Prognostic impact of decisions taken by the heart team in patients evaluated for transcatheter aortic valve implantation | Revista Portuguesa de Cardiologia (English edition)

array:24 ["pii" => "S2174204915002172" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.10.004" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "680" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:587-95" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2762 "formatos" => array:3 [ "EPUB" => 169 "HTML" => 2146 "PDF" => 447 ] ] "itemSiguiente" => array:19 [ "pii" => "S2174204915002184" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.10.005" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "681" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2015;34:597-606" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3373 "formatos" => array:3 [ "EPUB" => 160 "HTML" => 2721 "PDF" => 492 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "597" "paginaFinal" => "606" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "O valor prognóstico do rácio do índice de dispersão eritrocitária pelo número de plaquetas em doentes com enfarte do miocárdio com elevação do segmento ST submetidos a intervenção coronária percutânea" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1421 "Ancho" => 1589 "Tamanyo" => 102370 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curve for long-term survival according to red cell distribution width-to-platelet ratio (RPR) with a cutoff of 0.061. Cumulative event-free survival was defined as freedom from death." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hamdi Pusuroglu, Huseyin Altug Cakmak, Ozgur Akgul, Mehmet Erturk, Ozgur Surgit, Emre Akkaya, Umit Bulut, Aydin Yildirim" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Hamdi" "apellidos" => "Pusuroglu" ] 1 => array:2 [ "nombre" => "Huseyin Altug" "apellidos" => "Cakmak" ] 2 => array:2 [ "nombre" => "Ozgur" "apellidos" => "Akgul" ] 3 => array:2 [ "nombre" => "Mehmet" "apellidos" => "Erturk" ] 4 => array:2 [ "nombre" => "Ozgur" "apellidos" => "Surgit" ] 5 => array:2 [ "nombre" => "Emre" "apellidos" => "Akkaya" ] 6 => array:2 [ "nombre" => "Umit" "apellidos" => "Bulut" ] 7 => array:2 [ "nombre" => "Aydin" "apellidos" => "Yildirim" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002184?idApp=UINPBA00004E" "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915002184/v2_201703210134/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204915001828" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.08.002" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "664" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Rev Port Cardiol. 2015;34:583-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2445 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 1782 "PDF" => 510 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial Comment" "titulo" => "The economics and costs of patient referral protocols for cardiac surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "583" "paginaFinal" => "585" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A economia e os custos das redes de referenciação de doentes para cirurgia cardíaca" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Antunes" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Antunes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255115001778" "doi" => "10.1016/j.repc.2015.06.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001778?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001828?idApp=UINPBA00004E" "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915001828/v2_201703210134/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Prognostic impact of decisions taken by the heart team in patients evaluated for transcatheter aortic valve implantation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "587" "paginaFinal" => "595" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Diego Iglesias, Pablo Salinas, Raúl Moreno, Sergio García-Blas, Luis Calvo, Santiago Jiménez-Valero, Ángel Sánchez-Recalde, Guillermo Galeote, José María Mesa, Ignacio Plaza, José Luis López-Sendón" "autores" => array:11 [ 0 => array:4 [ "nombre" => "Diego" "apellidos" => "Iglesias" "email" => array:1 [ 0 => "diegoiglesiasdelvalle@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pablo" "apellidos" => "Salinas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Raúl" "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Sergio" "apellidos" => "García-Blas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Luis" "apellidos" => "Calvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Santiago" "apellidos" => "Jiménez-Valero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Ángel" "apellidos" => "Sánchez-Recalde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "Guillermo" "apellidos" => "Galeote" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 8 => array:3 [ "nombre" => "José María" "apellidos" => "Mesa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 9 => array:3 [ "nombre" => "Ignacio" "apellidos" => "Plaza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 10 => array:3 [ "nombre" => "José Luis" "apellidos" => "López-Sendón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Clinico Universitario, Valencia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Impacto das decisões tomadas pela Heart Team no prognóstico dos doentes propostos para implantação percutânea de prótese valvular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1802 "Ancho" => 1741 "Tamanyo" => 249112 ] ] "descripcion" => array:1 [ "en" => "Patient flowchart of the study and treatment groups after the heart team decision. AS: aortic stenosis; TAVI: transcatheter aortic valve implantation." ] ] ] "textoCompleto" => "IntroductionAortic stenosis (AS) is the most prevalent valvulopathy in developed countries. The condition is mainly of degenerative etiology<a class="elsevierStyleCrossRef" href="#bib0135">1</a> and is associated with aging, and is therefore becoming more frequent as the average age of the population increases.<a class="elsevierStyleCrossRef" href="#bib0140">2</a> It is a chronic and progressive disease characterized by lipid accumulation, inflammation and calcification, with many similarities in terms of pathophysiology and risk factors to atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0145">3</a> Once the patient has developed symptoms, the prognosis of unoperated patients is very poor, with a two-year survival around 21%, so they should be referred quickly for surgical aortic valve replacement (SAVR).<a class="elsevierStyleCrossRefs" href="#bib0150">4–6</a> However, many of them are considered at high risk for surgery due to advanced age and comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0165">7,8</a>Transcatheter aortic valve implantation (TAVI) has emerged in recent years as a less invasive alternative treatment for high-risk patients.<a class="elsevierStyleCrossRef" href="#bib0175">9</a> This strategy has been shown to reduce mortality and hospitalizations compared to conservative management in patients considered unfit for surgery, and survival rates are similar compared to surgical valve replacement in patients at high surgical risk but still considered operable.<a class="elsevierStyleCrossRefs" href="#bib0180">10,11</a> Nevertheless some candidates for TAVI are denied this technique for various reasons.It is known that the mortality of patients who are not operated is high and increases with age, left ventricular dysfunction, heart failure and kidney failure.<a class="elsevierStyleCrossRef" href="#bib0190">12</a> However, there are few data on patients treated conservatively after the recent emergence of this percutaneous intervention.<a class="elsevierStyleCrossRefs" href="#bib0195">13,14</a> The objective of this study is to analyze the survival and predictors of mortality of patients with AS and high surgical risk included in a TAVI evaluation program depending on the final treatment strategy decided by the heart team.MethodsPatientsIn accordance with standard practice, all patients with AS and indication for valve replacement (severe AS and related symptoms) were evaluated by a multidisciplinary team, including clinical and interventional cardiologists, cardiac surgeons and anesthesiologists (the heart team). Further visits by heart team members were made when needed, during which direct patient examination and a qualitative assessment of frailty were performed. Patients at high risk for conventional surgery were considered for TAVI, usually because of age, comorbidities, previous cardiac surgery, ventricular dysfunction or concomitant coronary artery disease, as were patients who refused SAVR. TAVI candidates underwent the standard protocol, according to the device manufacturer's recommendations, to confirm that they were suitable for this technique.<a class="elsevierStyleCrossRefs" href="#bib0205">15,16</a> All patients referred for TAVI evaluation between June 2008 and June 2012 were prospectively included in the study.Evaluation and treatment allocationThe first step in the evaluation was to confirm that there was indication for valve replacement according to the guidelines of the European Society of Cardiology.<a class="elsevierStyleCrossRef" href="#bib0215">17</a> Data from transthoracic echocardiographic study were reviewed to determine the severity of AS. The echocardiographic criteria of severity were those established by clinical practice guidelines: aortic valve area <1 cm2, mean gradient >40 mmHg and maximum jet velocity >4 m/s. Also, the presence of symptoms (angina, syncope and exertional dyspnea) secondary to valvular heart disease was determined by reviewing medical records and clinical visits.Subsequently, surgical risk with regard to age, cardiovascular risk factors, comorbidities, logistic EuroSCORE calculation<a class="elsevierStyleCrossRef" href="#bib0220">18</a> and baseline patient characteristics was evaluated, and the presence of contraindications for the intervention were ruled out: acute myocardial infarction in the last 30 days, hemodynamic instability, severe left ventricular dysfunction with ejection fraction (LVEF) less than 20% or life expectancy of less than 12 months because of non-cardiac problems.Patients who passed the initial assessment also underwent transesophageal echocardiography, cardiac catheterization and multidetector computed tomography (MDCT). The objective of the transesophageal study was to confirm the severity, mechanism and hemodynamics of AS, to measure the dimensions and morphology of the aortic valve annulus and to evaluate the existence of aortic insufficiency or other associated valvulopathies. Patients underwent coronary angiography to detect the existence of significant atherosclerotic lesions, and lower limb arterial angiography to confirm the criteria to perform the procedure by a transfemoral approach. Finally, MDCT was also used to study the left ventricular outflow tract and the aortic annulus and to measure the caliber of the iliac and femoral arteries.Finally, the results were presented to the heart team to make a final decision. Those who were considered suitable for the procedure underwent TAVI. Some were considered not to have indication for valve replacement at that time because of non-severe or only mildly symptomatic AS, and the heart team decided to defer invasive treatment. After the study protocol for TAVI candidates, some were considered anatomically unsuitable for TAVI or had other significant concomitant valve disease, without excessive surgical risk, so conventional surgery was reconsidered by the heart team and they underwent surgical valve replacement. The remaining patients were those who did not meet the appropriate anatomic conditions for a percutaneous technique, those with excessive risk and those who refused any intervention, and these received medical treatment only.ProcedureThe TAVI procedure was performed according to standard techniques described previously.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> In all cases the implanted valve was the Edwards SAPIEN Transcatheter Heart Valve (Edwards Lifesciences). Initially the approach was exclusively transfemoral with surgical exposure of the femoral artery by vascular surgery. However, from February 2011, a transapical TAVI program was introduced, performed by cardiac surgeons.<a class="elsevierStyleCrossRef" href="#bib0225">19</a> The approach was selected depending on the size of the annulus and femoral arteries: in patients with an annulus between 18 and 25 mm and femoral artery diameter >7 mm a transfemoral approach was used, while in patients with an aortic annulus between 25 and 27 mm or between 18 and 25 mm with femoral artery diameter <7 mm, transapical access was chosen once it became available. The cutoff point of 7 mm was reduced to 6 mm after the development of the new generation of valve and transfemoral delivery catheters in 2010 (XT valve with the NovaFlex delivery system).<a class="elsevierStyleCrossRef" href="#bib0230">20</a> Patients with annular diameters outside these limits or inadequate transfemoral access before the introduction of transapical access were considered unsuitable for the percutaneous technique.Data collectionInformation on baseline characteristics, cardiovascular risk factors, comorbidities, echocardiographic data and symptoms was collected in a specially designed prospective database. Follow-up information in the different groups was obtained prospectively by medical consultations, telephone interviews and review of computerized medical records. The day the heart team took the final decision on the most appropriate treatment strategy for each patient was considered as day 0 of the follow-up.Definition of variablesThe primary endpoint of the study was all-cause mortality during follow-up. Additionally, the cause of death was classified as cardiovascular or non-cardiovascular according to the Valve Academic Research Consortium criteria recommended for TAVI studies.<a class="elsevierStyleCrossRef" href="#bib0235">21</a> The secondary endpoint was event-free survival from the composite endpoint of major adverse cardiovascular events (MACE) defined as death, hospitalization for heart failure, non-fatal myocardial infarction or non-fatal stroke.Statistical analysisContinuous variables are presented as mean ± standard deviation and categorical variables are presented as relative frequencies (percentages). Statistical analysis of the results was performed by intention to treat, allocating the patient to the treatment group decided by the heart team. The analysis of all-cause death and MACE-free survival was performed by the Kaplan–Meier method and groups were compared with the log-rank test. Analysis of prognostic factors was performed with the Cox proportional hazards model, univariate and multivariate, calculating the hazard ratios for all-cause death. p values and 95% confidence intervals (CI) are bilateral, with a cutoff of 0.05 for statistical significance. All analyses were performed using SPSS® Statistics software, version 20 (IBM®).ResultsBetween June 2008 and June 2012 a total of 157 patients were evaluated for a possible TAVI procedure. The heart team discussed each case and decided the most appropriate treatment strategy. The mean time between the initial presentation of the case and the final decision of the heart team was 0.7 months (minimum 0.1; maximum 12.3). Of the 157 cases included in the evaluation protocol, eight patients died during the initial assessment before a final therapeutic decision of the heart team could be taken, and were excluded from the study. Of the 149 patients with a final decision from the heart team 79 (53.0%) were accepted for TAVI, 12 (8.1%) had the valve replacement deferred because of non-severe or only mildly symptomatic AS, 13 (8.7%) were redirected to conventional surgery and 45 (30.2%) received medical treatment for different reasons: excess risk, unfavorable iliac or femoral arterial anatomy (before the introduction of transapical access), concomitant disease (any short-term life-threatening non-cardiac condition) or patient refusal (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Mean follow-up was 16.6±14.1 months (maximum 55.3). No patients were lost during follow-up. All were monitored, at least by telephone interview.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>All patients in the TAVI and surgery groups underwent the procedure to which they were allocated. Of the patients undergoing TAVI, 64 (81.0%) were treated by transfemoral access and 15 (19.0%) by transapical access. Implant success was achieved in 75 of the 79 TAVI patients (94.9%). During follow-up, one patient in the deferred intervention group and three of the medical treatment group underwent SAVR. None of the patients undergoing TAVI underwent surgery during follow-up. In the medical treatment group two patients received percutaneous aortic valvuloplasty.Patients evaluated for TAVI had a mean age of 83.7 years and 57.0% were women. Mean EuroSCORE was 19.8±12.3. Patients in the medical treatment group had older age, more comorbidities and higher surgical risk, as shown by lower LVEF and higher EuroSCORE. Baseline characteristics and echocardiographic data in the different treatment groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Survival analysisMedian survival free from all-cause death was 34.7 months (95% CI 27.1–42.3) in the TAVI group, 47.4 months (95% CI 0–97.4) in the deferred intervention group, not available in the surgery group because more than 50% survived to the end of follow-up (mean survival 51.3 months, 95% CI 43.7–58.9), and 8.2 months (95% CI 5.6–10.9) in the medical treatment group (log-rank p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A). Overall survival at one year was 79.7% in the TAVI group, 91.7% in the deferred intervention group, 92.3% in the surgery group and 41.2% in the medical treatment group. Overall survival at two years was 67.4% in the TAVI group, 65.2% in the deferred intervention group, 92.3% in the surgery group and 21.7% in the medical treatment group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The cause of death was cardiovascular in 50.0% of deaths in the TAVI group, 100% of deaths in the deferred intervention and surgery groups and 83.3% of deaths in the medical treatment group.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Median event-free survival for the MACE composite secondary endpoint was 20.7 months (95% CI 9.6–31.8) in the TAVI group, 21.3 months (CI not calculable) in the deferred intervention group, 27.0 months (CI not calculable) in the surgery group and 7.2 months (95% CI 3.0–11.4) in the medical treatment group (log-rank p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B).Predictors of mortalityIn univariate analysis, the following variables: age, dyslipidemia, chronic renal failure, significant mitral regurgitation (grade 3 or 4) and treatment group, showed a statistically significant association with mortality during follow-up. All significant variables in univariate analysis were entered into the multivariate Cox proportional hazards model, in which only treatment group remained as an independent predictor of mortality (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Compared to the TAVI group, used as the reference category, the adjusted hazard ratio for all-cause death was 0.70 (95% CI 0.24–2.04) for the deferred intervention group, 0.16 (95% CI 0.02–1.19) for the conventional surgery group and 2.47 (95% CI 1.46–4.18) for the medical treatment group.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionThis single-center observational study of unselected patients shows that the prognosis of patients with severe AS and high surgical risk evaluated for TAVI is influenced by the final decision of the heart team. This prognosis is more favorable for patients who undergo aortic valve replacement, by either a percutaneous or a surgical approach, and for those who do not have a definite indication for valve replacement at the time of evaluation (deferred group). Conversely, it is poor for those considered unsuitable for TAVI or SAVR (medical treatment group), either because they have a contraindication for the percutaneous technique or because they refuse any invasive treatment. These patients have very high mortality, mostly from cardiovascular causes.Role of transcatheter aortic valve implantationVarious studies have shown poor outcomes for patients with severe AS treated conservatively. The introduction of TAVI has transformed the prospects for these patients, who now have a less invasive alternative to surgery for the treatment of their valvular heart disease. The TAVI procedure has demonstrated a reduction in mortality and hospitalization and improvement in cardiac symptoms compared to medical therapy in these patients.<a class="elsevierStyleCrossRef" href="#bib0180">10</a>The interest of this study lies not in analysis of the effectiveness of TAVI, for which there are several larger and multicenter registries, as well as a few randomized clinical trials, but in its description of the differences in the natural history of the disease according to treatment strategy. However, it is noteworthy that survival rates in our TAVI group were similar to data in the literature, with a one-year survival of 80% vs. 69–83% reported in various publications.<a class="elsevierStyleCrossRefs" href="#bib0180">10,11,13,22</a> It should be noted that ours is a national reference center with a volume of TAVI procedures slightly above the average in Portugal (19.8 annual procedures compared to the average of 16.4 per center recorded between 2010 and 2011).<a class="elsevierStyleCrossRef" href="#bib0245">23</a>Treatment groupsThe medical treatment group had the most adverse prognosis, with a survival rate of 41% at one year and 22% at two years, similar to that described in the literature before the introduction of TAVI. In this patient group aortic balloon valvuloplasty has not shown good results in the medium to long term, due to a high incidence of restenosis.<a class="elsevierStyleCrossRefs" href="#bib0250">24,25</a> There is no pharmacological treatment with a prognostic benefit in AS, so medical management should be directed to symptomatic relief. Our results support this approach, especially when taking into account that life expectancy is usually very limited for those who are not candidates for TAVI. This does not mean that patients who were considered unsuitable after evaluation should have been accepted for TAVI, but rather that they represent a very high risk population, with a particularly unfavorable prognosis.Regarding the deferred intervention and conventional surgery groups, although the Kaplan–Meier curves seem to indicate improved survival, there were no significant differences in survival compared to the TAVI group due to the limited number of patients in each group. The relatively low number of patients treated with SAVR in our series is explained by the fact that patients initially considered suitable for SAVR (low or intermediate risk) were not included in the TAVI evaluation program.Predictors of mortalityOur results suggest that the final treatment strategy adopted by the heart team is the main predictor of mortality in patients evaluated for TAVI. This is mainly due to the higher event rate in the medical treatment group, with a hazard ratio for all-cause mortality close to 2.5 compared to the group considered suitable for TAVI. Although in the deferred intervention and surgery groups the hazard ratio was lower than 1, in both cases the confidence intervals were wide and included the value 1, so it cannot be concluded that the prognosis of these groups is better than the TAVI group.Comparison with previous studiesThere are very few studies designed to evaluate the prognosis of patients with AS and high surgical risk depending on their suitability for TAVI. Wenaweser et al.<a class="elsevierStyleCrossRef" href="#bib0195">13</a> studied the evolution of a cohort of patients with severe AS at high risk according to treatment strategy, comparing medical treatment, SAVR and TAVI. Similarly to our study, a multidisciplinary team taking into account the patient's decision assigned the final treatment. Mortality at 30 months was significantly higher in the medical treatment group (61.5%) compared to the surgery group (22.4%) and TAVI group (22.6%). In this study, the variables of medical treatment, advanced age (>80 years), peripheral vascular disease and atrial fibrillation were associated with mortality at 30 months in multivariate analysis.Ben-Dor et al. analyzed the prognosis of patients not eligible for TAVI clinical trials because they did not meet inclusion/exclusion criteria.<a class="elsevierStyleCrossRef" href="#bib0200">14</a> The main exclusion criteria were low Society of Thoracic Surgeons score (<10%), peripheral vascular or aortic disease, aortic valve area >0.8 cm2, significant coronary artery disease requiring revascularization, and severe renal insufficiency. The study population was divided into two groups, one unsuitable for surgery who received medical treatment with or without aortic valvuloplasty and the other who underwent SAVR. Mortality in the medical/valvuloplasty treatment group was significantly higher than in the surgery group, 39.6% vs. 22.9% at one year and 53.4% vs. 28.1% at two years, respectively. Multivariate analysis identified renal failure, New York Heart Association class IV and systolic blood pressure as independent predictors of mortality in the medical group. This paper studied a highly selected population, and so the treatment groups were not comparable with our study. Furthermore, unlike our study, they excluded patients with significant coronary artery disease requiring revascularization and those with severe renal insufficiency (defined as creatinine >3.0 mg/dl or hemodialysis).In PARTNER cohort B (inoperable patients with severe symptomatic AS), mortality from any cause was 50.7% at one year and 68.0% at two years for the standard therapy group.<a class="elsevierStyleCrossRefs" href="#bib0180">10,26</a> Cardiovascular mortality was 44.6% and 62.4%, respectively. The main difference from our study was that medically treated patients were not considered unsuitable for TAVI by the heart team, but were assigned to standard therapy by the randomization process.Relevance and limitations of the studyThe prognostic data derived from this study are important for providing the patient with detailed and accurate information about the multiple treatment options available in high surgical risk AS. Most patients and families face this decision with many doubts because of fear of a major intervention, uncertainty about the potential improvement and ignorance of the natural history of the disease, as well as other personal, cultural and religious factors. We must not forget that a considerable proportion of our population (6.7%) refused any invasive treatment because of personal decisions by patients and relatives. This decision, especially in such an elderly population, should of course be respected, but every effort should be made to give comprehensive information about their expected prognosis.Despite the limitation of being a single-center study with a small number of patients, which reduces the power of the analysis, this was a prospective cohort study with a very long follow-up in all patients. Furthermore, the evaluation was performed in all patients by the same heart team, which gives the results greater consistency. Finally, the observational design of the study with no exclusion criteria more accurately represents daily clinical practice.Another limitation of the study should be noted. Many patients continued their monitoring in the hospitals from which they were referred and follow-up was done through telephone interviews. Therefore, we could not obtain information about possible complications of intervention, such as aortic regurgitation or need for pacemaker implantation.ConclusionsThe therapeutic decision taken by the heart team in patients with severe AS and high surgical risk, considered potential candidates for TAVI, is the main factor predicting long-term mortality. Those who are unsuitable for invasive treatment and receive medical treatment have a significantly higher mortality.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres817812" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec814927" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres817811" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec814926" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Evaluation and treatment allocation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Procedure" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Data collection" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Definition of variables" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Survival analysis" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Predictors of mortality" ] ] ] 7 => array:3 [ "identificador" => "sec0060" "titulo" => "Discussion" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Role of transcatheter aortic valve implantation" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Treatment groups" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Predictors of mortality" ] 3 => array:2 [ "identificador" => "sec0080" "titulo" => "Comparison with previous studies" ] 4 => array:2 [ "identificador" => "sec0085" "titulo" => "Relevance and limitations of the study" ] ] ] 8 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0095" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0100" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0105" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0110" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0115" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-09" "fechaAceptado" => "2015-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec814927" "palabras" => array:3 [ 0 => "Aortic stenosis" 1 => "Surgical aortic valve replacement" 2 => "Transcatheter aortic valve implantation" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec814926" "palabras" => array:3 [ 0 => "Estenose aórtica" 1 => "Substituição cirúrgica da válvula aórtica" 2 => "Implantação percutânea da válvula aórtica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo analyze long-term survival and predictors of mortality in patients evaluated for transcatheter aortic valve implantation (TAVI) depending on the decision taken by the heart team. MethodsAll patients with severe aortic stenosis and high surgical risk evaluated for TAVI between June 2008 and June 2012 were included. Patients were grouped according to the therapeutic strategy decided by the heart team. Mean follow-up was 16.6 months (maximum 55.3). ResultsA total of 149 patients were evaluated: 79 were accepted for TAVI, 12 had no current indication for valve replacement and were deferred, 13 were redirected to conventional surgery and 45 received medical treatment. The evaluated patients had a mean age of 83.7 years and a mean EuroSCORE of 19.8±12.3. Median survival free from all-cause death was 34.7 months (95% CI 27.1–42.3) in the TAVI group, 47.4 months (95% CI 0–97.4) in the deferred intervention group, not available in the surgery group and 8.2 months (95% CI 5.6–10.9) in the medical treatment group (log-rank p<0.001). After multivariable adjustment, only treatment group remained as an independent predictor of mortality. Considering the TAVI group as the reference category, the adjusted hazard ratio for all-cause death was 0.70 (95% CI 0.24–2.04) for the deferred intervention group, 0.16 (95% CI 0.02–1.19) for the surgery group and 2.47 (95% CI 1.46–4.18) for the medical treatment group. ConclusionThe decision taken by the heart team on potential candidates for TAVI has a decisive prognostic significance, as those who are unsuitable for any kind of valve replacement have a significantly higher mortality." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivosAnalisar a sobrevivência a longo prazo e os fatores preditores de mortalidade de doentes avaliados para implantação percutânea da válvula aórtica (TAVI), dependendo da decisão tomada pela Heart Team. MétodosForam incluídos todos os doentes com estenose aórtica grave e elevado risco cirúrgico avaliados para TAVI desde junho 2008 a junho 2012. Os doentes foram agrupados de acordo com a estratégia terapêutica decidida pela Heart Team. Seguimento médio 16,6 meses (máximo 55,3). ResultadosFoi avaliado um total de 149 doentes, dos quais 79 foram aceites para TAVI, 12 não apresentaram indicação para substituição valvular e foram diferidos, 13 foram redirecionados para cirurgia convencional e 45 receberam tratamento médico. Os doentes avaliados tinham uma idade média de 83,7 anos e um EuroSCORE médio de 19,8±12,3. A sobrevida média livre de todas as causas de morte foi 34,7 meses (IC 95% 27,1-42,3) no grupo TAVI, de 47,4 meses (IC 95% 0-97,4) no grupo de intervenção diferido, não disponível no grupo de cirurgia e de 8,2 meses (IC 95% 5,6-10,9) no grupo de tratamento médico (Log rank p <0,001). Após o ajuste de múltiplas variáveis, só o grupo de tratamento permaneceu como um fator preditor independente da mortalidade. Considerando o grupo TAVI como categoria de referência, a taxa de risco ajustada para todas as causas de morte foi de 0,70 (IC 95% 0,24-2,04) para o grupo de intervenção diferido, de 0,16 (IC 95% 0,02-1,19) para o grupo da cirurgia e de 2,47 (IC 95% 1,46-4,18) para o grupo de tratamento médico. ConclusãoA decisão tomada pela Heart Team relativamente aos potenciais candidatos para TAVI tem um impacto decisivo no prognóstico dado que os que não são elegíveis para qualquer tipo de substituição valvular apresentam uma mortalidade significativamente maior." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "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" => 1802 "Ancho" => 1741 "Tamanyo" => 249112 ] ] "descripcion" => array:1 [ "en" => "Patient flowchart of the study and treatment groups after the heart team decision. AS: aortic stenosis; TAVI: transcatheter aortic valve implantation." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2957 "Ancho" => 2277 "Tamanyo" => 346930 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier survival curves for all-cause death (A) and for major adverse cardiovascular events: death, hospitalization for heart failure, non-fatal myocardial infarction or non-fatal stroke (B). TAVI: transcatheter aortic valve implantation; MACE: major adverse cardiovascular events." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "AF: atrial fibrillation; AVA: aortic valve area; BMI: body mass index; CHD: coronary heart disease; COPD: chronic obstructive pulmonary disease; LBBB: left bundle bunch block; LVEF: left ventricular ejection fraction; NYHA: New York Heart Association; PVD: peripheral vascular disease; TAVI: transcatheter aortic valve implantation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TAVI (n=79) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deferred intervention (n=12) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery (n=13) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Medical treatment (n=45) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.0±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.4±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.4±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.4±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.085 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.315 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.3±4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.8±7.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.3±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.0±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.844 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Risk factors</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.103 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.206 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypercholesterolemia (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Comorbidities</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CHD (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous infarction (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart failure (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal failure<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.422 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PVD (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.904 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stroke (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Symptoms</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NYHA functional class (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.922 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.974 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angina (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Syncope (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Cardiac rhythm</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.130 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peacemaker (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.905 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LBBB (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.887 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Echocardiography</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.4±11.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.2±15.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.5±12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.7±16.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AVA (cm2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69±0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79±0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.61±0.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63±0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean gradient (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.5±14.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.1±18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.0±10.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.0±20.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EuroSCORE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.9±9.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.5±9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.0±12.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.1±15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1374644.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Comparison of categorical variables using the chi-square or Fisher's exact test and continuous variables using analysis of variance." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Defined as serum creatinine ≥2 mg/dl or creatinine clearance <50 ml/min/1.73 m2 according to the Cockcroft-Gault formula." ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of the patients and echocardiographic findings." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "TAVI: transcatheter aortic valve implantation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1 month \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1 year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 years \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAVI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deferred intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1374643.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Survival at 1 month, 1 year and 2 years by treatment group (%)." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CI: confidence interval; HR: hazard ratio; TAVI: transcatheter aortic valve implantation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Univariate analysis variable</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02–1.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27–0.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic renal failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.09–3.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral regurgitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01–2.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.050 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treatment group<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deferred intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.24–1.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02–1.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78–4.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Multivariate analysis variable</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treatment group<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deferred intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.24–2.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02–1.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.46–4.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1374645.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Compared to the reference category TAVI." ] ] ] "descripcion" => array:1 [ "en" => "Predictors of mortality by the Cox proportional hazards model." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Iung" 1 => "G. Baron" 2 => "E.G. Butchart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "1231" "paginaFinal" => "1243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12831818" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden of valvular heart diseases: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.T. Nkomo" 1 => "J.M. Gardin" 2 => "T.N. Skelton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(06)69208-8" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "2006" "volumen" => "368" "numero" => "9540" "paginaInicial" => "1005" "paginaFinal" => "1011" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16980116" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.A. Carabello" 1 => "W.J. Paulus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)60211-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "373" "paginaInicial" => "956" "paginaFinal" => "966" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19232707" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Ross Jr." 1 => "E. Braunwald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1968" "volumen" => "38" "paginaInicial" => "61" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4894151" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of aortic valve replacement on survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Schwarz" 1 => "P. Baumann" 2 => "J. Manthey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1982" "volumen" => "66" "paginaInicial" => "1105" "paginaFinal" => "1110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7127696" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history of very severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Rosenhek" 1 => "R. Zilberszac" 2 => "M. Schemper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.894170" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "121" "paginaInicial" => "151" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20026771" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Iung" 1 => "A. Cachier" 2 => "G. Baron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi471" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "2714" "paginaFinal" => "2720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16141261" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of patients with severe symptomatic aortic stenosis who do not undergo aortic valve replacement: the potential role of subjectively overestimated operative risk" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.S. Bach" 1 => "D. Siao" 2 => "S.E. Girard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCOUTCOMES.109.848259" "Revista" => array:6 [ "tituloSerie" => "Circ Cardiovasc Qual Outcomes" "fecha" => "2009" "volumen" => "2" "paginaInicial" => "533" "paginaFinal" => "539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031890" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve implantation: current status and future perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Salinas" 1 => "R. Moreno" 2 => "J.L. Lopez-Sendon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4330/wjc.v3.i6.177" "Revista" => array:6 [ "tituloSerie" => "World J Cardiol" "fecha" => "2011" "volumen" => "3" "paginaInicial" => "177" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21772944" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.B. Leon" 1 => "C.R. Smith" 2 => "M. Mack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1008232" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "363" "paginaInicial" => "1597" "paginaFinal" => "1607" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20961243" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter versus surgical aortic-valve replacement in high-risk patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.R. Smith" 1 => "M.B. Leon" 2 => "M.J. Mack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1103510" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "2187" "paginaFinal" => "2198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21639811" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Varadarajan" 1 => "N. Kapoor" 2 => "R.C. Bansal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2006.07.048" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2006" "volumen" => "82" "paginaInicial" => "2111" "paginaFinal" => "2115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17126120" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcomes of patients with severe aortic stenosis at increased surgical risk according to treatment modality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Wenaweser" 1 => "T. Pilgrim" 2 => "A. Kadner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2011.05.063" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2011" "volumen" => "58" "paginaInicial" => "2151" "paginaFinal" => "2162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22078420" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlates and causes of death in patients with severe symptomatic aortic stenosis who are not eligible to participate in a clinical trial of transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I. Ben-Dor" 1 => "A.D. Pichard" 2 => "M.A. Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.926873" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "122" "paginaInicial" => "S37" "paginaFinal" => "S42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20837923" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implantation of aortic valvular prosthesis via transfemoral catheter. Evaluation of candidates undergoing the procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Dobarro" 1 => "R. Moreno" 2 => "D. Filgueiras" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2009" "volumen" => "133" "paginaInicial" => "414" "paginaFinal" => "421" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Vahanian" 1 => "O. Alfieri" 2 => "N. Al-Attar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehn183" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "1463" "paginaFinal" => "1470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18474941" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on the management of valvular heart disease (version 2012)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Vahanian" 1 => "O. Alfieri" 2 => "F. Andreotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehs109" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2012" "volumen" => "33" "paginaInicial" => "2451" "paginaFinal" => "2496" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922415" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The logistic EuroSCORE" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Roques" 1 => "P. Michel" 2 => "A.R. Goldstone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "881" "paginaFinal" => "882" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12727160" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0225" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transapical minimally invasive aortic valve implantation: multicenter experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Walther" 1 => "P. Simon" 2 => "T. Dewey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.106.677237" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2007" "volumen" => "116" "paginaInicial" => "I240" "paginaFinal" => "I245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17846311" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0230" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new transcatheter aortic valve and percutaneous valve delivery system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.G. Webb" 1 => "L. Altwegg" 2 => "J.B. Masson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2008.07.075" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "1855" "paginaFinal" => "1858" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19442884" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0235" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.P. Kappetein" 1 => "S.J. Head" 2 => "P. Genereux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2012.09.001" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2012" "volumen" => "60" "paginaInicial" => "1438" "paginaFinal" => "1454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23036636" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0240" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registry of transcatheter aortic-valve implantation in high-risk patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Gilard" 1 => "H. Eltchaninoff" 2 => "B. Iung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1114705" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "1705" "paginaFinal" => "1715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22551129" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0245" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish Cardiac Catheterization and Coronary Intervention Registry. 21st official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2011)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.F. Diaz" 1 => "J.M. de La Torre" 2 => "M. Sabate" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cardiol (Engl Ed)" "fecha" => "2012" "volumen" => "65" "paginaInicial" => "1106" "paginaFinal" => "1116" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0250" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balloon aortic valvuloplasty in 170 consecutive patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.D. Safian" 1 => "A.D. Berman" 2 => "D.J. Diver" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198807213190301" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1988" "volumen" => "319" "paginaInicial" => "125" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3386691" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0255" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and hemodynamic follow-up after percutaneous aortic valvuloplasty in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.C. Block" 1 => "I.F. Palacios" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1988" "volumen" => "62" "paginaInicial" => "760" "paginaFinal" => "763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3421177" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0260" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic-valve replacement for inoperable severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.R. Makkar" 1 => "G.P. Fontana" 2 => "H. Jilaihawi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1202277" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "1696" "paginaFinal" => "1704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22443478" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915002172/v2_201703210134/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000010/v2_201703210134/S2174204915002172/v2_201703210134/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002172?idApp=UINPBA00004E"]

Statistics

Original Article

Prognostic impact of decisions taken by the heart team in patients evaluated for transcatheter aortic valve implantation

Impacto das decisões tomadas pela Heart Team no prognóstico dos doentes propostos para implantação percutânea de prótese valvular

Diego Iglesiasa,

Corresponding author

diegoiglesiasdelvalle@gmail.com

Corresponding author.

, Pablo Salinasb, Raúl Morenoc, Sergio García-Blasd, Luis Calvoc, Santiago Jiménez-Valeroc, Ángel Sánchez-Recaldec, Guillermo Galeotec, José María Mesac, Ignacio Plazaa, José Luis López-Sendónc

a Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain

b Hospital Clínico San Carlos, Madrid, Spain

c Hospital Universitario La Paz, Madrid, Spain

d Hospital Clinico Universitario, Valencia, Spain

Read

5862

Times
was read the article

1739

Total PDF

4123

Total HTML

Share statistics

 array:24 [
  "pii" => "S2174204915002172"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2015.10.004"
  "estado" => "S300"
  "fechaPublicacion" => "2015-10-01"
  "aid" => "680"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2015;34:587-95"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2762
    "formatos" => array:3 [
      "EPUB" => 169
      "HTML" => 2146
      "PDF" => 447
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2174204915002184"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.10.005"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "681"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2015;34:597-606"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3373
      "formatos" => array:3 [
        "EPUB" => 160
        "HTML" => 2721
        "PDF" => 492
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "597"
          "paginaFinal" => "606"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "O valor progn&#243;stico do r&#225;cio do &#237;ndice de dispers&#227;o eritrocit&#225;ria pelo n&#250;mero de plaquetas em doentes com enfarte do mioc&#225;rdio com eleva&#231;&#227;o do segmento ST submetidos a interven&#231;&#227;o coron&#225;ria percut&#226;nea"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1421
              "Ancho" => 1589
              "Tamanyo" => 102370
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve for long-term survival according to red cell distribution width-to-platelet ratio &#40;RPR&#41; with a cutoff of 0&#46;061&#46; Cumulative event-free survival was defined as freedom from death&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Hamdi Pusuroglu, Huseyin Altug Cakmak, Ozgur Akgul, Mehmet Erturk, Ozgur Surgit, Emre Akkaya, Umit Bulut, Aydin Yildirim"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Hamdi"
              "apellidos" => "Pusuroglu"
            ]
            1 => array:2 [
              "nombre" => "Huseyin Altug"
              "apellidos" => "Cakmak"
            ]
            2 => array:2 [
              "nombre" => "Ozgur"
              "apellidos" => "Akgul"
            ]
            3 => array:2 [
              "nombre" => "Mehmet"
              "apellidos" => "Erturk"
            ]
            4 => array:2 [
              "nombre" => "Ozgur"
              "apellidos" => "Surgit"
            ]
            5 => array:2 [
              "nombre" => "Emre"
              "apellidos" => "Akkaya"
            ]
            6 => array:2 [
              "nombre" => "Umit"
              "apellidos" => "Bulut"
            ]
            7 => array:2 [
              "nombre" => "Aydin"
              "apellidos" => "Yildirim"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002184?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915002184/v2_201703210134/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204915001828"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.08.002"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "664"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Cardiol. 2015;34:583-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2445
      "formatos" => array:3 [
        "EPUB" => 153
        "HTML" => 1782
        "PDF" => 510
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial Comment</span>"
      "titulo" => "The economics and costs of patient referral protocols for cardiac surgery"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "583"
          "paginaFinal" => "585"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "A economia e os custos das redes de referencia&#231;&#227;o de doentes para cirurgia card&#237;aca"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Manuel Antunes"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Antunes"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255115001778"
        "doi" => "10.1016/j.repc.2015.06.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001778?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001828?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915001828/v2_201703210134/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Prognostic impact of decisions taken by the heart team in patients evaluated for transcatheter aortic valve implantation"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "587"
        "paginaFinal" => "595"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Diego Iglesias, Pablo Salinas, Ra&#250;l Moreno, Sergio Garc&#237;a-Blas, Luis Calvo, Santiago Jim&#233;nez-Valero, &#193;ngel S&#225;nchez-Recalde, Guillermo Galeote, Jos&#233; Mar&#237;a Mesa, Ignacio Plaza, Jos&#233; Luis L&#243;pez-Send&#243;n"
        "autores" => array:11 [
          0 => array:4 [
            "nombre" => "Diego"
            "apellidos" => "Iglesias"
            "email" => array:1 [
              0 => "diegoiglesiasdelvalle&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Pablo"
            "apellidos" => "Salinas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ra&#250;l"
            "apellidos" => "Moreno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Sergio"
            "apellidos" => "Garc&#237;a-Blas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Luis"
            "apellidos" => "Calvo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Santiago"
            "apellidos" => "Jim&#233;nez-Valero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "&#193;ngel"
            "apellidos" => "S&#225;nchez-Recalde"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Guillermo"
            "apellidos" => "Galeote"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Jos&#233; Mar&#237;a"
            "apellidos" => "Mesa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Ignacio"
            "apellidos" => "Plaza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Jos&#233; Luis"
            "apellidos" => "L&#243;pez-Send&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Hospital Universitario Infanta Sof&#237;a&#44; San Sebasti&#225;n de los Reyes&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital Cl&#237;nico San Carlos&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Hospital Universitario La Paz&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Clinico Universitario&#44; Valencia&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Impacto das decis&#245;es tomadas pela <span class="elsevierStyleItalic">Heart Team</span> no progn&#243;stico dos doentes propostos para implanta&#231;&#227;o percut&#226;nea de pr&#243;tese valvular"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1802
            "Ancho" => 1741
            "Tamanyo" => 249112
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient flowchart of the study and treatment groups after the heart team decision&#46; AS&#58; aortic stenosis&#59; TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aortic stenosis &#40;AS&#41; is the most prevalent valvulopathy in developed countries&#46; The condition is mainly of degenerative etiology<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> and is associated with aging&#44; and is therefore becoming more frequent as the average age of the population increases&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> It is a chronic and progressive disease characterized by lipid accumulation&#44; inflammation and calcification&#44; with many similarities in terms of pathophysiology and risk factors to atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> Once the patient has developed symptoms&#44; the prognosis of unoperated patients is very poor&#44; with a two-year survival around 21&#37;&#44; so they should be referred quickly for surgical aortic valve replacement &#40;SAVR&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#8211;6</span></a> However&#44; many of them are considered at high risk for surgery due to advanced age and comorbidities&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Transcatheter aortic valve implantation &#40;TAVI&#41; has emerged in recent years as a less invasive alternative treatment for high-risk patients&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> This strategy has been shown to reduce mortality and hospitalizations compared to conservative management in patients considered unfit for surgery&#44; and survival rates are similar compared to surgical valve replacement in patients at high surgical risk but still considered operable&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;11</span></a> Nevertheless some candidates for TAVI are denied this technique for various reasons&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is known that the mortality of patients who are not operated is high and increases with age&#44; left ventricular dysfunction&#44; heart failure and kidney failure&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> However&#44; there are few data on patients treated conservatively after the recent emergence of this percutaneous intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">13&#44;14</span></a> The objective of this study is to analyze the survival and predictors of mortality of patients with AS and high surgical risk included in a TAVI evaluation program depending on the final treatment strategy decided by the heart team&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">In accordance with standard practice&#44; all patients with AS and indication for valve replacement &#40;severe AS and related symptoms&#41; were evaluated by a multidisciplinary team&#44; including clinical and interventional cardiologists&#44; cardiac surgeons and anesthesiologists &#40;the heart team&#41;&#46; Further visits by heart team members were made when needed&#44; during which direct patient examination and a qualitative assessment of frailty were performed&#46; Patients at high risk for conventional surgery were considered for TAVI&#44; usually because of age&#44; comorbidities&#44; previous cardiac surgery&#44; ventricular dysfunction or concomitant coronary artery disease&#44; as were patients who refused SAVR&#46; TAVI candidates underwent the standard protocol&#44; according to the device manufacturer&#39;s recommendations&#44; to confirm that they were suitable for this technique&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">15&#44;16</span></a> All patients referred for TAVI evaluation between June 2008 and June 2012 were prospectively included in the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evaluation and treatment allocation</span><p id="par0025" class="elsevierStylePara elsevierViewall">The first step in the evaluation was to confirm that there was indication for valve replacement according to the guidelines of the European Society of Cardiology&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> Data from transthoracic echocardiographic study were reviewed to determine the severity of AS&#46; The echocardiographic criteria of severity were those established by clinical practice guidelines&#58; aortic valve area &#60;1 cm<span class="elsevierStyleSup">2</span>&#44; mean gradient &#62;40 mmHg and maximum jet velocity &#62;4 m&#47;s&#46; Also&#44; the presence of symptoms &#40;angina&#44; syncope and exertional dyspnea&#41; secondary to valvular heart disease was determined by reviewing medical records and clinical visits&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Subsequently&#44; surgical risk with regard to age&#44; cardiovascular risk factors&#44; comorbidities&#44; logistic EuroSCORE calculation<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> and baseline patient characteristics was evaluated&#44; and the presence of contraindications for the intervention were ruled out&#58; acute myocardial infarction in the last 30 days&#44; hemodynamic instability&#44; severe left ventricular dysfunction with ejection fraction &#40;LVEF&#41; less than 20&#37; or life expectancy of less than 12 months because of non-cardiac problems&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients who passed the initial assessment also underwent transesophageal echocardiography&#44; cardiac catheterization and multidetector computed tomography &#40;MDCT&#41;&#46; The objective of the transesophageal study was to confirm the severity&#44; mechanism and hemodynamics of AS&#44; to measure the dimensions and morphology of the aortic valve annulus and to evaluate the existence of aortic insufficiency or other associated valvulopathies&#46; Patients underwent coronary angiography to detect the existence of significant atherosclerotic lesions&#44; and lower limb arterial angiography to confirm the criteria to perform the procedure by a transfemoral approach&#46; Finally&#44; MDCT was also used to study the left ventricular outflow tract and the aortic annulus and to measure the caliber of the iliac and femoral arteries&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; the results were presented to the heart team to make a final decision&#46; Those who were considered suitable for the procedure underwent TAVI&#46; Some were considered not to have indication for valve replacement at that time because of non-severe or only mildly symptomatic AS&#44; and the heart team decided to defer invasive treatment&#46; After the study protocol for TAVI candidates&#44; some were considered anatomically unsuitable for TAVI or had other significant concomitant valve disease&#44; without excessive surgical risk&#44; so conventional surgery was reconsidered by the heart team and they underwent surgical valve replacement&#46; The remaining patients were those who did not meet the appropriate anatomic conditions for a percutaneous technique&#44; those with excessive risk and those who refused any intervention&#44; and these received medical treatment only&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedure</span><p id="par0045" class="elsevierStylePara elsevierViewall">The TAVI procedure was performed according to standard techniques described previously&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> In all cases the implanted valve was the Edwards SAPIEN Transcatheter Heart Valve &#40;Edwards Lifesciences&#41;&#46; Initially the approach was exclusively transfemoral with surgical exposure of the femoral artery by vascular surgery&#46; However&#44; from February 2011&#44; a transapical TAVI program was introduced&#44; performed by cardiac surgeons&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> The approach was selected depending on the size of the annulus and femoral arteries&#58; in patients with an annulus between 18 and 25 mm and femoral artery diameter &#62;7 mm a transfemoral approach was used&#44; while in patients with an aortic annulus between 25 and 27 mm or between 18 and 25 mm with femoral artery diameter &#60;7 mm&#44; transapical access was chosen once it became available&#46; The cutoff point of 7 mm was reduced to 6 mm after the development of the new generation of valve and transfemoral delivery catheters in 2010 &#40;XT valve with the NovaFlex delivery system&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> Patients with annular diameters outside these limits or inadequate transfemoral access before the introduction of transapical access were considered unsuitable for the percutaneous technique&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data collection</span><p id="par0050" class="elsevierStylePara elsevierViewall">Information on baseline characteristics&#44; cardiovascular risk factors&#44; comorbidities&#44; echocardiographic data and symptoms was collected in a specially designed prospective database&#46; Follow-up information in the different groups was obtained prospectively by medical consultations&#44; telephone interviews and review of computerized medical records&#46; The day the heart team took the final decision on the most appropriate treatment strategy for each patient was considered as day 0 of the follow-up&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Definition of variables</span><p id="par0055" class="elsevierStylePara elsevierViewall">The primary endpoint of the study was all-cause mortality during follow-up&#46; Additionally&#44; the cause of death was classified as cardiovascular or non-cardiovascular according to the Valve Academic Research Consortium criteria recommended for TAVI studies&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> The secondary endpoint was event-free survival from the composite endpoint of major adverse cardiovascular events &#40;MACE&#41; defined as death&#44; hospitalization for heart failure&#44; non-fatal myocardial infarction or non-fatal stroke&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Continuous variables are presented as mean &#177; standard deviation and categorical variables are presented as relative frequencies &#40;percentages&#41;&#46; Statistical analysis of the results was performed by intention to treat&#44; allocating the patient to the treatment group decided by the heart team&#46; The analysis of all-cause death and MACE-free survival was performed by the Kaplan&#8211;Meier method and groups were compared with the log-rank test&#46; Analysis of prognostic factors was performed with the Cox proportional hazards model&#44; univariate and multivariate&#44; calculating the hazard ratios for all-cause death&#46; p values and 95&#37; confidence intervals &#40;CI&#41; are bilateral&#44; with a cutoff of 0&#46;05 for statistical significance&#46; All analyses were performed using SPSS<span class="elsevierStyleSup">&#174;</span> Statistics software&#44; version 20 &#40;IBM<span class="elsevierStyleSup">&#174;</span>&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Between June 2008 and June 2012 a total of 157 patients were evaluated for a possible TAVI procedure&#46; The heart team discussed each case and decided the most appropriate treatment strategy&#46; The mean time between the initial presentation of the case and the final decision of the heart team was 0&#46;7 months &#40;minimum 0&#46;1&#59; maximum 12&#46;3&#41;&#46; Of the 157 cases included in the evaluation protocol&#44; eight patients died during the initial assessment before a final therapeutic decision of the heart team could be taken&#44; and were excluded from the study&#46; Of the 149 patients with a final decision from the heart team 79 &#40;53&#46;0&#37;&#41; were accepted for TAVI&#44; 12 &#40;8&#46;1&#37;&#41; had the valve replacement deferred because of non-severe or only mildly symptomatic AS&#44; 13 &#40;8&#46;7&#37;&#41; were redirected to conventional surgery and 45 &#40;30&#46;2&#37;&#41; received medical treatment for different reasons&#58; excess risk&#44; unfavorable iliac or femoral arterial anatomy &#40;before the introduction of transapical access&#41;&#44; concomitant disease &#40;any short-term life-threatening non-cardiac condition&#41; or patient refusal &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Mean follow-up was 16&#46;6&#177;14&#46;1 months &#40;maximum 55&#46;3&#41;&#46; No patients were lost during follow-up&#46; All were monitored&#44; at least by telephone interview&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">All patients in the TAVI and surgery groups underwent the procedure to which they were allocated&#46; Of the patients undergoing TAVI&#44; 64 &#40;81&#46;0&#37;&#41; were treated by transfemoral access and 15 &#40;19&#46;0&#37;&#41; by transapical access&#46; Implant success was achieved in 75 of the 79 TAVI patients &#40;94&#46;9&#37;&#41;&#46; During follow-up&#44; one patient in the deferred intervention group and three of the medical treatment group underwent SAVR&#46; None of the patients undergoing TAVI underwent surgery during follow-up&#46; In the medical treatment group two patients received percutaneous aortic valvuloplasty&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients evaluated for TAVI had a mean age of 83&#46;7 years and 57&#46;0&#37; were women&#46; Mean EuroSCORE was 19&#46;8&#177;12&#46;3&#46; Patients in the medical treatment group had older age&#44; more comorbidities and higher surgical risk&#44; as shown by lower LVEF and higher EuroSCORE&#46; Baseline characteristics and echocardiographic data in the different treatment groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Survival analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Median survival free from all-cause death was 34&#46;7 months &#40;95&#37; CI 27&#46;1&#8211;42&#46;3&#41; in the TAVI group&#44; 47&#46;4 months &#40;95&#37; CI 0&#8211;97&#46;4&#41; in the deferred intervention group&#44; not available in the surgery group because more than 50&#37; survived to the end of follow-up &#40;mean survival 51&#46;3 months&#44; 95&#37; CI 43&#46;7&#8211;58&#46;9&#41;&#44; and 8&#46;2 months &#40;95&#37; CI 5&#46;6&#8211;10&#46;9&#41; in the medical treatment group &#40;log-rank p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#46; Overall survival at one year was 79&#46;7&#37; in the TAVI group&#44; 91&#46;7&#37; in the deferred intervention group&#44; 92&#46;3&#37; in the surgery group and 41&#46;2&#37; in the medical treatment group&#46; Overall survival at two years was 67&#46;4&#37; in the TAVI group&#44; 65&#46;2&#37; in the deferred intervention group&#44; 92&#46;3&#37; in the surgery group and 21&#46;7&#37; in the medical treatment group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The cause of death was cardiovascular in 50&#46;0&#37; of deaths in the TAVI group&#44; 100&#37; of deaths in the deferred intervention and surgery groups and 83&#46;3&#37; of deaths in the medical treatment group&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Median event-free survival for the MACE composite secondary endpoint was 20&#46;7 months &#40;95&#37; CI 9&#46;6&#8211;31&#46;8&#41; in the TAVI group&#44; 21&#46;3 months &#40;CI not calculable&#41; in the deferred intervention group&#44; 27&#46;0 months &#40;CI not calculable&#41; in the surgery group and 7&#46;2 months &#40;95&#37; CI 3&#46;0&#8211;11&#46;4&#41; in the medical treatment group &#40;log-rank p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Predictors of mortality</span><p id="par0090" class="elsevierStylePara elsevierViewall">In univariate analysis&#44; the following variables&#58; age&#44; dyslipidemia&#44; chronic renal failure&#44; significant mitral regurgitation &#40;grade 3 or 4&#41; and treatment group&#44; showed a statistically significant association with mortality during follow-up&#46; All significant variables in univariate analysis were entered into the multivariate Cox proportional hazards model&#44; in which only treatment group remained as an independent predictor of mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Compared to the TAVI group&#44; used as the reference category&#44; the adjusted hazard ratio for all-cause death was 0&#46;70 &#40;95&#37; CI 0&#46;24&#8211;2&#46;04&#41; for the deferred intervention group&#44; 0&#46;16 &#40;95&#37; CI 0&#46;02&#8211;1&#46;19&#41; for the conventional surgery group and 2&#46;47 &#40;95&#37; CI 1&#46;46&#8211;4&#46;18&#41; for the medical treatment group&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">This single-center observational study of unselected patients shows that the prognosis of patients with severe AS and high surgical risk evaluated for TAVI is influenced by the final decision of the heart team&#46; This prognosis is more favorable for patients who undergo aortic valve replacement&#44; by either a percutaneous or a surgical approach&#44; and for those who do not have a definite indication for valve replacement at the time of evaluation &#40;deferred group&#41;&#46; Conversely&#44; it is poor for those considered unsuitable for TAVI or SAVR &#40;medical treatment group&#41;&#44; either because they have a contraindication for the percutaneous technique or because they refuse any invasive treatment&#46; These patients have very high mortality&#44; mostly from cardiovascular causes&#46;</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Role of transcatheter aortic valve implantation</span><p id="par0100" class="elsevierStylePara elsevierViewall">Various studies have shown poor outcomes for patients with severe AS treated conservatively&#46; The introduction of TAVI has transformed the prospects for these patients&#44; who now have a less invasive alternative to surgery for the treatment of their valvular heart disease&#46; The TAVI procedure has demonstrated a reduction in mortality and hospitalization and improvement in cardiac symptoms compared to medical therapy in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The interest of this study lies not in analysis of the effectiveness of TAVI&#44; for which there are several larger and multicenter registries&#44; as well as a few randomized clinical trials&#44; but in its description of the differences in the natural history of the disease according to treatment strategy&#46; However&#44; it is noteworthy that survival rates in our TAVI group were similar to data in the literature&#44; with a one-year survival of 80&#37; vs&#46; 69&#8211;83&#37; reported in various publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;11&#44;13&#44;22</span></a> It should be noted that ours is a national reference center with a volume of TAVI procedures slightly above the average in Portugal &#40;19&#46;8 annual procedures compared to the average of 16&#46;4 per center recorded between 2010 and 2011&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Treatment groups</span><p id="par0110" class="elsevierStylePara elsevierViewall">The medical treatment group had the most adverse prognosis&#44; with a survival rate of 41&#37; at one year and 22&#37; at two years&#44; similar to that described in the literature before the introduction of TAVI&#46; In this patient group aortic balloon valvuloplasty has not shown good results in the medium to long term&#44; due to a high incidence of restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;25</span></a> There is no pharmacological treatment with a prognostic benefit in AS&#44; so medical management should be directed to symptomatic relief&#46; Our results support this approach&#44; especially when taking into account that life expectancy is usually very limited for those who are not candidates for TAVI&#46; This does not mean that patients who were considered unsuitable after evaluation should have been accepted for TAVI&#44; but rather that they represent a very high risk population&#44; with a particularly unfavorable prognosis&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the deferred intervention and conventional surgery groups&#44; although the Kaplan&#8211;Meier curves seem to indicate improved survival&#44; there were no significant differences in survival compared to the TAVI group due to the limited number of patients in each group&#46; The relatively low number of patients treated with SAVR in our series is explained by the fact that patients initially considered suitable for SAVR &#40;low or intermediate risk&#41; were not included in the TAVI evaluation program&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Predictors of mortality</span><p id="par0120" class="elsevierStylePara elsevierViewall">Our results suggest that the final treatment strategy adopted by the heart team is the main predictor of mortality in patients evaluated for TAVI&#46; This is mainly due to the higher event rate in the medical treatment group&#44; with a hazard ratio for all-cause mortality close to 2&#46;5 compared to the group considered suitable for TAVI&#46; Although in the deferred intervention and surgery groups the hazard ratio was lower than 1&#44; in both cases the confidence intervals were wide and included the value 1&#44; so it cannot be concluded that the prognosis of these groups is better than the TAVI group&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Comparison with previous studies</span><p id="par0125" class="elsevierStylePara elsevierViewall">There are very few studies designed to evaluate the prognosis of patients with AS and high surgical risk depending on their suitability for TAVI&#46; Wenaweser et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> studied the evolution of a cohort of patients with severe AS at high risk according to treatment strategy&#44; comparing medical treatment&#44; SAVR and TAVI&#46; Similarly to our study&#44; a multidisciplinary team taking into account the patient&#39;s decision assigned the final treatment&#46; Mortality at 30 months was significantly higher in the medical treatment group &#40;61&#46;5&#37;&#41; compared to the surgery group &#40;22&#46;4&#37;&#41; and TAVI group &#40;22&#46;6&#37;&#41;&#46; In this study&#44; the variables of medical treatment&#44; advanced age &#40;&#62;80 years&#41;&#44; peripheral vascular disease and atrial fibrillation were associated with mortality at 30 months in multivariate analysis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Ben-Dor et al&#46; analyzed the prognosis of patients not eligible for TAVI clinical trials because they did not meet inclusion&#47;exclusion criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> The main exclusion criteria were low Society of Thoracic Surgeons score &#40;&#60;10&#37;&#41;&#44; peripheral vascular or aortic disease&#44; aortic valve area &#62;0&#46;8 cm<span class="elsevierStyleSup">2</span>&#44; significant coronary artery disease requiring revascularization&#44; and severe renal insufficiency&#46; The study population was divided into two groups&#44; one unsuitable for surgery who received medical treatment with or without aortic valvuloplasty and the other who underwent SAVR&#46; Mortality in the medical&#47;valvuloplasty treatment group was significantly higher than in the surgery group&#44; 39&#46;6&#37; vs&#46; 22&#46;9&#37; at one year and 53&#46;4&#37; vs&#46; 28&#46;1&#37; at two years&#44; respectively&#46; Multivariate analysis identified renal failure&#44; New York Heart Association class IV and systolic blood pressure as independent predictors of mortality in the medical group&#46; This paper studied a highly selected population&#44; and so the treatment groups were not comparable with our study&#46; Furthermore&#44; unlike our study&#44; they excluded patients with significant coronary artery disease requiring revascularization and those with severe renal insufficiency &#40;defined as creatinine &#62;3&#46;0 mg&#47;dl or hemodialysis&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In PARTNER cohort B &#40;inoperable patients with severe symptomatic AS&#41;&#44; mortality from any cause was 50&#46;7&#37; at one year and 68&#46;0&#37; at two years for the standard therapy group&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;26</span></a> Cardiovascular mortality was 44&#46;6&#37; and 62&#46;4&#37;&#44; respectively&#46; The main difference from our study was that medically treated patients were not considered unsuitable for TAVI by the heart team&#44; but were assigned to standard therapy by the randomization process&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Relevance and limitations of the study</span><p id="par0140" class="elsevierStylePara elsevierViewall">The prognostic data derived from this study are important for providing the patient with detailed and accurate information about the multiple treatment options available in high surgical risk AS&#46; Most patients and families face this decision with many doubts because of fear of a major intervention&#44; uncertainty about the potential improvement and ignorance of the natural history of the disease&#44; as well as other personal&#44; cultural and religious factors&#46; We must not forget that a considerable proportion of our population &#40;6&#46;7&#37;&#41; refused any invasive treatment because of personal decisions by patients and relatives&#46; This decision&#44; especially in such an elderly population&#44; should of course be respected&#44; but every effort should be made to give comprehensive information about their expected prognosis&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Despite the limitation of being a single-center study with a small number of patients&#44; which reduces the power of the analysis&#44; this was a prospective cohort study with a very long follow-up in all patients&#46; Furthermore&#44; the evaluation was performed in all patients by the same heart team&#44; which gives the results greater consistency&#46; Finally&#44; the observational design of the study with no exclusion criteria more accurately represents daily clinical practice&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Another limitation of the study should be noted&#46; Many patients continued their monitoring in the hospitals from which they were referred and follow-up was done through telephone interviews&#46; Therefore&#44; we could not obtain information about possible complications of intervention&#44; such as aortic regurgitation or need for pacemaker implantation&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">The therapeutic decision taken by the heart team in patients with severe AS and high surgical risk&#44; considered potential candidates for TAVI&#44; is the main factor predicting long-term mortality&#46; Those who are unsuitable for invasive treatment and receive medical treatment have a significantly higher mortality&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Ethical disclosures</span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Protection of human and animal subjects</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Confidentiality of data</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Right to privacy and informed consent</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres817812"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec814927"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres817811"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec814926"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Evaluation and treatment allocation"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Procedure"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Data collection"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Definition of variables"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Survival analysis"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Predictors of mortality"
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0060"
          "titulo" => "Discussion"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Role of transcatheter aortic valve implantation"
            ]
            1 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Treatment groups"
            ]
            2 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Predictors of mortality"
            ]
            3 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Comparison with previous studies"
            ]
            4 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Relevance and limitations of the study"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Conclusions"
        ]
        9 => array:3 [
          "identificador" => "sec0095"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0105"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0110"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0115"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-12-09"
    "fechaAceptado" => "2015-03-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec814927"
          "palabras" => array:3 [
            0 => "Aortic stenosis"
            1 => "Surgical aortic valve replacement"
            2 => "Transcatheter aortic valve implantation"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec814926"
          "palabras" => array:3 [
            0 => "Estenose a&#243;rtica"
            1 => "Substitui&#231;&#227;o cir&#250;rgica da v&#225;lvula a&#243;rtica"
            2 => "Implanta&#231;&#227;o percut&#226;nea da v&#225;lvula a&#243;rtica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze long-term survival and predictors of mortality in patients evaluated for transcatheter aortic valve implantation &#40;TAVI&#41; depending on the decision taken by the heart team&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All patients with severe aortic stenosis and high surgical risk evaluated for TAVI between June 2008 and June 2012 were included&#46; Patients were grouped according to the therapeutic strategy decided by the heart team&#46; Mean follow-up was 16&#46;6 months &#40;maximum 55&#46;3&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 149 patients were evaluated&#58; 79 were accepted for TAVI&#44; 12 had no current indication for valve replacement and were deferred&#44; 13 were redirected to conventional surgery and 45 received medical treatment&#46; The evaluated patients had a mean age of 83&#46;7 years and a mean EuroSCORE of 19&#46;8&#177;12&#46;3&#46; Median survival free from all-cause death was 34&#46;7 months &#40;95&#37; CI 27&#46;1&#8211;42&#46;3&#41; in the TAVI group&#44; 47&#46;4 months &#40;95&#37; CI 0&#8211;97&#46;4&#41; in the deferred intervention group&#44; not available in the surgery group and 8&#46;2 months &#40;95&#37; CI 5&#46;6&#8211;10&#46;9&#41; in the medical treatment group &#40;log-rank p&#60;0&#46;001&#41;&#46; After multivariable adjustment&#44; only treatment group remained as an independent predictor of mortality&#46; Considering the TAVI group as the reference category&#44; the adjusted hazard ratio for all-cause death was 0&#46;70 &#40;95&#37; CI 0&#46;24&#8211;2&#46;04&#41; for the deferred intervention group&#44; 0&#46;16 &#40;95&#37; CI 0&#46;02&#8211;1&#46;19&#41; for the surgery group and 2&#46;47 &#40;95&#37; CI 1&#46;46&#8211;4&#46;18&#41; for the medical treatment group&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The decision taken by the heart team on potential candidates for TAVI has a decisive prognostic significance&#44; as those who are unsuitable for any kind of valve replacement have a significantly higher mortality&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analisar a sobreviv&#234;ncia a longo prazo e os fatores preditores de mortalidade de doentes avaliados para implanta&#231;&#227;o percut&#226;nea da v&#225;lvula a&#243;rtica &#40;TAVI&#41;&#44; dependendo da decis&#227;o tomada pela <span class="elsevierStyleItalic">Heart Team</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos todos os doentes com estenose a&#243;rtica grave e elevado risco cir&#250;rgico avaliados para TAVI desde junho 2008 a junho 2012&#46; Os doentes foram agrupados de acordo com a estrat&#233;gia terap&#234;utica decidida pela <span class="elsevierStyleItalic">Heart Team</span>&#46; Seguimento m&#233;dio 16&#44;6 meses &#40;m&#225;ximo 55&#44;3&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foi avaliado um total de 149 doentes&#44; dos quais 79 foram aceites para TAVI&#44; 12 n&#227;o apresentaram indica&#231;&#227;o para substitui&#231;&#227;o valvular e foram diferidos&#44; 13 foram redirecionados para cirurgia convencional e 45 receberam tratamento m&#233;dico&#46; Os doentes avaliados tinham uma idade m&#233;dia de 83&#44;7 anos e um EuroSCORE m&#233;dio de 19&#44;8&#177;12&#44;3&#46; A sobrevida m&#233;dia livre de todas as causas de morte foi 34&#44;7 meses &#40;IC 95&#37; 27&#44;1-42&#44;3&#41; no grupo TAVI&#44; de 47&#44;4 meses &#40;IC 95&#37; 0-97&#44;4&#41; no grupo de interven&#231;&#227;o diferido&#44; n&#227;o dispon&#237;vel no grupo de cirurgia e de 8&#44;2 meses &#40;IC 95&#37; 5&#44;6-10&#44;9&#41; no grupo de tratamento m&#233;dico &#40;<span class="elsevierStyleItalic">Log rank</span> p &#60;0&#44;001&#41;&#46; Ap&#243;s o ajuste de m&#250;ltiplas vari&#225;veis&#44; s&#243; o grupo de tratamento permaneceu como um fator preditor independente da mortalidade&#46; Considerando o grupo TAVI como categoria de refer&#234;ncia&#44; a taxa de risco ajustada para todas as causas de morte foi de 0&#44;70 &#40;IC 95&#37; 0&#44;24-2&#44;04&#41; para o grupo de interven&#231;&#227;o diferido&#44; de 0&#44;16 &#40;IC 95&#37; 0&#44;02-1&#44;19&#41; para o grupo da cirurgia e de 2&#44;47 &#40;IC 95&#37; 1&#44;46-4&#44;18&#41; para o grupo de tratamento m&#233;dico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A decis&#227;o tomada pela <span class="elsevierStyleItalic">Heart Team</span>&#160;relativamente aos potenciais candidatos para TAVI tem um impacto decisivo no progn&#243;stico dado que os que n&#227;o s&#227;o eleg&#237;veis para qualquer tipo de substitui&#231;&#227;o valvular apresentam uma mortalidade significativamente maior&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "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" => 1802
            "Ancho" => 1741
            "Tamanyo" => 249112
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient flowchart of the study and treatment groups after the heart team decision&#46; AS&#58; aortic stenosis&#59; TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2957
            "Ancho" => 2277
            "Tamanyo" => 346930
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier survival curves for all-cause death &#40;A&#41; and for major adverse cardiovascular events&#58; death&#44; hospitalization for heart failure&#44; non-fatal myocardial infarction or non-fatal stroke &#40;B&#41;&#46; TAVI&#58; transcatheter aortic valve implantation&#59; MACE&#58; major adverse cardiovascular events&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; AVA&#58; aortic valve area&#59; BMI&#58; body mass index&#59; CHD&#58; coronary heart disease&#59; COPD&#58; chronic obstructive pulmonary disease&#59; LBBB&#58; left bundle bunch block&#59; LVEF&#58; left ventricular ejection fraction&#59; NYHA&#58; New York Heart Association&#59; PVD&#58; peripheral vascular disease&#59; TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TAVI &#40;n&#61;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deferred intervention &#40;n&#61;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery &#40;n&#61;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Medical treatment &#40;n&#61;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;0&#177;6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;4&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;4&#177;5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;4&#177;5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;315&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;3&#177;4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;8&#177;7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;3&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;0&#177;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;844&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Risk factors</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypercholesterolemia &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CHD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous infarction &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart failure &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renal failure<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;422&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PVD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;904&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stroke &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Symptoms</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NYHA functional class &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;922&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;974&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Angina &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Syncope &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Cardiac rhythm</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peacemaker &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LBBB &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;887&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Echocardiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVEF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;4&#177;11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;2&#177;15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;5&#177;12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;7&#177;16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AVA &#40;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&#177;0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79&#177;0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;61&#177;0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&#177;0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean gradient &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;5&#177;14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;1&#177;18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;0&#177;10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;0&#177;20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">EuroSCORE</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;9&#177;9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;5&#177;9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;0&#177;12&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;1&#177;15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1374644.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Comparison of categorical variables using the chi-square or Fisher&#39;s exact test and continuous variables using analysis of variance&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Defined as serum creatinine &#8805;2 mg&#47;dl or creatinine clearance &#60;50 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> according to the Cockcroft-Gault formula&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the patients and echocardiographic findings&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAVI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deferred intervention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1374643.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Survival at 1 month&#44; 1 year and 2 years by treatment group &#40;&#37;&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; HR&#58; hazard ratio&#59; TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Univariate analysis variable</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02&#8211;1&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&#8211;0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&#8211;3&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mitral regurgitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&#8211;2&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Treatment group<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deferred intervention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;24&#8211;1&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&#8211;1&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;78&#8211;4&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Multivariate analysis variable</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Treatment group<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Deferred intervention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;24&#8211;2&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&#8211;1&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;46&#8211;4&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1374645.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Compared to the reference category TAVI&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Predictors of mortality by the Cox proportional hazards model&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective survey of patients with valvular heart disease in Europe&#58; the Euro Heart Survey on Valvular Heart Disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Iung"
                            1 => "G&#46; Baron"
                            2 => "E&#46;G&#46; Butchart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "1231"
                        "paginaFinal" => "1243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12831818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burden of valvular heart diseases&#58; a population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46;T&#46; Nkomo"
                            1 => "J&#46;M&#46; Gardin"
                            2 => "T&#46;N&#46; Skelton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(06)69208-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2006"
                        "volumen" => "368"
                        "numero" => "9540"
                        "paginaInicial" => "1005"
                        "paginaFinal" => "1011"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16980116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;A&#46; Carabello"
                            1 => "W&#46;J&#46; Paulus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(09)60211-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2009"
                        "volumen" => "373"
                        "paginaInicial" => "956"
                        "paginaFinal" => "966"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19232707"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Ross Jr&#46;"
                            1 => "E&#46; Braunwald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1968"
                        "volumen" => "38"
                        "paginaInicial" => "61"
                        "paginaFinal" => "67"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4894151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of aortic valve replacement on survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Schwarz"
                            1 => "P&#46; Baumann"
                            2 => "J&#46; Manthey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1982"
                        "volumen" => "66"
                        "paginaInicial" => "1105"
                        "paginaFinal" => "1110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7127696"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural history of very severe aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Rosenhek"
                            1 => "R&#46; Zilberszac"
                            2 => "M&#46; Schemper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.109.894170"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "121"
                        "paginaInicial" => "151"
                        "paginaFinal" => "156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20026771"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decision-making in elderly patients with severe aortic stenosis&#58; why are so many denied surgery&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Iung"
                            1 => "A&#46; Cachier"
                            2 => "G&#46; Baron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi471"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "2714"
                        "paginaFinal" => "2720"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16141261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of patients with severe symptomatic aortic stenosis who do not undergo aortic valve replacement&#58; the potential role of subjectively overestimated operative risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;S&#46; Bach"
                            1 => "D&#46; Siao"
                            2 => "S&#46;E&#46; Girard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCOUTCOMES.109.848259"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Qual Outcomes"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "533"
                        "paginaFinal" => "539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter aortic valve implantation&#58; current status and future perspectives"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Salinas"
                            1 => "R&#46; Moreno"
                            2 => "J&#46;L&#46; Lopez-Sendon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4330/wjc.v3.i6.177"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "3"
                        "paginaInicial" => "177"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21772944"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;B&#46; Leon"
                            1 => "C&#46;R&#46; Smith"
                            2 => "M&#46; Mack"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1008232"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "363"
                        "paginaInicial" => "1597"
                        "paginaFinal" => "1607"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20961243"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter versus surgical aortic-valve replacement in high-risk patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;R&#46; Smith"
                            1 => "M&#46;B&#46; Leon"
                            2 => "M&#46;J&#46; Mack"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1103510"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2011"
                        "volumen" => "364"
                        "paginaInicial" => "2187"
                        "paginaFinal" => "2198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21639811"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Varadarajan"
                            1 => "N&#46; Kapoor"
                            2 => "R&#46;C&#46; Bansal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2006.07.048"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2006"
                        "volumen" => "82"
                        "paginaInicial" => "2111"
                        "paginaFinal" => "2115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17126120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical outcomes of patients with severe aortic stenosis at increased surgical risk according to treatment modality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Wenaweser"
                            1 => "T&#46; Pilgrim"
                            2 => "A&#46; Kadner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2011.05.063"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2011"
                        "volumen" => "58"
                        "paginaInicial" => "2151"
                        "paginaFinal" => "2162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22078420"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlates and causes of death in patients with severe symptomatic aortic stenosis who are not eligible to participate in a clinical trial of transcatheter aortic valve implantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Ben-Dor"
                            1 => "A&#46;D&#46; Pichard"
                            2 => "M&#46;A&#46; Gonzalez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.109.926873"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "paginaInicial" => "S37"
                        "paginaFinal" => "S42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20837923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantation of aortic valvular prosthesis via transfemoral catheter&#46; Evaluation of candidates undergoing the procedure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Dobarro"
                            1 => "R&#46; Moreno"
                            2 => "D&#46; Filgueiras"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2009"
                        "volumen" => "133"
                        "paginaInicial" => "414"
                        "paginaFinal" => "421"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter valve implantation for patients with aortic stenosis&#58; a position statement from the European Association of Cardio-Thoracic Surgery &#40;EACTS&#41; and the European Society of Cardiology &#40;ESC&#41;&#44; in collaboration with the European Association of Percutaneous Cardiovascular Interventions &#40;EAPCI&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Vahanian"
                            1 => "O&#46; Alfieri"
                            2 => "N&#46; Al-Attar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehn183"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "1463"
                        "paginaFinal" => "1470"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18474941"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines on the management of valvular heart disease &#40;version 2012&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Vahanian"
                            1 => "O&#46; Alfieri"
                            2 => "F&#46; Andreotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs109"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2451"
                        "paginaFinal" => "2496"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922415"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The logistic EuroSCORE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Roques"
                            1 => "P&#46; Michel"
                            2 => "A&#46;R&#46; Goldstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "881"
                        "paginaFinal" => "882"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12727160"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transapical minimally invasive aortic valve implantation&#58; multicenter experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Walther"
                            1 => "P&#46; Simon"
                            2 => "T&#46; Dewey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.106.677237"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2007"
                        "volumen" => "116"
                        "paginaInicial" => "I240"
                        "paginaFinal" => "I245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17846311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new transcatheter aortic valve and percutaneous valve delivery system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;G&#46; Webb"
                            1 => "L&#46; Altwegg"
                            2 => "J&#46;B&#46; Masson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.07.075"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "1855"
                        "paginaFinal" => "1858"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19442884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Updated standardized endpoint definitions for transcatheter aortic valve implantation&#58; the Valve Academic Research Consortium-2 consensus document"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;P&#46; Kappetein"
                            1 => "S&#46;J&#46; Head"
                            2 => "P&#46; Genereux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2012.09.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2012"
                        "volumen" => "60"
                        "paginaInicial" => "1438"
                        "paginaFinal" => "1454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23036636"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Registry of transcatheter aortic-valve implantation in high-risk patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Gilard"
                            1 => "H&#46; Eltchaninoff"
                            2 => "B&#46; Iung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1114705"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "1705"
                        "paginaFinal" => "1715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22551129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish Cardiac Catheterization and Coronary Intervention Registry&#46; 21st official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology &#40;1990-2011&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;F&#46; Diaz"
                            1 => "J&#46;M&#46; de La Torre"
                            2 => "M&#46; Sabate"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cardiol &#40;Engl Ed&#41;"
                        "fecha" => "2012"
                        "volumen" => "65"
                        "paginaInicial" => "1106"
                        "paginaFinal" => "1116"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Balloon aortic valvuloplasty in 170 consecutive patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;D&#46; Safian"
                            1 => "A&#46;D&#46; Berman"
                            2 => "D&#46;J&#46; Diver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198807213190301"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1988"
                        "volumen" => "319"
                        "paginaInicial" => "125"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3386691"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and hemodynamic follow-up after percutaneous aortic valvuloplasty in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;C&#46; Block"
                            1 => "I&#46;F&#46; Palacios"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "1988"
                        "volumen" => "62"
                        "paginaInicial" => "760"
                        "paginaFinal" => "763"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3421177"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter aortic-valve replacement for inoperable severe aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;R&#46; Makkar"
                            1 => "G&#46;P&#46; Fontana"
                            2 => "H&#46; Jilaihawi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1202277"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "1696"
                        "paginaFinal" => "1704"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22443478"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003400000010/v2_201703210134/S2174204915002172/v2_201703210134/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000010/v2_201703210134/S2174204915002172/v2_201703210134/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002172?idApp=UINPBA00004E"
]

Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2015.10.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	3	11
2024 October	33	24	57
2024 September	43	20	63
2024 August	42	29	71
2024 July	33	28	61
2024 June	36	26	62
2024 May	26	20	46
2024 April	32	22	54
2024 March	37	23	60
2024 February	42	45	87
2024 January	45	36	81
2023 December	35	27	62
2023 November	43	24	67
2023 October	36	17	53
2023 September	24	21	45
2023 August	27	13	40
2023 July	22	12	34
2023 June	18	8	26
2023 May	41	22	63
2023 April	18	7	25
2023 March	42	24	66
2023 February	36	14	50
2023 January	27	13	40
2022 December	38	19	57
2022 November	56	18	74
2022 October	21	20	41
2022 September	23	23	46
2022 August	31	38	69
2022 July	34	35	69
2022 June	20	23	43
2022 May	17	33	50
2022 April	32	23	55
2022 March	24	35	59
2022 February	20	23	43
2022 January	30	26	56
2021 December	20	34	54
2021 November	36	41	77
2021 October	39	43	82
2021 September	21	30	51
2021 August	29	29	58
2021 July	27	33	60
2021 June	21	26	47
2021 May	27	35	62
2021 April	39	39	78
2021 March	68	29	97
2021 February	48	14	62
2021 January	26	14	40
2020 December	44	6	50
2020 November	35	22	57
2020 October	29	15	44
2020 September	80	15	95
2020 August	19	11	30
2020 July	62	11	73
2020 June	61	21	82
2020 May	45	5	50
2020 April	54	6	60
2020 March	47	16	63
2020 February	84	47	131
2020 January	30	9	39
2019 December	33	13	46
2019 November	33	7	40
2019 October	36	5	41
2019 September	32	8	40
2019 August	31	6	37
2019 July	31	12	43
2019 June	32	18	50
2019 May	32	11	43
2019 April	19	11	30
2019 March	43	15	58
2019 February	49	15	64
2019 January	22	9	31
2018 December	80	14	94
2018 November	188	11	199
2018 October	414	10	424
2018 September	116	15	131
2018 August	36	5	41
2018 July	32	7	39
2018 June	41	9	50
2018 May	32	7	39
2018 April	36	7	43
2018 March	40	3	43
2018 February	20	6	26
2018 January	27	6	33
2017 December	59	7	66
2017 November	48	8	56
2017 October	36	8	44
2017 September	30	13	43
2017 August	24	8	32
2017 July	22	9	31
2017 June	27	6	33
2017 May	22	3	25
2017 April	19	2	21
2017 March	31	6	37
2017 February	26	3	29
2017 January	24	2	26
2016 December	18	6	24
2016 November	15	3	18
2016 October	20	5	25
2016 September	14	4	18
2016 August	8	3	11
2016 July	13	3	16
2016 June	5	2	7
2016 May	5	4	9
2016 April	10	1	11
2016 March	16	9	25
2016 February	24	14	38
2016 January	19	11	30
2015 December	15	9	24
2015 November	35	15	50

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter