Mitral valve replacement combined with coronary artery bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation | Revista Portuguesa de Cardiologia (English edition)

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Sá, Evelyn F. Soares, Cecília A. Santos, Omar J. Figueiredo, Renato O.A. Lima, Rodrigo R. Escobar, Frederico P. Vasconcelos, Ricardo C. Lima" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Michel Pompeu B.O." "apellidos" => "Sá" "email" => array:1 [ 0 => "michel_pompeu@yahoo.com.br" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Evelyn F." "apellidos" => "Soares" ] 2 => array:2 [ "nombre" => "Cecília A." "apellidos" => "Santos" ] 3 => array:2 [ "nombre" => "Omar J." "apellidos" => "Figueiredo" ] 4 => array:2 [ "nombre" => "Renato O.A." "apellidos" => "Lima" ] 5 => array:2 [ "nombre" => "Rodrigo R." "apellidos" => "Escobar" ] 6 => array:2 [ "nombre" => "Frederico P." "apellidos" => "Vasconcelos" ] 7 => array:2 [ "nombre" => "Ricardo C." "apellidos" => "Lima" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Pernanbuco, Brazil" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Substituição da valva mitral combinada com cirurgia de revascularização do miocárdio em pacientes com regurgitação mitral isquémica moderada a grave" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1236 "Ancho" => 1597 "Tamanyo" => 61087 ] ] "descripcion" => array:1 [ "en" => "Improvement in left ventricular ejection fraction by echocardiography after surgery. Values expressed as mean±standard deviation. CABG: coronary artery bypass grafting; MVR: mitral valve replacement; Postop: postoperative." ] ] ] "textoCompleto" => "IntroductionIschemic mitral regurgitation (IMR) is defined as mitral valve (MV) insufficiency precipitated by myocardial infarction, with normal leaflet and chordal morphology. IMR usually occurs with right or circumflex coronary infarction involving the posterior ventricular wall, posterior papillary muscle, and adjacent mitral annulus.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Common anatomic features include annular dilatation, displacement of papillary muscles, and varying degrees of leaflet restriction or tethering.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> There is a clear association between IMR and increased late mortality.<a class="elsevierStyleCrossRefs" href="#bib0010">2–7</a> Even after revascularization, IMR reduces late survival.<a class="elsevierStyleCrossRefs" href="#bib0010">2–7</a>Several studies have shown increased perioperative mortality for valve replacement in this situation, but the subject remains controversial.<a class="elsevierStyleCrossRefs" href="#bib0040">8–12</a>The objective of this study was to investigate the differences in immediate postoperative results (in-hospital complications and evolution) in patients with IMR undergoing coronary artery bypass grafting (CABG) with intraoperative correction of valve dysfunction by mitral valve replacement (MVR) compared with those undergoing CABG only.MethodsStudy populationWe studied 42 consecutive patients with coronary artery disease associated with moderate-to-severe IMR undergoing CABG at the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco (PROCAPE), between May 2007 and April 2010.Definition of ischemic mitral regurgitationIMR was defined as valve insufficiency caused by coronary artery disease. All patients had a history of myocardial infarction, ejection fraction <50% by echocardiography and moderate-to-severe functional MVR (without intrinsic changes in valve leaflets and/or subvalvular apparatus). All patients had one or more left ventricular (LV) segmental wall motion abnormalities and significant coronary disease in the territory supplying the wall motion abnormality.Exclusion criteriaPatients with rheumatic, myxomatous, infectious, or congenital diseases of the mitral valve were excluded. Patients with mitral regurgitation due to papillary muscle rupture, torn or elongated chordae tendineae, or ballooning or scalloping of the mitral leaflets were not considered to have IMR. Patients with mild MVR were also not considered for the study.Study designWe performed a retrospective study using medical records and initially generated two groups: CABG+MVR (biological valve prosthesis) or CABG only. In each instance, the operative approach for concomitant MVR had been chosen by the attending surgeon.Variables and outcomesThe following variables were compared:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(1)Preoperative clinical characteristics: age >70 years, gender (male or female), obesity (body mass index≥30kg/m2), hypertension, diabetes, smoking, chronic obstructive pulmonary disease (dyspnea or chronic cough and prolonged use of bronchodilators or corticosteroids and/or radiological changes including opacification due to hyperinflation and/or elevation of the ribs and/or flattening of the diaphragm), renal disease (creatinine ≥2.3mg/dl or preoperative dialysis), myocardial infarction <30 days previously, EuroSCORE ≥6 (high risk), and New York Heart Association (NYHA) functional class I, II, III or IV;</li><li class="elsevierStyleListItem" id="lsti0010">(2)Procedural characteristics: number of aortocoronary bypasses; as all patients underwent on-pump surgery, we assessed cardiopulmonary bypass (CPB) duration (in min) and aortic clamp time (in min);</li><li class="elsevierStyleListItem" id="lsti0015">(3)Major procedure-related complications: hemorrhagic shock, neurologic complications (stroke or transient ischemic attack), low cardiac output (signs of poor peripheral and/or central perfusion including cold extremities, oliguria/anuria or decreased level of consciousness, and need for inotropic support with dopamine 4μg/kg/min for at least 12hours or intra-aortic balloon pump to maintain systolic blood pressure greater than 90mmHg), and renal complications (creatinine ≥2.3mg/dl or postoperative dialysis);</li><li class="elsevierStyleListItem" id="lsti0020">(4)Minor procedure-related complications: respiratory complications (pulmonary infection, acute respiratory distress syndrome, atelectasis, need for intubation for more than 48hours), atrial fibrillation (AF) after surgery, need for multiple transfusions (more than three units of packed red blood cells);</li><li class="elsevierStyleListItem" id="lsti0025">(5)Preoperative and postoperative left ventricular ejection fraction (LVEF) by echocardiography performed during hospitalization;</li><li class="elsevierStyleListItem" id="lsti0030">(6)Length of stay in intensive care unit (days) and hospital (days);</li><li class="elsevierStyleListItem" id="lsti0035">(7)Outcome (survivor or death).</li></ul>Statistical analysisStatistical analysis and interpretation were performed in SPSS (Statistical Package for the Social Sciences) version 15. Data were stored in duplicate to validate the consistency of the data and the analysis in order to minimize error.Univariate analysis for categorical variables was performed with the chi-square test or Fisher's exact test, as appropriate. The Student's t test was used for continuous variables. Verification of the hypothesis of equality of variances was performed using Levene's F test. Values of p<0.05 were considered statistically significant.Ethical considerationsThis study was approved by the Research Ethics Committee of Complexo Hospitalar do Hospital Universitário Oswaldo Cruz/Pronto Socorro Cardiológico de Pernambuco – HUOC/PROCAPE, file no. 132/2009.ResultsPopulation characteristicsMean patient age was 63.4±8.5 years; 64.8% (n=23) were male and 35.2% (n=19) female.The 42 patients with moderate-to-severe IMR were among 542 patients who underwent CABG consecutively during the study period, and thus the prevalence of moderate-to-severe IMR was 8.1% among operated patients. Of these, 38.1% (n=16) underwent CABG+MVR and 61.9% (n=26) underwent CABG only.For almost all the preoperative variables (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), there were no statistically significant differences, except for the proportion of patients in NYHA class III/IV, with more patients in this class in the CABG+MVR group than in the CABG-only group (68.7% vs. 30.8%, p=0.012).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Procedural characteristicsAs expected (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), patients undergoing CABG+MVR showed a higher proportion with prolonged CPB time (p=0.001) and prolonged aortic clamp time (p<0.001). There was no difference in the proportion of the number of coronary bypasses as a categorical variable; however, when analyzed as a continuous variable, the CABG+MVR group underwent more coronary bypasses than the CABG-only group (3.06±0.85 vs. 2.46±0.81, p=0.028).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Postoperative evolutionThe CABG+MVR group showed lower rates of low cardiac output (6.3% vs. 42.3%, p=0.014) and atrial fibrillation (6.3% vs. 38.5%, p=0.021). The other variables showed no statistically significant differences (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>There were no statistically significant differences between groups in length of stay in intensive care (7.81±5.86 vs. 8.35±7.10 days, p=0.802) or in hospital (44.06±18.61 vs. 40.54±19.66 days, p=0.568).Assessment of left ventricular functionBoth the CABG+MVR group (54.13±4.51 vs. 45.25±4.54, p=0.041) and the CABG-only group (50.92±3.25 vs. 46.62±3.19, p=0.049) had higher mean LVEF in the postoperative period than in the preoperative period (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Both groups thus had higher mean LVEF in the postoperative than in the preoperative period, showing an improvement in LV function after surgical procedures. However, the average gain in LVEF in the CABG+MVR group was higher than that in the CABG-only group (8.88±2.39 vs. 4.31±1.23, p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>MortalityThere was no significant difference between groups in operative mortality (6.3% vs. 7.7%, p=0.679) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).DiscussionThe prevalence of moderate-to-severe IMR detected by transthoracic echocardiography and/or cardiac catheterization in myocardial infarction patients with coronary artery disease ranges from 3% to 12%.<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> The prevalence of 8.1% observed in our study is within the range reported in the literature.Mitral regurgitation causes atrial hemodynamic overload, which leads to tissue fibrosis; consequently, a non-homogenous distribution of diastolic depolarization potentials, refractory periods, and conduction properties occurs within the atrial muscle.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> All of these factors enhance the probability of reentry circuits forming around areas with longer refractory periods.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> MVR eliminates regurgitation, thereby reducing atrial hemodynamic overload and interrupting the cascade of events that culminates in the development of postoperative atrial fibrillation. In our study, the CABG+MVR group, despite longer exposure to CPB (known as a risk factor for developing postoperative AF<a class="elsevierStyleCrossRef" href="#bib0080">16</a>) showed a lower rate of AF than the CABG-only group (6.3% vs. 38.5%, p=0.021).It seems logical to assume that the volume overload associated with mitral regurgitation will be particularly detrimental to patients with compromised LV function.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> There is also a loss of flow to the aorta, since part of the ejected volume is directed to the left atrium. MVR eliminates the volume overload and the loss of volume ejected toward the left atrium, displacing the entire cardiac output in the correct direction (to the aorta). This explains the lower rate of low cardiac output in the CABG+MVR group (despite longer exposure to CPB, known as a risk factor for development of postoperative low cardiac output<a class="elsevierStyleCrossRef" href="#bib0080">16</a>) compared to CABG only (6.3% vs. 42.3%; p=0.014).Segmental wall motion abnormalities and LV distortion and remodeling after myocardial infarction displace the papillary muscles from the mitral annulus.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> This displacement puts excessive tension on the chordae, resulting in apical mitral leaflet tethering, restricting coaptation during systole.<a class="elsevierStyleCrossRefs" href="#bib0095">19–21</a> Leaflet tethering is compounded by LV contractile dysfunction, which decreases the closing force on the leaflets.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> Once IMR begins, end-diastolic LV volume and wall stress increase in tandem with preload.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> LV mass also increases progressively without a concomitant increase in end-diastolic wall thickness, resulting in generalized loss of myocardial contractile function.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Increased wall stress causes further LV dysfunction,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> which in turn results in further papillary muscle displacement and leaflet tenting. If LV dilation occurs, it leads to annular enlargement and dysfunction, thereby increasing valvular incompetence.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Chronic IMR therefore begets MR in a self-perpetuating manner. CABG surgery may interrupt the perpetuation and/or progression of this vicious cycle.MVR is still a reasonable surgical option in many patients with IMR, mainly because of its reliability and reproducibility. It should be considered for patients with acute IMR, and for those with chronic IMR and multiple comorbidities, complex regurgitant jets (noncentral or more than one jet), or severe tethering of both MV leaflets.<a class="elsevierStyleCrossRefs" href="#bib0045">9,24,25</a>Some studies indicate greater perioperative mortality associated with this procedure, suggesting that preference should be given to less aggressive procedures such as CABG only or CABG associated with MVR.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> However, in our study, although the CABG+MVR group had a statistically significant higher prevalence of patients with worse functional class, there was no difference in operative mortality (6.3% vs. 7.7%; p=0.679) between groups. A possible explanation for this is that, unlike in other studies, MVR was the first choice for mitral valve surgery, and not a result of initial unsuccessful mitral valve repair (reoperation and/or prolonged CPB time as a function of failed valve repair might have increased operative mortality in this group). In addition, surgical intervention can prevent the LV overload and remodeling that results from mitral regurgitation, which may improve surgical outcomes.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>Goland et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> studied changes in LVEF in 83 patients with moderate IMR who underwent CABG associated with MVR (n=28) or CABG only (n=55). Patients who underwent CABG only showed significant improvement in LVEF in the early postoperative period (39±11 vs. 45±13; p=0.002), as did the CABG+MVR group (37±11 vs. 44±11; p=0.02). We also observed the same results of MVR, with the CABG+MVR group showing higher mean LVEF in the postoperative than in the preoperative period (54.13±4.51 vs. 45.25±4.54, p=0.041), as did the CABG-only group (52.92±4.25 vs. 48.62±4.19, p=0.049). So we observed improvement in postoperative LVEF in both groups. Furthermore, we found that the average gain in LVEF in the CABG+MVR group was higher than in the CABG-only group (8.88±2.39 vs. 4.31±1.23, p<0.001). As can be seen, in the case of LVEF, CABG+MVR provides better improvement than CABG only.Although we did not analyze the approach to mitral valve repair, some considerations should be borne in mind. This is a technique intended to reduce or eliminate mitral regurgitation, while preserving the valve. Several investigators have suggested that repair is better than replacement for patients with IMR.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Others, however, have documented similar survival after repair and after replacement.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Late survival is poor for all approaches, with most patients dying within seven years of surgery.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> However, choice of surgical procedure has an important impact on survival. Among the most severely ill patients, the survival benefit of mitral valve surgery (by either valve repair or replacement) is diminished, which leads us to conclude that clinical status is an important determinant of survival.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> It seems that the “repair vs. replacement” debate remains undecided, although there is a strong tendency in the medical community in favor of repair.Study limitationsThe chief limitation of this study is its retrospective nature, with various sources of bias. Selection bias and lack of a uniform surgical experience (different surgeons operating) are important limitations. In many cases the surgeon did not opt for valve repair because of the unavailability of intraoperative transesophageal echocardiography at our institution. Decisions to perform concomitant MVR were made on the basis of surgical considerations and preferences. The surgeons may have selected replacement for patients who had worse heart failure, and thus may have replaced valves in the more severe or symptomatic patients. A randomized prospective design would overcome this limitation.Another limitation is the lack of uniformity of echocardiographic evaluation of mitral regurgitation grade and complete follow-up, since the echocardiograms were performed by several operators using different equipment and our results are restricted to the in-hospital period.An important limitation is that ventricular diameters (systolic and diastolic) were not taken into consideration, which may well have influenced the results to some extent.Small sample size is another limitation of this study. This is the consequence of selecting a very homogeneous group with only moderate-to-severe mitral regurgitation, a history of myocardial infarction, impaired LV function, and a single mitral valve surgical approach (valve replacement). This prevented the application of multivariate logistic regression analysis, so the study is limited to the use of univariate analysis, which may affect the consistency of the presented evidence.ConclusionTaking into account the severity of this population, patients who underwent CABG only or CABG+MVR surgery experienced no statistically different mortality rates, despite the presence of multiple comorbidities and impaired LVEF. MVR can be performed safely, concomitantly with CABG, in patients with moderate-to-severe IMR. In such patients, the combined procedure resulted in lower rates of postoperative atrial fibrillation and low cardiac output than CABG only. Both surgical approaches resulted in significant improvement in postoperative LVEF. However, there was greater improvement in the combined surgery group, which may result in greater benefit to this group. Despite being a more aggressive approach, the combined surgical procedure did not increase morbidity or mortality.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres177657" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec166310" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres177656" "titulo" => array:6 [ 0 => "Resumo" 1 => "Introdução" 2 => "Objetivo" 3 => "Métodos" 4 => "Resultados" 5 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec166311" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Definition of ischemic mitral regurgitation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Exclusion criteria" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Study design" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Variables and outcomes" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Ethical considerations" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Population characteristics" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Procedural characteristics" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Postoperative evolution" ] 3 => array:2 [ "identificador" => "sec0070" "titulo" => "Assessment of left ventricular function" ] 4 => array:2 [ "identificador" => "sec0075" "titulo" => "Mortality" ] ] ] 7 => array:3 [ "identificador" => "sec0080" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Study limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0095" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-02-04" "fechaAceptado" => "2012-07-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec166310" "palabras" => array:3 [ 0 => "Mitral valve insufficiency" 1 => "Coronary artery bypass" 2 => "Myocardial ischemia" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec166311" "palabras" => array:3 [ 0 => "Insuficiência da valva mitral" 1 => "Ponte de artéria coronária" 2 => "Isquemia miocárdica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionIschemic mitral regurgitation (IMR) is associated with increased mortality. Even after coronary artery bypass grafting (CABG), IMR reduces survival. Several studies have shown increased perioperative mortality for mitral valve replacement (MVR) in this situation, but the subject remains controversial. ObjectiveTo investigate the impact of MVR on immediate outcomes in patients with moderate-to-severe IMR undergoing concomitant CABG compared with those undergoing CABG only. MethodsWe performed a retrospective study of 42 patients undergoing CABG+MVR (n=16) or CABG only (n=26) at the Division of Cardiovascular Surgery of PROCAPE, between May 2007 and April 2010. Preoperative clinical characteristics, procedural characteristics, major and minor complications after surgery, preoperative and postoperative left ventricular ejection fraction (LVEF) by echocardiography, and outcome (survivor or death) were assessed. ResultsMean patient age was 63.4±8.5 years, and 64.8% (n=23) were male. The CABG+MVR group showed lower rates of postoperative low cardiac output (6.3% vs. 42.3%, p=0.014) and atrial fibrillation (6.3% vs. 38.5%, p=0.021). Both groups had higher mean LVEF in the postoperative compared with the preoperative period, but the average gain in LVEF in the CABG+MVR group was higher than in the CABG-only group (8.88±2.39 vs. 4.31±1.23, p<0.001). There was no significant difference in operative mortality (6.3% vs. 7.7%, p=0.679). ConclusionsCABG+MVR can be performed safely in patients with moderate-to-severe IMR. CABG+MVR resulted in lower rates of complications than CABG only. Both surgical approaches resulted in significant improvement of postoperative LVEF. However, there was greater improvement in the CABG+MVR group." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "IntroduçãoA Regurgitação mitral isquémica (RMI) está associada ao aumento da mortalidade. Mesmo após a cirurgia de revascularização miocárdica (CRM), reduz a sobrevida. Vários estudos enfatizam o aumento da mortalidade perioperatória com troca valvar mitral (TVM) nesta situação, mas isto ainda é controverso. ObjetivoInvestigar o impacto da TVM nos resultados imediatos em pacientes com RMI moderada a grave submetidos à CRM em comparação com aqueles submetidos à CRM apenas. MétodosEstudo retrospetivo de 42 pacientes submetidos à CRM+TVM (n=16) ou CRM isolada (n=26) na Divisão de Cirurgia Cardiovascular do PROCAPE, de maio de 2007 a abril de 2010. Foram avaliadas características clínicas pré-operatórias, características do procedimento, complicações após a cirurgia, fração de ejeção do ventrículo esquerdo (FEVE) pré e pós-operatório pelo ecocardiograma e evolução (sobrevivência ou óbito). ResultadosA idade média dos pacientes foi de 63,4 anos (±8,5), sendo 64,8% (n=23) do sexo masculino. O grupo CRM+TVM apresentou menores taxas de baixo débito cardíaco no pós-operatório (6,3 versus 42,3%, p=0,014) e fibrilação atrial (6,3% versus 38,5%, p=0,021). Ambos os grupos apresentaram maior média de FEVE no pós-operatório em comparação com o período pré-operatório; no entanto, o ganho médio da FEVE no grupo CRM+TVM foi maior em comparação com o grupo CRM isolada (8,88±2,39 versus 4,31±1,23, p<0,001). Não houve diferença significativa nas taxas de mortalidade operatória (6,3 versus 7,7%, p=0,679). ConclusõesCRM+TVM pode ser realizada com segurança em pacientes que têm RMI moderada a grave. CRM+TVM resultou em menores taxas de complicações do que a CRM isolada. Ambas as abordagens cirúrgicas resultaram em melhoria significativa da FEVE pós-operatória, por outro lado, houve maior ganho no grupo CRM+TVM." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1271 "Ancho" => 1549 "Tamanyo" => 90489 ] ] "descripcion" => array:1 [ "en" => "Analysis of left ventricular ejection fraction by echocardiography before and after surgery. Values expressed as mean±standard deviation. CABG: coronary artery bypass grafting; MVR: mitral valve replacement; Preop: preoperative; Postop: postoperative." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1236 "Ancho" => 1597 "Tamanyo" => 61087 ] ] "descripcion" => array:1 [ "en" => "Improvement in left ventricular ejection fraction by echocardiography after surgery. Values expressed as mean±standard deviation. CABG: coronary artery bypass grafting; MVR: mitral valve replacement; Postop: postoperative." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">CABG+MVR</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">CABG</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age >70 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.879<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.633<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.256<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.394<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.139<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.320<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MI <30 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.808<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EuroSCORE ≥6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.380<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NYHA class \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.012<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I/II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III/IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272090.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Fisher's exact test." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Pearson's chi-square test. CABG: coronary artery bypass grafting; COPD: chronic obstructive pulmonary disease; MI: myocardial infarction; MVR: mitral valve replacement; NYHA: New York Heart Association." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients undergoing coronary artery bypass grafting with and without mitral valve replacement." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">CABG+MVR</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">CABG</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of bypasses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.058<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 or more \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CPB time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91–120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aortic clamp time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272092.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Fisher's exact test." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Fisher's chi-square test. CABG: coronary artery bypass grafting; CPB: cardiopulmonary bypass; MVR: mitral valve replacement." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of coronary artery bypass grafting procedures with and without mitral valve replacement." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">CABG+MVR</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">CABG</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OR (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shock/hemorrhage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low cardiac output \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.014<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.09 (0.01–0.81) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.138<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 (0.01–1.68) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurologic complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.10 (0.08–10.82) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.021<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 (0.01–0.96) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.316<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.44 (0.06–2.28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple transfusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.116<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.31 (0.05–1.64) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.679<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.80 (0.03–12.98) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab272091.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "Pearson's chi-square test." ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "Fisher's exact test. CABG: coronary artery bypass grafting; CI: confidence interval; MVR: mitral valve replacement; OR: odds ratio calculated for CABG+MVR compared to CABG only." ] ] ] "descripcion" => array:1 [ "en" => "Complications and mortality in patients undergoing coronary artery bypass grafting with and without mitral valve replacement." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy: new insights from anatomic study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Heub" 1 => "F. Jatene" 2 => "L. Moreira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mtc.2002.125342" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2002" "volumen" => "124" "paginaInicial" => "1216" "paginaFinal" => "1224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12447190" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.N. Schroder" 1 => "M.L. Williams" 2 => "J.A. Hata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.104.523472" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "112" "paginaInicial" => "I293" "paginaFinal" => "I298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16159834" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.A. Grossi" 1 => "G.A. Crooke" 2 => "P.L. DiGiorgi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.105.001230" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2006" "volumen" => "114" "paginaInicial" => "I573" "paginaFinal" => "I576" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16820640" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.D. Diodato" 1 => "M.R. Moon" 2 => "M.K. Pasque" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2004.03.022" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2004" "volumen" => "78" "paginaInicial" => "794" "paginaFinal" => "799" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15336993" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of no-to-moderate mitral regurgitation on late results after isolated coronary artery bypass grafting in patients with ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Di Mauro" 1 => "G. Di Giammarco" 2 => "G. Vitolla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2006.01.061" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2006" "volumen" => "81" "paginaInicial" => "2128" "paginaFinal" => "2134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16731141" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.R. Wong" 1 => "A.K. Agnihotri" 2 => "J.W. Hung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2005.03.034" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2005" "volumen" => "80" "paginaInicial" => "570" "paginaFinal" => "577" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16039207" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic ischemic mitral regurgitation: repair, replace or rethink?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.A. Borger" 1 => "A. Alam" 2 => "P.M. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2005.08.080" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2006" "volumen" => "81" "paginaInicial" => "1153" "paginaFinal" => "1161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16488757" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischemic mitral valve reconstruction and replacement: comparison of long-term survival and complications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.A. Grossi" 1 => "J.D. Goldberg" 2 => "A. LaPietra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mtc.2001.116945" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2001" "volumen" => "122" "paginaInicial" => "1107" "paginaFinal" => "1124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11726886" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is repair preferable to replacement for ischemic mitral regurgitation?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.M. Gillinov" 1 => "P.N. Wierup" 2 => "E.H. Blackstone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mtc.2001.116557" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2001" "volumen" => "122" "paginaInicial" => "1125" "paginaFinal" => "1141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11726887" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitral repair versus replacement for ischemic mitral regurgitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O.O. Al-Radi" 1 => "P.C. Austin" 2 => "J.V. Tu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2004.09.044" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2005" "volumen" => "79" "paginaInicial" => "1260" "paginaFinal" => "1267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15797060" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitral repair is superior to replacement when associated with coronary artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.B. Reece" 1 => "C.G. Tribble" 2 => "P.I. Ellman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2004" "volumen" => "239" "paginaInicial" => "671" "paginaFinal" => "677" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15082971" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.H. Thourani" 1 => "W.S. Weintraub" 2 => "R.A. Guyton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000079169.15862.13" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2003" "volumen" => "108" "paginaInicial" => "298" "paginaFinal" => "304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12835220" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importance of mitral regurgitation in patients undergoing percutaneous coronary intervention for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.G. Pellizzon" 1 => "C.L. Grines" 2 => "D.A. Cox" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2003.11.046" "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "1368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15093869" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Bursi" 1 => "M. Enriquez-Sarano" 2 => "V.T. Nkomo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000151097.30779.04" "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "111" "paginaInicial" => "295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15655133" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Sueda" 1 => "H. Nagata" 2 => "K. Orihashi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1997" "volumen" => "63" "paginaInicial" => "1070" "paginaFinal" => "1075" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9124907" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative study between on-pump and off-pump coronary artery bypass graft in women" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.P.B.O. Sá" 1 => "L.P. Lima" 2 => "F.G. 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Carabello" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Valve Dis" "fecha" => "2000" "volumen" => "9" "paginaInicial" => "600" "paginaFinal" => "608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11041171" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chordal cutting. A new therapeutic approach for ischemic mitral regurgitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Messas" 1 => "J.L. Guerro" 2 => "M.D. Handschumacher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2001" "volumen" => "104" "paginaInicial" => "1958" "paginaFinal" => "1963" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11602501" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation: insights from three-dimensional echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Liel-Cohen" 1 => "J.L. Guerroro" 2 => "Y. 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Moainie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2002" "volumen" => "40" "paginaInicial" => "1160" "paginaFinal" => "1167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12354444" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I.L. Kron" 1 => "G.R. Green" 2 => "J.T. Cope" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2002" "volumen" => "74" "paginaInicial" => "600" "paginaFinal" => "601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12173864" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischemic mitral regurgitation redux – to repair or to replace?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.C. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2000" "volumen" => "122" "paginaInicial" => "159" "paginaFinal" => "162" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitral valve surgery for chronic ischemic mitral regurgitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.M. Calafiore" 1 => "M. Di Mauro" 2 => "S. 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Siegel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Tex Heart Inst J" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "416" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19876417" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitral valve reconstruction and replacement for ischemic mitral insufficiency: seven years’ follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Hausmann" 1 => "H. Siniawski" 2 => "R. 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Original article

Mitral valve replacement combined with coronary artery bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation

Substituição da valva mitral combinada com cirurgia de revascularização do miocárdio em pacientes com regurgitação mitral isquémica moderada a grave

Michel Pompeu B.O. Sá

Corresponding author

michel_pompeu@yahoo.com.br

Corresponding author.

, Evelyn F. Soares, Cecília A. Santos, Omar J. Figueiredo, Renato O.A. Lima, Rodrigo R. Escobar, Frederico P. Vasconcelos, Ricardo C. Lima

Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Pernanbuco, Brazil

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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Improvement in left ventricular ejection fraction by echocardiography after surgery&#46; Values expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; CABG&#58; coronary artery bypass grafting&#59; MVR&#58; mitral valve replacement&#59; Postop&#58; postoperative&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ischemic mitral regurgitation &#40;IMR&#41; is defined as mitral valve &#40;MV&#41; insufficiency precipitated by myocardial infarction&#44; with normal leaflet and chordal morphology&#46; IMR usually occurs with right or circumflex coronary infarction involving the posterior ventricular wall&#44; posterior papillary muscle&#44; and adjacent mitral annulus&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Common anatomic features include annular dilatation&#44; displacement of papillary muscles&#44; and varying degrees of leaflet restriction or tethering&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There is a clear association between IMR and increased late mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;7</span></a> Even after revascularization&#44; IMR reduces late survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have shown increased perioperative mortality for valve replacement in this situation&#44; but the subject remains controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study was to investigate the differences in immediate postoperative results &#40;in-hospital complications and evolution&#41; in patients with IMR undergoing coronary artery bypass grafting &#40;CABG&#41; with intraoperative correction of valve dysfunction by mitral valve replacement &#40;MVR&#41; compared with those undergoing CABG only&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">We studied 42 consecutive patients with coronary artery disease associated with moderate-to-severe IMR undergoing CABG at the Division of Cardiovascular Surgery of Pronto Socorro Cardiol&#243;gico de Pernambuco &#40;PROCAPE&#41;&#44; between May 2007 and April 2010&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Definition of ischemic mitral regurgitation</span><p id="par0025" class="elsevierStylePara elsevierViewall">IMR was defined as valve insufficiency caused by coronary artery disease&#46; All patients had a history of myocardial infarction&#44; ejection fraction &#60;50&#37; by echocardiography and moderate-to-severe functional MVR &#40;without intrinsic changes in valve leaflets and&#47;or subvalvular apparatus&#41;&#46; All patients had one or more left ventricular &#40;LV&#41; segmental wall motion abnormalities and significant coronary disease in the territory supplying the wall motion abnormality&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Exclusion criteria</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with rheumatic&#44; myxomatous&#44; infectious&#44; or congenital diseases of the mitral valve were excluded&#46; Patients with mitral regurgitation due to papillary muscle rupture&#44; torn or elongated chordae tendineae&#44; or ballooning or scalloping of the mitral leaflets were not considered to have IMR&#46; Patients with mild MVR were also not considered for the study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">We performed a retrospective study using medical records and initially generated two groups&#58; CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR &#40;biological valve prosthesis&#41; or CABG only&#46; In each instance&#44; the operative approach for concomitant MVR had been chosen by the attending surgeon&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Variables and outcomes</span><p id="par0040" class="elsevierStylePara elsevierViewall">The following variables were compared&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Preoperative clinical characteristics&#58; age &#62;70 years&#44; gender &#40;male or female&#41;&#44; obesity &#40;body mass index<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; hypertension&#44; diabetes&#44; smoking&#44; chronic obstructive pulmonary disease &#40;dyspnea or chronic cough and prolonged use of bronchodilators or corticosteroids and&#47;or radiological changes including opacification due to hyperinflation and&#47;or elevation of the ribs and&#47;or flattening of the diaphragm&#41;&#44; renal disease &#40;creatinine &#8805;2&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl or preoperative dialysis&#41;&#44; myocardial infarction &#60;30 days previously&#44; EuroSCORE &#8805;6 &#40;high risk&#41;&#44; and New York Heart Association &#40;NYHA&#41; functional class I&#44; II&#44; III or IV&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Procedural characteristics&#58; number of aortocoronary bypasses&#59; as all patients underwent on-pump surgery&#44; we assessed cardiopulmonary bypass &#40;CPB&#41; duration &#40;in min&#41; and aortic clamp time &#40;in min&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Major procedure-related complications&#58; hemorrhagic shock&#44; neurologic complications &#40;stroke or transient ischemic attack&#41;&#44; low cardiac output &#40;signs of poor peripheral and&#47;or central perfusion including cold extremities&#44; oliguria&#47;anuria or decreased level of consciousness&#44; and need for inotropic support with dopamine 4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#47;min for at least 12<span class="elsevierStyleHsp" style=""></span>hours or intra-aortic balloon pump to maintain systolic blood pressure greater than 90<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; and renal complications &#40;creatinine &#8805;2&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl or postoperative dialysis&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Minor procedure-related complications&#58; respiratory complications &#40;pulmonary infection&#44; acute respiratory distress syndrome&#44; atelectasis&#44; need for intubation for more than 48<span class="elsevierStyleHsp" style=""></span>hours&#41;&#44; atrial fibrillation &#40;AF&#41; after surgery&#44; need for multiple transfusions &#40;more than three units of packed red blood cells&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;5&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Preoperative and postoperative left ventricular ejection fraction &#40;LVEF&#41; by echocardiography performed during hospitalization&#59;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;6&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Length of stay in intensive care unit &#40;days&#41; and hospital &#40;days&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;7&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Outcome &#40;survivor or death&#41;&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Statistical analysis and interpretation were performed in SPSS &#40;Statistical Package for the Social Sciences&#41; version 15&#46; Data were stored in duplicate to validate the consistency of the data and the analysis in order to minimize error&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Univariate analysis for categorical variables was performed with the chi-square test or Fisher&#39;s exact test&#44; as appropriate&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span> test was used for continuous variables&#46; Verification of the hypothesis of equality of variances was performed using Levene&#39;s <span class="elsevierStyleItalic">F</span> test&#46; Values of p&#60;0&#46;05 were considered statistically significant&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical considerations</span><p id="par0090" class="elsevierStylePara elsevierViewall">This study was approved by the Research Ethics Committee of Complexo Hospitalar do Hospital Universit&#225;rio Oswaldo Cruz&#47;Pronto Socorro Cardiol&#243;gico de Pernambuco &#8211; HUOC&#47;PROCAPE&#44; file no&#46; 132&#47;2009&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Population characteristics</span><p id="par0095" class="elsevierStylePara elsevierViewall">Mean patient age was 63&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5 years&#59; 64&#46;8&#37; &#40;n&#61;23&#41; were male and 35&#46;2&#37; &#40;n&#61;19&#41; female&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The 42 patients with moderate-to-severe IMR were among 542 patients who underwent CABG consecutively during the study period&#44; and thus the prevalence of moderate-to-severe IMR was 8&#46;1&#37; among operated patients&#46; Of these&#44; 38&#46;1&#37; &#40;n&#61;16&#41; underwent CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR and 61&#46;9&#37; &#40;n&#61;26&#41; underwent CABG only&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">For almost all the preoperative variables &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; there were no statistically significant differences&#44; except for the proportion of patients in NYHA class III&#47;IV&#44; with more patients in this class in the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group than in the CABG-only group &#40;68&#46;7&#37; vs&#46; 30&#46;8&#37;&#44; p&#61;0&#46;012&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Procedural characteristics</span><p id="par0110" class="elsevierStylePara elsevierViewall">As expected &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; patients undergoing CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR showed a higher proportion with prolonged CPB time &#40;p&#61;0&#46;001&#41; and prolonged aortic clamp time &#40;p&#60;0&#46;001&#41;&#46; There was no difference in the proportion of the number of coronary bypasses as a categorical variable&#59; however&#44; when analyzed as a continuous variable&#44; the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group underwent more coronary bypasses than the CABG-only group &#40;3&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;85 vs&#46; 2&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;81&#44; p&#61;0&#46;028&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Postoperative evolution</span><p id="par0115" class="elsevierStylePara elsevierViewall">The CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group showed lower rates of low cardiac output &#40;6&#46;3&#37; vs&#46; 42&#46;3&#37;&#44; p&#61;0&#46;014&#41; and atrial fibrillation &#40;6&#46;3&#37; vs&#46; 38&#46;5&#37;&#44; p&#61;0&#46;021&#41;&#46; The other variables showed no statistically significant differences &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">There were no statistically significant differences between groups in length of stay in intensive care &#40;7&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;86 vs&#46; 8&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;10 days&#44; p&#61;0&#46;802&#41; or in hospital &#40;44&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;61 vs&#46; 40&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;66 days&#44; p&#61;0&#46;568&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Assessment of left ventricular function</span><p id="par0125" class="elsevierStylePara elsevierViewall">Both the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group &#40;54&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;51 vs&#46; 45&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;54&#44; p&#61;0&#46;041&#41; and the CABG-only group &#40;50&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;25 vs&#46; 46&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;19&#44; p&#61;0&#46;049&#41; had higher mean LVEF in the postoperative period than in the preoperative period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Both groups thus had higher mean LVEF in the postoperative than in the preoperative period&#44; showing an improvement in LV function after surgical procedures&#46; However&#44; the average gain in LVEF in the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group was higher than that in the CABG-only group &#40;8&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;39 vs&#46; 4&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;23&#44; p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Mortality</span><p id="par0135" class="elsevierStylePara elsevierViewall">There was no significant difference between groups in operative mortality &#40;6&#46;3&#37; vs&#46; 7&#46;7&#37;&#44; p&#61;0&#46;679&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">The prevalence of moderate-to-severe IMR detected by transthoracic echocardiography and&#47;or cardiac catheterization in myocardial infarction patients with coronary artery disease ranges from 3&#37; to 12&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> The prevalence of 8&#46;1&#37; observed in our study is within the range reported in the literature&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Mitral regurgitation causes atrial hemodynamic overload&#44; which leads to tissue fibrosis&#59; consequently&#44; a non-homogenous distribution of diastolic depolarization potentials&#44; refractory periods&#44; and conduction properties occurs within the atrial muscle&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> All of these factors enhance the probability of reentry circuits forming around areas with longer refractory periods&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> MVR eliminates regurgitation&#44; thereby reducing atrial hemodynamic overload and interrupting the cascade of events that culminates in the development of postoperative atrial fibrillation&#46; In our study&#44; the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group&#44; despite longer exposure to CPB &#40;known as a risk factor for developing postoperative AF<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#41; showed a lower rate of AF than the CABG-only group &#40;6&#46;3&#37; vs&#46; 38&#46;5&#37;&#44; p&#61;0&#46;021&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">It seems logical to assume that the volume overload associated with mitral regurgitation will be particularly detrimental to patients with compromised LV function&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> There is also a loss of flow to the aorta&#44; since part of the ejected volume is directed to the left atrium&#46; MVR eliminates the volume overload and the loss of volume ejected toward the left atrium&#44; displacing the entire cardiac output in the correct direction &#40;to the aorta&#41;&#46; This explains the lower rate of low cardiac output in the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group &#40;despite longer exposure to CPB&#44; known as a risk factor for development of postoperative low cardiac output<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#41; compared to CABG only &#40;6&#46;3&#37; vs&#46; 42&#46;3&#37;&#59; p&#61;0&#46;014&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Segmental wall motion abnormalities and LV distortion and remodeling after myocardial infarction displace the papillary muscles from the mitral annulus&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This displacement puts excessive tension on the chordae&#44; resulting in apical mitral leaflet tethering&#44; restricting coaptation during systole&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a> Leaflet tethering is compounded by LV contractile dysfunction&#44; which decreases the closing force on the leaflets&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Once IMR begins&#44; end-diastolic LV volume and wall stress increase in tandem with preload&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> LV mass also increases progressively without a concomitant increase in end-diastolic wall thickness&#44; resulting in generalized loss of myocardial contractile function&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Increased wall stress causes further LV dysfunction&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> which in turn results in further papillary muscle displacement and leaflet tenting&#46; If LV dilation occurs&#44; it leads to annular enlargement and dysfunction&#44; thereby increasing valvular incompetence&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Chronic IMR therefore begets MR in a self-perpetuating manner&#46; CABG surgery may interrupt the perpetuation and&#47;or progression of this vicious cycle&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">MVR is still a reasonable surgical option in many patients with IMR&#44; mainly because of its reliability and reproducibility&#46; It should be considered for patients with acute IMR&#44; and for those with chronic IMR and multiple comorbidities&#44; complex regurgitant jets &#40;noncentral or more than one jet&#41;&#44; or severe tethering of both MV leaflets&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;24&#44;25</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Some studies indicate greater perioperative mortality associated with this procedure&#44; suggesting that preference should be given to less aggressive procedures such as CABG only or CABG associated with MVR&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> However&#44; in our study&#44; although the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group had a statistically significant higher prevalence of patients with worse functional class&#44; there was no difference in operative mortality &#40;6&#46;3&#37; vs&#46; 7&#46;7&#37;&#59; p&#61;0&#46;679&#41; between groups&#46; A possible explanation for this is that&#44; unlike in other studies&#44; MVR was the first choice for mitral valve surgery&#44; and not a result of initial unsuccessful mitral valve repair &#40;reoperation and&#47;or prolonged CPB time as a function of failed valve repair might have increased operative mortality in this group&#41;&#46; In addition&#44; surgical intervention can prevent the LV overload and remodeling that results from mitral regurgitation&#44; which may improve surgical outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Goland et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> studied changes in LVEF in 83 patients with moderate IMR who underwent CABG associated with MVR &#40;n&#61;28&#41; or CABG only &#40;n&#61;55&#41;&#46; Patients who underwent CABG only showed significant improvement in LVEF in the early postoperative period &#40;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11 vs&#46; 45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#59; p&#61;0&#46;002&#41;&#44; as did the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group &#40;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11 vs&#46; 44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#59; p&#61;0&#46;02&#41;&#46; We also observed the same results of MVR&#44; with the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group showing higher mean LVEF in the postoperative than in the preoperative period &#40;54&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;51 vs&#46; 45&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;54&#44; p&#61;0&#46;041&#41;&#44; as did the CABG-only group &#40;52&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;25 vs&#46; 48&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;19&#44; p&#61;0&#46;049&#41;&#46; So we observed improvement in postoperative LVEF in both groups&#46; Furthermore&#44; we found that the average gain in LVEF in the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group was higher than in the CABG-only group &#40;8&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;39 vs&#46; 4&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;23&#44; p&#60;0&#46;001&#41;&#46; As can be seen&#44; in the case of LVEF&#44; CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR provides better improvement than CABG only&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Although we did not analyze the approach to mitral valve repair&#44; some considerations should be borne in mind&#46; This is a technique intended to reduce or eliminate mitral regurgitation&#44; while preserving the valve&#46; Several investigators have suggested that repair is better than replacement for patients with IMR&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Others&#44; however&#44; have documented similar survival after repair and after replacement&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Late survival is poor for all approaches&#44; with most patients dying within seven years of surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However&#44; choice of surgical procedure has an important impact on survival&#46; Among the most severely ill patients&#44; the survival benefit of mitral valve surgery &#40;by either valve repair or replacement&#41; is diminished&#44; which leads us to conclude that clinical status is an important determinant of survival&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> It seems that the &#8220;repair vs&#46; replacement&#8221; debate remains undecided&#44; although there is a strong tendency in the medical community in favor of repair&#46;</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study limitations</span><p id="par0180" class="elsevierStylePara elsevierViewall">The chief limitation of this study is its retrospective nature&#44; with various sources of bias&#46; Selection bias and lack of a uniform surgical experience &#40;different surgeons operating&#41; are important limitations&#46; In many cases the surgeon did not opt for valve repair because of the unavailability of intraoperative transesophageal echocardiography at our institution&#46; Decisions to perform concomitant MVR were made on the basis of surgical considerations and preferences&#46; The surgeons may have selected replacement for patients who had worse heart failure&#44; and thus may have replaced valves in the more severe or symptomatic patients&#46; A randomized prospective design would overcome this limitation&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Another limitation is the lack of uniformity of echocardiographic evaluation of mitral regurgitation grade and complete follow-up&#44; since the echocardiograms were performed by several operators using different equipment and our results are restricted to the in-hospital period&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">An important limitation is that ventricular diameters &#40;systolic and diastolic&#41; were not taken into consideration&#44; which may well have influenced the results to some extent&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Small sample size is another limitation of this study&#46; This is the consequence of selecting a very homogeneous group with only moderate-to-severe mitral regurgitation&#44; a history of myocardial infarction&#44; impaired LV function&#44; and a single mitral valve surgical approach &#40;valve replacement&#41;&#46; This prevented the application of multivariate logistic regression analysis&#44; so the study is limited to the use of univariate analysis&#44; which may affect the consistency of the presented evidence&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0200" class="elsevierStylePara elsevierViewall">Taking into account the severity of this population&#44; patients who underwent CABG only or CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR surgery experienced no statistically different mortality rates&#44; despite the presence of multiple comorbidities and impaired LVEF&#46; MVR can be performed safely&#44; concomitantly with CABG&#44; in patients with moderate-to-severe IMR&#46; In such patients&#44; the combined procedure resulted in lower rates of postoperative atrial fibrillation and low cardiac output than CABG only&#46; Both surgical approaches resulted in significant improvement in postoperative LVEF&#46; However&#44; there was greater improvement in the combined surgery group&#44; which may result in greater benefit to this group&#46; Despite being a more aggressive approach&#44; the combined surgical procedure did not increase morbidity or mortality&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Definition of ischemic mitral regurgitation"
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    "fechaRecibido" => "2012-02-04"
    "fechaAceptado" => "2012-07-12"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ischemic mitral regurgitation &#40;IMR&#41; is associated with increased mortality&#46; Even after coronary artery bypass grafting &#40;CABG&#41;&#44; IMR reduces survival&#46; Several studies have shown increased perioperative mortality for mitral valve replacement &#40;MVR&#41; in this situation&#44; but the subject remains controversial&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To investigate the impact of MVR on immediate outcomes in patients with moderate-to-severe IMR undergoing concomitant CABG compared with those undergoing CABG only&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of 42 patients undergoing CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR &#40;n&#61;16&#41; or CABG only &#40;n&#61;26&#41; at the Division of Cardiovascular Surgery of PROCAPE&#44; between May 2007 and April 2010&#46; Preoperative clinical characteristics&#44; procedural characteristics&#44; major and minor complications after surgery&#44; preoperative and postoperative left ventricular ejection fraction &#40;LVEF&#41; by echocardiography&#44; and outcome &#40;survivor or death&#41; were assessed&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mean patient age was 63&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5 years&#44; and 64&#46;8&#37; &#40;n&#61;23&#41; were male&#46; The CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group showed lower rates of postoperative low cardiac output &#40;6&#46;3&#37; vs&#46; 42&#46;3&#37;&#44; p&#61;0&#46;014&#41; and atrial fibrillation &#40;6&#46;3&#37; vs&#46; 38&#46;5&#37;&#44; p&#61;0&#46;021&#41;&#46; Both groups had higher mean LVEF in the postoperative compared with the preoperative period&#44; but the average gain in LVEF in the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group was higher than in the CABG-only group &#40;8&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;39 vs&#46; 4&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;23&#44; p&#60;0&#46;001&#41;&#46; There was no significant difference in operative mortality &#40;6&#46;3&#37; vs&#46; 7&#46;7&#37;&#44; p&#61;0&#46;679&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR can be performed safely in patients with moderate-to-severe IMR&#46; CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR resulted in lower rates of complications than CABG only&#46; Both surgical approaches resulted in significant improvement of postoperative LVEF&#46; However&#44; there was greater improvement in the CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR group&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A Regurgita&#231;&#227;o mitral isqu&#233;mica &#40;RMI&#41; est&#225; associada ao aumento da mortalidade&#46; Mesmo ap&#243;s a cirurgia de revasculariza&#231;&#227;o mioc&#225;rdica &#40;CRM&#41;&#44; reduz a sobrevida&#46; V&#225;rios estudos enfatizam o aumento da mortalidade perioperat&#243;ria com troca valvar mitral &#40;TVM&#41; nesta situa&#231;&#227;o&#44; mas isto ainda &#233; controverso&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Investigar o impacto da TVM nos resultados imediatos em pacientes com RMI moderada a grave submetidos &#224; CRM em compara&#231;&#227;o com aqueles submetidos &#224; CRM apenas&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo de 42 pacientes submetidos &#224; CRM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TVM &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; ou CRM isolada &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; na Divis&#227;o de Cirurgia Cardiovascular do PROCAPE&#44; de maio de 2007 a abril de 2010&#46; Foram avaliadas caracter&#237;sticas cl&#237;nicas pr&#233;-operat&#243;rias&#44; caracter&#237;sticas do procedimento&#44; complica&#231;&#245;es ap&#243;s a cirurgia&#44; fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#40;FEVE&#41; pr&#233; e p&#243;s-operat&#243;rio pelo ecocardiograma e evolu&#231;&#227;o &#40;sobreviv&#234;ncia ou &#243;bito&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A idade m&#233;dia dos pacientes foi de 63&#44;4 anos &#40;&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5&#41;&#44; sendo 64&#44;8&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41; do sexo masculino&#46; O grupo CRM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TVM apresentou menores taxas de baixo d&#233;bito card&#237;aco no p&#243;s-operat&#243;rio &#40;6&#44;3 <span class="elsevierStyleItalic">versus</span> 42&#44;3&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; e fibrila&#231;&#227;o atrial &#40;6&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 38&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46; Ambos os grupos apresentaram maior m&#233;dia de FEVE no p&#243;s-operat&#243;rio em compara&#231;&#227;o com o per&#237;odo pr&#233;-operat&#243;rio&#59; no entanto&#44; o ganho m&#233;dio da FEVE no grupo CRM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TVM foi maior em compara&#231;&#227;o com o grupo CRM isolada &#40;8&#44;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;39 <span class="elsevierStyleItalic">versus</span> 4&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;23&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o houve diferen&#231;a significativa nas taxas de mortalidade operat&#243;ria &#40;6&#44;3 <span class="elsevierStyleItalic">versus</span> 7&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;679&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CRM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TVM pode ser realizada com seguran&#231;a em pacientes que t&#234;m RMI moderada a grave&#46; CRM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TVM resultou em menores taxas de complica&#231;&#245;es do que a CRM isolada&#46; Ambas as abordagens cir&#250;rgicas resultaram em melhoria significativa da FEVE p&#243;s-operat&#243;ria&#44; por outro lado&#44; houve maior ganho no grupo CRM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>TVM&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Analysis of left ventricular ejection fraction by echocardiography before and after surgery&#46; Values expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; CABG&#58; coronary artery bypass grafting&#59; MVR&#58; mitral valve replacement&#59; Preop&#58; preoperative&#59; Postop&#58; postoperative&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">CABG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MVR</td><td class="td" title="\n
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                  \t\t\t\t">OR &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Shock&#47;hemorrhage&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Low cardiac output&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;014<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;09 &#40;0&#46;01&#8211;0&#46;81&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renal complications&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;11 &#40;0&#46;01&#8211;1&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neurologic complications&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;10 &#40;0&#46;08&#8211;10&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">38&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;021<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;11 &#40;0&#46;01&#8211;0&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Respiratory complications&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">34&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;316<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;44 &#40;0&#46;06&#8211;2&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiple transfusion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">42&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;116<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;31 &#40;0&#46;05&#8211;1&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Death&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;679<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;80 &#40;0&#46;03&#8211;12&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab272091.png"
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      "titulo" => "References"
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy&#58; new insights from anatomic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Heub"
                            1 => "F&#46; Jatene"
                            2 => "L&#46; Moreira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mtc.2002.125342"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2002"
                        "volumen" => "124"
                        "paginaInicial" => "1216"
                        "paginaFinal" => "1224"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12447190"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of mitral valve regurgitation evaluated by intraoperative transesophageal echocardiography on long-term outcomes after coronary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;N&#46; Schroder"
                            1 => "M&#46;L&#46; Williams"
                            2 => "J&#46;A&#46; Hata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.104.523472"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2005"
                        "volumen" => "112"
                        "paginaInicial" => "I293"
                        "paginaFinal" => "I298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16159834"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;A&#46; Grossi"
                            1 => "G&#46;A&#46; Crooke"
                            2 => "P&#46;L&#46; DiGiorgi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.105.001230"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2006"
                        "volumen" => "114"
                        "paginaInicial" => "I573"
                        "paginaFinal" => "I576"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16820640"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization&#58; a propensity analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;D&#46; Diodato"
                            1 => "M&#46;R&#46; Moon"
                            2 => "M&#46;K&#46; Pasque"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2004.03.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2004"
                        "volumen" => "78"
                        "paginaInicial" => "794"
                        "paginaFinal" => "799"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15336993"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of no-to-moderate mitral regurgitation on late results after isolated coronary artery bypass grafting in patients with ischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Di Mauro"
                            1 => "G&#46; Di Giammarco"
                            2 => "G&#46; Vitolla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2006.01.061"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2006"
                        "volumen" => "81"
                        "paginaInicial" => "2128"
                        "paginaFinal" => "2134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16731141"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;R&#46; Wong"
                            1 => "A&#46;K&#46; Agnihotri"
                            2 => "J&#46;W&#46; Hung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2005.03.034"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2005"
                        "volumen" => "80"
                        "paginaInicial" => "570"
                        "paginaFinal" => "577"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16039207"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic ischemic mitral regurgitation&#58; repair&#44; replace or rethink&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Borger"
                            1 => "A&#46; Alam"
                            2 => "P&#46;M&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2005.08.080"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2006"
                        "volumen" => "81"
                        "paginaInicial" => "1153"
                        "paginaFinal" => "1161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16488757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ischemic mitral valve reconstruction and replacement&#58; comparison of long-term survival and complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;A&#46; Grossi"
                            1 => "J&#46;D&#46; Goldberg"
                            2 => "A&#46; LaPietra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mtc.2001.116945"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2001"
                        "volumen" => "122"
                        "paginaInicial" => "1107"
                        "paginaFinal" => "1124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11726886"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is repair preferable to replacement for ischemic mitral regurgitation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;M&#46; Gillinov"
                            1 => "P&#46;N&#46; Wierup"
                            2 => "E&#46;H&#46; Blackstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mtc.2001.116557"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2001"
                        "volumen" => "122"
                        "paginaInicial" => "1125"
                        "paginaFinal" => "1141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11726887"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mitral repair versus replacement for ischemic mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "O&#46;O&#46; Al-Radi"
                            1 => "P&#46;C&#46; Austin"
                            2 => "J&#46;V&#46; Tu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2004.09.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2005"
                        "volumen" => "79"
                        "paginaInicial" => "1260"
                        "paginaFinal" => "1267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15797060"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mitral repair is superior to replacement when associated with coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;B&#46; Reece"
                            1 => "C&#46;G&#46; Tribble"
                            2 => "P&#46;I&#46; Ellman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2004"
                        "volumen" => "239"
                        "paginaInicial" => "671"
                        "paginaFinal" => "677"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15082971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement&#58; effect of age and concomitant coronary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46;H&#46; Thourani"
                            1 => "W&#46;S&#46; Weintraub"
                            2 => "R&#46;A&#46; Guyton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000079169.15862.13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2003"
                        "volumen" => "108"
                        "paginaInicial" => "298"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12835220"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Importance of mitral regurgitation in patients undergoing percutaneous coronary intervention for acute myocardial infarction&#58; the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications &#40;CADILLAC&#41; trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;G&#46; Pellizzon"
                            1 => "C&#46;L&#46; Grines"
                            2 => "D&#46;A&#46; Cox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2003.11.046"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2004"
                        "volumen" => "43"
                        "paginaInicial" => "1368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15093869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heart failure and death after myocardial infarction in the community&#58; the emerging role of mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Bursi"
                            1 => "M&#46; Enriquez-Sarano"
                            2 => "V&#46;T&#46; Nkomo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000151097.30779.04"
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2005"
                        "volumen" => "111"
                        "paginaInicial" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15655133"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Sueda"
                            1 => "H&#46; Nagata"
                            2 => "K&#46; Orihashi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1997"
                        "volumen" => "63"
                        "paginaInicial" => "1070"
                        "paginaFinal" => "1075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9124907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative study between on-pump and off-pump coronary artery bypass graft in women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "F&#46;G&#46; Rueda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Cir Cardiovasc"
                        "fecha" => "2010"
                        "volumen" => "25"
                        "paginaInicial" => "238"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation&#63; A meta-analysis on 2479 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "U&#46; Benedetto"
                            1 => "G&#46; Melina"
                            2 => "A&#46; Roscitano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiovasc Med"
                        "fecha" => "2009"
                        "volumen" => "10"
                        "paginaInicial" => "109"
                        "paginaFinal" => "114"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pathophysiology of mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Carabello"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Valve Dis"
                        "fecha" => "2000"
                        "volumen" => "9"
                        "paginaInicial" => "600"
                        "paginaFinal" => "608"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11041171"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chordal cutting&#46; A new therapeutic approach for ischemic mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Messas"
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                          ]
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                        "paginaInicial" => "1958"
                        "paginaFinal" => "1963"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11602501"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation&#58; insights from three-dimensional echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Liel-Cohen"
                            1 => "J&#46;L&#46; Guerroro"
                            2 => "Y&#46; Otsuji"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "paginaFinal" => "2763"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10851215"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
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                      "titulo" => "Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction&#58; a quantitative clinical study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;F&#46; Yiu"
                            1 => "M&#46; Enriquez-Sarano"
                            2 => "C&#46; Tribouilloy"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "paginaInicial" => "1400"
                        "paginaFinal" => "1406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10993859"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Extension of borderzone myocardium in postinfarction dilated cardiomyopathy"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;M&#46; Jackson"
                            1 => "J&#46;H&#46; Gorman III"
                            2 => "S&#46;L&#46; Moainie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2002"
                        "volumen" => "40"
                        "paginaInicial" => "1160"
                        "paginaFinal" => "1167"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12354444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46;L&#46; Kron"
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                            2 => "J&#46;T&#46; Cope"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2002"
                        "volumen" => "74"
                        "paginaInicial" => "600"
                        "paginaFinal" => "601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12173864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ischemic mitral regurgitation redux &#8211; to repair or to replace&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;C&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2000"
                        "volumen" => "122"
                        "paginaInicial" => "159"
                        "paginaFinal" => "162"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mitral valve surgery for chronic ischemic mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;M&#46; Calafiore"
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2003.11.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2004"
                        "volumen" => "77"
                        "paginaInicial" => "1989"
                        "paginaFinal" => "1997"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15172252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Coronary revascularization alone or with mitral valve repair&#46; Outcomes in patients with moderate ischemic mitral regurgitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Goland"
                            1 => "L&#46;S&#46;C&#46; Czer"
                            2 => "R&#46;J&#46; Siegel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tex Heart Inst J"
                        "fecha" => "2009"
                        "volumen" => "36"
                        "paginaInicial" => "416"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19876417"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mitral valve reconstruction and replacement for ischemic mitral insufficiency&#58; seven years&#8217; follow-up"
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                          "etal" => false
                          "autores" => array:3 [
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                            2 => "R&#46; Hetzer"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Valve Dis"
                        "fecha" => "1999"
                        "volumen" => "8"
                        "paginaInicial" => "536"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2013.02.006

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Year/Month	Html	Pdf	Total

2024 November	4	3	7
2024 October	28	29	57
2024 September	32	34	66
2024 August	41	29	70
2024 July	33	26	59
2024 June	29	28	57
2024 May	20	16	36
2024 April	24	23	47
2024 March	25	17	42
2024 February	25	38	63
2024 January	23	31	54
2023 December	17	30	47
2023 November	18	18	36
2023 October	11	12	23
2023 September	18	22	40
2023 August	15	13	28
2023 July	21	7	28
2023 June	31	9	40
2023 May	27	25	52
2023 April	12	6	18
2023 March	20	17	37
2023 February	13	13	26
2023 January	16	22	38
2022 December	26	16	42
2022 November	31	13	44
2022 October	29	20	49
2022 September	15	24	39
2022 August	24	32	56
2022 July	24	24	48
2022 June	10	15	25
2022 May	19	23	42
2022 April	24	19	43
2022 March	12	30	42
2022 February	18	19	37
2022 January	21	14	35
2021 December	13	26	39
2021 November	31	29	60
2021 October	28	42	70
2021 September	13	21	34
2021 August	24	26	50
2021 July	13	24	37
2021 June	15	15	30
2021 May	16	30	46
2021 April	19	37	56
2021 March	59	17	76
2021 February	58	8	66
2021 January	27	12	39
2020 December	54	8	62
2020 November	54	12	66
2020 October	18	7	25
2020 September	37	5	42
2020 August	18	3	21
2020 July	50	13	63
2020 June	40	2	42
2020 May	41	4	45
2020 April	41	8	49
2020 March	33	3	36
2020 February	99	12	111
2020 January	34	8	42
2019 December	51	7	58
2019 November	53	9	62
2019 October	66	5	71
2019 September	38	7	45
2019 August	37	10	47
2019 July	47	11	58
2019 June	53	3	56
2019 May	38	5	43
2019 April	52	13	65
2019 March	90	9	99
2019 February	96	7	103
2019 January	72	5	77
2018 December	102	16	118
2018 November	96	6	102
2018 October	165	9	174
2018 September	63	13	76
2018 August	108	6	114
2018 July	27	5	32
2018 June	45	4	49
2018 May	53	7	60
2018 April	32	3	35
2018 March	57	7	64
2018 February	36	6	42
2018 January	33	11	44
2017 December	49	16	65
2017 November	49	10	59
2017 October	43	14	57
2017 September	41	6	47
2017 August	53	8	61
2017 July	27	6	33
2017 June	44	13	57
2017 May	87	8	95
2017 April	53	11	64
2017 March	59	18	77
2017 February	54	6	60
2017 January	49	3	52
2016 December	68	15	83
2016 November	37	2	39
2016 October	17	5	22
2016 September	21	4	25
2016 August	10	0	10
2016 July	7	1	8
2016 June	5	2	7
2016 May	10	4	14
2016 April	13	8	21
2016 March	25	9	34
2016 February	35	23	58
2016 January	20	10	30
2015 December	26	8	34
2015 November	16	11	27
2015 October	25	15	40
2015 September	27	12	39
2015 August	20	4	24
2015 July	19	3	22
2015 June	12	1	13
2015 May	29	8	37
2015 April	22	12	34
2015 March	16	8	24
2015 February	13	2	15
2015 January	27	8	35
2014 December	33	7	40
2014 November	17	5	22
2014 October	28	4	32
2014 September	20	6	26
2014 August	19	4	23
2014 July	22	12	34
2014 June	20	5	25
2014 May	22	6	28
2014 April	18	3	21
2014 March	40	12	52
2014 February	37	3	40
2014 January	41	14	55
2013 December	34	8	42
2013 November	40	15	55
2013 October	25	9	34
2013 September	29	13	42
2013 August	40	11	51
2013 July	29	10	39
2013 June	30	7	37
2013 May	30	4	34
2013 April	51	20	71
2013 March	38	12	50

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