Mortality in isolated coronary artery bypass surgery in elderly patients. A retrospective analysis over 14 years | Revista Española de Anestesiología y Reanimación (English Edition)

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A retrospective analysis over 14 years" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "262" "paginaFinal" => "272" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Carmona García, E. Mateo, F. Hornero, M. López Cantero, I. Zarragoikoetxea" "autores" => array:5 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Carmona García" "email" => array:1 [ 0 => "paulac_g@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Mateo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Hornero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." 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"apellidos" => "Zarragoikoetxea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anestesiología y Reanimación, Consorcio Hospital General de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Cirugía Cardiovascular, Consorcio Hospital General de Valencia, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad de nla cirugía coronaria aislada en octogenarios. Análisis restrospectivo de 14 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1164 "Ancho" => 1658 "Tamanyo" => 164074 ] ] "descripcion" => array:1 [ "en" => "Distribution of coronary surgery (off-pump and on-pump) in octogenarians during the study period." ] ] ] "textoCompleto" => "IntroductionCardiovascular disease is the leading cause of morbidity and mortality in the elderly. Because coronary heart disease is more severe in this subgroup of patients and the benefit of revascularization is greater, elderly patients are often referred for coronary revascularization.<a class="elsevierStyleCrossRef" href="#bib0200">1</a> The choice of the best revascularization method (surgical or percutaneous [PTCA]) is more complicated in the elderly than in their younger counterparts. Although coronary artery bypass grafting (CABG) carries a higher risk in elderly patient, mortality among this group in recent decades has decreased from 12% to 2.6%, according to some published series.<a class="elsevierStyleCrossRefs" href="#bib0200">1–4</a> Advances and improvements in perioperative and postoperative techniques (internal mammary artery grafts, better myocardial protection, better postoperative management<a class="elsevierStyleCrossRefs" href="#bib0220">5,6</a>) could explain this trend.Randomized trials have shown the benefits of coronary surgery in high-risk patients, with greater long-term survival, and a 2- to 4-fold greater likelihood of recurrent angina and need for repeat revascularization in the subgroup of patients undergoing PTCA.<a class="elsevierStyleCrossRefs" href="#bib0230">7–11</a> Meta-analyses of these studies have confirmed these results.<a class="elsevierStyleCrossRefs" href="#bib0255">12–14</a> There is evidence that CABG has a greater impact on long-term survival in elderly patients, at the expense of a higher incidence of strokes and greater perioperative morbidity compared with PTCA, which is a far less invasive technique.<a class="elsevierStyleCrossRef" href="#bib0200">1</a>Since individuals over 80 are high-risk patients with considerable postoperative morbidity and mortality, we need to identify both the factors related to morbidity and mortality and the results obtained by each hospital this subgroup of patients. A good preoperative assessment, administration of the best therapy based on existing guidelines and individual risk factors, and early detection of immediate complications are essential if we are to improve the level of care given to this high-risk group.The aim of this study is to analyze perioperative outcomes, long-term survival and predictors of early mortality in a cohort of patients aged over 80 years undergoing CABG surgery.Materials and methodsThe study was approved by the hospital's Independent Ethics Committee (number 869). This is a retrospective cohort study of data from a consecutive series of patients undergoing isolated CABG surgery from 1999 to 2013. The data were drawn from prospectively collected data in the PALEX DATA (Palex Medical, Barcelona, Spain) database compiled by the Cardiac Surgery Service.All patients aged over 18 years undergoing scheduled and urgent off-pump and on-pump CABG from 1999 to 2013. The surgical technique (off-pump or on-pump) was decided by the surgical team. Exclusion criteria were: patients undergoing concomitant heart valve or thoracic aorta surgery and/or reoperations. Patients aged 80 years or older were identified from the data set and included as a subgroup in the study.Surgical techniqueIn patients undergoing on-pump CABG, cardiopulmonary bypass (CPB) was established by cannulation of the ascending aorta and right atrium. Non-pulsatile coronary pulmonary bypass was performed using alpha-stat blood gas management strategies, cold cardioplegic solution was infused at moderate systemic hypothermia (32–34°C), and the flow rate was adjusted to achieve a mean arterial pressure of between 60 and 80mmHg. The membrane oxygenator was primed with 1000ml crystalloid solution, 500ml of gelfundin® (B. Braun Melsungen AG, Melsungen, Germany), 250ml of 20% mannitol and 5000IU heparin. The myocardium protection was achieved with intermittent antegrade and retrograde hyperkalaemic cardioplegia. In the case of off-pump revascularization, adjustable stabilizers were used to expose the coronary arteries, thus facilitating anastomosis by improving visibility and stability. Heparin at a dose of 300IU/kg was administered for on-pump procedures and 150IU/kg for off-pump surgery. The activated clotting time was maintained above 400s for on-pump surgery and above 300s for off-pump surgery. The effect of heparin was reversed with protamine sulphate at a ratio of 1:1.Anaesthetic techniqueAnaesthesia was induced with midazolam, fentanyl, etomidate and cisatracurium or rocuronium. It was maintained with sevoflurane and intravenous infusion of remifentanil. Morphine chloride was given for analgesia in the immediate postoperative period.Haemodynamic monitoring consisted of invasive blood pressure measurements, central venous pressure, transoesophageal echocardiography determined by the attending anaesthetist, pulse oximetry, 5-lead electrocardiogram and computerized ST segment analysis. Nasopharyngeal temperature was measure, and diuresis was recorded hourly. Respiratory monitoring included end-tidal CO2 and inspiratory and expiratory sevoflurane concentration, and a peak flow metre was used to monitor airway volumes and pressures. Depth of anaesthesia was monitored using the bispectral index (BIS®, Covidien, Boulder, CO, USA), and brain metabolism in patients undergoing on-pump surgery was determined by cerebral oxygen saturation measured at the right or left temporal area (INVOS®, Covidien, Boulder, CO, USA). After completion of the surgery, patients were admitted to the post-anaesthesia care unit where they underwent protocolized early extubation. They were taken to the hospital ward once discharge criteria had been met.Perioperative morbidity during hospitalization, all-cause surgery-related mortality during hospitalization and at 30 days, and length of hospital and ICU stay were analyzed. Crude survival and mortality rates during the study period were retrieved from the Spanish National Health System database. The study period was divided into 2 bands: 1, from 1999 to 2005 and another from 2006 to 2013. The bands are defined in <a class="elsevierStyleCrossRef" href="#sec0065">Appendix 1</a>. Perioperative predictors of 30-day mortality were analyzed.Statistical analysisDescriptive variables, namely, mortality, greater perioperative morbidity and hospital stay recorded from cases and controls were tested statistically. Descriptive data are shown as percentages and mean (SD) or median (interquartile range). Quantitative variables were tested using Student's t-test or Mann–Whitney U test, while the chi square or Fisher exact test were used for categorical variables. A p value of <0.05 was considered statistically significant.Thirty-day mortality was also tested using univariate and multivariate Cox regression in order to detect independent predictors for the subgroup of patients aged over 80 years. Data with a p value of <0.1 from the univariate analysis were included in the Cox regression multivariate model. The results of the univariate and multivariate Cox regression and the stepwise method are shown as regression coefficient (B), regression coefficient significance level, and predicted hazard ratio, with a 95% confidence interval for each variable included in the model. To avoid collinearity, variables that could clinically be related were not entered into the same model. Kaplan–Meier survival curves were used to estimate long-term survival. Statistical analysis was performed on SPSS® version 20.0.1. (SPSS, Inc., Chicago, IL, USA).ResultsNinety-nine patients aged over 80 years (over-80 group), with an average age of 82±3.5 years, and 2998 patients aged under 80 years (control group), with a mean age of 64.2±9.7 years, were identified among patients undergoing CABG. The over-80 population accounted for 3.1% of the total population of our sample. Among the over-80s, additive EuroSCORE was 8.4±4.8, showing a preponderance of arterial hypertension (75.4%) and history of smoking (74.5%); 28.6% were women (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Off-pump CABG was performed in 78.8% of patients, with a mean of 2.7±0.8 grafts, mostly involving the anterior descending coronary artery (98%), with arterial grafts performed in 92.9% of patients. Thirty-day mortality was 11.2%. The study period was divided into 2 bands: 1, from 1999 to 2005 and another from 2006 to 2013. Mortality in the over-80 group did not differ between periods: 9.1% vs. 12.1% (p=0.7).Mean ICU stay was 4.4±12.1 days, and mean hospital stay was 9.0±10.0 days. Patients in the over-80 group underwent reoperation for bleeding in 9.2% vs. 2.9% of cases (p=0.001), and presented a higher incidence of major cardiovascular complications (acute perioperative myocardial infarction, AV block, heart failure and cardiogenic shock): 6.1% vs. 2.1% (p=0.001). Neurological, respiratory, kidney and infectious complications did not differ significantly between groups: 3.1% vs. 3.1% (p=0.9), 9.1% vs. 11.6% (p=0.9), 6.1% vs. 6.1% (p=0.5), and 2.1% vs. 2.5% (p=0.6) in the over-80 group vs. controls, respectively (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Overall causes of death are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Slightly over half (54.5%) of non-survivors in over-80 group had been reoperated for bleeding in the immediate postoperative period (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). All (100%) reoperated patients were from the off-pump CABG group (p=0.1); of these, 56% were men. Among patients aged >80 years who died, 7 were receiving dual antiplatelet therapy; of these, 5 underwent urgent CABG and 2 expedited CABG for severe coronary artery lesion. Four of the non-survivors receiving dual antiplatelet therapy were reoperated for bleeding.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Duration of CPB and cardiac ischaemia in patients undergoing on-pump revascularization was 128.1±28.1 and 69.8±2min, respectively.The distribution of CABG patients in the over-80 group over the study is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. A gradual increase in over-80 patients undergoing isolated CABG can be observed.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Mean follow-up was 6.3±4.2 years for the over-80 group. Accumulated survival rate of these patients during follow-up was 65.7% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In the univariate analysis, statistically significant predictors of 30-day mortality were: reoperation for bleeding (hazard ratio 9.4; 95% CI 2–43.5) and major haemodynamic complications (hazard ratio 24.2; 95% CI 3.7–156.6). In the Cox regression multivariate analysis, independent perioperative predictors of mortality were also reoperation for bleeding and major haemodynamic complications (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>DiscussionThis analysis of a cohort of patients undergoing CABG over a period of 14 years shows that individuals aged over 80 years present significant perioperative mortality, with a high incidence of major cardiovascular complications and reoperation for bleeding. We observed that off-pump CABG is more frequent in this subgroup of patients. Independent predictors of mortality in the over-80 group were major cardiovascular complications and reoperation for postoperative bleeding.The aim of this study was not to compare surgical techniques (off-pump or on-pump) or to compare this small cohort with the cohort of younger patients (which differs greatly in characteristics and size), but rather to show the characteristics that make this population more vulnerable and detect predictors of mortality that can help optimize their management and improve surgical outcomes.In our series, patients over 80 years accounted for 3.1% of all patients undergoing CABG surgery. Due to the increasing number of octogenarian patients in our setting, the Consensus Document of the Spanish Societies of Cardiology, Internal Medicine, Primary Care, and Geriatrics<a class="elsevierStyleCrossRef" href="#bib0270">15</a> calls for specialists to be familiar with the perioperative morbidity and mortality that characterize this population.In the 2013 database of the Spanish Society for Thoracic-Cardiovascular Surgery (SECTCV),<a class="elsevierStyleCrossRef" href="#bib0275">16</a> 4.6% of all patients undergoing coronary surgery were aged over 80 years. As age increases, so does hospital mortality, and according to the foregoing database the risk of hospital death is now 3 times higher in the over-80s compared to younger patients (OR 2.7; 95% CI 1.9–4.0). The crude hospital mortality rate for women is clearly higher in cardiac surgery performed in the over-80 age group: 9.2% (95% CI 4.9–16.2) vs. 7.4% (95% CI 4.7–11.2) in women vs. men, respectively. Our results largely echo those of the national registry, with an OR of 3.5 (95% CI, 1.8–6.8) for the over-80 age group. In the European register, crude mortality in patients over 80 was 6.7%, and is also higher in women (7.5% vs. 6.3%, respectively).<a class="elsevierStyleCrossRef" href="#bib0210">3</a> In our series mortality in women is also higher (17.8% vs. 8.4%) for this age group.The mortality rate observed in our over-80 group is consistent with the EuroSCORE for our study group. In this study, risk predictors are limited to the over-80 group; other studies<a class="elsevierStyleCrossRefs" href="#bib0280">17–19</a> have described predictors in larger populations.According to the SECTCV report, advanced age was not a factor in the choice of vascular grafts in octogenarian patients, and in 90% of patients at least 1 arterial graft was used, as was the case in our series.The choice of off-pump or on-pump CABG in this group of patients with high comorbidity has not so far been studied in randomized trials. Although none of the randomized clinical trials or meta-analyses published to date have shown a clear benefit or statistically significant difference in short-term mortality for off-pump vs. conventional CABG, it is widely believed that octogenarians and higher risk patients could benefit more from off-pump surgery. In our patients, mortality occurs in the off-pump CABG group (in our centre, it is up to the surgeon to choose the surgical technique); however, this may be due to our small sample size and the fact that most patients in the over-80 group underwent off-pump CABG, and we were therefore unable to establish off-pump or on-pump CABG as the cause of death.Randomized trials comparing medical treatment with percutaneous revascularization have included subgroups of patients aged over 65 and 70 years. Authors, such as Graham et al. in their observational APPROACH study, have reported a 1-year mortality rate of 12%, although 4-year survival in patients aged over 80 years undergoing CABG was 77.8%, higher than that obtained with percutaneous revascularization (71.5%) and medical therapy (60.3%).<a class="elsevierStyleCrossRef" href="#bib0200">1</a> The authors conclude that, paradoxically, elderly patients have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients. More recent series, however, report a far lower rate of early mortality in patients aged over 75 years than that observed in our series. A study in point is that of Diegeler et al., with a mortality rate of 2.6% in this subgroup of patients.<a class="elsevierStyleCrossRef" href="#bib0215">4</a> Our long-term crude mortality rate is similar to that found in the literature, with a 5-year survival rate of 65.7%.One of the most interesting issues analyzed in our study is reoperation for bleeding as an independent predictor of mortality in this subgroup of patients. Major perioperative bleeding has been described in the literature as an independent predictor of mortality,<a class="elsevierStyleCrossRef" href="#bib0295">20</a> while age, history of kidney disease, liver disease, female sex and body mass index are factors that increase the likelihood of postoperative bleeding.<a class="elsevierStyleCrossRef" href="#bib0300">21</a> The high prevalence of bleeding could also be related to the urgency of the surgery and the administration of dual antiplatelet therapy immediately prior to the intervention. The recommendation to maintain acetylsalicylic acid until the day of surgery, found in most guidelines, could have a major impact in this age subgroup.<a class="elsevierStyleCrossRef" href="#bib0305">22</a> In our series, we searched the medical records of non-survivors to determine which had been taking antiplatelet therapy before surgery, as this detail was not included in the database, and found that 4 of the 7 non-survivors receiving dual antiplatelet therapy were reoperated for bleeding. Observance of pre-operative antiplatelet therapy discontinuation schedules, individualized assessment and careful haemostasis are important factors in the prevention of reoperation for bleeding in this particularly vulnerable population.One impactful aspect not included in any risk scales, but increasingly assessed in this population, is frailty.<a class="elsevierStyleCrossRef" href="#bib0310">23</a> Frailty could be considered a marker of biological age, it is closely related to mental status, and worsens surgical outcomes, regardless of age, sex and comorbidities.<a class="elsevierStyleCrossRef" href="#bib0315">24</a> Mortality following percutaneous revascularization is up to 4 times higher (6% vs. 28%) in patients with a diagnosis of frailty compared to non-frail patients.<a class="elsevierStyleCrossRef" href="#bib0320">25</a> The retrospective nature of our study prevented us from analysing this factor, but we believe it could influence observed mortality rates.The presence of aortic atheroma has recently been identified as the most important predictor of neurological damage.<a class="elsevierStyleCrossRef" href="#bib0325">26</a> The risk of this condition increases in elderly patients. However, the indications and benefits of off-pump surgery continue to stir up much controversy in the literature, and both results and methodology diverge greatly.<a class="elsevierStyleCrossRefs" href="#bib0215">4,18,27</a> Given this uncertainty and the need to characterize the subgroups of patients in whom off-pump surgery<a class="elsevierStyleCrossRefs" href="#bib0335">28–30</a> would be associated with lower morbidity, the German Off-Pump Coronary Artery Bypass Grafting in Elderly Patients (GOPCABE) study set out to clarify the potential benefits of off-pump CABG in high-risk patients, such as the over-70s age group. The authors of the study observed no differences in either mortality or major complications. Similarly, Raja et al., studying a group of octogenarians, found no differences in morbidity and mortality between off-pump and on-pump CABG.<a class="elsevierStyleCrossRef" href="#bib0350">31</a>In our hospital, the choice of off- or on-pump is up to the surgeons, who base their decision on the high comorbidity observed by the professionals involved. In our series of octogenarians, 78.8% of revascularizations were performed off-pump, which may explain the absence of the high rates of neurological morbidity observed in other studies in elderly patients undergoing revascularization.The limitations of this study are those inherent to a retrospective observational study based on data from a single institution.We did not attempt to compare groups with very different characteristics nor compare the surgical technique. Instead, we focused on identifying which perioperative characteristics are associated with poorer outcomes in a subgroup that is, a priori, liable to present a worse prognosis, and identifying the complications most likely to increase mortality in this subgroup.The EuroSCORE was designed to assess risk in patients undergoing on-pump cardiac surgery, and would therefore provide an inaccurate assessment of patients undergoing off-pump CABG.<a class="elsevierStyleCrossRef" href="#bib0355">32</a>A limited number of intraoperative variables were collected in the database, and this lack of information prevented us from gaining deeper insight into morbidity and mortality.Complications were defined according to standard criteria used in the literature; however, variations in these criteria could limit the extrapolation of our results. In this respect, in terms of technical definitions, revascularization variables were based on the number of grafts performed, not on the definition of the revascularization procedure using in each patient or any other revascularization integrity index.Another limitation of our study involves our 30-day follow-up of complications and mortality. This means that any fatality occurring immediately after this period may have been surgery-related, but was not detected. Although we performed a long-term follow-up of the cohort of octogenarians, and have data for cumulative survival over medium-term follow-up, do not know whether the ultimate cause of death was cardiovascular or otherwise, and, therefore, whether CABG surgery may have played a key role in the outcome. Furthermore, our study is susceptible to information bias due to the lack of data on postoperative bleeding and transfusion rates, which in many other studies have been reported as independent risk factors for increased morbidity and mortality.Details of antiplatelet therapy administered prior to CABG are not available on the database; this treatment was only retrieved from the medical records of non-survivors. An analysis of the type and time of withdrawal of antiplatelet therapy in all patients could have provided more data for our mortality analysis.Similarly, preoperative blood workup details, such as haemoglobin and haematocrit, are not included in our database. Other studies have shown that these factors, particularly in octogenarians, have an impact on morbidity and mortality. Guidelines recommend optimizing perioperative anaemia, particularly in this patient group.Another factor that could cause bias is the study period; this was extensive, and both surgical techniques and perioperative management have changed significantly in this time. Moreover, the learning curve inherent to any technique, and the involvement of resident surgeons is always a factor to consider in these studies. Due to the small size of the over-80 group, we did not perform a subanalysis to compare outcomes between octogenarians undergoing on-pump vs. off-pump CABG, as no firm conclusions could have been drawn from these outcomes, and they could have been confounding factors in our statistical analysis.In conclusion, mortality among octogenarian patients is high relative to a higher incidence of reoperations for bleeding and postoperative cardiovascular complications. Reoperation for bleeding and cardiovascular complications are independent predictors of mortality. Measures to reduce postoperative bleeding and careful surgical haemostasis could considerably reduce mortality.Ethical responsibilitiesProtection of human and animal rightsThe authors declare that the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with those of the World Health Organization and the Helsinki Declaration.Data confidentialityThe authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications.Right to privacy and informed consentThe authors declare that no patient data appears in this article.Conflict of interestsThe authors declare no conflict of interest with respect to the information provided in the article." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres833128" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec829036" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres833127" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec829035" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Anaesthetic technique" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of human and animal rights" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-04-18" "fechaAceptado" => "2016-12-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec829036" "palabras" => array:5 [ 0 => "Coronary revascularization" 1 => "Elderly patients" 2 => "Cardiac surgery" 3 => "Outcomes" 4 => "Morbimortality" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec829035" "palabras" => array:4 [ 0 => "Revascularización coronaria" 1 => "Paciente anciano" 2 => "Cirugía cardiaca" 3 => "Morbimortalidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionWe aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup. Material and methodFrom January 1999 to June 2013, 3097 patients underwent consecutive coronary artery bypass graft surgery. Patients aged over 80 years were identified. Multivariate survival analysis using Cox's regression model was performed. ResultsWe identified 99 patients older than 80 years (80-group; mean age 82±3.5 years) and 2957 younger than 80 years (control group) (mean age 64.2±9.7 years). Additive EuroSCORE was 8.4±4.8 and 4.6±4.6 (p<0.001) in the 80-group vs. control group, respectively. Off-pump coronary artery bypass graft was performed in 79.6 vs. 41.6% (p<0.001) in the 80-group vs. the control group, respectively. There was significantly higher 30 day-mortality in the 80-group, 11.2 vs. 3.3%, respectively (p<0.001). Patients in the 80-group underwent reintervention for bleeding more frequently (9.2 vs. 2.9%; p=0.001) and had a higher incidence of major cardiovascular complications than the control group (6.1 vs. 2.1%; p=0.001). Independent predictors of mortality for the 80-group were: reoperation for bleeding (HR 5.7; 95% CI 1.6–19.5) and cardiovascular complications (HR 3.7; 95% CI 1.1–12.2). The mean follow-up was 6.3±4.2 years for the octogenarian group. The cumulative survival of these patients was 65.7% during the study period. ConclusionCoronary artery bypass graft is performed preferably in patients over 80 years old under the off-pump procedure. Mortality is higher in this group of patients probably related to a higher incidence of cardiovascular complications and reintervention for bleeding in the immediate postoperative period." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl objetivo de este estudio es describir nuestra experiencia en la cirugía de revascularización coronaria aislada en pacientes mayores de 80 años e identificar los riesgos específicos y predictores de mortalidad precoz. Material y métodosEntre enero de 1999 y junio de 2013, 3.097 pacientes fueron sometidos a cirugía de revascularización coronaria aislada. Se analizaron los pacientes mayores de 80 años de edad. Se realizó una regresión mutivariante de Cox para predictores de mortalidad. ResultadosSe identificaron 99 pacientes mayores de 80 años (grupo-80; edad media 82±3,5 años) y 2.957 menores de 80 años (grupo control; edad media 64,2±9,7 años). El EuroSCORE aditivo fue 8,4±4,8 y 4,6±4,6 (p<0,001) en los>80 años vs.<80 años, respectivamente. La cirugía sin CEC se realizó en el 79,6% en el grupo-80 años. La mortalidad a los 30 días en el grupo-80 fue significativamente superior, del 11,2 vs. 3,3% (p<0,001). El grupo-80 se reintervino por sangrado más frecuentemente (9,2 vs. 2,9%; p=0,001) y tuvieron con mayor frecuencia complicaciones cardiovasculares mayores (6,1 vs. 2,1%; p=0,001). Los predictores independientes de mortalidad a 30 días fueron: la reintervención por sangrado (HR 5,7; IC 95% 1,6-19,5) y las complicaciones cardiovasculares mayores (HR 3,7; IC 95% 1,1-12,2). El seguimiento medio del grupo-80 fue de 6,3±4,2 años, con una supervivencia acumulada de estos pacientes del 65,7% durante el periodo de estudio. ConclusiónLa cirugía de revascularización coronaria aislada se realiza preferentemente en pacientes mayores de 80 años sin CEC. Presentan una mayor incidencia de complicaciones cardiovasculares, reintervenciones por sangrado en el postoperatorio inmediato y una mortalidad más elevada." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Carmona García P, Mateo E, Hornero F, López Cantero M, Zarragoikoetxea I. Mortalidad de nla cirugía coronaria aislada en octogenarios. Análisis restrospectivo de 14 años. Rev Esp Anestesiol Reanim. 2017;64:262–272." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "Preoperative variables analyzed<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Age</li><li class="elsevierStyleListItem" id="lsti0010">•Sex</li><li class="elsevierStyleListItem" id="lsti0015">•Additive Euroscore</li><li class="elsevierStyleListItem" id="lsti0020">•Smoking history</li><li class="elsevierStyleListItem" id="lsti0025">•Presence of cardiovascular risk factors: hypertension, dyslipidaemia</li><li class="elsevierStyleListItem" id="lsti0030">•Type 1 and 2 diabetes mellitus</li><li class="elsevierStyleListItem" id="lsti0035">•History of stroke</li><li class="elsevierStyleListItem" id="lsti0040">•Chronic obstructive pulmonary disease treated with long-term bronchodilators or inhaled or oral corticosteroids.</li><li class="elsevierStyleListItem" id="lsti0045">•Previous episodes of congestive heart failure</li><li class="elsevierStyleListItem" id="lsti0050">•Acute myocardial infarction before surgery</li><li class="elsevierStyleListItem" id="lsti0055">•History of previous percutaneous revascularization with angioplasty or fibrinolysis</li><li class="elsevierStyleListItem" id="lsti0060">•NYHA functional class</li><li class="elsevierStyleListItem" id="lsti0065">•Peripheral vascular disease, defined as the presence of intermittent claudication of the lower limbs, over 50% occlusion of the carotid artery, amputation due to artery disease, undergoing or scheduled for surgery involving the abdominal aorta or lower limb arteries</li><li class="elsevierStyleListItem" id="lsti0070">•Chronic renal failure, defined as preoperative creatinine >2mg/dL and/or need for preoperative haemodialysis</li><li class="elsevierStyleListItem" id="lsti0075">•Immunocompromised</li><li class="elsevierStyleListItem" id="lsti0080">•History of malignant ventricular arrhythmias</li><li class="elsevierStyleListItem" id="lsti0085">•Pacemaker-dependent</li><li class="elsevierStyleListItem" id="lsti0090">•Number of affected coronary vessels</li><li class="elsevierStyleListItem" id="lsti0095">•Priority surgery. Urgent surgery is defined surgery performed in hospitalized patients that require intervention or surgery during their current hospital stay for medical reasons. These patients cannot be discharged home without a definitive procedure. Emergency surgery is defined surgery that is performed before the start of the next working day following the decision to operate.</li></ul> Intraoperative<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0100">•Type of surgery performed: off-pump or on-pump</li><li class="elsevierStyleListItem" id="lsti0105">•Number of grafts performed</li><li class="elsevierStyleListItem" id="lsti0110">•Revascularization of the anterior descending artery</li><li class="elsevierStyleListItem" id="lsti0115">•Revascularization with mammary artery graft</li><li class="elsevierStyleListItem" id="lsti0120">•Time on pump and aortic clamping time</li></ul> Postoperative morbidity and mortality (see definitions in section 4)<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0125">•All-cause or in-hospital 30-day mortality</li><li class="elsevierStyleListItem" id="lsti0130">•Clinical complications</li><li class="elsevierStyleListItem" id="lsti0135">•Hospital stay (days): ICU stay and hospital stay</li><li class="elsevierStyleListItem" id="lsti0140">•Survival during follow-up</li><li class="elsevierStyleListItem" id="lsti0145">•Definition of dependent clinical variables or outcomes<a class="elsevierStyleCrossRef" href="#bib0360">33</a></li></ul> Perioperative mortality, defined as all-cause 30-day mortality.<a class="elsevierStyleCrossRef" href="#bib0275">16</a> Classified as being due to cardiovascular or non-cardiovascular causes. Death from cardiovascular causes:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0150">•Cardiac death: myocardial infarction, cardiac tamponade, worsening heart failure</li><li class="elsevierStyleListItem" id="lsti0155">•Non-cardiac death: neurological events, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm or other vascular disease</li><li class="elsevierStyleListItem" id="lsti0160">•Procedure-related deaths, including those related to any procedure-related complication</li><li class="elsevierStyleListItem" id="lsti0165">•Deaths related to valvular dysfunction</li><li class="elsevierStyleListItem" id="lsti0170">•Sudden or unwitnessed death</li><li class="elsevierStyleListItem" id="lsti0175">•Death from unknown causes</li><li class="elsevierStyleListItem" id="lsti0180">•Non-cardiovascular death: related to any other medical condition (trauma, cancer, suicide, etc.)</li><li class="elsevierStyleListItem" id="lsti0185">•Definition of myocardial infarction</li></ul> 2.1. Perioperative myocardial infarction (within 72h), defined as the association of any of the following events:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0190">•New symptoms (typical chest pain or shortness of breath) or signs (ventricular arrhythmias, worsening signs of heart failure, new ST-segment changes, haemodynamic instability, new Q waves in at least 2 contiguous leads, loss of viable myocardium on imaging studies, or new alterations in regional contractility) of ischaemia.</li><li class="elsevierStyleListItem" id="lsti0195">•Elevation of biomarkers (preferably troponin I and CK-MB) in the first 72h: values in excess of 15 times the upper limit of normal of troponin I and 5 times the upper limit of CK-MB in any sample analyzed within 72h. If markers were already above the 99th percentile at baseline, an increase of at least 50% post-procedure is needed for a positive finding.</li></ul> 2.2. Myocardial infarction after the first 72h, defined by any of the following criteria:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0200">•Elevation of biomarkers (preferably troponin I), with at least 1 of the values above the 99th percentile, with evidence of myocardial ischaemia, as defined below</li><li class="elsevierStyleListItem" id="lsti0205">•Ischaemic symptoms</li></ul> ECG changes indicative of ischaemia, such as new left bundle branch block and ST segment changes<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0210">•New pathological Q waves in at least 2 contiguous leads</li><li class="elsevierStyleListItem" id="lsti0215">•Loss of viable myocardium on imaging studies or new alterations in regional contractility</li><li class="elsevierStyleListItem" id="lsti0220">•Death due to sudden cardiac arrest preceded by symptoms suggestive of myocardial infarction accompanied by, presumably, ST-segment elevation or new left bundle branch block and evidence of fresh thrombus on coronary angiography and/or autopsy</li><li class="elsevierStyleListItem" id="lsti0225">•Path lab findings of acute myocardial infarction</li></ul> Stroke, infarction or transient ischaemic attack: defined as global or focal neurological dysfunction caused by cerebral, spinal or retinal vascular injury caused by haemorrhage or infarction. Confirmation of diagnosis by at least one of the following:<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0230">•Neurologist. Can be diagnosed simply by clinical signs</li><li class="elsevierStyleListItem" id="lsti0235">•By imaging technique: computed tomography or magnetic resonance imaging</li></ul> Major bleeding, defined as one of the following<a class="elsevierStyleCrossRef" href="#bib0365">34</a>: bleeding associated with a reduction in the haemoglobin concentration of at least 3g/dL or requiring transfusion of 2 or 3 packed red blood cells; or bleeding requiring surgical revision that does not meet the criteria for life-threatening bleeding. Acute kidney injury,<a class="elsevierStyleCrossRef" href="#bib0370">35</a> defined as a 2-fold increase in baseline serum creatinine or serum creatinine >4mg/dL with a sharp increase of at least 0.5mg/dL or urine output <0 3ml/kg/h lasting >24h or anuria lasting >12h, and patients requiring renal replacement therapy. Conduction abnormalities and arrhythmias that cause haemodynamic instability or require therapy.<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0240">•Pulmonary complications: intubation >48h, need for tracheostomy, postoperative pneumonia defined as the presence of new or progressive pulmonary infiltrates with signs of systemic infection (leucocytosis, fever), changes in sputum characteristics and detection of a causal microbiological agent,<a class="elsevierStyleCrossRefs" href="#bib0375">36–38</a> or acute respiratory distress syndrome<a class="elsevierStyleCrossRef" href="#bib0390">39</a> defined as hypoxaemia (Pa O2/FIO2 ≤300mmHg), radiological pulmonary infiltrates, respiratory system compliance ≤40mL/cmH2O, need for PEEP ≥10cmH2O and an adjusted respiratory minute volume of ≥10L/min</li></ul> Reoperation for bleeding or tamponade during the immediate postoperative period. Surgical wound infection: superficial and deep." "etiqueta" => "Appendix 1" "titulo" => "Study variables, data, events and complications" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1164 "Ancho" => 1658 "Tamanyo" => 164074 ] ] "descripcion" => array:1 [ "en" => "Distribution of coronary surgery (off-pump and on-pump) in octogenarians during the study period." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1799 "Ancho" => 1632 "Tamanyo" => 89122 ] ] "descripcion" => array:1 [ "en" => "Cumulative survival in study octogenarians during the study period." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AMI: acute myocardial infarction; COPD: chronic obstructive pulmonary disease; DM: diabetes mellitus; EF: ejection fraction; HTN: hypertension; PTCA: percutaneous transluminal coronary angioplasty.Data expressed as number (percentage) of patients; mean±standard deviation; or percentage" "tablatextoimagen" => array:1 [ 0 => array:2 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group (n=2998) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Over-80 group (n=99) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2423 (80.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71 (71.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.2±9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82.5±3.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Additive Euroscore \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.6±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.4±4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1663 (55.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 (74.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1852 (61.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 (74.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1294 (43.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">448 (14.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic kidney failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">157 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1750 (58.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">374 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extracardiac artery disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">439 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carotid involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">139 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Expedited/emergency surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1022 (34.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (45.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unstable angina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1273 (42.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (54.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous AMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1233 (41.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous PTCA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">242 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous thrombolysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous EF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.3±17.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.2±9.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multivessel disease (≥3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403323.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Preoperative characteristics." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AF: atrial fibrillation; AKF: acute kidney failure; AV: atrioventricular; CHF: congestive heart failure; HD: haemodialysis; PO: Perioperative; TIA: transient ischaemic attack.Data expressed as number (percentage) of patients; mean±standard deviation" "tablatextoimagen" => array:1 [ 0 => array:2 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group (n=2998) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Over-80 group (n=99) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemodynamic complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AV block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PO infarction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiogenic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psychomotor agitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">348 (11.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atelectasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumothorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CKD without HD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">148 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CKD with HD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reoperation for bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infectious complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary tract infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bacteraemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical wound complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403320.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Statistical significance" ] ] ] "descripcion" => array:1 [ "en" => "Preoperative morbidity." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data expressed as number (percentage) of patients." "tablatextoimagen" => array:1 [ 0 => array:2 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cause of death \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group (n=2998) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Over-80 group (n=99) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Major bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Digestive (intestinal ischaemia) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403321.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Causes of death." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AF: atrial fibrillation; AMI: acute myocardial infarction; CABG: isolated coronary artery bypass surgery; CV: cardiovascular; IABP: intra-aortic balloon pump; M: man; PO RRT: postoperative renal replacement therapy; W: woman." "tablatextoimagen" => array:1 [ 0 => array:2 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of grafts \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cause of death \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Off-pump/on-pump \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dual antiplatelet therapy before surgery<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reoperation for bleeding \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cardiovascular complications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PO RRT \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perioperative AMI+cardiogenic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perioperative AMI+cardiac rupture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perioperative AMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cardiogenic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cardiogenic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Major bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypovolaemic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Respiratory (bronchoaspiration) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Scheduled \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Scheduled \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Off-pump \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Scheduled \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IABP Left femoral thrombosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403322.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Dual antiplatelet therapy: no suspension of clopidogrel at least 5 days before surgery." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Tirofiban+acetylsalicylic acid administered up to 4h before surgery." ] ] ] "descripcion" => array:1 [ "en" => "Mortality in over-80 group patients." ] ] 6 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "HR: hazard ratio; 95% CI: 95% confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">30-Day mortality, HR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Major cardiovascular complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 (1.1–12.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reoperation for bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 (1.6–19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403324.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Cox regression multivariate analysis of mortality in the over-80 group." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:39 [ 0 => array:3 [ "identificador" => "bib0200" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub 2002/05/22]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival after coronary revascularization in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. 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Original Article

Mortality in isolated coronary artery bypass surgery in elderly patients. A retrospective analysis over 14 years

Mortalidad de nla cirugía coronaria aislada en octogenarios. Análisis restrospectivo de 14 años

P. Carmona Garcíaa,

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paulac_g@hotmail.com

Corresponding author.

, E. Mateob, F. Horneroc, M. López Canteroa, I. Zarragoikoetxeaa

a Departamento de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain

b Departamento de Anestesiología y Reanimación, Consorcio Hospital General de Valencia, Valencia, Spain

c Departamento de Cirugía Cardiovascular, Consorcio Hospital General de Valencia, Valencia, Spain

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of coronary surgery &#40;off-pump and on-pump&#41; in octogenarians during the study period&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease is the leading cause of morbidity and mortality in the elderly&#46; Because coronary heart disease is more severe in this subgroup of patients and the benefit of revascularization is greater&#44; elderly patients are often referred for coronary revascularization&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a> The choice of the best revascularization method &#40;surgical or percutaneous &#91;PTCA&#93;&#41; is more complicated in the elderly than in their younger counterparts&#46; Although coronary artery bypass grafting &#40;CABG&#41; carries a higher risk in elderly patient&#44; mortality among this group in recent decades has decreased from 12&#37; to 2&#46;6&#37;&#44; according to some published series&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#8211;4</span></a> Advances and improvements in perioperative and postoperative techniques &#40;internal mammary artery grafts&#44; better myocardial protection&#44; better postoperative management<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">5&#44;6</span></a>&#41; could explain this trend&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Randomized trials have shown the benefits of coronary surgery in high-risk patients&#44; with greater long-term survival&#44; and a 2- to 4-fold greater likelihood of recurrent angina and need for repeat revascularization in the subgroup of patients undergoing PTCA&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">7&#8211;11</span></a> Meta-analyses of these studies have confirmed these results&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">12&#8211;14</span></a> There is evidence that CABG has a greater impact on long-term survival in elderly patients&#44; at the expense of a higher incidence of strokes and greater perioperative morbidity compared with PTCA&#44; which is a far less invasive technique&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Since individuals over 80 are high-risk patients with considerable postoperative morbidity and mortality&#44; we need to identify both the factors related to morbidity and mortality and the results obtained by each hospital this subgroup of patients&#46; A good preoperative assessment&#44; administration of the best therapy based on existing guidelines and individual risk factors&#44; and early detection of immediate complications are essential if we are to improve the level of care given to this high-risk group&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study is to analyze perioperative outcomes&#44; long-term survival and predictors of early mortality in a cohort of patients aged over 80 years undergoing CABG surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study was approved by the hospital&#39;s Independent Ethics Committee &#40;number 869&#41;&#46; This is a retrospective cohort study of data from a consecutive series of patients undergoing isolated CABG surgery from 1999 to 2013&#46; The data were drawn from prospectively collected data in the PALEX DATA &#40;Palex Medical&#44; Barcelona&#44; Spain&#41; database compiled by the Cardiac Surgery Service&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients aged over 18 years undergoing scheduled and urgent off-pump and on-pump CABG from 1999 to 2013&#46; The surgical technique &#40;off-pump or on-pump&#41; was decided by the surgical team&#46; Exclusion criteria were&#58; patients undergoing concomitant heart valve or thoracic aorta surgery and&#47;or reoperations&#46; Patients aged 80 years or older were identified from the data set and included as a subgroup in the study&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical technique</span><p id="par0035" class="elsevierStylePara elsevierViewall">In patients undergoing on-pump CABG&#44; cardiopulmonary bypass &#40;CPB&#41; was established by cannulation of the ascending aorta and right atrium&#46; Non-pulsatile coronary pulmonary bypass was performed using alpha-stat blood gas management strategies&#44; cold cardioplegic solution was infused at moderate systemic hypothermia &#40;32&#8211;34<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; and the flow rate was adjusted to achieve a mean arterial pressure of between 60 and 80<span class="elsevierStyleHsp" style=""></span>mmHg&#46; The membrane oxygenator was primed with 1000<span class="elsevierStyleHsp" style=""></span>ml crystalloid solution&#44; 500<span class="elsevierStyleHsp" style=""></span>ml of gelfundin<span class="elsevierStyleSup">&#174;</span> &#40;B&#46; Braun Melsungen AG&#44; Melsungen&#44; Germany&#41;&#44; 250<span class="elsevierStyleHsp" style=""></span>ml of 20&#37; mannitol and 5000<span class="elsevierStyleHsp" style=""></span>IU heparin&#46; The myocardium protection was achieved with intermittent antegrade and retrograde hyperkalaemic cardioplegia&#46; In the case of off-pump revascularization&#44; adjustable stabilizers were used to expose the coronary arteries&#44; thus facilitating anastomosis by improving visibility and stability&#46; Heparin at a dose of 300<span class="elsevierStyleHsp" style=""></span>IU&#47;kg was administered for on-pump procedures and 150<span class="elsevierStyleHsp" style=""></span>IU&#47;kg for off-pump surgery&#46; The activated clotting time was maintained above 400<span class="elsevierStyleHsp" style=""></span>s for on-pump surgery and above 300<span class="elsevierStyleHsp" style=""></span>s for off-pump surgery&#46; The effect of heparin was reversed with protamine sulphate at a ratio of 1&#58;1&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Anaesthetic technique</span><p id="par0040" class="elsevierStylePara elsevierViewall">Anaesthesia was induced with midazolam&#44; fentanyl&#44; etomidate and cisatracurium or rocuronium&#46; It was maintained with sevoflurane and intravenous infusion of remifentanil&#46; Morphine chloride was given for analgesia in the immediate postoperative period&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Haemodynamic monitoring consisted of invasive blood pressure measurements&#44; central venous pressure&#44; transoesophageal echocardiography determined by the attending anaesthetist&#44; pulse oximetry&#44; 5-lead electrocardiogram and computerized ST segment analysis&#46; Nasopharyngeal temperature was measure&#44; and diuresis was recorded hourly&#46; Respiratory monitoring included end-tidal CO<span class="elsevierStyleInf">2</span> and inspiratory and expiratory sevoflurane concentration&#44; and a peak flow metre was used to monitor airway volumes and pressures&#46; Depth of anaesthesia was monitored using the bispectral index &#40;BIS<span class="elsevierStyleSup">&#174;</span>&#44; Covidien&#44; Boulder&#44; CO&#44; USA&#41;&#44; and brain metabolism in patients undergoing on-pump surgery was determined by cerebral oxygen saturation measured at the right or left temporal area &#40;INVOS<span class="elsevierStyleSup">&#174;</span>&#44; Covidien&#44; Boulder&#44; CO&#44; USA&#41;&#46; After completion of the surgery&#44; patients were admitted to the post-anaesthesia care unit where they underwent protocolized early extubation&#46; They were taken to the hospital ward once discharge criteria had been met&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Perioperative morbidity during hospitalization&#44; all-cause surgery-related mortality during hospitalization and at 30 days&#44; and length of hospital and ICU stay were analyzed&#46; Crude survival and mortality rates during the study period were retrieved from the Spanish National Health System database&#46; The study period was divided into 2 bands&#58; 1&#44; from 1999 to 2005 and another from 2006 to 2013&#46; The bands are defined in <a class="elsevierStyleCrossRef" href="#sec0065">Appendix 1</a>&#46; Perioperative predictors of 30-day mortality were analyzed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Descriptive variables&#44; namely&#44; mortality&#44; greater perioperative morbidity and hospital stay recorded from cases and controls were tested statistically&#46; Descriptive data are shown as percentages and mean &#40;SD&#41; or median &#40;interquartile range&#41;&#46; Quantitative variables were tested using Student&#39;s <span class="elsevierStyleItalic">t</span>-test or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#44; while the chi square or Fisher exact test were used for categorical variables&#46; A <span class="elsevierStyleItalic">p</span> value of &#60;0&#46;05 was considered statistically significant&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Thirty-day mortality was also tested using univariate and multivariate Cox regression in order to detect independent predictors for the subgroup of patients aged over 80 years&#46; Data with a <span class="elsevierStyleItalic">p</span> value of &#60;0&#46;1 from the univariate analysis were included in the Cox regression multivariate model&#46; The results of the univariate and multivariate Cox regression and the stepwise method are shown as regression coefficient &#40;<span class="elsevierStyleItalic">B</span>&#41;&#44; regression coefficient significance level&#44; and predicted hazard ratio&#44; with a 95&#37; confidence interval for each variable included in the model&#46; To avoid collinearity&#44; variables that could clinically be related were not entered into the same model&#46; Kaplan&#8211;Meier survival curves were used to estimate long-term survival&#46; Statistical analysis was performed on SPSS<span class="elsevierStyleSup">&#174;</span> version 20&#46;0&#46;1&#46; &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Ninety-nine patients aged over 80 years &#40;over-80 group&#41;&#44; with an average age of 82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5 years&#44; and 2998 patients aged under 80 years &#40;control group&#41;&#44; with a mean age of 64&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 years&#44; were identified among patients undergoing CABG&#46; The over-80 population accounted for 3&#46;1&#37; of the total population of our sample&#46; Among the over-80s&#44; additive EuroSCORE was 8&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&#44; showing a preponderance of arterial hypertension &#40;75&#46;4&#37;&#41; and history of smoking &#40;74&#46;5&#37;&#41;&#59; 28&#46;6&#37; were women &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Off-pump CABG was performed in 78&#46;8&#37; of patients&#44; with a mean of 2&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8 grafts&#44; mostly involving the anterior descending coronary artery &#40;98&#37;&#41;&#44; with arterial grafts performed in 92&#46;9&#37; of patients&#46; Thirty-day mortality was 11&#46;2&#37;&#46; The study period was divided into 2 bands&#58; 1&#44; from 1999 to 2005 and another from 2006 to 2013&#46; Mortality in the over-80 group did not differ between periods&#58; 9&#46;1&#37; vs&#46; 12&#46;1&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Mean ICU stay was 4&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;1 days&#44; and mean hospital stay was 9&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;0 days&#46; Patients in the over-80 group underwent reoperation for bleeding in 9&#46;2&#37; vs&#46; 2&#46;9&#37; of cases &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and presented a higher incidence of major cardiovascular complications &#40;acute perioperative myocardial infarction&#44; AV block&#44; heart failure and cardiogenic shock&#41;&#58; 6&#46;1&#37; vs&#46; 2&#46;1&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Neurological&#44; respiratory&#44; kidney and infectious complications did not differ significantly between groups&#58; 3&#46;1&#37; vs&#46; 3&#46;1&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#41;&#44; 9&#46;1&#37; vs&#46; 11&#46;6&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#41;&#44; 6&#46;1&#37; vs&#46; 6&#46;1&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#41;&#44; and 2&#46;1&#37; vs&#46; 2&#46;5&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#41; in the over-80 group vs&#46; controls&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Overall causes of death are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Slightly over half &#40;54&#46;5&#37;&#41; of non-survivors in over-80 group had been reoperated for bleeding in the immediate postoperative period &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; All &#40;100&#37;&#41; reoperated patients were from the off-pump CABG group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41;&#59; of these&#44; 56&#37; were men&#46; Among patients aged <span class="elsevierStyleMonospace">&#62;</span>80 years who died&#44; 7 were receiving dual antiplatelet therapy&#59; of these&#44; 5 underwent urgent CABG and 2 expedited CABG for severe coronary artery lesion&#46; Four of the non-survivors receiving dual antiplatelet therapy were reoperated for bleeding&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Duration of CPB and cardiac ischaemia in patients undergoing on-pump revascularization was 128&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;1 and 69&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>min&#44; respectively&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The distribution of CABG patients in the over-80 group over the study is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; A gradual increase in over-80 patients undergoing isolated CABG can be observed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Mean follow-up was 6&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2 years for the over-80 group&#46; Accumulated survival rate of these patients during follow-up was 65&#46;7&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In the univariate analysis&#44; statistically significant predictors of 30-day mortality were&#58; reoperation for bleeding &#40;hazard ratio 9&#46;4&#59; 95&#37; CI 2&#8211;43&#46;5&#41; and major haemodynamic complications &#40;hazard ratio 24&#46;2&#59; 95&#37; CI 3&#46;7&#8211;156&#46;6&#41;&#46; In the Cox regression multivariate analysis&#44; independent perioperative predictors of mortality were also reoperation for bleeding and major haemodynamic complications &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This analysis of a cohort of patients undergoing CABG over a period of 14 years shows that individuals aged over 80 years present significant perioperative mortality&#44; with a high incidence of major cardiovascular complications and reoperation for bleeding&#46; We observed that off-pump CABG is more frequent in this subgroup of patients&#46; Independent predictors of mortality in the over-80 group were major cardiovascular complications and reoperation for postoperative bleeding&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The aim of this study was not to compare surgical techniques &#40;off-pump or on-pump&#41; or to compare this small cohort with the cohort of younger patients &#40;which differs greatly in characteristics and size&#41;&#44; but rather to show the characteristics that make this population more vulnerable and detect predictors of mortality that can help optimize their management and improve surgical outcomes&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In our series&#44; patients over 80 years accounted for 3&#46;1&#37; of all patients undergoing CABG surgery&#46; Due to the increasing number of octogenarian patients in our setting&#44; the Consensus Document of the Spanish Societies of Cardiology&#44; Internal Medicine&#44; Primary Care&#44; and Geriatrics<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a> calls for specialists to be familiar with the perioperative morbidity and mortality that characterize this population&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the 2013 database of the Spanish Society for Thoracic-Cardiovascular Surgery &#40;SECTCV&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">16</span></a> 4&#46;6&#37; of all patients undergoing coronary surgery were aged over 80 years&#46; As age increases&#44; so does hospital mortality&#44; and according to the foregoing database the risk of hospital death is now 3 times higher in the over-80s compared to younger patients &#40;OR 2&#46;7&#59; 95&#37; CI 1&#46;9&#8211;4&#46;0&#41;&#46; The crude hospital mortality rate for women is clearly higher in cardiac surgery performed in the over-80 age group&#58; 9&#46;2&#37; &#40;95&#37; CI 4&#46;9&#8211;16&#46;2&#41; vs&#46; 7&#46;4&#37; &#40;95&#37; CI 4&#46;7&#8211;11&#46;2&#41; in women vs&#46; men&#44; respectively&#46; Our results largely echo those of the national registry&#44; with an OR of 3&#46;5 &#40;95&#37; CI&#44; 1&#46;8&#8211;6&#46;8&#41; for the over-80 age group&#46; In the European register&#44; crude mortality in patients over 80 was 6&#46;7&#37;&#44; and is also higher in women &#40;7&#46;5&#37; vs&#46; 6&#46;3&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a> In our series mortality in women is also higher &#40;17&#46;8&#37; vs&#46; 8&#46;4&#37;&#41; for this age group&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The mortality rate observed in our over-80 group is consistent with the EuroSCORE for our study group&#46; In this study&#44; risk predictors are limited to the over-80 group&#59; other studies<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">17&#8211;19</span></a> have described predictors in larger populations&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">According to the SECTCV report&#44; advanced age was not a factor in the choice of vascular grafts in octogenarian patients&#44; and in 90&#37; of patients at least 1 arterial graft was used&#44; as was the case in our series&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The choice of off-pump or on-pump CABG in this group of patients with high comorbidity has not so far been studied in randomized trials&#46; Although none of the randomized clinical trials or meta-analyses published to date have shown a clear benefit or statistically significant difference in short-term mortality for off-pump vs&#46; conventional CABG&#44; it is widely believed that octogenarians and higher risk patients could benefit more from off-pump surgery&#46; In our patients&#44; mortality occurs in the off-pump CABG group &#40;in our centre&#44; it is up to the surgeon to choose the surgical technique&#41;&#59; however&#44; this may be due to our small sample size and the fact that most patients in the over-80 group underwent off-pump CABG&#44; and we were therefore unable to establish off-pump or on-pump CABG as the cause of death&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Randomized trials comparing medical treatment with percutaneous revascularization have included subgroups of patients aged over 65 and 70 years&#46; Authors&#44; such as Graham et al&#46; in their observational APPROACH study&#44; have reported a 1-year mortality rate of 12&#37;&#44; although 4-year survival in patients aged over 80 years undergoing CABG was 77&#46;8&#37;&#44; higher than that obtained with percutaneous revascularization &#40;71&#46;5&#37;&#41; and medical therapy &#40;60&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a> The authors conclude that&#44; paradoxically&#44; elderly patients have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients&#46; More recent series&#44; however&#44; report a far lower rate of early mortality in patients aged over 75 years than that observed in our series&#46; A study in point is that of Diegeler et al&#46;&#44; with a mortality rate of 2&#46;6&#37; in this subgroup of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">4</span></a> Our long-term crude mortality rate is similar to that found in the literature&#44; with a 5-year survival rate of 65&#46;7&#37;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">One of the most interesting issues analyzed in our study is reoperation for bleeding as an independent predictor of mortality in this subgroup of patients&#46; Major perioperative bleeding has been described in the literature as an independent predictor of mortality&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">20</span></a> while age&#44; history of kidney disease&#44; liver disease&#44; female sex and body mass index are factors that increase the likelihood of postoperative bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a> The high prevalence of bleeding could also be related to the urgency of the surgery and the administration of dual antiplatelet therapy immediately prior to the intervention&#46; The recommendation to maintain acetylsalicylic acid until the day of surgery&#44; found in most guidelines&#44; could have a major impact in this age subgroup&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> In our series&#44; we searched the medical records of non-survivors to determine which had been taking antiplatelet therapy before surgery&#44; as this detail was not included in the database&#44; and found that 4 of the 7 non-survivors receiving dual antiplatelet therapy were reoperated for bleeding&#46; Observance of pre-operative antiplatelet therapy discontinuation schedules&#44; individualized assessment and careful haemostasis are important factors in the prevention of reoperation for bleeding in this particularly vulnerable population&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">One impactful aspect not included in any risk scales&#44; but increasingly assessed in this population&#44; is frailty&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> Frailty could be considered a marker of biological age&#44; it is closely related to mental status&#44; and worsens surgical outcomes&#44; regardless of age&#44; sex and comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a> Mortality following percutaneous revascularization is up to 4 times higher &#40;6&#37; vs&#46; 28&#37;&#41; in patients with a diagnosis of frailty compared to non-frail patients&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">25</span></a> The retrospective nature of our study prevented us from analysing this factor&#44; but we believe it could influence observed mortality rates&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The presence of aortic atheroma has recently been identified as the most important predictor of neurological damage&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> The risk of this condition increases in elderly patients&#46; However&#44; the indications and benefits of off-pump surgery continue to stir up much controversy in the literature&#44; and both results and methodology diverge greatly&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;18&#44;27</span></a> Given this uncertainty and the need to characterize the subgroups of patients in whom off-pump surgery<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">28&#8211;30</span></a> would be associated with lower morbidity&#44; the German Off-Pump Coronary Artery Bypass Grafting in Elderly Patients &#40;GOPCABE&#41; study set out to clarify the potential benefits of off-pump CABG in high-risk patients&#44; such as the over-70s age group&#46; The authors of the study observed no differences in either mortality or major complications&#46; Similarly&#44; Raja et al&#46;&#44; studying a group of octogenarians&#44; found no differences in morbidity and mortality between off-pump and on-pump CABG&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">31</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In our hospital&#44; the choice of off- or on-pump is up to the surgeons&#44; who base their decision on the high comorbidity observed by the professionals involved&#46; In our series of octogenarians&#44; 78&#46;8&#37; of revascularizations were performed off-pump&#44; which may explain the absence of the high rates of neurological morbidity observed in other studies in elderly patients undergoing revascularization&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The limitations of this study are those inherent to a retrospective observational study based on data from a single institution&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">We did not attempt to compare groups with very different characteristics nor compare the surgical technique&#46; Instead&#44; we focused on identifying which perioperative characteristics are associated with poorer outcomes in a subgroup that is&#44; a priori&#44; liable to present a worse prognosis&#44; and identifying the complications most likely to increase mortality in this subgroup&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The EuroSCORE was designed to assess risk in patients undergoing on-pump cardiac surgery&#44; and would therefore provide an inaccurate assessment of patients undergoing off-pump CABG&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A limited number of intraoperative variables were collected in the database&#44; and this lack of information prevented us from gaining deeper insight into morbidity and mortality&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Complications were defined according to standard criteria used in the literature&#59; however&#44; variations in these criteria could limit the extrapolation of our results&#46; In this respect&#44; in terms of technical definitions&#44; revascularization variables were based on the number of grafts performed&#44; not on the definition of the revascularization procedure using in each patient or any other revascularization integrity index&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Another limitation of our study involves our 30-day follow-up of complications and mortality&#46; This means that any fatality occurring immediately after this period may have been surgery-related&#44; but was not detected&#46; Although we performed a long-term follow-up of the cohort of octogenarians&#44; and have data for cumulative survival over medium-term follow-up&#44; do not know whether the ultimate cause of death was cardiovascular or otherwise&#44; and&#44; therefore&#44; whether CABG surgery may have played a key role in the outcome&#46; Furthermore&#44; our study is susceptible to information bias due to the lack of data on postoperative bleeding and transfusion rates&#44; which in many other studies have been reported as independent risk factors for increased morbidity and mortality&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Details of antiplatelet therapy administered prior to CABG are not available on the database&#59; this treatment was only retrieved from the medical records of non-survivors&#46; An analysis of the type and time of withdrawal of antiplatelet therapy in all patients could have provided more data for our mortality analysis&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Similarly&#44; preoperative blood workup details&#44; such as haemoglobin and haematocrit&#44; are not included in our database&#46; Other studies have shown that these factors&#44; particularly in octogenarians&#44; have an impact on morbidity and mortality&#46; Guidelines recommend optimizing perioperative anaemia&#44; particularly in this patient group&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Another factor that could cause bias is the study period&#59; this was extensive&#44; and both surgical techniques and perioperative management have changed significantly in this time&#46; Moreover&#44; the learning curve inherent to any technique&#44; and the involvement of resident surgeons is always a factor to consider in these studies&#46; Due to the small size of the over-80 group&#44; we did not perform a subanalysis to compare outcomes between octogenarians undergoing on-pump vs&#46; off-pump CABG&#44; as no firm conclusions could have been drawn from these outcomes&#44; and they could have been confounding factors in our statistical analysis&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In conclusion&#44; mortality among octogenarian patients is high relative to a higher incidence of reoperations for bleeding and postoperative cardiovascular complications&#46; Reoperation for bleeding and cardiovascular complications are independent predictors of mortality&#46; Measures to reduce postoperative bleeding and careful surgical haemostasis could considerably reduce mortality&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of human and animal rights</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with those of the World Health Organization and the Helsinki Declaration&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Data confidentiality</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interests</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest with respect to the information provided in the article&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From January 1999 to June 2013&#44; 3097 patients underwent consecutive coronary artery bypass graft surgery&#46; Patients aged over 80 years were identified&#46; Multivariate survival analysis using Cox&#39;s regression model was performed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We identified 99 patients older than 80 years &#40;80-group&#59; mean age 82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5 years&#41; and 2957 younger than 80 years &#40;control group&#41; &#40;mean age 64&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 years&#41;&#46; Additive EuroSCORE was 8&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8 and 4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41; in the 80-group vs&#46; control group&#44; respectively&#46; Off-pump coronary artery bypass graft was performed in 79&#46;6 vs&#46; 41&#46;6&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41; in the 80-group vs&#46; the control group&#44; respectively&#46; There was significantly higher 30 day-mortality in the 80-group&#44; 11&#46;2 vs&#46; 3&#46;3&#37;&#44; respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41;&#46; Patients in the 80-group underwent reintervention for bleeding more frequently &#40;9&#46;2 vs&#46; 2&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41; and had a higher incidence of major cardiovascular complications than the control group &#40;6&#46;1 vs&#46; 2&#46;1&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41;&#46; Independent predictors of mortality for the 80-group were&#58; reoperation for bleeding &#40;HR 5&#46;7&#59; 95&#37; CI 1&#46;6&#8211;19&#46;5&#41; and cardiovascular complications &#40;HR 3&#46;7&#59; 95&#37; CI 1&#46;1&#8211;12&#46;2&#41;&#46; The mean follow-up was 6&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2 years for the octogenarian group&#46; The cumulative survival of these patients was 65&#46;7&#37; during the study period&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Coronary artery bypass graft is performed preferably in patients over 80 years old under the off-pump procedure&#46; Mortality is higher in this group of patients probably related to a higher incidence of cardiovascular complications and reintervention for bleeding in the immediate postoperative period&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es describir nuestra experiencia en la cirug&#237;a de revascularizaci&#243;n coronaria aislada en pacientes mayores de 80 a&#241;os e identificar los riesgos espec&#237;ficos y predictores de mortalidad precoz&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Entre enero de 1999 y junio de 2013&#44; 3&#46;097 pacientes fueron sometidos a cirug&#237;a de revascularizaci&#243;n coronaria aislada&#46; Se analizaron los pacientes mayores de 80 a&#241;os de edad&#46; Se realiz&#243; una regresi&#243;n mutivariante de Cox para predictores de mortalidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 99 pacientes mayores de 80 a&#241;os &#40;grupo-80&#59; edad media 82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5 a&#241;os&#41; y 2&#46;957 menores de 80 a&#241;os &#40;grupo control&#59; edad media 64&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;7 a&#241;os&#41;&#46; El EuroSCORE aditivo fue 8&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;8 y 4&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en los<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os vs&#46;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os&#44; respectivamente&#46; La cirug&#237;a sin CEC se realiz&#243; en el 79&#44;6&#37; en el grupo-80 a&#241;os&#46; La mortalidad a los 30 d&#237;as en el grupo-80 fue significativamente superior&#44; del 11&#44;2 vs&#46; 3&#44;3&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El grupo-80 se reintervino por sangrado m&#225;s frecuentemente &#40;9&#44;2 vs&#46; 2&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y tuvieron con mayor frecuencia complicaciones cardiovasculares mayores &#40;6&#44;1 vs&#46; 2&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los predictores independientes de mortalidad a 30 d&#237;as fueron&#58; la reintervenci&#243;n por sangrado &#40;HR 5&#44;7&#59; IC 95&#37; 1&#44;6-19&#44;5&#41; y las complicaciones cardiovasculares mayores &#40;HR 3&#44;7&#59; IC 95&#37; 1&#44;1-12&#44;2&#41;&#46; El seguimiento medio del grupo-80 fue de 6&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;2 a&#241;os&#44; con una supervivencia acumulada de estos pacientes del 65&#44;7&#37; durante el periodo de estudio&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a de revascularizaci&#243;n coronaria aislada se realiza preferentemente en pacientes mayores de 80 a&#241;os sin CEC&#46; Presentan una mayor incidencia de complicaciones cardiovasculares&#44; reintervenciones por sangrado en el postoperatorio inmediato y una mortalidad m&#225;s elevada&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Carmona Garc&#237;a P&#44; Mateo E&#44; Hornero F&#44; L&#243;pez Cantero M&#44; Zarragoikoetxea I&#46; Mortalidad de nla cirug&#237;a coronaria aislada en octogenarios&#46; An&#225;lisis restrospectivo de 14 a&#241;os&#46; Rev Esp Anestesiol Reanim&#46; 2017&#59;64&#58;262&#8211;272&#46;</p>"
      ]
    ]
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            "apendice" => "<p id="par0235" class="elsevierStylePara elsevierViewall">Preoperative variables analyzed<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0240" class="elsevierStylePara elsevierViewall">Age</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Sex</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Additive Euroscore</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Smoking history</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Presence of cardiovascular risk factors&#58; hypertension&#44; dyslipidaemia</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Type 1 and 2 diabetes mellitus</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0270" class="elsevierStylePara elsevierViewall">History of stroke</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease treated with long-term bronchodilators or inhaled or oral corticosteroids&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Previous episodes of congestive heart failure</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Acute myocardial infarction before surgery</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0290" class="elsevierStylePara elsevierViewall">History of previous percutaneous revascularization with angioplasty or fibrinolysis</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0295" class="elsevierStylePara elsevierViewall">NYHA functional class</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0300" class="elsevierStylePara elsevierViewall">Peripheral vascular disease&#44; defined as the presence of intermittent claudication of the lower limbs&#44; over 50&#37; occlusion of the carotid artery&#44; amputation due to artery disease&#44; undergoing or scheduled for surgery involving the abdominal aorta or lower limb arteries</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0305" class="elsevierStylePara elsevierViewall">Chronic renal failure&#44; defined as preoperative creatinine &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and&#47;or need for preoperative haemodialysis</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Immunocompromised</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0315" class="elsevierStylePara elsevierViewall">History of malignant ventricular arrhythmias</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Pacemaker-dependent</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Number of affected coronary vessels</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Priority surgery&#46; Urgent surgery is defined surgery performed in hospitalized patients that require intervention or surgery during their current hospital stay for medical reasons&#46; These patients cannot be discharged home without a definitive procedure&#46; Emergency surgery is defined surgery that is performed before the start of the next working day following the decision to operate&#46;</p></li></ul></p> <p id="par0335" class="elsevierStylePara elsevierViewall">Intraoperative<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0340" class="elsevierStylePara elsevierViewall">Type of surgery performed&#58; off-pump or on-pump</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">&#8226;</span><p id="par0345" class="elsevierStylePara elsevierViewall">Number of grafts performed</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">&#8226;</span><p id="par0350" class="elsevierStylePara elsevierViewall">Revascularization of the anterior descending artery</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">&#8226;</span><p id="par0355" class="elsevierStylePara elsevierViewall">Revascularization with mammary artery graft</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">&#8226;</span><p id="par0360" class="elsevierStylePara elsevierViewall">Time on pump and aortic clamping time</p></li></ul></p> <p id="par0365" class="elsevierStylePara elsevierViewall">Postoperative morbidity and mortality &#40;see definitions in section 4&#41;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">&#8226;</span><p id="par0370" class="elsevierStylePara elsevierViewall">All-cause or in-hospital 30-day mortality</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">&#8226;</span><p id="par0375" class="elsevierStylePara elsevierViewall">Clinical complications</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">&#8226;</span><p id="par0380" class="elsevierStylePara elsevierViewall">Hospital stay &#40;days&#41;&#58; ICU stay and hospital stay</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">&#8226;</span><p id="par0385" class="elsevierStylePara elsevierViewall">Survival during follow-up</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">&#8226;</span><p id="par0390" class="elsevierStylePara elsevierViewall">Definition of dependent clinical variables or outcomes<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a></p></li></ul></p> <p id="par0395" class="elsevierStylePara elsevierViewall">Perioperative mortality&#44; defined as all-cause 30-day mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">16</span></a> Classified as being due to cardiovascular or non-cardiovascular causes&#46;</p> <p id="par0400" class="elsevierStylePara elsevierViewall">Death from cardiovascular causes&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">&#8226;</span><p id="par0405" class="elsevierStylePara elsevierViewall">Cardiac death&#58; myocardial infarction&#44; cardiac tamponade&#44; worsening heart failure</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">&#8226;</span><p id="par0410" class="elsevierStylePara elsevierViewall">Non-cardiac death&#58; neurological events&#44; pulmonary embolism&#44; ruptured aortic aneurysm&#44; dissecting aneurysm or other vascular disease</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">&#8226;</span><p id="par0415" class="elsevierStylePara elsevierViewall">Procedure-related deaths&#44; including those related to any procedure-related complication</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">&#8226;</span><p id="par0420" class="elsevierStylePara elsevierViewall">Deaths related to valvular dysfunction</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">&#8226;</span><p id="par0425" class="elsevierStylePara elsevierViewall">Sudden or unwitnessed death</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">&#8226;</span><p id="par0430" class="elsevierStylePara elsevierViewall">Death from unknown causes</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">&#8226;</span><p id="par0435" class="elsevierStylePara elsevierViewall">Non-cardiovascular death&#58; related to any other medical condition &#40;trauma&#44; cancer&#44; suicide&#44; etc&#46;&#41;</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">&#8226;</span><p id="par0440" class="elsevierStylePara elsevierViewall">Definition of myocardial infarction</p></li></ul></p> <p id="par0445" class="elsevierStylePara elsevierViewall">2&#46;1&#46; Perioperative myocardial infarction &#40;within 72<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; defined as the association of any of the following events&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">&#8226;</span><p id="par0450" class="elsevierStylePara elsevierViewall">New symptoms &#40;typical chest pain or shortness of breath&#41; or signs &#40;ventricular arrhythmias&#44; worsening signs of heart failure&#44; new ST-segment changes&#44; haemodynamic instability&#44; new Q waves in at least 2 contiguous leads&#44; loss of viable myocardium on imaging studies&#44; or new alterations in regional contractility&#41; of ischaemia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0195"><span class="elsevierStyleLabel">&#8226;</span><p id="par0455" class="elsevierStylePara elsevierViewall">Elevation of biomarkers &#40;preferably troponin I and CK-MB&#41; in the first 72<span class="elsevierStyleHsp" style=""></span>h&#58; values in excess of 15 times the upper limit of normal of troponin I and 5 times the upper limit of CK-MB in any sample analyzed within 72<span class="elsevierStyleHsp" style=""></span>h&#46; If markers were already above the 99th percentile at baseline&#44; an increase of at least 50&#37; post-procedure is needed for a positive finding&#46;</p></li></ul></p> <p id="par0460" class="elsevierStylePara elsevierViewall">2&#46;2&#46; Myocardial infarction after the first 72<span class="elsevierStyleHsp" style=""></span>h&#44; defined by any of the following criteria&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0200"><span class="elsevierStyleLabel">&#8226;</span><p id="par0465" class="elsevierStylePara elsevierViewall">Elevation of biomarkers &#40;preferably troponin I&#41;&#44; with at least 1 of the values above the 99th percentile&#44; with evidence of myocardial ischaemia&#44; as defined below</p></li><li class="elsevierStyleListItem" id="lsti0205"><span class="elsevierStyleLabel">&#8226;</span><p id="par0470" class="elsevierStylePara elsevierViewall">Ischaemic symptoms</p></li></ul></p> <p id="par0475" class="elsevierStylePara elsevierViewall">ECG changes indicative of ischaemia&#44; such as new left bundle branch block and ST segment changes<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0210"><span class="elsevierStyleLabel">&#8226;</span><p id="par0480" class="elsevierStylePara elsevierViewall">New pathological Q waves in at least 2 contiguous leads</p></li><li class="elsevierStyleListItem" id="lsti0215"><span class="elsevierStyleLabel">&#8226;</span><p id="par0485" class="elsevierStylePara elsevierViewall">Loss of viable myocardium on imaging studies or new alterations in regional contractility</p></li><li class="elsevierStyleListItem" id="lsti0220"><span class="elsevierStyleLabel">&#8226;</span><p id="par0490" class="elsevierStylePara elsevierViewall">Death due to sudden cardiac arrest preceded by symptoms suggestive of myocardial infarction accompanied by&#44; presumably&#44; ST-segment elevation or new left bundle branch block and evidence of fresh thrombus on coronary angiography and&#47;or autopsy</p></li><li class="elsevierStyleListItem" id="lsti0225"><span class="elsevierStyleLabel">&#8226;</span><p id="par0495" class="elsevierStylePara elsevierViewall">Path lab findings of acute myocardial infarction</p></li></ul></p> <p id="par0500" class="elsevierStylePara elsevierViewall">Stroke&#44; infarction or transient ischaemic attack&#58; defined as global or focal neurological dysfunction caused by cerebral&#44; spinal or retinal vascular injury caused by haemorrhage or infarction&#46; Confirmation of diagnosis by at least one of the following&#58;<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0230"><span class="elsevierStyleLabel">&#8226;</span><p id="par0505" class="elsevierStylePara elsevierViewall">Neurologist&#46; Can be diagnosed simply by clinical signs</p></li><li class="elsevierStyleListItem" id="lsti0235"><span class="elsevierStyleLabel">&#8226;</span><p id="par0510" class="elsevierStylePara elsevierViewall">By imaging technique&#58; computed tomography or magnetic resonance imaging</p></li></ul></p> <p id="par0515" class="elsevierStylePara elsevierViewall">Major bleeding&#44; defined as one of the following<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">34</span></a>&#58; bleeding associated with a reduction in the haemoglobin concentration of at least 3<span class="elsevierStyleHsp" style=""></span>g&#47;dL or requiring transfusion of 2 or 3 packed red blood cells&#59; or bleeding requiring surgical revision that does not meet the criteria for life-threatening bleeding&#46;</p> <p id="par0520" class="elsevierStylePara elsevierViewall">Acute kidney injury&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">35</span></a> defined as a 2-fold increase in baseline serum creatinine or serum creatinine &#62;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL with a sharp increase of at least 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL or urine output &#60;0 3<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h lasting &#62;24<span class="elsevierStyleHsp" style=""></span>h or anuria lasting &#62;12<span class="elsevierStyleHsp" style=""></span>h&#44; and patients requiring renal replacement therapy&#46;</p> <p id="par0525" class="elsevierStylePara elsevierViewall">Conduction abnormalities and arrhythmias that cause haemodynamic instability or require therapy&#46;<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0240"><span class="elsevierStyleLabel">&#8226;</span><p id="par0530" class="elsevierStylePara elsevierViewall">Pulmonary complications&#58; intubation &#62;48<span class="elsevierStyleHsp" style=""></span>h&#44; need for tracheostomy&#44; postoperative pneumonia defined as the presence of new or progressive pulmonary infiltrates with signs of systemic infection &#40;leucocytosis&#44; fever&#41;&#44; changes in sputum characteristics and detection of a causal microbiological agent&#44;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">36&#8211;38</span></a> or acute respiratory distress syndrome<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a> defined as hypoxaemia &#40;Pa O<span class="elsevierStyleInf">2</span>&#47;FIO<span class="elsevierStyleInf">2</span> &#8804;300<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; radiological pulmonary infiltrates&#44; respiratory system compliance &#8804;40<span class="elsevierStyleHsp" style=""></span>mL&#47;cmH<span class="elsevierStyleInf">2</span>O&#44; need for PEEP &#8805;10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and an adjusted respiratory minute volume of &#8805;10<span class="elsevierStyleHsp" style=""></span>L&#47;min</p></li></ul></p> <p id="par0535" class="elsevierStylePara elsevierViewall">Reoperation for bleeding or tamponade during the immediate postoperative period&#46;</p> <p id="par0540" class="elsevierStylePara elsevierViewall">Surgical wound infection&#58; superficial and deep&#46;</p>"
            "etiqueta" => "Appendix 1"
            "titulo" => "Study variables&#44; data&#44; events and complications"
            "identificador" => "sec0065"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of coronary surgery &#40;off-pump and on-pump&#41; in octogenarians during the study period&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival in study octogenarians during the study period&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AMI&#58; acute myocardial infarction&#59; COPD&#58; chronic obstructive pulmonary disease&#59; DM&#58; diabetes mellitus&#59; EF&#58; ejection fraction&#59; HTN&#58; hypertension&#59; PTCA&#58; percutaneous transluminal coronary angioplasty&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Data expressed as number &#40;percentage&#41; of patients&#59; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#59; or percentage</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2998&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Over-80 group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2423 &#40;80&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;71&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Additive Euroscore&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1663 &#40;55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HTN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1852 &#40;61&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1294 &#40;43&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">448 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">157 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1750 &#40;58&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;40&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">374 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extracardiac artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">439 &#40;14&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carotid involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Expedited&#47;emergency surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1022 &#40;34&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;45&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unstable angina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1273 &#40;42&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;54&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous AMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1233 &#40;41&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;24&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous PTCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">242 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous thrombolysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous EF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multivessel disease &#40;&#8805;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; AKF&#58; acute kidney failure&#59; AV&#58; atrioventricular&#59; CHF&#58; congestive heart failure&#59; HD&#58; haemodialysis&#59; PO&#58; Perioperative&#59; TIA&#58; transient ischaemic attack&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Data expressed as number &#40;percentage&#41; of patients&#59; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation</p>"
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                  <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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2998&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Over-80 group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Death</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Haemodynamic complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AV block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PO infarction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiogenic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Neurological complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psychomotor agitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pulmonary complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">348 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atelectasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pleural effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Kidney complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">182 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CKD without HD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CKD with HD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Reoperation for bleeding</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Infectious complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urinary tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bacteraemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Surgical wound complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Preoperative morbidity&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Data expressed as number &#40;percentage&#41; of patients&#46;</p>"
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                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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cause of death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2998&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Over-80 group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Major bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Digestive &#40;intestinal ischaemia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; AMI&#58; acute myocardial infarction&#59; CABG&#58; isolated coronary artery bypass surgery&#59; CV&#58; cardiovascular&#59; IABP&#58; intra-aortic balloon pump&#59; M&#58; man&#59; PO RRT&#58; postoperative renal replacement therapy&#59; W&#58; woman&#46;</p>"
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              "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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of grafts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cause of death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Off-pump&#47;on-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dual antiplatelet therapy before surgery<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reoperation for bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cardiovascular complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PO RRT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perioperative AMI<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cardiogenic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perioperative AMI<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cardiac rupture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perioperative AMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cardiogenic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cardiogenic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypovolaemic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Respiratory &#40;bronchoaspiration&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scheduled&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scheduled&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neurological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Off-pump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scheduled&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IABP Left femoral thrombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:39 [
            0 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "1"
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                0 => array:3 [
                  "comentario" => "&#91;Epub 2002&#47;05&#47;22&#93;"
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                    0 => array:2 [
                      "titulo" => "Survival after coronary revascularization in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Graham"
                            1 => "W&#46;A&#46; Ghali"
                            2 => "P&#46;D&#46; Faris"
                            3 => "P&#46;D&#46; Galbraith"
                            4 => "C&#46;M&#46; Norris"
                            5 => "M&#46;L&#46; Knudtson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "105"
                        "paginaInicial" => "2378"
                        "paginaFinal" => "2384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12021224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Epub 2012&#47;01&#47;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improving results for coronary artery bypass graft surgery in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; Yanagawa"
                            1 => "K&#46;D&#46; Algarni"
                            2 => "T&#46;M&#46; Yau"
                            3 => "V&#46; Rao"
                            4 => "S&#46;J&#46; Brister"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezr300"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2012"
                        "volumen" => "42"
                        "paginaInicial" => "507"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22246966"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0210"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Epub 2013&#47;06&#47;22&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The European Association for Cardio-Thoracic Surgery &#40;EACTS&#41; database&#58; an introduction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;J&#46; Head"
                            1 => "N&#46;J&#46; Howell"
                            2 => "R&#46;L&#46; Osnabrugge"
                            3 => "B&#46; Bridgewater"
                            4 => "B&#46;E&#46; Keogh"
                            5 => "R&#46; Kinsman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezt303"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2013"
                        "volumen" => "44"
                        "paginaInicial" => "e175"
                        "paginaFinal" => "e180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23786918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Epub 2013&#47;03&#47;13&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Off-pump versus on-pump coronary-artery bypass grafting in elderly patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Diegeler"
                            1 => "J&#46; Borgermann"
                            2 => "U&#46; Kappert"
                            3 => "M&#46; Breuer"
                            4 => "A&#46; Boning"
                            5 => "A&#46; Ursulescu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1211666"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "1189"
                        "paginaFinal" => "1198"
                        "link" => array:1 [
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              "etiqueta" => "5"
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2017.03.004

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