44; &#60;1&#37; and 4&#37;&#59; and gated LVEF exercise&#47;rest &#8804;5&#37;&#44; 17&#37; and 38&#37;&#46; Higher LVEF ex&#47;rest ratio &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;01&#41;&#44; male sex &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;05&#41;&#44; and a higher number of grafts &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;01&#41; were predictive of improvement in CHF class at follow-up based on the results of a multivariate analysis&#46; After three years of follow-up&#44; 84&#37; of the patients were in class I&#47;II&#44; LVEF was 45&#177;7&#37;&#44; and gated LVEF ex&#47;rest ratio was 13&#37; higher &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;01&#41; compared to the beginning of the study&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSIONS&#58;</span><p id="spara120" class="elsevierStyleSimplePara elsevierViewall">These data suggest that aneurysmectomy among patients with severe LV dysfunction result in short- and long-term favorable functional outcome and survival&#46; Selection of appropriate surgical candidates may substantially improve survival rates among these patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "ceabs10"
            "titulo" => "INTRODUCTION&#58;"
          ]
          1 => array:2 [
            "identificador" => "ceabs20"
            "titulo" => "METHODS AND MATERIAL&#58;"
          ]
          2 => array:2 [
            "identificador" => "ceabs30"
            "titulo" => "RESULTS&#58;"
          ]
          3 => array:2 [
            "identificador" => "ceabs40"
            "titulo" => "CONCLUSIONS&#58;"
          ]
        ]
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig1-cln_65p947"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 259
            "Ancho" => 420
            "Tamanyo" => 8872
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Left ventricular ejection fraction &#40;LVEF&#41; determined by contrast ventriculogram&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig2-cln_65p947"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 436
            "Ancho" => 661
            "Tamanyo" => 35237
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Cumulative mortality&#58; A&#44; global&#59; B&#44; according to baseline congestive heart failure New York Heart Association classification &#40;CHF NYHF&#41;&#59; C&#44; according to baseline left ventricular ejection fraction &#40;LVEF&#41;&#59; D&#44; according to baseline gated left ventricular ejection fraction &#40;LVEF&#41; exercise &#40;ex&#41;&#47;rest ratio&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig3-cln_65p947"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 247
            "Ancho" => 446
            "Tamanyo" => 16988
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Incidence of congestive heart failure after surgery according to functional class &#40;New York Heart Association classification&#41;&#46; &#8727;<span class="elsevierStyleItalic">p</span>&#60;0&#46;01 vs&#46; baseline&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "t1-cln_65p947"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic&#44; n &#40;percentage&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">111 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Age &#40;in years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">61&#177;9 &#40;range&#58; 31-78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">76 &#40;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">75 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Total cholesterol &#62; 240 mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">64 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">59 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Months since myocardial infarction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">9&#46;4&#177;6&#46;2 &#40;range&#59; 1&#46;5-32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Functional class &#40;CHF NYHA&#41;<a class="elsevierStyleCrossRef" href="#tfn1-cln_65p947">a</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">16 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">53 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">59 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">41 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Electrocardiographic Findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sinus rhythm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">135 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">84 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left anterior divisional block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">81 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left bundle branch block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">53 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>First degree atrioventricular block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">38 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Third degree atrioventricular block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">6 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tfn1-cln_65p947"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">CHF NYHA&#44; congestive heart failure according to the New York Heart Association&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Baseline clinical characteristics of the study population &#40;n &#61; 169&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "t2-cln_65p947"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Lesion on left anterior descending artery &#40;LADA&#41; n&#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tfn2-cln_65p947">a</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Occlusion of LADA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">87 &#40;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Critical stenosis of LADA &#40;70-99&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">52 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 70&#37; stenosis of LADA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">30 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Type of lesion n&#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tfn3-cln_65p947">b</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Uniarterial lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">51 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Biarterial lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">62 &#40;37&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Triarterial lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">56 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Left ventricular ejection mean&#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">22&#177;5&#37; &#40;range&#58; 11-30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tfn2-cln_65p947"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="cenpara20">Between lesions on LADA&#58; <span class="elsevierStyleItalic">p</span>&#60;0&#46;0001&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tfn3-cln_65p947"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="cenpara30">Between types of lesion&#58; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;58&#46;</p> <p class="elsevierStyleNotepara" id="cenpara40">Note&#58; Left ventricular ejection fraction measured by contrasted ventriculography&#46; Data expressed as number or percentage&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">Baseline angiographic data of the study population &#40;n &#61; 169&#41;&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "t3-cln_65p947"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">All grafts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Left internal thoracic artery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Right internal thoracic artery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Radial artery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Safena vein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Grafts&#47; patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="bottom">1&#46;8 &#177; 0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Mitral valve replacement&#47;repair&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Surgical treatment&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "t4-cln_65p947"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spara80" class="elsevierStyleSimplePara elsevierViewall">Between patients who survived and patients who died during hospitalization&#58; <span class="elsevierStyleSup">a</span><span class="elsevierStyleItalic">p</span>&#60;0&#46;0001&#44; <span class="elsevierStyleSup">b</span><span class="elsevierStyleItalic">p</span>&#60;0&#46;01&#44; <span class="elsevierStyleSup">c</span><span class="elsevierStyleItalic">p</span> &#61; 0&#46;001&#46;&#8727; &#61; more than 24 hours after surgery&#46; Mean&#177;SD&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Total &#40;n &#61; 169&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Survived &#40;n &#61; 158&#44; 93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Died &#40;n &#61; 11&#44; 7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Intensive care unit &#40;in days&#41;<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">16&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">12&#177;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">19&#177;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Hospital stay &#40;in days&#41;<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">27&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">15&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">33&#177;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Need of vasoactive agents&#44; n&#40;&#37;&#41;<span class="elsevierStyleSup">a &#8727;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">109 &#40;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">98 &#40;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">11 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Need of mechanical ventilation n&#40;&#37;&#41;<span class="elsevierStyleSup">b &#8727;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;4&#177;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;8&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">4&#46;8&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Acute renal failure n&#40;&#37;&#41;<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">19 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">8 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">11 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Urinary or respiratory tract infection n&#40;&#37;&#41;<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">11 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">31 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">8 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara70" class="elsevierStyleSimplePara elsevierViewall">Post-surgical in-hospital data&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:33 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgery for left ventricular aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              V Dor \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/00001573-199012000-00009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Cardiol"
                        "fecha" => "1990"
                        "volumen" => "5"
                        "paginaInicial" => "773"
                        "paginaFinal" => "780"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10149333"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/00001573-199012000-00009"
                      "WWW" => array:1 [
                        "link" => "10&#46;1097&#47;00001573-199012000-00009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular aneurysmectomy&#58; resection or reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              AD Jatene \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1985"
                        "volumen" => "89"
                        "paginaInicial" => "321"
                        "paginaFinal" => "331"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3974267"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              GB Luciani \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Montalbano \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              G Casali \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Mazzucco \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thor Cardiovasc Surg"
                        "fecha" => "2000"
                        "volumen" => "120"
                        "paginaInicial" => "478"
                        "paginaFinal" => "489"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1067&#47;mtc&#46;2000&#46;108692"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular aneurysms&#58; pathophysiologic observations and standard resection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              JL Cox \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Sem Thorac Cardiovasc Surg"
                        "fecha" => "1997"
                        "volumen" => "9"
                        "paginaInicial" => "113"
                        "paginaFinal" => "122"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary bypass surgery with or without surgical ventricular reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              RH Jones \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              EJ Velazquez \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RE Michler \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              G Sopko \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JK Oh \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              CM O&#39;Connor \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "360"
                        "paginaInicial" => "1705"
                        "paginaFinal" => "1717"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1056&#47;NEJMoa0900559"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventricular aneurysm after myocardial infarction&#58; surgical excision with use of temporary cardiopulmonary bypass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              DA Cooley \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              HA Collins \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              GC Morris \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              DW Chapman \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1958"
                        "volumen" => "167"
                        "paginaInicial" => "557"
                        "paginaFinal" => "560"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular aneurysm&#58; a new surgical approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              V Dor \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Saab \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              P Coste \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Kornaszewska \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              F Montiglio \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1989"
                        "volumen" => "37"
                        "paginaInicial" => "11"
                        "paginaFinal" => "19"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1055&#47;s-2007-1013899"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventricular endoaneurysmorraphy&#58; results of an improved method of repair"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              DA Cooley \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tex Heart Inst J"
                        "fecha" => "1989"
                        "volumen" => "16"
                        "paginaInicial" => "72"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15227216"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of biplane angiography for the measurement of left ventricular volume in man"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              HT Dodge \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              H Sandler \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              DH Ballew \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JD Lord \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "1960"
                        "volumen" => "60"
                        "paginaInicial" => "762"
                        "paginaFinal" => "776"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;0002-8703&#40;60&#41;90359-8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myocardial viability assessment in ischemic cardiomyopathy&#58; benefits of coronary revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              GD Dreyfus \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              D Duboc \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Blasco \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              F Vigoni \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              C Dubois \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              D Brodaty \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/0003-4975(94)90091-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1994"
                        "volumen" => "57"
                        "paginaInicial" => "1402"
                        "paginaFinal" => "1408"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8010780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/0003-4975(94)90091-4"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;0003-4975&#40;94&#41;90091-4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary artery bypass grafting in severe left ventricular dysfunction&#58; excellent survival with improved ejection fraction and functional status"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              JA Elefteriades \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Tolis \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E Levi \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              LK Mills \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              BL Zaret \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/0735-1097(93)90551-b"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1993"
                        "volumen" => "22"
                        "paginaInicial" => "1411"
                        "paginaFinal" => "1417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8227799"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/0735-1097(93)90551-b"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;0735-1097&#40;93&#41;90551-B"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improvement of left ventricular ejection fraction&#44; heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JJ Bax \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              D Poldermans \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Elhendy \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JH Cornel \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              E Boersma \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              R Rambaldi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0735-1097(99)00157-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1999"
                        "volumen" => "34"
                        "paginaInicial" => "163"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10400006"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0735-1097(99)00157-6"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0735-1097&#40;99&#41;00157-6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              The SOLVD Investigators \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199108013250501"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1991"
                        "volumen" => "325"
                        "paginaInicial" => "293"
                        "paginaFinal" => "302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2057034"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1056/NEJM199108013250501"
                      "WWW" => array:1 [
                        "link" => "10&#46;1056&#47;NEJM199108013250501"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              A Yamaguchi \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              T Ino \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              H Adachi \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              S Murata \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              H Kamio \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M Okada \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1997"
                        "volumen" => "65"
                        "paginaInicial" => "434"
                        "paginaFinal" => "438"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0003-4975&#40;97&#41;01155-7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              GB Luciani \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Montalbano \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              G Casali \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Mazzucco \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1067/mtc.2000.108692"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2000"
                        "volumen" => "120"
                        "paginaInicial" => "478"
                        "paginaFinal" => "489"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10962408"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1067/mtc.2000.108692"
                      "WWW" => array:1 [
                        "link" => "10&#46;1067&#47;mtc&#46;2000&#46;108692"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elective vs non-elective radial artery grafts&#58; comparing midterm results through 64-slice computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              R Rocha-e-Silva \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              TSG Santos \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              CE Rochite \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JA Rocha-Filho \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              AP Mansur \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              J Fabri Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s1807-59322007000600012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinics"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "725"
                        "paginaFinal" => "730"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18209915"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary revascularization with the left internal thoracic artery and radial artery&#46; Comparison of short-term clinical evolution between electve and emergency surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              R Rocha-e-Silva \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AP Mansur \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Fabri Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RB Ramos \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              CECC Filho \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              LAO Dallan \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clinics"
                        "fecha" => "2005"
                        "volumen" => "60"
                        "paginaInicial" => "227"
                        "paginaFinal" => "232"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of invasive therapies in enderly patients with acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JC Nicolau \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PA Lemos \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              M Wajngarten \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RR Giraldez \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              CV Serrano Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              EE Martinez \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1590/s1807-59322009000600010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinics"
                        "fecha" => "2009"
                        "volumen" => "64"
                        "paginaInicial" => "553"
                        "paginaFinal" => "560"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19578659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1590/s1807-59322009000600010"
                      "WWW" => array:1 [
                        "link" => "10&#46;1590&#47;S1807-59322009000600010"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term follow-up of patients indergone coronary artery bypass grafting with exclusive use of arterial grafts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              AA Abdouni \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LAF Lisboa \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              LB Puig \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              CE Tossuniam \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              LAO Dallan \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              FB Jatene \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Bras Cir Cardiovasc"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "paginaInicial" => "494"
                        "paginaFinal" => "500"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1590&#47;S0102-76382008000400007"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical myocardial revascularization of patients with ischemic cardiomyopath and severe left ventricuar disfnction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              AL Hovnanian \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AM Soeiro \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              CV Serrano Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              SA Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              FB Jatene \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              NAG Stolg \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1590/S1807-59322010000100002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinics"
                        "fecha" => "2010"
                        "volumen" => "65"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20126339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1590/S1807-59322010000100002"
                      "WWW" => array:1 [
                        "link" => "10&#46;1590&#47;S1807-59322010000100002"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The importance of completeness of revascularization during long-term follow-up after coronary artery operations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              E Jones \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              WS Weintraub \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1996"
                        "volumen" => "62"
                        "paginaInicial" => "401"
                        "paginaFinal" => "409"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary artery bypass grafting in patients with an ejection fraction of twenty or less"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              TK Kaul \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AK Agnihotri \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BL Fields \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              LS Riggins \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              DA Wyatt \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              CR Jones \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0022-5223(96)70377-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1996"
                        "volumen" => "111"
                        "paginaInicial" => "1001"
                        "paginaFinal" => "1012"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8622298"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0022-5223(96)70377-x"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0022-5223&#40;96&#41;70377-X"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Managemento of heart failure&#46; III&#46; The role of myocardial revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              DW Baker \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Jones \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Hodges \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              BM Massie \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MA Kostam \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              EA Rose \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.272.19.1528"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1994"
                        "volumen" => "272"
                        "paginaInicial" => "1528"
                        "paginaFinal" => "1534"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7966846"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1001/jama.272.19.1528"
                      "WWW" => array:1 [
                        "link" => "10&#46;1001&#47;jama&#46;272&#46;19&#46;1528"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary artery bypass grafting in patients with poor left ventricular function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              ST Christakis \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RD Weisel \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SE Fremes \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              J Ivanov \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              T David \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              BS Goldman \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1992"
                        "volumen" => "103"
                        "paginaInicial" => "1083"
                        "paginaFinal" => "1092"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1597972"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting survival after coronary revascularization for ischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              SE Langenburg \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              SA Buchanan \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              LH Blackbourne \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RP Scheri \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              KN Sinclair \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              J Martinez \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/0003-4975(95)00755-A"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1995"
                        "volumen" => "60"
                        "paginaInicial" => "1193"
                        "paginaFinal" => "1197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8526598"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/0003-4975(95)00755-A"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;0003-4975&#40;95&#41;00755-A"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protection in the failing heart"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              IL Kron \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0003-4975(99)01021-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1999"
                        "volumen" => "68"
                        "paginaInicial" => "1971"
                        "paginaFinal" => "1973"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10585113"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0003-4975(99)01021-8"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0003-4975&#40;99&#41;01021-8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-risk reparative surgery&#58; a neglected alternative to heart transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              JA Sanchez \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              CR Smith \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RE Drusin \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              DS Reison \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JR Malm \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              EA Rose \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.cir.82.1.302"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1990"
                        "volumen" => "82"
                        "numero" => "Suppl 4"
                        "paginaInicial" => "302"
                        "paginaFinal" => "305"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2194698"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-risk heart surgery in the heart transplant candidate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              BM Blakeman \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Pifarre \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              H Sullivan \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MR Costanzo-Nordin \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MJ Zucker \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Heart Lung Transplant"
                        "fecha" => "1990"
                        "volumen" => "9"
                        "paginaInicial" => "468"
                        "paginaFinal" => "472"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of operative risk for coronary bypass operations in patients with left ventricular dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              TM Yau \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PW Fedak \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RD Weisel \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C Teng \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              J Ivanov \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(99)70094-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1999"
                        "volumen" => "118"
                        "paginaInicial" => "1006"
                        "paginaFinal" => "1013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10595971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/S0022-5223(99)70094-2"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0022-5223&#40;99&#41;70094-2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term survival of patients with coronary artery disease and left ventricular dysfunction&#58; implications for the role of myocardial viability assessment in management decisions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              MF Di Carli \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Maddahi \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              S Rokhsar \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              HR Schelbert \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              D Bianco-Batlles \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RC Brunken \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(98)70052-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1998"
                        "volumen" => "116"
                        "paginaInicial" => "997"
                        "paginaFinal" => "1004"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9832692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/S0022-5223(98)70052-2"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0022-5223&#40;98&#41;70052-2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The importance of completeness of revascularization during long-term follow-up after coronary artery operations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              E Jones \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              WS Weintraub \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1996"
                        "volumen" => "62"
                        "paginaInicial" => "401"
                        "paginaFinal" => "409"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Degree of risk related to procedures performed in conjunction with surgca myocardial revascularization in octogenarians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              JCR Iglezias \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LAO Dallan \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Louen&#231;&#227;o Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              AL Celullare \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              R Pereira \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              NAG Stolf \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clinics"
                        "fecha" => "2009"
                        "volumen" => "64"
                        "paginaInicial" => "387"
                        "paginaFinal" => "392"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1590&#47;S1807-59322009000500003"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative reproducibility and validity of systems foe assessing cardiovascular functional class&#58; advantages of a new specific activity scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              L Goldman \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              B Hashimoto \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              EF Cook \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Loscalzo \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.cir.64.6.1227"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1981"
                        "volumen" => "64"
                        "paginaInicial" => "1227"
                        "paginaFinal" => "1234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7296795"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18075932/0000006500000010/v1_202212010724/S1807593222029167/v1_202212010724/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006500000010/v1_202212010724/S1807593222029167/v1_202212010724/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029167?idApp=UINPBA00004N"
]

Article information

ISSN: 18075932
Original language: English

DOI:10.1590/S1807-59322010001000004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	0	5
2024 October	73	22	95
2024 September	31	9	40
2024 August	39	15	54
2024 July	45	15	60
2024 June	34	22	56
2024 May	49	11	60
2024 April	38	8	46
2024 March	54	11	65
2024 February	38	9	47
2024 January	24	10	34
2023 December	22	18	40
2023 November	18	19	37
2023 October	27	32	59
2023 September	17	28	45
2023 August	7	7	14
2023 July	6	15	21
2023 June	14	11	25
2023 May	0	2	2
2023 April	2	1	3
2023 March	4	1	5
2023 February	0	3	3
2023 January	2	2	4
2022 December	11	3	14

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter