metricas
covid
Buscar en
Cirugía Cardiovascular
Toda la web
Inicio Cirugía Cardiovascular Revascularización miocárdica con uso de doble arteria mamaria interna y morbil...
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Original
Revascularización miocárdica con uso de doble arteria mamaria interna y morbilidad esternal. Experiencia de un centro
Sternal morbidity and double internal mammary artery myocardial revascularization. Experience of a single centre
Sara Badia
Autor para correspondencia
sara.badia@hotmail.com

Autor para correspondencia.
, Elisabet Berastegui, M. Luisa Cámara, Luis Delgado, Claudio Fernández, Ignasi Julià, Bernat Romero, Xavier Ruyra
Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
Leído
2940
Veces
se ha leído el artículo
630
Total PDF
2310
Total HTML
Compartir estadísticas
 array:24 [
  "pii" => "S1134009616302601"
  "issn" => "11340096"
  "doi" => "10.1016/j.circv.2016.11.049"
  "estado" => "S300"
  "fechaPublicacion" => "2017-05-01"
  "aid" => "315"
  "copyright" => "Sociedad Española de Cirugía Torácica-Cardiovascular"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Cir Cardiov. 2017;24:149-56"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 982
    "formatos" => array:3 [
      "EPUB" => 52
      "HTML" => 762
      "PDF" => 168
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1134009617300025"
    "issn" => "11340096"
    "doi" => "10.1016/j.circv.2016.12.002"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "326"
    "copyright" => "Sociedad Española de Cirugía Torácica-Cardiovascular"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Cir Cardiov. 2017;24:157-63"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2042
      "formatos" => array:3 [
        "EPUB" => 42
        "HTML" => 1440
        "PDF" => 560
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo especial</span>"
      "titulo" => "Estratificaci&#243;n de la estenosis a&#243;rtica&#58; en la integraci&#243;n juiciosa de datos est&#225; el &#233;xito"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "157"
          "paginaFinal" => "163"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Aortic stenosis stratification&#58; How to successfully join the pieces of the puzzle"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figura 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1051
              "Ancho" => 2333
              "Tamanyo" => 234651
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Imagen de score calcio mediante TC cardiaca&#46; A&#41; Visi&#243;n directa de calcio en VAo mediante TC&#46; B&#41; Cuantificaci&#243;n de calcio mediante software &#40;Score calcio&#41;&#46; En este caso de 3&#46;598 unidades Agatston&#44; indicativo de EAo severa&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Maria Mart&#237;n, Marcel Almendarez, Alberto Alperi, Cecilia Corros, V&#237;ctor Le&#243;n, David Calvo, Jes&#250;s M&#46; de la Hera"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Maria"
              "apellidos" => "Mart&#237;n"
            ]
            1 => array:2 [
              "nombre" => "Marcel"
              "apellidos" => "Almendarez"
            ]
            2 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Alperi"
            ]
            3 => array:2 [
              "nombre" => "Cecilia"
              "apellidos" => "Corros"
            ]
            4 => array:2 [
              "nombre" => "V&#237;ctor"
              "apellidos" => "Le&#243;n"
            ]
            5 => array:2 [
              "nombre" => "David"
              "apellidos" => "Calvo"
            ]
            6 => array:2 [
              "nombre" => "Jes&#250;s M&#46;"
              "apellidos" => "de la Hera"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134009617300025?idApp=UINPBA00004N"
    "url" => "/11340096/0000002400000003/v1_201705170023/S1134009617300025/v1_201705170023/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1134009616301784"
    "issn" => "11340096"
    "doi" => "10.1016/j.circv.2016.09.008"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "289"
    "copyright" => "Sociedad Espa&#241;ola de Cirug&#237;a Tor&#225;cica&#45;Cardiovascular"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Cir Cardiov. 2017;24:142-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2061
      "formatos" => array:3 [
        "EPUB" => 44
        "HTML" => 1709
        "PDF" => 308
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Cirug&#237;a coronaria con doble arteria mamaria&#58; nuestra experiencia inicial y resultados a corto plazo"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "142"
          "paginaFinal" => "148"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Bilateral internal mammary artery grafting&#58; Our initial experience and short-term outcomes"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2467
              "Ancho" => 2500
              "Tamanyo" => 535074
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Configuraciones de injertos en cirug&#237;a con doble mamaria&#46; A&#58; doble mamaria in situ con AMD prea&#243;rtica&#59; B&#58; doble mamaria in situ con AMD retroa&#243;rtica&#59; C&#58; doble mamaria con injerto compuesto en T&#59; D&#58; doble mamaria con AMD libre &#40;injerto aortocoronario&#41;&#46; AMI&#58; arteria mamaria izquierda&#59; AMD&#58; arteria mamaria derecha&#59; ADA&#58; arteria descendente anterior&#59; OM&#58; obtusa marginal&#59; ACD&#58; arteria coronaria derecha&#59; IVP&#58; arteria interventricular posterior&#59; VS&#58; vena safena&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Alcocer-Di&#233;guez, Jos&#233; Albors-Mart&#237;n, Antonio Garc&#237;a-Valent&#237;n, Eduardo T&#233;bar-Bot&#237;"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Alcocer-Di&#233;guez"
            ]
            1 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Albors-Mart&#237;n"
            ]
            2 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Garc&#237;a-Valent&#237;n"
            ]
            3 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "T&#233;bar-Bot&#237;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134009616301784?idApp=UINPBA00004N"
    "url" => "/11340096/0000002400000003/v1_201705170023/S1134009616301784/v1_201705170023/es/main.assets"
  ]
  "es" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
    "titulo" => "Revascularizaci&#243;n mioc&#225;rdica con uso de doble arteria mamaria interna y morbilidad esternal&#46; Experiencia de un centro"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "149"
        "paginaFinal" => "156"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Sara Badia, Elisabet Berastegui, M&#46; Luisa C&#225;mara, Luis Delgado, Claudio Fern&#225;ndez, Ignasi Juli&#224;, Bernat Romero, Xavier Ruyra"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Sara"
            "apellidos" => "Badia"
            "email" => array:1 [
              0 => "sara&#46;badia&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Elisabet"
            "apellidos" => "Berastegui"
          ]
          2 => array:2 [
            "nombre" => "M&#46; Luisa"
            "apellidos" => "C&#225;mara"
          ]
          3 => array:2 [
            "nombre" => "Luis"
            "apellidos" => "Delgado"
          ]
          4 => array:2 [
            "nombre" => "Claudio"
            "apellidos" => "Fern&#225;ndez"
          ]
          5 => array:2 [
            "nombre" => "Ignasi"
            "apellidos" => "Juli&#224;"
          ]
          6 => array:2 [
            "nombre" => "Bernat"
            "apellidos" => "Romero"
          ]
          7 => array:2 [
            "nombre" => "Xavier"
            "apellidos" => "Ruyra"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Cirug&#237;a Cardiaca&#44; Hospital Universitari Germans Trias i Pujol&#44; Badalona&#44; Barcelona&#44; Espa&#241;a"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Sternal morbidity and double internal mammary artery myocardial revascularization&#46; Experience of a single centre"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1341
            "Ancho" => 1690
            "Tamanyo" => 73696
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Diagrama Box-plot&#46; Comparaci&#243;n de d&#237;as de estancia postoperatorios seg&#250;n grupos 1&#58; desarrollo de infecci&#243;n superficial&#47;grupo 2&#58; no desarrollo de infecci&#243;n superficial&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El uso de arteria mamaria interna para revascularizar la arteria descendente anterior es considerado como tratamiento de elecci&#243;n en cirug&#237;a de revascularizaci&#243;n mioc&#225;rdica&#44; ya que muestra los mejores resultados a medio y largo plazo<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1-4</span></a>&#46; El uso de doble arteria mamaria se ha vuelto muy popular por este motivo<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5-9</span></a>&#44; pero&#44; no obstante&#44; est&#225; asociado a un aumento de riesgo de complicaciones esternales&#44; tales como&#58; dehiscencia esternal&#44; mediastinitis y&#47;o problemas de herida quir&#250;rgica<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">10&#44;11</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Con este estudio hemos querido analizar la frecuencia de estos problemas de herida y estern&#243;n en pacientes intervenidos en nuestro centro con uso de doble arteria mamaria y los factores de riesgo que pudieran favorecer problemas esternales&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Estudio descriptivo retrospectivo&#44; seleccionando de nuestra base de datos a 526 pacientes a los cuales se les realiz&#243; cirug&#237;a de revascularizaci&#243;n mioc&#225;rdica aislada &#40;&#171;coronarios puros&#187;&#41;&#44; utilizando ambas arterias mamarias internas&#44; con o sin otros injertos concomitantes&#46; La muestra recogida incluye a pacientes intervenidos en nuestro centro desde enero del 2001 hasta diciembre del 2015&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se ha realizado un an&#225;lisis de los siguientes factores en la muestra&#58; edad&#44; sexo&#44; hipertensi&#243;n arterial &#40;HTA&#41;&#44; diabetes mellitus &#40;DM&#41;&#44; obesidad&#44; dislipidemia &#40;DL&#41;&#44; tabaquismo&#44; enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41;&#44; accidente cerebrovascular agudo &#40;ACV&#41;&#44; insuficiencia renal &#40;IR&#41;&#44; fracci&#243;n de eyecci&#243;n de ventr&#237;culo izquierdo &#40;FEVI&#41;&#44; vasculopat&#237;a perif&#233;rica&#44; tiempo de circulaci&#243;n extracorp&#243;rea &#40;CEC&#41;&#44; tiempo de pinzamiento a&#243;rtico&#44; transfusi&#243;n de concentrados de hemat&#237;es en quir&#243;fano y durante el ingreso&#44; reintervenci&#243;n por sangrado excesivo en las primeras 24<span class="elsevierStyleHsp" style=""></span>h posquir&#250;rgicas y n&#250;mero de derivaciones coronarias realizadas&#46; Tambi&#233;n se ha analizado el EuroScore log&#237;stico <span class="elsevierStyleSmallCaps">i</span> medio de la muestra y comparado con la mortalidad obtenida&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se han analizado los datos del grupo de manera conjunta y separados por t&#233;cnica quir&#250;rgica &#40;arteria mamaria interna esqueletizada o pediculada&#41;&#44; encontr&#225;ndose muestras comparables de ambos grupos y sin encontrarse diferencias estad&#237;sticamente significativas en cuanto a resultados&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Estudiando la morbilidad esternal hemos buscado la relaci&#243;n de los factores antes descritos en aquellos pacientes que han presentado alg&#250;n tipo de complicaci&#243;n&#44; ya sea dehiscencia esternal&#44; como infecci&#243;n superficial de la herida quir&#250;rgica &#40;afectaci&#243;n de piel y&#47;o tejido celular subcut&#225;neo&#41; o infecci&#243;n profunda &#40;mediastinitis&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de dehiscencia esternal se realiz&#243; mediante criterios cl&#237;nicos&#58; dolor&#44; disnea e inestabilidad esternal palpable&#44; y se confirm&#243; mediante hallazgos quir&#250;rgicos&#44; encontr&#225;ndose uni&#243;n inadecuada de ambos bordes esternales&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de infecci&#243;n superficial de herida quir&#250;rgica se basa en criterios cl&#237;nicos &#40;problemas locales&#58; calor&#44; rubor&#44; dolor&#44; exudado&#44; dehiscencia cut&#225;nea&#41; y criterios de laboratorio&#58; leucocitosis y cultivo recogido de la herida positivo&#46; Con o sin hemocultivos positivos&#44; pero sin llegar a tener afectaci&#243;n m&#225;s all&#225; del tejido celular subcut&#225;neo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Entre las dehiscencias esternales se encontraron 2 mediastinitis&#44; consideradas infecciones de herida profunda&#44; ya que presentaron una colecci&#243;n retroesternal&#44; con olor f&#233;tido y cultivos positivos de la misma&#44; adem&#225;s de dehiscencia esternal y leucocitosis como hallazgo de laboratorio&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">T&#233;cnica quir&#250;rgica</span><p id="par0050" class="elsevierStylePara elsevierViewall">La revascularizaci&#243;n mioc&#225;rdica se realiz&#243; mediante esternotom&#237;a media completa en el 100&#37; de los casos y con el uso de CEC en 448 pacientes &#40;85&#44;2&#37;&#41;&#46; Canulaci&#243;n central arterial en aorta ascendente y venosa con c&#225;nula &#250;nica cavo-atrial&#46; Heparinizaci&#243;n completa mediante 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg de peso&#46; Con hipotermia ligera &#40;34<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; y protecci&#243;n mioc&#225;rdica v&#237;a anter&#243;grada en todos los casos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; disecci&#243;n esqueletizada&#44; sin ning&#250;n tipo de tejido acompa&#241;ante&#44; de ambas arterias mamarias internas en 421 pacientes &#40;80&#44;04&#37;&#41;&#44; mientras que en el 19&#44;96&#37; &#40;105 pacientes&#41; se obtuvieron los injertos de manera pediculada &#40;junto con sus venas sat&#233;lite&#44; la parte adjunta de los m&#250;sculos intercostales y la fascia intrator&#225;cica&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ambas arterias mamarias se utilizaron para revascularizar el &#225;rbol arterial izquierdo&#46; Se complet&#243; la revascularizaci&#243;n del &#225;rbol arterial derecho&#44; en aquellos pacientes que fuera necesario&#44; mediante el uso de otros injertos &#40;vena safena y&#47;o arteria radial&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La arteria mamaria interna derecha se utiliz&#243; tanto como injerto <span class="elsevierStyleItalic">in situ</span> &#40;a trav&#233;s del seno transverso de manera retroa&#243;rtica&#44; conservando su origen en la arteria subclavia&#41;&#44; como injerto libre &#40;desconectada de la arteria subclavia y anastomosada a la aorta&#41; y&#44; en la mayor&#237;a de los casos&#44; como injerto en T o Y desde la arteria mamaria izquierda&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Profilaxis antibi&#243;tica intravenosa con cefazolina 2<span class="elsevierStyleHsp" style=""></span>g&#44; 30 min antes de la intervenci&#243;n y posteriormente cada 8<span class="elsevierStyleHsp" style=""></span>h hasta completar 3 dosis&#44; y para aquellos pacientes al&#233;rgicos&#44; vancomicina 1<span class="elsevierStyleHsp" style=""></span>g por v&#237;a intravenosa cada 12<span class="elsevierStyleHsp" style=""></span>h hasta completar 2 dosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">El programa estad&#237;stico SPSS versi&#243;n 22&#46;0 &#40;IBM&#47;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; EE&#46; UU&#46;&#41; fue utilizado para el an&#225;lisis&#46; Las variables continuas con distribuci&#243;n normal fueron expresadas como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n t&#237;pica&#46; Las variables continuas con distribuci&#243;n no normal fueron expresadas como mediana y el rango intercuart&#237;lico&#46; Las variables categ&#243;ricas fueron expresadas como proporciones&#46; Se realiz&#243; un an&#225;lisis preliminar univariante de las variables perioperatorias para determinar los posibles factores de riesgo de dehiscencia esternal&#44; mediastinitis y&#47;o problemas de herida quir&#250;rgica&#44; con un grado de significaci&#243;n estad&#237;stica p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Completado con regresi&#243;n log&#237;stica univariante y pruebas multivariantes para esclarecer posibles factores favorecedores de problemas de herida superficial&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">La edad media de los pacientes fue 59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 a&#241;os&#46; En su mayor&#237;a varones &#40;88&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los pacientes eran hipertensos &#40;59&#37;&#41;&#44; diab&#233;ticos &#40;61&#37;&#41; y dislipid&#233;micos &#40;71&#37;&#41;&#44; tan solo un 12&#37; de ellos eran obesos &#40;&#237;ndice de masa corporal<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30&#41; y un 39&#37; fumadores&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En su mayor&#237;a se intervino a pacientes con una FEVI normal &#40;52&#37;&#41;&#44; seguido de aquellos pacientes con FEVI ligera &#40;23&#37;&#41; o moderadamente deprimida &#40;21&#44;3&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Un 7&#44;4&#37; de los pacientes presentaban IR previa a la intervenci&#243;n entre sus antecedentes &#40;creatinina &#62; 200<span class="elsevierStyleHsp" style=""></span>mmol&#47;l o &#62;2&#44;26<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; Mientras que un 8&#44;6&#37; presentaba EPOC&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La incidencia de arteriopat&#237;a perif&#233;rica entre los pacientes fue de un 17&#44;5&#37; y antecedente de ACV previo en un 3&#44;6&#37;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En su mayor&#237;a &#40;83&#44;2&#37;&#41; se realizaron 2-3 derivaciones coronarias por paciente&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Se utiliz&#243; la mamaria derecha como injerto libre en un 4&#44;4&#37; de los pacientes &#40;23 pacientes&#41;&#44; mamaria derecha de mamaria izquierda en el 77&#37; &#40;405 pacientes&#41; y mamaria derecha <span class="elsevierStyleItalic">in situ</span> en el 23&#44;6&#37; &#40;124 pacientes&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El tiempo medio de CEC fue de 66&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;42 min y de pinzamiento a&#243;rtico medio de 44&#44;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;42 min&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Se reintervino por sangrado excesivo en las primeras 24 h a 10 pacientes &#40;1&#44;9&#37;&#41;&#44; sin encontrarse diferencias estad&#237;sticamente significativas en la incidencia de dehiscencia esternal o problemas de herida quir&#250;rgica en estos pacientes&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Necesitaron transfusi&#243;n un 38&#37; de los pacientes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">De los 526 pacientes&#44; fallecieron 5 &#40;mortalidad de 1&#37;&#41;&#44; inferior a la mortalidad esperada &#40;EuroScore medio 2&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;44&#47;EuroScore log&#237;stico <span class="elsevierStyleSmallCaps">i</span> &#37;&#58; 2&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;27&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Las <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a> muestra los datos demogr&#225;ficos separando la muestra en 2 grupos seg&#250;n la t&#233;cnica de obtenci&#243;n del injerto mamario &#40;esqueletizada vs&#46; pediculada&#41;&#44; encontr&#225;ndose muestras comparables sin apenas diferencias en cuanto a factores de riesgo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Durante el postoperatorio presentaron dehiscencia esternal 3 pacientes &#40;0&#44;57&#37;&#41;&#44; sin encontrarse relaci&#243;n estad&#237;sticamente significativa con ninguno de los factores analizados&#46; Uno de los pacientes present&#243; dehiscencia esternal as&#233;ptica&#44; mientras que los otros 2 hab&#237;an desarrollado mediastinitis &#40;0&#44;38&#37;&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">No hay suficientes casos de dehiscencia esternal ni de mediastinitis como para poder extraer conclusiones estad&#237;sticamente significativas y&#47;o valorables&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Centr&#225;ndonos en aquellos pacientes que presentaron problemas de herida superficial&#44; se encontraron 29 pacientes &#40;5&#44;52&#37;&#41;&#44; 2 de ellos con hemocultivos positivos&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El an&#225;lisis preliminar evidenci&#243; como factores de riesgo para desarrollar infecci&#243;n superficial de la herida quir&#250;rgica&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsit0075"><span class="elsevierStyleLabel">&#8211;</span><p id="par0305" class="elsevierStylePara elsevierViewall">El sexo&#44; ya que un 17&#44;7&#37; de las mujeres frente a un 5&#44;4&#37; de los hombres presentaron esta complicaci&#243;n&#44; con un nivel de significaci&#243;n p &#60; 0&#44;000&#46;</p></li><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Insuficiencia renal&#44; con una diferencia fuertemente significativa p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 en la incidencia de infecci&#243;n superficial entre los que presentan IR &#40;18&#44;6&#37;&#41; y los que no &#40;5&#44;8&#37;&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Transfusi&#243;n de concentrado de hemat&#237;es en quir&#243;fano&#58; presenta una clara diferencia significativa &#40;18&#44;3&#37; de infecciones en aquellos transfundidos frente a 5&#44;1&#37; los no transfundidos&#44; p &#60; 0&#44;000&#41;&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">As&#237; mismo se encontr&#243; relaci&#243;n con los siguientes factores&#44; aunque sin llegar a la significaci&#243;n estad&#237;stica&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Hay mayor incidencia de infecci&#243;n superficial de la herida quir&#250;rgica entre los pacientes diab&#233;ticos &#40;9&#44;8&#37;&#41; frente a los no diab&#233;ticos &#40;5&#44;3&#37;&#41;&#44; no llegando a ser esta diferencia estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;069&#41;&#46; Al desglosarlo por tipos de tratamiento&#44; aquellos con antidiab&#233;ticos orales presentan mayor incidencia &#40;10&#44;9&#37;&#41; frente a los insulinodependientes &#40;7&#44;7&#37;&#41;&#44; siendo esta diferencia no significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;223&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Parece haber diferencias entre los pacientes con EPOC&#44; 13&#44;3&#37; de infecciones frente a un 6&#44;8&#37; en aquellos que no presentan EPOC&#44; pero esta diferencia no es significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;113&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Lo mismo ocurre con los pacientes obesos&#58; un 10&#44;9&#37; de infecciones en obesos frente a un 6&#44;3&#37; en no obesos&#44; con una p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;166&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Aquellos pacientes a los que se les realiz&#243; una revascularizaci&#243;n incompleta &#40;ya sea por malos vasos&#44; lecho distal afectado o tama&#241;o de la arteria<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#41; parecen tener mayor incidencia de infecci&#243;n &#40;11&#44;6&#37; frente a 5&#44;9&#37; en los que se consigui&#243; realizar revascularizaci&#243;n completa&#41;&#46; Est&#225; al l&#237;mite de la significaci&#243;n p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;058&#46; Esto puede ser debido a que esta arteriopat&#237;a de peque&#241;o vaso afecte tambi&#233;n a la circulaci&#243;n del tejido celular subcut&#225;neo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8211;</span><p id="par0340" class="elsevierStylePara elsevierViewall">Un dato curioso es la menor incidencia de infecci&#243;n en aquellos pacientes exfumadores &#40;4&#44;8&#37;&#41; frente a los no fumadores &#40;9&#44;7&#37;&#41;&#44; aunque la mayor incidencia es en aquellos pacientes fumadores &#40;16&#44;7&#37;&#41; independientemente del n&#250;mero de paquetes&#47;a&#241;o&#44; aunque estas diferencias no son significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41;&#46;</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">El hecho de desarrollar infecci&#243;n superficial de la herida provoca un aumento de estancia hospitalaria estad&#237;sticamente significativo p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#44; siendo la media de estancia de los que no desarrollaron infecci&#243;n de 10 d&#237;as frente a 30 d&#237;as en los que si la desarrollaron &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">En los contrastes no param&#233;tricos de variables que no siguen una ley normal&#44; la comparaci&#243;n de medias de las variables cuantitativas dividiendo a los pacientes en 2 grupos&#44; grupo 1&#58; infecci&#243;n superficial s&#237; y grupo 2&#58; infecci&#243;n superficial no&#44; no muestran diferencias significativas en las variables analizadas &#40;edad&#44; nivel de creatinina&#44; tiempo de CEC&#44; tiempo de pinzamiento a&#243;rtico&#44; n&#250;mero de injertos&#44; EuroScore log&#237;stico <span class="elsevierStyleSmallCaps">i</span>&#44; hematocrito &#40;Hto&#41; postoperatorio&#44; hemoglobina &#40;Hb&#41; postoperatoria&#44; duraci&#243;n de la intervenci&#243;n&#41;&#44; con nivel de significaci&#243;n p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 y tampoco subiendo la significaci&#243;n a p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;10&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Seg&#250;n los resultados de regresi&#243;n log&#237;stica univariante&#44; usando como variable dependiente la infecci&#243;n superficial y como variables independientes las variables cuantitativas y cualitativas a analizar&#44; se observan asociaciones en las siguientes&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8211;</span><p id="par0345" class="elsevierStylePara elsevierViewall">Confirmaci&#243;n de asociaci&#243;n con el sexo&#44; encontr&#225;ndose ser hombre como factor protector &#40;intervalo de confianza &#91;IC&#93; del 95&#37;&#58; 0&#44;123-0&#44;568&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con una odds ratio &#40;OR&#41; para mujer de 3&#44;78&#44; lo que significa que ser mujer aumenta casi 4 veces el riesgo de presentar infecci&#243;n respecto a ser hombre&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8211;</span><p id="par0350" class="elsevierStylePara elsevierViewall">La IR aumenta 3&#44;7 veces el riesgo de desarrollar infecci&#243;n superficial de la herida &#40;IC del 95&#37;&#58; 1&#44;575-8&#44;757&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8211;</span><p id="par0355" class="elsevierStylePara elsevierViewall">La transfusi&#243;n de concentrados de hemat&#237;es en quir&#243;fano aumenta el riesgo en 4&#44;2 veces respecto a los que no se transfundieron en quir&#243;fano &#40;aunque estos requirieran posteriormente en unidad de cuidados intensivos o planta hospitalaria de alguna transfusi&#243;n&#41; &#40;IC del 95&#37;&#58; 2&#44;022-8&#44;764&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46;</p></li></ul></p><p id="par0180" class="elsevierStylePara elsevierViewall">Otros factores con clara tendencia sin llegar a ser significativos son los siguientes&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8211;</span><p id="par0360" class="elsevierStylePara elsevierViewall">Revascularizaci&#243;n incompleta&#58; parece tener 2 veces m&#225;s riesgo de presentar infecci&#243;n que aquellos en los que es posible realizar una revascularizaci&#243;n completa &#40;OR 2&#44;084&#41;&#44; estando esta asociaci&#243;n al l&#237;mite de la significaci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;063&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8211;</span><p id="par0365" class="elsevierStylePara elsevierViewall">Tabaquismo&#58; se observa mayor incidencia &#40;sin ser estad&#237;sticamente significativa&#41; de infecci&#243;n superficial en aquellos fumadores de m&#225;s de 2 paquetes al d&#237;a&#44; con una OR seg&#250;n Propensity score de 1&#44;9&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8211;</span><p id="par0370" class="elsevierStylePara elsevierViewall">Diab&#233;ticos en tratamiento con antidiab&#233;ticos orales presentan 2&#44;2 veces m&#225;s riesgo de infecci&#243;n frente a los no diab&#233;ticos&#44; mientras que aquellos en tratamiento con insulina presentan un riesgo ligeramente menor &#40;OR de 1&#44;5&#41;&#46; Diferencias estad&#237;sticamente no significativas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8211;</span><p id="par0375" class="elsevierStylePara elsevierViewall">Se ha encontrado como factor protector el tratamiento previo a la intervenci&#243;n con nitratos&#59; pudiera explicarse por el efecto vasodilatador que podr&#237;a tener repercusi&#243;n a nivel cut&#225;neo y subcut&#225;neo &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;307&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;054&#41;&#46;</p></li></ul></p><p id="par0185" class="elsevierStylePara elsevierViewall">No se han encontrado diferencias estad&#237;sticamente significativas en cuanto a desarrollo de infecci&#243;n seg&#250;n los tiempos de CEC y de pinzamiento a&#243;rtico&#44; ni en aquellos pacientes con funci&#243;n de ventr&#237;culo izquierdo deprimida&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Factores como la edad&#44; HTA&#44; DL&#44; vasculopat&#237;a perif&#233;rica&#44; ACV previo y reintervenci&#243;n por sangrado las primeras 24<span class="elsevierStyleHsp" style=""></span>h no han a&#241;adido riesgo de problemas de herida esternal&#46; As&#237; mismo&#44; el riesgo medido por EuroScore I tampoco se asocia a riesgo de infecci&#243;n superficial obtenido en nuestra serie de pacientes&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">No se han encontrado diferencias estad&#237;sticamente significativas en cuanto a incidencia de infecci&#243;n seg&#250;n los diferentes tipos de t&#233;cnicas quir&#250;rgicas &#40;arteria mamaria interna pediculada frente a esqueletizada&#41;&#44; ni de los factores de riesgo influyentes en los 2 grupos por separado&#46; Cabe destacar que la muestra de pacientes con t&#233;cnica pediculada es mucho menor y esto pudiera tener repercusi&#243;n estad&#237;stica &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariante se confirma como &#250;nico par&#225;metro significativo el sexo&#44; siendo factor protector ser hombre &#40;IC del 95&#37;&#58; 0&#44;060-0&#44;743&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46; Otros factores tienen clara tendencia a favorecer la infecci&#243;n&#44; como son la Hb postoperatoria &#40;cada gramo de aumento de Hb supone un aumento de riesgo de 1&#44;466 veces&#44; IC del 95&#37;&#58; 0&#44;965-2&#44;228&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;073&#41;&#46; Aquellos pacientes que presentan EPOC tendr&#237;an un riesgo aumentado 3&#44;475 veces &#40;IC del 95&#37;&#58; 0&#44;9-13&#44;417&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;071&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">No se han encontrado asociaciones con el resto de interacciones entre variables&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Como prueba de bondad de ajuste del modelo obtuvimos una curva caracter&#237;sticas operativas del receptor &#40;COR&#41; comparando las probabilidades de tener infecci&#243;n superficial que pronostica el modelo de la curva de probabilidad 0&#44;5&#44; con un &#225;rea bajo la curva recogido como contraste de hip&#243;tesis seg&#250;n la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0215" class="elsevierStylePara elsevierViewall">En cirug&#237;a de revascularizaci&#243;n mioc&#225;rdica&#44; el uso de arteria mamaria interna como injerto arterial est&#225; considerado como patr&#243;n de oro<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1-4</span></a>&#59; sin embargo&#44; el uso doble de arteria mamaria&#44; que deber&#237;a mejorar estos resultados&#44; se ha asociado a una mayor incidencia de dehiscencia esternal y&#47;o problemas de herida quir&#250;rgica<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">10&#44;12-22</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">De manera tradicional se ha considerado que la cirug&#237;a de revascularizaci&#243;n mioc&#225;rdica con el uso de injertos arteriales es superior a aquella realizada con venas&#46; Dicho abordaje aporta unos excelentes resultados de permeabilidad a largo plazo minimizando la necesidad de reintervenciones&#46; Esto es especialmente importante en pacientes j&#243;venes y&#47;o con enfermedad multivaso&#46; Sin embargo&#44; la revascularizaci&#243;n arterial ha recorrido un largo camino antes de ser ampliamente apreciada&#44; con algunos debates a&#250;n sin resolver&#44; como la relaci&#243;n entre el uso de doble arteria mamaria y la infecci&#243;n esternal&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">La disecci&#243;n de la arteria mamaria interna de manera pediculada para su utilizaci&#243;n como injerto implica la disecci&#243;n de la pleura parietal circundante&#44; venas&#44; m&#250;sculo y fascia acompa&#241;ante&#44; dejando el pecho devascularizado&#44; especialmente con el uso de ambas arterias mamarias<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a>&#46; Esto&#44; seg&#250;n autores como de Paulis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a>&#44; podr&#237;a traducirse en disminuci&#243;n significativa del aporte de sangre esternal&#44; lo que perjudica la cicatrizaci&#243;n de heridas y conduce posteriormente a la infecci&#243;n esternal&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Debido a ello&#44; algunos autores recomiendan el uso de arteria esqueletizada para evitar infecciones esternales<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a>&#46; En nuestro estudio no se encuentran diferencias significativas en cuanto a t&#233;cnica quir&#250;rgica utilizada&#44; pero el n&#250;mero de pacientes realizado mediante t&#233;cnica pediculada es menor&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Los pacientes con heridas inicialmente comprometidas por la capacidad de curaci&#243;n &#40;p&#46; ej&#46;&#44; pacientes con DM&#41; est&#225;n en mayor riesgo para desarrollar mediastinitis posquir&#250;rgica&#44; especialmente en pacientes sometidos a arteria mamaria interna bilateral &#40;AMIB&#41;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">26&#44;27</span></a>&#46; Esto queda respaldado por publicaciones antiguas&#44; como las de Loop et al&#46;&#44; gran estudio retrospectivo de 1990&#44; con pacientes diab&#233;ticos que recib&#237;an AMIB&#59; se concluy&#243; que eran 5 veces m&#225;s propensos a presentar mediastinitis<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a>&#46; Otro estudio&#44; de Borger et al&#46;&#44; compuesto por m&#225;s de 12&#46;000 pacientes&#44; inform&#243; de que el riesgo de mediastinitis en los pacientes diab&#233;ticos aument&#243; del 1&#44;3 al 14&#44;3&#37; con el uso de AMIB<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a>&#46; En nuestra serie&#44; los diab&#233;ticos tienen mayor incidencia de infecci&#243;n superficial &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;069&#41; sin llegar a ser significativa&#59; esto queda apoyado por numerosos estudios m&#225;s recientes&#44; que muestran las ventajas del uso de doble arteria mamaria frente a mamaria &#250;nica&#46; Un ejemplo de ello son los trabajos de Puskas et al&#46; y Stevens et al&#46;&#44; y la revisi&#243;n de Raja&#44; los cuales demuestran el beneficio del uso de doble arteria mamaria incluso en pacientes diab&#233;ticos&#44; sin encontrar diferencias estad&#237;sticamente significativas en cuanto a incidencia de infecci&#243;n esternal profunda &#40;mediastinitis&#41; en aquellos casos en los que se us&#243; una mamaria con respecto a los de doble arteria mamaria&#44; y con mejor supervivencia a largo plazo de estos &#250;ltimos<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">26&#44;30&#44;31</span></a>&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">O Galbut et al&#46;&#44; con un estudio multivariante&#44; el cual observa ventajas de uso de AMIB con mayor supervivencia a largo plazo en pacientes revascularizados con AMIB con respecto a arteria mamaria interna unilateral &#40;AMIU&#41;&#44; sin encontrar m&#225;s infecciones esternales tanto en pacientes con funci&#243;n ventricular normal&#44; como aquellos con funci&#243;n ventricular disminuida<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a>&#44; hallazgo coincidente en nuestra serie&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Incluso autores como Hashimoto et al&#46; obtienen beneficios a largo plazo en pacientes octogenarios en t&#233;rminos de supervivencia y ausencia de eventos cardiacos&#44; o cerebrovasculares en aquellos pacientes revascularizados con ambas arterias mamarias respecto a los de mamaria &#250;nica&#44; sin incrementar con ello la tasa de infecci&#243;n esternal<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">El metaan&#225;lisis de Smith et al&#46; apoya la teor&#237;a del aumento de supervivencia de aquellos pacientes con doble mamaria respecto a mamaria &#250;nica<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a>&#46; As&#237; mismo&#44; hay estudios que objetivan este beneficio en supervivencia en pacientes obesos<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">35&#44;36</span></a>&#59; sin embargo&#44; otros estudios encuentran mayor tasa de infecci&#243;n esternal en obesos sin el aumento de supervivencia con el uso de AMIB respecto a AMIU<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Otro estudio reciente de Kurlansky et al&#46; inform&#243; de los resultados que comparan los beneficios de supervivencia a 30 a&#241;os de seguimiento de AMIU vs&#46; AMIB<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a>&#46; A los 15 a&#241;os&#44; la supervivencia fue del 39&#37; para AMIU y el 53&#44;5&#37; para AMIB&#44; mientras que a los 25 a&#241;os la supervivencia fue de 16&#44;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#37; para AMIU y 28&#44;5&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&#37; para AMIB &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">A la luz de estas contradicciones&#44; este art&#237;culo intenta esclarecer los resultados de esta t&#233;cnica quir&#250;rgica y su &#233;xito cl&#237;nico&#44; seg&#250;n la experiencia de un centro de territorio nacional con a&#241;os de experiencia y diferentes cirujanos&#44; as&#237; como un breve comparativo entre ambas t&#233;cnicas quir&#250;rgicas &#40;arteria mamaria interna pediculada vs&#46; arteria mamaria esqueletizada&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0265" class="elsevierStylePara elsevierViewall">El uso de doble arteria mamaria para revascularizaci&#243;n mioc&#225;rdica es una t&#233;cnica segura y reproducible&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">La incidencia de dehiscencia esternal seg&#250;n nuestra casu&#237;stica fue del 0&#44;58&#37;&#46; No obstante&#44; analizando esta incidencia en nuestros pacientes&#44; hemos visto que no hay una mayor proporci&#243;n de dehiscencia esternal&#59; sin embargo&#44; s&#237; encontramos pacientes que desarrollaron problemas de herida&#44; encontr&#225;ndose una asociaci&#243;n con parte de los factores de riesgo analizados&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Tan solo 2 pacientes &#40;0&#44;38&#37;&#41; presentaron mediastinitis&#59; esto nos indica que en su mayor&#237;a desarrollaron problemas superficiales de la herida quir&#250;rgica&#46; En mujeres&#44; pacientes nefr&#243;patas&#44; diab&#233;ticos&#44; con EPOC y obesos&#44; habr&#237;a que extremar las precauciones y los cuidados de la herida&#44; ya que presentan una mayor incidencia&#44; siendo esta diferencia estad&#237;sticamente significativa tan solo en mujeres y pacientes con nefropat&#237;a&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Un dato curioso es el aumento de incidencia estad&#237;sticamente significativa en aquellos pacientes que requirieron transfusi&#243;n de concentrado de hemat&#237;es en quir&#243;fano&#59; esta asociaci&#243;n no se encuentra con los par&#225;metros de HB y&#47;o Hto prequir&#250;rgico ni prealta&#44; ni con la necesidad de transfundir en el resto del tiempo de ingreso&#44; por lo que habr&#237;a que plantearse ser m&#225;s estrictos con el punto de corte a partir del cual transfundir a nuestros pacientes durante la intervenci&#243;n&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Responsabilidades &#233;ticas</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protecci&#243;n de personas y animales</span><p id="par0285" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidencialidad de los datos</span><p id="par0290" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Derecho a la privacidad y consentimiento informado</span><p id="par0295" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0300" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres839873"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introducci&#243;n y objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec835474"
          "titulo" => "Palabras clave"
        ]
        2 => array:3 [
          "identificador" => "xres839874"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introduction and objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec835475"
          "titulo" => "Keywords"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "M&#233;todos"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "T&#233;cnica quir&#250;rgica"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "An&#225;lisis estad&#237;stico"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Resultados"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discusi&#243;n"
        ]
        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conclusiones"
        ]
        9 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Responsabilidades &#233;ticas"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Protecci&#243;n de personas y animales"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Confidencialidad de los datos"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Derecho a la privacidad y consentimiento informado"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicto de intereses"
        ]
        11 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-06-13"
    "fechaAceptado" => "2016-11-24"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec835474"
          "palabras" => array:5 [
            0 => "Arteria mamaria interna"
            1 => "Cirug&#237;a de revascularizaci&#243;n mioc&#225;rdica"
            2 => "Dehiscencia esternal"
            3 => "Mediastinitis"
            4 => "Obesidad"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec835475"
          "palabras" => array:5 [
            0 => "Internal mammary artery"
            1 => "Coronary artery bypass grafting"
            2 => "Sternal dehiscence"
            3 => "Mediastinitis"
            4 => "Obesity"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El empleo de doble mamaria se ha asociado con un aumento de complicaciones esternales&#44; especialmente en pacientes diab&#233;ticos y obesos&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este trabajo es revisar los factores de riesgo de aquellos pacientes en los que se ha usado doble mamaria y la tasa de complicaci&#243;n esternal en este grupo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De nuestra base de datos se ha seleccionado a 526 pacientes revascularizados quir&#250;rgicamente con uso de doble arteria mamaria&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La edad media de los pacientes fue de 59 a&#241;os&#44; con un EuroScore log&#237;stico-1 medio de 2&#44;7&#37;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentaron dehiscencia esternal 3 pacientes &#40;0&#44;57&#37;&#41;&#44; no se correlacion&#243; con ning&#250;n factor de riesgo&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Problemas de herida tanto superficial como profunda 31 pacientes &#40;5&#46;9&#37;&#41;&#44; &#40;2 mediastinitis-0&#46;38&#37;&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Con respecto a los pacientes que presentaron infecci&#243;n superficial de la herida quir&#250;rgica &#40;29 pacientes&#44; 5&#44;513&#37;&#41;&#44; se obtuvo mayor incidencia en mujeres&#44; pacientes con insuficiencia renal y aquellos a los que se les realiz&#243; transfusi&#243;n de concentrado de hemat&#237;es en quir&#243;fano&#44; Siendo estas diferencias estad&#237;sticamente significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Tambi&#233;n hubo mayor incidencia de infecci&#243;n superficial en pacientes diab&#233;ticos&#44; enfermedad pulmonar obstructiva cr&#243;nica&#44; obesos&#44; fumadores y a aquellos a los que se les realiz&#243; revascularizaci&#243;n mioc&#225;rdica incompleta&#44; siendo estas diferencias no significativas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En nuestra experiencia&#44; la utilizaci&#243;n de doble mamaria no se acompa&#241;&#243; de mayor incidencia de dehiscencia esternal&#44; pero si con problemas de infecci&#243;n superficial de la herida&#44; sobre todo en el grupo de pacientes mujeres&#44; con insuficiencia renal y transfundidos en quir&#243;fano&#46; Para mantener el beneficio de la doble mamaria en estos pacientes&#44; deber&#237;amos ser especialmente cuidadosos e implementar nuevas estrategias de cierre esternal&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction and objectives</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The use of double internal mammary artery in coronary artery bypass grafting has been associated with increased sternal complications&#44; especially in diabetic and obese patients&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The aim of this article is to review the risk factors for those patients who underwent coronary artery bypass grafting with the use of double internal mammary artery and to analyse the sternal complication rate in this group&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A total 526 patients revascularized with use of double internal mammary artery were selected from our database&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The mean age of the patients was 59 years&#44; with a mean logistics EuroScore I of 2&#46;7&#37;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">There were a total of 3 &#40;0&#46;57&#37;&#41; cases with sternal instability&#44; which did not correspond with any risk factor&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A sternal associated infection was observed in 31 &#40;5&#46;9&#37;&#41; patients&#44; but only 2 of them developed deep infection&#47;mediastinitis &#40;0&#46;38&#37;&#41;&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Of the patients who had superficial infection of the surgical wound &#40;29 patients&#44; 5&#46;5&#37;&#41;&#44; there was a higher incidence in women&#44; patients with renal failure&#44; and those who received a transfusion of packed red blood cells during the surgery&#46; These findings were statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">There was also a higher incidence &#40;with no statistically significant differences&#41; of superficial infection in patients with diabetes&#44; COPD&#44; obese&#44; smokers&#44; and those who underwent incomplete myocardial revascularisation&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">In our experience&#44; the use of double internal mammary artery was not accompanied by an increased incidence of sternal instability&#44; but it was associated with superficial infections&#44; in the group of female patients&#44; renal disease&#44; and those who needed red blood cells during the surgery&#46; To maintain the benefit of the double internal mammary artery bypass grafting in these patients&#44; special care should be taken&#44; and new strategies for sternal closure should be implemented&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1341
            "Ancho" => 1690
            "Tamanyo" => 73696
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Diagrama Box-plot&#46; Comparaci&#243;n de d&#237;as de estancia postoperatorios seg&#250;n grupos 1&#58; desarrollo de infecci&#243;n superficial&#47;grupo 2&#58; no desarrollo de infecci&#243;n superficial&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 3520
            "Ancho" => 2993
            "Tamanyo" => 393025
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Curva COR&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "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="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo de intervenci&#243;n</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Arteria mamaria interna esqueletizada</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Arteria mamaria interna pediculada</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Recuento&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">&#37; del N de la columna&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">Recuento&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">&#37; del N de la columna&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  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</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="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;1&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>Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#44;9&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">FEVI</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="elsevierStyleHsp" style=""></span>Normal &#40;&#62; 60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#44;2&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>Ligera &#40;51-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;2&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>Moderada &#40;31-50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#44;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"><span class="elsevierStyleHsp" style=""></span>Severa &#40;21-30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">6&#44;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"><span class="elsevierStyleHsp" style=""></span>Muy severa &#40;&#60; 21&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;2&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="char" valign="top">0&#44;0&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Tabaquismo</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#44;6&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>Tabaquismo previo &#40;&#43; 1 mes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">166&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#44;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"><span class="elsevierStyleHsp" style=""></span>Tabaquismo actual &#40;&#60; 1 paquete&#47;d&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">5&#44;1&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>Tabaquismo actual &#40;1-2 paquetes&#47;d&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;3&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>Tabaquismo actual &#40;&#62; 2 paquetes&#47;d&#237;a&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;3&#37;&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="char" valign="top">3&#44;1&#37;&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Diabetes</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">194&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#44;5&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>Dieta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;5&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="char" valign="top">3&#44;3&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>Antidiab&#233;ticos orales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#44;5&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>Insulina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">8&#44;7&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Hipertensi&#243;n</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;0&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>No tratada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">1&#44;0&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>Tratada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">239&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#44;0&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Hipercolesterolemia</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;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"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#44;2&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Historia familiar de enfermedad coronaria</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">370&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#44;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"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;3&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Enfermedad vascular perif&#233;rica</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#44;1&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>Aneurismas&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="char" valign="top">0&#44;6&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="char" valign="top">0&#44;0&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>Perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">13&#44;1&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>Cerebral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">1&#44;7&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="char" valign="top">0&#44;0&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>M&#250;ltiple&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">2&#44;0&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="char" valign="top">2&#44;4&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>Perif&#233;rica<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>coronaria<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>m&#250;ltiple&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;3&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="char" valign="top">0&#44;0&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>Cerebral<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;3&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="char" valign="top">2&#44;4&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>Cerebral<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>perif&#233;rica<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>m&#250;ltiple&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;3&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="char" valign="top">0&#44;0&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">EPOC</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">308&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#44;5&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>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">9&#44;5&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">ACV</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#44;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"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">7&#44;1&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Obesidad</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">368&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#44;5&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>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">10&#44;5&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="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Nefropat&#237;a</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="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#44;4&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>Insuficiencia renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">1&#44;2&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>Di&#225;lisis&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="char" valign="top">1&#44;2&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="char" valign="top">0&#44;0&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>Trasplante funcionante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;3&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="char" valign="top">0&#44;0&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>Di&#225;lisis<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>creatinina<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mmol l-1&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="char" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">1&#44;2&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>Insuficiencia renal cr&#243;nica<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>creatinina<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mmol l-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">1&#44;2&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>Insuficiencia renal cr&#243;nica<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>di&#225;lisis<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>creatinina<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mmol l-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;3&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="char" valign="top">0&#44;0&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>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;3&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="char" valign="top">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1417902.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Datos demogr&#225;ficos divididos seg&#250;n t&#233;cnica de obtenci&#243;n arteria mamaria interna&#46; Variables cualitativas</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "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="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo de intervenci&#243;n</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sig&#46; asint&#243;t&#46; &#40;bilateral&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Arteria mamaria interna esqueletizada</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Arteria mamaria interna pediculada</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Media&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">Desv&#46; t&#237;pica&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">Media&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">Desv&#46; t&#237;pica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;898&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">EuroScore I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;5087&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;6421&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;6213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;9860&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;385&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">Creatinina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;807&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">Hematocrito preoperatorio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;898&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">Hemoglobina preoperatoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;697&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1417901.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Datos demogr&#225;ficos divididos seg&#250;n t&#233;cnica de obtenci&#243;n arteria mamaria interna&#46; Variables cuantitativas</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">ET&#58; error t&#237;pico&#59; Exp&#40;B&#41;&#58; odds ratio&#46;</p>"
          "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="" valign="top" scope="col">&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">B&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">ET&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">Wald&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">gl&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">Sig&#46;&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">Exp&#40;B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IC del 95&#37; para Exp&#40;B&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Inferior&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">Superior&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">Sexo &#40;hombre&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#44;828&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;641&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;564&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">Insuficiencia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;487&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;674&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;861&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;591&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">Hemat&#237;es en quir&#243;fano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;904&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;590&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;469&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;777&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;843&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">Hemoglobina postoperatoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;467&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;592&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;596&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;280&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">Enfermedad pulmonar obstructiva cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;629&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;697&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;815&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;367&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;876&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;358&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">Diabetes tipo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;687&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;481&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;775&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;106&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">Obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#44;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;824&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;121&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">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;6&#44;581&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;953&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;353&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1417900.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Multivariante&#46; Esqueletizada</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">ET&#58; error t&#237;pico&#59; Exp&#40;B&#41;&#58; odds ratio&#46;</p>"
          "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="" valign="top" scope="col">&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">B&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">ET&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">Wald&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">gl&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">Sig&#46;&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">Exp&#40;B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IC del 95&#37; para Exp&#40;B&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Inferior&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">Superior&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">Sexo &#40;hombre&#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&#44;386&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;515&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;999&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">258&#44;887&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">Insuficiencia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;248&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;931&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;840&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#44;974&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;589&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3080&#44;605&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">Hemat&#237;es en quir&#243;fano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;643&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;068&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;800&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">501&#44;333&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">Hemoglobina postoperatoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#44;721&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;875&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;678&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;486&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;087&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;704&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">Enfermedad pulmonar obstructiva cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#44;346&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;896&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;707&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127&#44;524&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">Diabetes tipo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;083&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;433&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;450&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;953&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#44;009&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">Obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;833&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;513&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;468&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;322&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">121&#44;379&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">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;555&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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="char" valign="top">0&#44;862&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;734&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1417899.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Multivariante arteria mamaria interna pediculada</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:38 [
            0 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The left internal mammary artery&#58; The graft of choice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;E&#46; Okies"
                            1 => "U&#46;S&#46; Page"
                            2 => "J&#46;C&#46; Bigelow"
                            3 => "A&#46;H&#46; Krause"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1984"
                        "volumen" => "70"
                        "numero" => "Supl 1"
                        "paginaInicial" => "213"
                        "paginaFinal" => "221"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Twelve-year experience with internal mammary artery for coronary artery bypass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;B&#46; Barner"
                            1 => "J&#46;W&#46; Standeven"
                            2 => "J&#46; Reese"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1985"
                        "volumen" => "90"
                        "paginaInicial" => "668"
                        "paginaFinal" => "675"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2865410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;D&#46; Loop"
                            1 => "B&#46;W&#46; Lytle"
                            2 => "D&#46;M&#46; Cosgrove"
                            3 => "R&#46;W&#46; Stewart"
                            4 => "M&#46; Goormastic"
                            5 => "G&#46;W&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198601023140101"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "1986"
                        "volumen" => "314"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3484393"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937816001666"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary bypass surgery with internalthoracic-artery grafts &#8212;effects on survival over a 15-year period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Cameron"
                            1 => "K&#46;B&#46; Davis"
                            2 => "G&#46; Green"
                            3 => "H&#46;V&#46; Schaff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199601253340402"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "1996"
                        "volumen" => "334"
                        "paginaInicial" => "216"
                        "paginaFinal" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8531997"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937815025946"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized trial to compare bilateral vs single internal mammary coronary artery bypass grafting&#58; 1-year results of the arterial revascularisation trial &#40;ART&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;P&#46; Taggart"
                            1 => "D&#46;G&#46; Altman"
                            2 => "A&#46;M&#46; Gray"
                            3 => "B&#46; Lees"
                            4 => "F&#46; Nugara"
                            5 => "L&#46;M&#46; Yu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehq318"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "2470"
                        "paginaFinal" => "2481"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20805116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Twelve-year experience with internal mammary artery for coronary artery bypass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;B&#46; Barner"
                            1 => "J&#46;W&#46; Standeven"
                            2 => "J&#46; Reese"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1985"
                        "volumen" => "90"
                        "paginaInicial" => "668"
                        "paginaFinal" => "675"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2865410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved late survival with arterial revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Locker"
                            1 => "H&#46;V&#46; Schaff"
                            2 => "J&#46;A&#46; Dearani"
                            3 => "R&#46;C&#46; Daly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2225-319X.2013.06.02"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Cardiothorac Surg&#46;"
                        "fecha" => "2013"
                        "volumen" => "2"
                        "paginaInicial" => "467"
                        "paginaFinal" => "474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977624"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resultados cl&#237;nicos de la revascularizaci&#243;n mioc&#225;rdica con doble arteria mamaria versus &#250;nica&#58; 15 a&#241;os de seguimiento"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; L&#243;pez"
                            1 => "R&#46; Voces"
                            2 => "P&#46; Lima"
                            3 => "G&#46; Reyes"
                            4 => "J&#46; Silva"
                            5 => "M&#46; Ruiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2001"
                        "volumen" => "54"
                        "paginaInicial" => "868"
                        "paginaFinal" => "879"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11446963"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;discusi&#243;n 776&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Propensity matched analysis of bilateral internal mammary artery versus single leftinternal mammary artery grafting at 17-year follow-up&#58; Validation of a contemporary surgical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;B&#46; Grau"
                            1 => "G&#46; Ferrari"
                            2 => "A&#46;W&#46; Mak"
                            3 => "R&#46;E&#46; Shaw"
                            4 => "M&#46;E&#46; Brizzio"
                            5 => "B&#46;P&#46; Mindich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezr213"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Cardiothorac Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "41"
                        "paginaInicial" => "770"
                        "paginaFinal" => "775"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22290908"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937815005086"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of bilateral internal mammary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Kouchoukos"
                            1 => "T&#46; Wareing"
                            2 => "S&#46; Murphy"
                            3 => "C&#46; Pelate"
                            4 => "W&#46; Marshall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1990"
                        "volumen" => "49"
                        "paginaInicial" => "210"
                        "paginaFinal" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2306142"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resultados a corto-medio plazo en revascularizaci&#243;n mioc&#225;rdica aislada con injerto de arteria mamaria interna bilateral en 497 pacientes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;E&#46; Mart&#237;n"
                            1 => "J&#46;M&#46; Mart&#237;nez"
                            2 => "J&#46; Gualis"
                            3 => "J&#46; G&#243;mez-Plana"
                            4 => "E&#46; Mart&#237;n"
                            5 => "J&#46; Otero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Cardiov&#46;"
                        "fecha" => "2016"
                        "volumen" => "23"
                        "paginaInicial" => "11"
                        "paginaFinal" => "17"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factores de riesgo para mediastinitis y dehiscencia esternal despu&#233;s de cirug&#237;a cardiaca"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Careaga"
                            1 => "G&#46;G&#46; Aguirre"
                            2 => "L&#46;E&#46; Medina"
                            3 => "G&#46; Borrayo"
                            4 => "G&#46; Prado"
                            5 => "R&#46; Arg&#252;ero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1157/13084640"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2006"
                        "volumen" => "59"
                        "paginaInicial" => "130"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16540034"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does mammary artery grafting increase surgical risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Cosgrove"
                            1 => "B&#46;W&#46; Lytle"
                            2 => "F&#46;D&#46; Loop"
                            3 => "M&#46;D&#46; Taylor"
                            4 => "R&#46;W&#46; Stewart"
                            5 => "C&#46;C&#46; Gill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1988"
                        "volumen" => "95"
                        "paginaInicial" => "850"
                        "paginaFinal" => "856"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3361932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skeletonized versus pedicled internal thoracic artery and risk of sternal wound infection after coronary bypass surgery&#58; Meta-analysis and metaregression of 4817 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;P&#46; S&#225;"
                            1 => "P&#46;E&#46; Ferraz"
                            2 => "R&#46;R&#46; Escobar"
                            3 => "F&#46;P&#46; Vasconcelos"
                            4 => "A&#46;A&#46; Ferraz"
                            5 => "D&#46;M&#46; Braile"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivt012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg&#46;"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "849"
                        "paginaFinal" => "857"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23446674"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediastinitis after coronary artery bypass graft surgery&#58; Influence of the mammary grafting for diabetic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Tavolacci"
                            1 => "V&#46; Merle"
                            2 => "V&#46; Josset"
                            3 => "F&#46; Bouchart"
                            4 => "P&#46; Litzler"
                            5 => "A&#46; Tabley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Hosp Infect&#46;"
                        "fecha" => "2003"
                        "volumen" => "55"
                        "paginaInicial" => "21"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14505605"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937815022978"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of both internal thoracic arteries in diabetic patients increases deep sternal wound infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;B&#46; Savage"
                            1 => "J&#46;D&#46; Grab"
                            2 => "S&#46;M&#46; O&#8217;Brien"
                            3 => "A&#46; Ali"
                            4 => "E&#46;J&#46; Okum"
                            5 => "R&#46;A&#46; Perez-Tamayo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2006.09.094"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2007"
                        "volumen" => "83"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17307448"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937815025946"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A rational approach to wound difficulties after sternotomy&#58; The problem"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Thomas"
                            1 => "N&#46; Kouchoukos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2001"
                        "volumen" => "72"
                        "paginaInicial" => "1411"
                        "paginaFinal" => "1418"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11603488"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk score elaboration for mediastinitis after coronary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;H&#46; Magedanz"
                            1 => "L&#46;C&#46; Bodanese"
                            2 => "J&#46;C&#46; Guaragna"
                            3 => "L&#46;C&#46; Albuquerque"
                            4 => "V&#46; Martins"
                            5 => "S&#46;D&#46; Minossi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Cir Cardiovasc&#46;"
                        "fecha" => "2010"
                        "volumen" => "25"
                        "paginaInicial" => "154"
                        "paginaFinal" => "159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical site infection after cardiac surgery&#58; A simplified surveillance method"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Parisian Mediastinitis Study Group"
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;C&#46; Lucet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/509853"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol&#46;"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "1393"
                        "paginaFinal" => "1396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17152040"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediastinistis postoperatoria en cirug&#237;a cardiaca"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Fulquet-Carreras"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Cardiov&#46;"
                        "fecha" => "2013"
                        "volumen" => "20"
                        "paginaInicial" => "10"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validating a 3-point prediction rule for surgical site infection after coronary artery bypass surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;F&#46; Chen"
                            1 => "D&#46;J&#46; Anderson"
                            2 => "K&#46;S&#46; Kaye"
                            3 => "D&#46;J&#46; Sexton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/649019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol&#46;"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "64"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19911975"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for deep sternal wound infection after sternotomy&#58; A prospective&#44; multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The Parisian Mediastinitis Study Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1996"
                        "volumen" => "111"
                        "paginaInicial" => "1200"
                        "paginaFinal" => "1207"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8642821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral internal mammary artery grafting&#58; Are BIMA better&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;P&#46; Taggart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart&#46;"
                        "fecha" => "2002"
                        "volumen" => "88"
                        "paginaInicial" => "7"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12067929"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection&#58; The role of skeletonization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; De Paulis"
                            1 => "S&#46; deNotaris"
                            2 => "R&#46; Scaffa"
                            3 => "S&#46; Nardella"
                            4 => "J&#46; Zeitani"
                            5 => "C&#46; del Giudice"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2004.07.059"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2005"
                        "volumen" => "129"
                        "paginaInicial" => "536"
                        "paginaFinal" => "543"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15746736"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937815005086"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral internal mammary artery grafting and risk of sternal wound infection&#58; Evidence from observational studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Dai"
                            1 => "Z&#46; Lu"
                            2 => "H&#46; Zhu"
                            3 => "S&#46; Xue"
                            4 => "F&#46; Lian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2012.12.038"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2013"
                        "volumen" => "95"
                        "paginaInicial" => "1938"
                        "paginaFinal" => "1945"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23453745"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S000293781501025X"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival&#44; even among diabetic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;D&#46; Puskas"
                            1 => "A&#46; Sadiq"
                            2 => "T&#46;A&#46; Vassiliades"
                            3 => "P&#46;D&#46; Kilgo"
                            4 => "O&#46;M&#46; Lattouf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2012.03.082"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "94"
                        "paginaInicial" => "710"
                        "paginaFinal" => "715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22677228"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937815022310"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of bilateral internal thoracic arteries in diabetic patients increases deep sternal wound infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;B&#46; Savage"
                            1 => "J&#46;D&#46; Grab"
                            2 => "S&#46;M&#46; O&#8217;Brien"
                            3 => "A&#46; Ali"
                            4 => "E&#46;J&#46; Okum"
                            5 => "R&#46;A&#46; Perez-Tamayo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2006.09.094"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2007"
                        "volumen" => "83"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17307448"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sternal wound complication after isolated coronary artery bypass grafting&#58; Early and late mortality&#44; morbidity and cost of care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;D&#46; Loop"
                            1 => "B&#46;W&#46; Lytle"
                            2 => "D&#46;M&#46; Cosgrove"
                            3 => "S&#46; Mahfood"
                            4 => "M&#46;C&#46; McHenry"
                            5 => "M&#46; Goormastic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1990"
                        "volumen" => "49"
                        "paginaInicial" => "179"
                        "paginaFinal" => "187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2306138"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Deep sternal wound infection&#58; Risk factors and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Borger"
                            1 => "V&#46; Rao"
                            2 => "R&#46;D&#46; Weisel"
                            3 => "J&#46; Ivanov"
                            4 => "G&#46; Cohen"
                            5 => "H&#46;E&#46; Scully"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1998"
                        "volumen" => "65"
                        "paginaInicial" => "1050"
                        "paginaFinal" => "1056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9564926"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937808009101"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Stevens"
                            1 => "M&#46; Carrier"
                            2 => "L&#46;P&#46; Perrault"
                            3 => "Y&#46; H&#233;bert"
                            4 => "R&#46; Cartier"
                            5 => "D&#46; Bouchard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2004.10.048"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Cardiothorac Surg&#46;"
                        "fecha" => "2005"
                        "volumen" => "27"
                        "paginaInicial" => "281"
                        "paginaFinal" => "288"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15691683"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937800570732"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral internal mammary artery grafting in diabetics&#58; Outcomes&#44; concerns and controversies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;G&#46; Raja"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijsu.2014.10.004"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "numero" => "Pt B"
                        "paginaInicial" => "153"
                        "paginaFinal" => "157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25467310"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "e4"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral internal thoracic artery grafting improves long-term survival in patients with reduced ejection fraction&#58; A propensity-matched study with 30-year follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;L&#46; Galbut"
                            1 => "P&#46;A&#46; Kurlansky"
                            2 => "E&#46;A&#46; Traad"
                            3 => "M&#46;J&#46; Dorman"
                            4 => "M&#46; Zucker"
                            5 => "G&#46; Ebra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2011.12.026"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "143"
                        "paginaInicial" => "844"
                        "paginaFinal" => "853"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22245240"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S000293781501025X"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Published online 2015 May 25"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral internal thoracic artery grafting&#58; Is it reasonable in octogenarians&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Hashimoto"
                            1 => "T&#46; Fukui"
                            2 => "S&#46; Takanashi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5761/atcs.oa.14-00305"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "452"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26004110"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937816000028"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Published online 2013 Sep 30"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does the use of bilateral mammary artery grafts compared with the use of a single mammary artery graft offer a long-term survival benefit in patients undergoing coronary artery bypass surgery&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Smith"
                            1 => "G&#46;T&#46;L&#46; Kloppenburg"
                            2 => "W&#46;J&#46; Morshuis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivt423"
                      "Revista" => array:7 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "18"
                        "paginaInicial" => "96"
                        "paginaFinal" => "101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24087830"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937816001666"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "e1-2&#46; Epub 2014 Sep 16"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of the second internal thoracic artery on short- and long-term outcomes in obese patients&#58; A propensity score matched analysis"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Harefield Cardiac Outcomes Research Group"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "U&#46; Benedetto"
                            1 => "A&#46; Montecalvo"
                            2 => "H&#46; Kattach"
                            3 => "M&#46; Amrani"
                            4 => "S&#46;G&#46; Raja"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2014.08.060"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "149"
                        "paginaInicial" => "841"
                        "paginaFinal" => "847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25298150"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Epub 2015 Jan 15"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral internal mammary artery grafting in obese&#58; Outcomes&#44; concerns and controversies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Vitulli"
                            1 => "G&#46; Frati"
                            2 => "U&#46; Benedetto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijsu.2015.01.010"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "numero" => "Pt B"
                        "paginaInicial" => "158"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25598215"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "pii&#58;ezw164&#46; &#91;Epub ahead of print&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral mammary artery grafting increases postoperative mediastinitis without survival benefit in obese patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Ruka"
                            1 => "F&#46; Dagenais"
                            2 => "S&#46; Mohammadi"
                            3 => "V&#46; Chauvette"
                            4 => "P&#46; Poirier"
                            5 => "P&#46; Voisine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezt164"
                      "Revista" => array:3 [
                        "tituloSerie" => "Eur J Cardiothorac Surg&#46;"
                        "fecha" => "2016"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23650023"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;A&#46; Kurlansky"
                            1 => "E&#46;A&#46; Traad"
                            2 => "M&#46;J&#46; Dorman"
                            3 => "D&#46;L&#46; Galbut"
                            4 => "M&#46; Zucker"
                            5 => "G&#46; Ebra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2010.04.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2010"
                        "volumen" => "90"
                        "paginaInicial" => "101"
                        "paginaFinal" => "108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20609757"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937816000028"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/11340096/0000002400000003/v1_201705170023/S1134009616302601/v1_201705170023/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "11744"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/11340096/0000002400000003/v1_201705170023/S1134009616302601/v1_201705170023/es/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134009616302601?idApp=UINPBA00004N"
]
Información del artículo
ISSN: 11340096
Idioma original: Español
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 4 1 5
2024 Octubre 12 7 19
2024 Septiembre 29 15 44
2024 Agosto 10 7 17
2024 Julio 18 8 26
2024 Junio 13 7 20
2024 Mayo 16 6 22
2024 Abril 21 3 24
2024 Marzo 21 5 26
2024 Febrero 18 5 23
2024 Enero 25 9 34
2023 Diciembre 14 17 31
2023 Noviembre 20 9 29
2023 Octubre 11 7 18
2023 Septiembre 15 8 23
2023 Agosto 8 9 17
2023 Julio 10 7 17
2023 Junio 23 4 27
2023 Mayo 48 7 55
2023 Abril 46 2 48
2023 Marzo 45 8 53
2023 Febrero 14 2 16
2023 Enero 19 1 20
2022 Diciembre 36 7 43
2022 Noviembre 43 9 52
2022 Octubre 58 9 67
2022 Septiembre 53 10 63
2022 Agosto 38 15 53
2022 Julio 22 11 33
2022 Junio 25 14 39
2022 Mayo 19 6 25
2022 Abril 28 9 37
2022 Marzo 49 7 56
2022 Febrero 41 6 47
2022 Enero 54 12 66
2021 Diciembre 48 11 59
2021 Noviembre 30 7 37
2021 Octubre 38 16 54
2021 Septiembre 42 11 53
2021 Agosto 22 6 28
2021 Julio 23 4 27
2021 Junio 32 8 40
2021 Mayo 27 12 39
2021 Abril 91 19 110
2021 Marzo 30 10 40
2021 Febrero 16 2 18
2021 Enero 22 5 27
2020 Diciembre 9 9 18
2020 Noviembre 21 7 28
2020 Octubre 13 2 15
2020 Septiembre 19 7 26
2020 Agosto 20 10 30
2020 Julio 17 11 28
2020 Junio 23 11 34
2020 Mayo 19 8 27
2020 Abril 21 6 27
2020 Marzo 26 9 35
2020 Febrero 26 6 32
2020 Enero 27 3 30
2019 Diciembre 32 4 36
2019 Noviembre 13 4 17
2019 Octubre 11 5 16
2019 Septiembre 29 9 38
2019 Agosto 14 10 24
2019 Julio 23 5 28
2019 Junio 55 8 63
2019 Mayo 106 7 113
2019 Abril 44 7 51
2019 Marzo 4 1 5
2019 Febrero 11 4 15
2019 Enero 8 7 15
2018 Diciembre 8 3 11
2018 Noviembre 9 5 14
2018 Octubre 19 17 36
2018 Septiembre 14 5 19
2018 Agosto 12 9 21
2018 Julio 10 1 11
2018 Junio 11 1 12
2018 Mayo 40 4 44
2018 Abril 31 2 33
2018 Marzo 12 3 15
2018 Febrero 6 0 6
2018 Enero 13 0 13
2017 Diciembre 12 0 12
2017 Noviembre 15 0 15
2017 Octubre 16 6 22
2017 Septiembre 19 2 21
2017 Agosto 32 1 33
2017 Julio 16 1 17
2017 Junio 45 14 59
2017 Mayo 32 11 43
2017 Abril 0 5 5
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos