Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience | Revista Portuguesa de Cardiologia (English edition)

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SAVR: surgical aortic valve replacement; TAVI: transcatheter aortic valve implantation." ] ] ] "textoCompleto" => "IntroductionDegenerative aortic stenosis (AS) is the most prevalent type of valvular disease in Europe, due to aging populations and increased survival.<a class="elsevierStyleCrossRefs" href="#bib0135">1,2</a> When it develops, there is a long asymptomatic period.<a class="elsevierStyleCrossRefs" href="#bib0135">1,2</a> Once symptoms occur, the prognosis of severe AS is dire; sudden death is frequent and survival rates are only 15-50% at five years.<a class="elsevierStyleCrossRefs" href="#bib0135">1,3</a>Surgical aortic valve replacement (SAVR) is the standard therapy for severe AS,<a class="elsevierStyleCrossRefs" href="#bib0135">1,2,4</a> increasing survival and improving quality of life.<a class="elsevierStyleCrossRef" href="#bib0135">1</a> In patients at high surgical risk, transcatheter aortic valve implantation (TAVI) is a good alternative, with procedural success rates of over 90%.<a class="elsevierStyleCrossRefs" href="#bib0135">1,4–8</a>Assessment by a heart team is currently considered essential in the selection of patients, based on their risk profile and the technical suitability of TAVI.<a class="elsevierStyleCrossRefs" href="#bib0135">1,5,6,9</a> Despite its importance, there is a lack of published evidence on this subject. In addition, considering the complexity and high costs involved in TAVI, the resources involved need to be rationalized.<a class="elsevierStyleCrossRef" href="#bib0180">10</a>The aim of this paper was to assess a prospective standardized decision process by a heart team regarding patient selection and performance and results of the procedure, from the beginning of the program in 2008 until 2015.MethodsFrom its beginning in 2008 up to 2015, the Hospital Santa Cruz TAVI program assessed 473 patients with severe symptomatic AS. A total of 383 patients completed the assessment process. Of these, 80 (20.9%) were selected for SAVR, 214 (55.9%) for TAVI and 89 (23.2%) for conservative treatment alone.All patients are included in a prospective program that scrutinizes proposed candidates referred by their attending physicians. Briefly, the patient pathway starts with a clinical appointment that is followed by non-invasive and invasive tests and, finally, a multidisciplinary discussion (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Candidate assessment is thorough, including the presence of symptoms, comorbidities and functional capacity. If needed, additional exams are requested: transthoracic echocardiography, complete laboratory tests including blood count, coagulation, N-terminal pro-B-type natriuretic peptide (NT-proBNP), kidney and liver function tests, and a high-resolution thoracic-abdominal-pelvic gated computed tomography (CT) scan. After complete assessment, the data are gathered and the patient is discussed at a dedicated heart team meeting to select the most appropriate therapeutic strategy. The team is composed of cardiologists – including clinical cardiologists, interventional cardiologists, and experts in cardiac imaging and heart failure – and cardiac surgeons, who meet fortnightly to discuss clinical cases. Results are continuously monitored for quality assessment.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The TAVI heart team criteria are based on two factors: indication (inoperable or high surgical risk, as approved by heart team consensus) and lack of futility (subjective assessment of significant improvement in quality of life and predicted survival beyond one year).The possible access routes are determined and the final route is selected according to the first implantation date available in order to intervene as early as possible. Thus, an arterial approach is only considered when there is clinical or anatomical contraindication for any other route.If the patient is approved for either of the invasive strategies (SAVR or TAVI), he or she goes on a waiting list for the procedure. Patients refused for any invasive intervention return to their referring physician to continue on optimal medical therapy. Those selected for SAVR or TAVI are followed at 30 days, six months and one year after the procedure, and then annually.Statistical analysisAll clinical and procedural data are collected in a dedicated database (Cardiobase™) and a continuous ongoing registry, the Valve Catheter Restorative Operation on Santa Cruz Hospital (VCROSS). Anonymous data is exported for statistical analysis, performed with SPSS version 20.0 (IBM SPSS, Chicago, IL, USA).Continuous variables are expressed as median (interquartile range [IQR]). Categorical variables are expressed as absolute value and respective percentages. Differences in means between groups were assessed by the Kruskal-Wallis test and differences between categorical variables were assessed by the chi-square test. A p-value of 0.05 or less was considered significant. Mortality during follow-up was analyzed by Kaplan-Meier survival curves.ResultsPatient selectionFrom 2008 up to 2015, 473 patients with severe symptomatic AS were assessed in the TAVI program at Hospital Santa Cruz (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>As at April 2015, the assessment was not completed in 33 patients (7.0%) and 45 died during the initial assessment (9.5%). An additional 12 (3.0%) patients returned to their physicians because severe AS was not confirmed.A total of 383 patients with severe AS completed the heart team assessment process. Of these, 80 (20.9%) were selected for SAVR, 214 (55.9%) for TAVI and 89 (23.2%) for medical treatment alone.Population characteristicsThe characteristics of patients in the different treatment groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In all groups patients were mostly female. The medical therapy group had a higher median age than the other groups and patients undergoing SAVR were younger overall (p=0.023).The most prevalent comorbidities were hypertension, diabetes and coronary artery disease. The TAVI group included a significantly higher number of patients previously treated by coronary angioplasty (p=0.005). The medical therapy group showed a higher prevalence of comorbidities such as lung disease, history of stroke and chronic kidney disease (stages 4 and 5). This group also presented a higher incidence of left ventricular dysfunction, followed by the TAVI group (p=0.015). Comorbidities such as porcelain aorta, liver cirrhosis and prior thoracic radiotherapy were only found in the TAVI and medical therapy groups, since these patients were considered inoperable.Comparing the most used surgical risk scores, the medical therapy group had a higher median logistic EuroSCORE I (18.4%), followed by the TAVI group (16.8%) (p≤0.001), but the median values of both groups were below 20%. Mortality predicted by the EuroSCORE II and Society of Thoracic Surgeons (STS) scores was higher in the TAVI group, followed by the medical therapy group (p=0.005 and p<0.001, respectively). The SAVR group presented the lowest risk scores.Patient selection for different treatmentsIn the eight years of the program, 207 TAVI procedures were performed in 202 patients. The procedure was successful in 97.6% of cases (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). A total of five cases needed reintervention, mostly (n=3) due to prosthesis migration.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The median time between the heart team's decision and bioprosthesis implantation was 70 days (IQR 34-129).The most frequent implantation route was transfemoral (64.3%), followed by transapical (30.9%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The CoreValve® system was the most used device (58.0%), followed by the Edwards Sapiens® (39.1%). <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> describes the main characteristics of the percutaneous aortic valve implantation.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Most of the patients selected for SAVR underwent isolated valvular intervention (85.7%). Only a minority also underwent associated coronary artery bypass surgery (14.3%).Patients were refused for any kind of invasive intervention for a variety of reasons (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). The most frequent reason was predicted lack of improvement of quality of life after the procedure due to comorbidities (39.4%), which included several patients with severe chronic lung disease. The second most frequent cause was life expectancy of less than a year (18.2%), in most cases due to diagnosed cancer at the time of TAVI assessment. The third most frequent reason was frailty (12.2%), an extreme vulnerability to adverse events as determined by the heart team, usually based on very low gait speed, severely decreased muscle mass and/or malnutrition. The fourth was the presence of associated severe disease of other valves making a major contribution to the patient's symptoms (all patients with concomitant severe mitral disease). Although patients were refused predominantly for clinical reasons, some were also rejected for technical reasons, including inadequate annulus size (3.0%) or the absence of a route for a TAVI procedure (1.5%).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Note that a substantial proportion (25.8%) of all patients included in the medical therapy group (89 patients) refused any invasive therapy, either TAVI or SAVR (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).Long-term follow-upOver a median follow-up of 49 months (95% confidence interval 43-55), comparison of the different therapeutic strategies revealed higher mortality in the medical therapy group (57.6%) followed by the TAVI group (37.6%) (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). Mortality at 30 days post-procedure (SAVR vs. TAVI) was almost the same in both groups, slightly higher in the SAVR group.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia>Analysis of the Kaplan-Meier curves for the different therapeutic strategies shows that after an initial stage in which the surgical procedure and TAVI had higher periprocedural mortality, both subsequently depart from the medical therapy survival curve (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). Although SAVR appears to present a more favorable survival curve, there was no statistically significant difference in comparison with TAVI (p=0.130). Survival curves for both TAVI and SAVR were significantly different from that of the medical strategy.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThe main contribution of this study is to provide evidence that implementation of a heart team, as recommended by the guidelines for treatment of severe aortic stenosis, should be performed prospectively under a well-defined, ongoing and carefully staged protocol that enables the activation of a multidisciplinary team that can provide all available therapies (TAVI, SAVR and conservative treatment).Our group foresaw that patient selection would have a crucial role in the success of transcatheter aortic valve implantation, and thus a visionary multidisciplinary program was set in place. The heart team has become fundamental in the assessment of patients based on their risk profile and the technical suitability of TAVI.<a class="elsevierStyleCrossRefs" href="#bib0135">1,4–6,8,9,11–16</a> In the current context of an increasing elderly population, the availability of new treatments for severe aortic stenosis requires multidisciplinary clinical expertise for the accurate diagnosis of heart valve disease and assessment of comorbidities and risks of intervention, in addition to the rationalization of resources, considering the complexity and high costs of TAVI.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> The technique should be performed in centers of excellence with a trained multidisciplinary heart team treating a minimum of 50 cases per year, appropriate technical facilities and a prospective registry for monitoring purposes.<a class="elsevierStyleCrossRef" href="#bib0200">14</a>A broad group of specialists is required to assess these patients and to provide a rapid selection process, since short-term mortality in these patients is significant.<a class="elsevierStyleCrossRefs" href="#bib0140">2,14,15</a> Our experience reports 45 deaths during the assessment phase (9.5%) and 15 deaths in patients after complete assessment awaiting SAVR or TAVI (3.2%). This highlights the severity of the disease and shows the need for a faster assessment process and treatment. Our median time of 70 days between the decision to perform TAVI and implantation of the bioprosthesis seems excessive, and this recently prompted our center to expand its multislice CT scan facility, which hopefully will reduce this delay.Multidisciplinary interaction between physicians is needed, enabling all the patient's biopsychosocial characteristics to be considered.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> The clinical cardiologist is responsible for patient selection and indication and for pre- and post-procedure follow-up.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> The interventional cardiologist is responsible for organizing the heart team and monitoring procedural performance,<a class="elsevierStyleCrossRef" href="#bib0180">10</a> while the cardiovascular surgeon is responsible for performing transaortic and transapical procedures, assisting with the transfemoral approach, and treating possible complications.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> The echocardiographer is responsible for anatomical and functional characterization of the diseased valve, intraoperative assessment of correct positioning of the prosthesis, and monitoring of post-procedural complications.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> The heart team also includes other professionals such as anesthetists, nurses and physical therapists. The consensus nowadays is not to perform a TAVI procedure in sites lacking a heart team.<a class="elsevierStyleCrossRef" href="#bib0180">10</a>TAVI is currently recommended in symptomatic patients with severe AS who are at high surgical risk or are considered ineligible for SAVR.<a class="elsevierStyleCrossRefs" href="#bib0135">1,6,8,13,14</a> Surgical risk has been traditionally assessed using scores such as EuroSCORE and STS. A logistic EuroSCORE I of over 20% and a STS mortality score of more than 10% have been proposed as indicators of high surgical risk (in combination with clinical judgment).<a class="elsevierStyleCrossRef" href="#bib0215">17</a> A EuroSCORE II cut-off of 7% appears to be equivalent to a Logistic EuroSCORE of 20% or an STS score of 10%.<a class="elsevierStyleCrossRef" href="#bib0185">11</a> In our center, both the TAVI and medical therapy groups presented lower values than these. This variability of calculated scores has been described in other TAVI populations.<a class="elsevierStyleCrossRefs" href="#bib0175">9,11,18,19</a> A French center reported only half of patients reaching these threshold values.<a class="elsevierStyleCrossRef" href="#bib0185">11</a> This is explained by the fact that these scoring systems were created on the basis of standard cardiac surgery databases and are thus unable to assess serious conditions that many of these patients suffer from.<a class="elsevierStyleCrossRefs" href="#bib0135">1,5,18,20,21</a> Comparison between the scores shows no significant differences in discriminatory power, and correlation between them appears to be at best modest.<a class="elsevierStyleCrossRefs" href="#bib0185">11,20</a> In the real world, the available surgical risk scores do not accurately predict mortality after TAVI.<a class="elsevierStyleCrossRef" href="#bib0235">21</a> New promising and more accurate scores are emerging to replace the currently used surgical risk scores, including variables such as porcelain thoracic aorta, anemia, left ventricular dysfunction, recent myocardial infarction and critical aortic valve stenosis.<a class="elsevierStyleCrossRef" href="#bib0240">22</a> For this reason, a heart team composed of individuals trained in systematic patient assessment enables better selection of individuals who may benefit from the various treatment strategies until more reliable risk scores become available.In this cohort the main causes for patients being refused any kind of invasive procedure were low life expectancy and the presence of severe comorbidities which made TAVI unlikely to improve quality of life.<a class="elsevierStyleCrossRef" href="#bib0135">1</a> One of these comorbidities is chronic obstructive pulmonary disease, which is associated with higher mortality at mid-term follow-up in patients undergoing TAVI.<a class="elsevierStyleCrossRef" href="#bib0245">23</a> One study has revealed that TAVI was futile in more than one third of these patients and that a shorter distance in the six-minute walk test was a predictor of lack of benefit.<a class="elsevierStyleCrossRef" href="#bib0245">23</a>Frailty was the third most common reason for patients being refused for TAVI in our center. Frailty syndrome is characterized by decreased muscle mass and energy expenditure and malnutrition, leading to extreme vulnerability to adverse events.<a class="elsevierStyleCrossRefs" href="#bib0160">6,24</a> A study assessing the frailty status of 159 patients through assessment of gait speed, grip strength, serum albumin and degree of independence in daily activities determined that frailty was not associated with increased periprocedural complications in patients selected for TAVI, but was associated with increased one-year mortality after the procedure.<a class="elsevierStyleCrossRef" href="#bib0250">24</a> Our assessment of patients’ frailty was mostly subjective. This is a limitation, and the use of objective measurements and questionnaires has since been implemented.Other comorbidities not included in current scores are liver cirrhosis, porcelain aorta and prior radiotherapy.<a class="elsevierStyleCrossRefs" href="#bib0135">1,4–6</a> Furthermore, assessment of neurocognitive function, functional status, mobility, and supports is increasingly being recognized as important in patient selection.<a class="elsevierStyleCrossRef" href="#bib0170">8</a> The heart team is thus crucial in individualized patient assessment.<a class="elsevierStyleCrossRefs" href="#bib0135">1,5,6</a> This is particularly important in the current environment of limited resources.<a class="elsevierStyleCrossRef" href="#bib0160">6</a> In the future a validated risk score for TAVI will probably be created, similar to the logistic EuroSCORE, EuroSCORE II and STS mortality score for surgical procedures, taking into account many variables already considered in the assessment process.<a class="elsevierStyleCrossRefs" href="#bib0155">5,6,18,22</a>Another important heart team decision is that of revascularization of coronary artery disease, which is often found coexisting with valvular disease, since they share the same risk factors.<a class="elsevierStyleCrossRefs" href="#bib0155">5,7</a> Up to three-quarters of patients undergoing TAVI have coronary artery disease.<a class="elsevierStyleCrossRef" href="#bib0155">5</a> The optimal management of these patients is not well defined. Some authors argue that a staged approach (percutaneous coronary intervention followed by TAVI) is prudent in patients with lesions in the left main or proximal arteries (especially if dominant in the case of the right coronary artery or circumflex artery).<a class="elsevierStyleCrossRef" href="#bib0155">5</a> Although this reduces procedure time, radiation and contrast exposure, it requires arterial access twice, with inherent risk for vascular and bleeding complications and additional hospitalization costs.<a class="elsevierStyleCrossRef" href="#bib0165">7</a> In the elderly population with severe AS who undergo TAVI, coronary revascularization is usually incomplete.<a class="elsevierStyleCrossRef" href="#bib0165">7</a> Judicious decisions concerning revascularization (not always deciding on complete revascularization) are more likely to achieve favorable mid-term outcomes.<a class="elsevierStyleCrossRef" href="#bib0165">7</a>Anatomical assessment of patients is also essential, including arterial vasculature and the aortic valve apparatus (including the left ventricular outflow tract, aortic annulus diameter, sinus of Valsalva, sinotubular junction, ascending aorta and degree of calcification), to choose the most appropriate access route and transcatheter valve size.<a class="elsevierStyleCrossRefs" href="#bib0150">4–6,8,15</a> Which approach is used (transfemoral vs. transapical) has no prognostic value in acute and late outcomes.<a class="elsevierStyleCrossRef" href="#bib0210">16</a> Usually the transfemoral approach is preferred, and an alternative route is only selected if there is a prohibitively small or diseased iliofemoral arterial system, mobile plaque, excessive calcification, or extreme tortuosity of the descending thoracic aorta.<a class="elsevierStyleCrossRefs" href="#bib0150">4,6,8,15</a> The fact that the most frequent implantation route was transfemoral (64.3%) reflects our strategy of implanting on the first available date without selecting a route if individually possible. This enabled the earliest treatment for each patient to be chosen.The choice of prosthetic aortic valve is another important issue. As pointed out above, several devices are currently available with different characteristics that confer benefits in different clinical settings. For example, repositioning features are required for cases of extreme aortic calcification, potential coronary obstruction, bicuspid aortic valve, aortic regurgitation, valve-in-valve technique or left ventricular septal hypertrophy. Radiopaque markers are particularly useful in chronic kidney disease patients. The self-expandable feature is important when there is significant concomitant aortic regurgitation.TAVI has been shown to be a feasible procedure.<a class="elsevierStyleCrossRefs" href="#bib0135">1,4–6,8</a> One-year survival rates of 60-80% are reported, depending on the severity of comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0135">1,8</a> In our population the survival rate of TAVI patients at one-year follow-up was 84.1%. Mortality at 30 days was 4.4%, lower than the 9-10% usually described in other series.<a class="elsevierStyleCrossRef" href="#bib0220">18</a>The literature on TAVI vs. SAVR for patients at high surgical risk shows that major adverse outcomes are similar between the two treatment modalities.<a class="elsevierStyleCrossRef" href="#bib0145">3</a> However, the results are limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods.<a class="elsevierStyleCrossRef" href="#bib0145">3</a>As in our population, other studies show that after an initial stage in which the surgical procedure and TAVI had higher periprocedural mortality, both subsequently depart from the conservative therapy survival curve, showing a better outcome.<a class="elsevierStyleCrossRef" href="#bib0225">19</a> Although SAVR appeared to present a more favorable survival curve, this was not statistically significant difference from that of TAVI, both having comparable survival curves at one year. SAVR performed in centers with a TAVI program is associated with significantly lower mortality and complication rates than that performed in centers without a TAVI program.<a class="elsevierStyleCrossRef" href="#bib0255">25</a>A heart team approach is essential for TAVI in the current management of patients with severe aortic stenosis. This applies at each step of the procedure: patient selection, performance of the procedure, post-procedural care and evaluation of the results.<a class="elsevierStyleCrossRef" href="#bib0260">26</a>ConclusionsA prospective multidisciplinary heart team program was able to appropriately select candidates for transcatheter aortic valve implantation, surgical aortic valve replacement and conservative treatment, matching the risk of both invasive treatments. The study is unique because it demonstrates the success of a standardized approach that requires continuous monitoring to be efficient in a timely manner.Key pointsWhat is known about the topic?<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•The literature available on TAVI vs. SAVR for patients at high surgical risk shows that major adverse outcomes are similar between the two treatment modalities. However, the results are limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods.</li><li class="elsevierStyleListItem" id="lsti0010">•A heart team assessment is considered central to the selection of patients with severe AS. This applies at each step of the procedure: patient selection, performance of the procedure, post-procedural care and evaluation of the results.</li><li class="elsevierStyleListItem" id="lsti0015">•Despite its importance, there is a marked lack of publications in this area.</li></ul>What does this study add?<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">•The heart team is crucial for individualized assessment of patients. This is particularly important in the current environment of limited resources.</li><li class="elsevierStyleListItem" id="lsti0025">•The main contribution of this study is to provide evidence that implementation of a heart team, as recommended by the guidelines for treatment of severe aortic stenosis, must be performed prospectively under a well-defined, ongoing and carefully staged protocol that enables the activation of a multidisciplinary team that can provide all available therapies (TAVI, SAVR and conservative treatment).</li><li class="elsevierStyleListItem" id="lsti0030">•This standardized approach requires continuous monitoring to be efficient in a timely manner.</li></ul>Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres957258" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec928584" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres957257" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec928583" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Patient selection" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Population characteristics" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Patient selection for different treatments" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Long-term follow-up" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Key points" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-16" "fechaAceptado" => "2016-11-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec928584" "palabras" => array:5 [ 0 => "Severe aortic stenosis" 1 => "Transcatheter aortic valve implantation" 2 => "Surgical aortic valve replacement" 3 => "Heart team" 4 => "Standardization" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec928583" "palabras" => array:5 [ 0 => "Estenose aórtica grave" 1 => "Válvula aórtica percutânea" 2 => "Substituição valvular aórtica cirúrgica" 3 => "Heart Team" 4 => "Standardização" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionAortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. MethodsThe heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. ResultsTAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients’ outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). ConclusionsThe heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "IntroduçãoA estenose aórtica é atualmente a doença valvular mais prevalente na Europa. A substituição valvular aórtica cirúrgica (SVAC) é atualmente considerada a terapêutica de primeira linha, a implantação de válvula aórtica percutânea (VAP) é considerada uma opção em doentes com elevado risco cirúrgico. A avaliação dos doentes pelo Heart Team encontra-se preconizada pelas recentes guidelines publicadas de doenças valvulares, contudo existem poucas publicações acerca dessa temática. O objetivo deste manuscrito é descrever a experiência de um programa multidisciplinar VAP, iniciado em 2008. MétodosO Heart Team avaliou de forma prospetiva e padronizada 473 doentes. Desses, 214 foram selecionados para VAP e 80 para SVAC. Os grupos foram comparados no que respeita às suas características demográficas, clínicas, de procedimento e quanto à sua evolução (mortalidade). ResultadosO grupo VAP apresentou maior idade do que o grupo SVAC (mediana 83 versus 81 anos) e apresentou scores de risco cirúrgico mais elevados (mediana Euroscore II 5,3 versus 3,6% e STS 5,1 versus 3,1%), tal como o grupo de doentes apenas sob terapêutica médica. Esses scores não foram capazes de avaliar múltiplas comorbilidades. A mortalidade entre os três grupos apresentou diferenças com significado estatístico (SVAC 25% versus VAP 37,6% versus terapêutica conservadora 57,6%, p=0,001). ConclusõesO programa Heart Team foi capaz de selecionar de forma adequada os doentes para as diversas estratégias terapêuticas tendo em conta o risco de ambos os procedimentos invasivos. Uma abordagem eficiente e standardizada pela Heart Team deve ser estimulada, necessitando de reavaliação continua." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1892 "Ancho" => 2549 "Tamanyo" => 620341 ] ] "descripcion" => array:1 [ "en" => "Schematic representation of heart team assessment of patients with severe aortic stenosis. CT: computed tomography; SAVR: surgical aortic valve replacement; 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" => 1637 "Ancho" => 2468 "Tamanyo" => 497655 ] ] "descripcion" => array:1 [ "en" => "Schematic representation of patient assessment in the TAVI program at Hospital Santa Cruz. AS: aortic stenosis; SAVR: surgical aortic valve replacement; TAVI: transcatheter aortic valve implantation." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1747 "Ancho" => 2508 "Tamanyo" => 243983 ] ] "descripcion" => array:1 [ "en" => "Kaplan-Meier curves of the different therapeutic strategies. SAVR: surgical aortic valve replacement; TAVI: transcatheter aortic valve implantation." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "BMI: body mass index; CABG: coronary artery bypass surgery; CrCl: creatinine clearance; IQR: interquartile range; PAD: peripheral arterial disease; PCI: percutaneous coronary intervention; STS: Society of Thoracic Surgeons score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables, n (%) \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">SAVR (n=56) \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=202) \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 therapy (n=66) \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="5" align="left" valign="top">Demographic characteristics</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age in years, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 (76-84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (78-87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (80-88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.023<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (46.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (44.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (42.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.906<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Anthropometric data</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI in kg/m2, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.4 (22.9-29.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.8 (23.4-28.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.6 (23.3-27.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.435<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" 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">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (71.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">157 (77.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (77.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.609<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">13 (23.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (35.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (28.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.199<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coronary artery disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (46.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116 (57.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (53.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.329<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous PCI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 (42.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (24.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (10.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (21.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (18.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.199<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lung disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (14.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (17.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (28.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.072<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (22.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">1 (1.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (16.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (24.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Porcelain aorta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (16.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liver cirrhosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.128<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prior thoracic radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.294<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CrCl (≤30 ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (22.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (25.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.167<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="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="" 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="5" align="left" valign="top">Left ventricular function</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ejection fraction ≤40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (7.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (17.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (27.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Surgical risk scores</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EuroSCORE I, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.8 (8.1-16.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.8 (11.4-25.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.4 (12.8-31.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EuroSCORE II, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 (2.5-5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (3.6-8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 (3.8-7.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STS mortality, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (1.8-5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 (3.5-7.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6 (2.8-6.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1621951.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Kruskal-Wallis test." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Chi-square test." ] ] ] "descripcion" => array:1 [ "en" => "Characterization of patients treated by the different strategies." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "LVOT: left ventricular outflow tract." "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 " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Variable, n (%)</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">Procedural success (n=202) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">197 (97.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Causes of reintervention (n=5)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prosthesis migration to LVOT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (20%) \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">Prosthesis embolization to aorta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (40%) \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">Access failure<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="char" valign="top">2 (40%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1621948.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "In two patients the first approach via a transapical route was unsuccessful, so they were later reintervened by another route." ] ] ] "descripcion" => array:1 [ "en" => "Success of TAVI procedure and causes of reintervention." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "This table includes the first intervention and the five cases of reintervention." "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">Variable, n (%) \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">n=202 patients, 207 procedures \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="2" align="left" valign="top">Implantation route</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfemoral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133 (64.3%) \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">Transapical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (30.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Subclavian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transaortic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (1.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Type of valve implanted</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medtronic CoreValve® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113 (54.6%) \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">Edwards Sapien XT® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (37.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">St. Jude Portico® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (1.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Boston Lotus Valve® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (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">Medtronic CoreValve Evolut® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Edwards Sapien 3® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1621949.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Implantation route and type of valve implanted in transcatheter aortic valve implantation procedures." ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Sc: subclavian; SE: self-expandable; TA: transapical; TAo: transaortic; TF: transfemoral." "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">Features \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">Sapiens XT Ascendra \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">Sapiens Certitude \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">Engager \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">Symetis Acurate \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">Sapiens XT Novoflex+ \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">Sapiens Commander \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">CoreValve \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">CoreValve Evolut R \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">Portico \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">Lotus \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">Implantation route \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TA/TAo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TA/TAo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TF/TAo/Sc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TF/TAo/Sc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TF/Sc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TF \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">Time of preparation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Slow \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Slow \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fast \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">Profile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24-26F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16-20F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14-16F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18F \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">Repositioning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recapture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \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">Release \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mechanical \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">Pericardial tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Porcine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Porcine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Porcine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Porcine + bovine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine \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">Radiopaque marker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1621947.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main characteristics of prosthetic aortic valves used in transcatheter aortic valve implantation procedures." ] ] 7 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "APT: antiplatelet therapy; 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">Variable, n (%) \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">n=66 \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">Improvement of quality of life by TAVI unlikely because of comorbidities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (39.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Life expectancy <1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (18.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frailty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (12.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Associated severe primary disease of other valves making a major contribution to the patient's symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Significant clinical improvement after medical therapy or angioplasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (6.1%) \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">Severe left ventricular dysfunction, without contractile reserve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4.5%) \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">Inadequate annulus size (<18 mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe anemia, unable to receive blood transfusions if needed or contraindication to APT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extreme left ventricular hypertrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.5%) \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">No access for valve implantation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.5%) \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">Active endocarditis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1621950.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Reasons given by the heart team for rejecting patients for surgical aortic valve replacement or transcatheter aortic valve implantation." ] ] 8 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SAVR: surgical aortic valve replacement; 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">SAVR (n=56) \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=202) \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">Conservative therapy (n=66) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (37.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (57.6%) \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><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality 30 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (7.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (4.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" 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">Mortality 30 days-1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (11.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (19.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" 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">Mortality 1-3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (5.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (12.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (28.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.00111 \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">Mortality 3-5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (8.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (7.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \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">Mortality >5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1621946.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mortality in the different treatment groups." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "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" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve implantation: results of a new therapeutic option for high surgical risk aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Salinas" 1 => "R. Moreno" 2 => "L. Calvo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2011.12.008" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "143" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22240099" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Cao" 1 => "S. Ang" 2 => "P. Indraratna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2225-319X.2012.11.09" "Revista" => array:6 [ "tituloSerie" => "Ann Cardiothorac Surg" "fecha" => "2013" "volumen" => "2" "paginaInicial" => "10" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977554" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Généreux" 1 => "S. Head" 2 => "D. Wood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehs220" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2012" "volumen" => "33" "paginaInicial" => "2388" "paginaFinal" => "2398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22851654" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient selection for transcatheter aortic valve implantation: patient risk profile and anatomical selection criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Piazza" 1 => "R. Lange" 2 => "G. Martucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acvd.2012.02.007" "Revista" => array:6 [ "tituloSerie" => "Arch Cardiovasc Dis" "fecha" => "2012" "volumen" => "105" "paginaInicial" => "165" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22520800" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient selection for transcatheter aortic valve implantation: an interventional cardiology perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Mylotte" 1 => "G. Martucci" 2 => "N. Piazza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2225-319X.2012.06.08" "Revista" => array:6 [ "tituloSerie" => "Ann Cardiothorac Surg" "fecha" => "2012" "volumen" => "1" "paginaInicial" => "206" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977496" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complete revascularization is not a prerequisite for success in current transcatheter aortic valve implantation practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Mieghem" 1 => "R. Van der Boon" 2 => "E. Faqiri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol Interv" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "867" "paginaFinal" => "875" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current status of transcatheter aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Webb" 1 => "D. Wood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2012.01.071" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2012" "volumen" => "60" "paginaInicial" => "483" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22749306" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Introduction of an interdisciplinary heart team-based transcatheter aortic valve implantation programme: short and mid-term outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Martínez" 1 => "M. Seco" 2 => "S. Jaijee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/imj.12514" "Revista" => array:6 [ "tituloSerie" => "Intern Med J" "fecha" => "2014" "volumen" => "44" "paginaInicial" => "876" "paginaFinal" => "883" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24965193" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is heart team fundamental to aortic stenosis transcatheter treatment?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Rosa" 1 => "A. Lopes" 2 => "T. Accorsi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2014" "volumen" => "102" "paginaInicial" => "e51" "paginaFinal" => "e52" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Agreement between the new EuroSCORE II, the Logistic EuroSCORE and the Society of Thoracic Surgeons score: implications for transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Arangalage" 1 => "C. Cimadevilla" 2 => "S. Alkhoder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acvd.2014.05.002" "Revista" => array:6 [ "tituloSerie" => "Arch Cardiovasc Dis" "fecha" => "2014" "volumen" => "107" "paginaInicial" => "353" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24996564" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Position statement for the operator and institutional requirements for a transcatheter aortic valve implantation (TAVI) program" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Walters" 1 => "M. Webster" 2 => "S. Pasupati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hlc.2014.09.009" "Revista" => array:6 [ "tituloSerie" => "Heart Lung Circ" "fecha" => "2015" "volumen" => "24" "paginaInicial" => "219" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25488705" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to set up a successful TAVI program" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Vallely" 1 => "M. Wilson" 2 => "M. Adams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2225-319X.2012.06.04" "Revista" => array:6 [ "tituloSerie" => "Ann Cardiothorac Surg" "fecha" => "2012" "volumen" => "1" "paginaInicial" => "185" "paginaFinal" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977492" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Position statement on transcatheter aortic valve implantation in Portugal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Teles" 1 => "V. Ribeiro" 2 => "L. Patrício" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2013.02.009" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "801" "paginaFinal" => "805" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23916790" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sustitución percutánea de válvula aórtica. Un enfoque multidisciplinario, la clave del éxito" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Palacios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.recesp.2012.07.008" "Revista" => array:7 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2012" "volumen" => "65" "numero" => "Suppl. 2" "paginaInicial" => "29" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22921172" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Rodés-Cabau" 1 => "J. Webb" 2 => "A. Cheung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2009.12.014" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "1080" "paginaFinal" => "1090" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20096533" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "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" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting risk in transcatheter aortic valve implantation: comparative analysis of EuroSCORE II and established risk stratification tools" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Silaschi" 1 => "L. Conradi" 2 => "M. Seiffert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0034-1389107" "Revista" => array:6 [ "tituloSerie" => "Thorac Cardiovasc Surg" "fecha" => "2015" "volumen" => "63" "paginaInicial" => "472" "paginaFinal" => "478" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25191764" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0225" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Schymik" 1 => "M. Heimeshoff" 2 => "P. Bramlage" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.25866" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2015" "volumen" => "86" "paginaInicial" => "738" "paginaFinal" => "744" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25641398" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0230" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of 30-day mortality after transcatheter aortic valve implantation: a comparison of logistic EuroSCORE, STS score and EuroSCORE II" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Johansson" 1 => "S. Nozohoor" 2 => "I. Zindovic" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Valve Dis" "fecha" => "2014" "volumen" => "23" "paginaInicial" => "567" "paginaFinal" => "574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25799705" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0235" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of surgical risk scores to predict mortality after transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Silva" 1 => "P. Caramori" 2 => "A. Filho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5935/abc.20150084" "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2015" "volumen" => "105" "paginaInicial" => "241" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26247244" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0240" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of the “TAVI2-SCORe” versus surgical risk scores for prediction of one year mortality in 511 patients who underwent transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Debonnaire" 1 => "L. Fusini" 2 => "R. Wolterbeek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2014.10.029" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2015" "volumen" => "115" "paginaInicial" => "234" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25432413" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0245" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Mok" 1 => "L. Nombela-Franco" 2 => "E. Dumont" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcin.2013.06.008" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Interv" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "1072" "paginaFinal" => "1084" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24156967" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0250" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Green" 1 => "A. Woglom" 2 => "P. Genereux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcin.2012.06.011" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Interv" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "974" "paginaFinal" => "981" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22995885" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0255" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of inhospital outcomes of surgical aortic valve replacement in hospitals with and without availability of a transcatheter aortic valve implantation program (from a Nationally Representative Database)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Singh" 1 => "A. Badheka" 2 => "S. Patel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2015.07.039" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2015" "volumen" => "116" "paginaInicial" => "1229" "paginaFinal" => "1236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26297512" "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 implantation: our vision of the future" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Vahanian" 1 => "D. Himbert" 2 => "E. Brochet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acvd.2012.01.004" "Revista" => array:6 [ "tituloSerie" => "Arch Cardiovasc Dis" "fecha" => "2012" "volumen" => "105" "paginaInicial" => "181" "paginaFinal" => "186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22520802" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000011/v1_201712190639/S2174204917303288/v1_201712190639/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/21742049/0000003600000011/v1_201712190639/S2174204917303288/v1_201712190639/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303288?idApp=UINPBA00004E"]

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Original Article

Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience

Vantagens de uma abordagem multidisciplinar na avaliação de doentes em programa VAP: oito anos de experiência

Cátia Costaa,b,

Corresponding author

ccatiasofia@sapo.pt

Corresponding author.

, Rui Campante Telesa,g, João Britoa, José Pedro Nevesc, Henrique Mesquita Gabriela, Miguel Abecassisc, Regina Ribeirasa, João Abecasisa,g, Tiago Nolascoc, Maria da Conceição Furstenaud, Nélson Valea, António Tralhãoa, Sérgio Madeiraa, João Mesquitaa, Carla Saraivae, Rita Caléa,f, Manuel Almeidaa,g, Ana Aleixog, Miguel Mendesa

a Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal

b Serviço de Cardiologia, Hospital Santarém, Santarém, Portugal

c Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal

d Serviço de Anestesiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal

e Serviço de Imagiologia, Hospital S. Francisco Xavier (CHLO), Lisboa, Portugal

f Serviço de Cardiologia, Hospital Garcia Orta, Almada, Portugal

g CEDOC, Nova Medical School, Lisboa, Portugal

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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curves of the different therapeutic strategies&#46; SAVR&#58; surgical aortic valve replacement&#59; TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Degenerative aortic stenosis &#40;AS&#41; is the most prevalent type of valvular disease in Europe&#44; due to aging populations and increased survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a> When it develops&#44; there is a long asymptomatic period&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a> Once symptoms occur&#44; the prognosis of severe AS is dire&#59; sudden death is frequent and survival rates are only 15-50&#37; at five years&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Surgical aortic valve replacement &#40;SAVR&#41; is the standard therapy for severe AS&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> increasing survival and improving quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> In patients at high surgical risk&#44; transcatheter aortic valve implantation &#40;TAVI&#41; is a good alternative&#44; with procedural success rates of over 90&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;4&#8211;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Assessment by a heart team is currently considered essential in the selection of patients&#44; based on their risk profile and the technical suitability of TAVI&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;5&#44;6&#44;9</span></a> Despite its importance&#44; there is a lack of published evidence on this subject&#46; In addition&#44; considering the complexity and high costs involved in TAVI&#44; the resources involved need to be rationalized&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this paper was to assess a prospective standardized decision process by a heart team regarding patient selection and performance and results of the procedure&#44; from the beginning of the program in 2008 until 2015&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">From its beginning in 2008 up to 2015&#44; the Hospital Santa Cruz TAVI program assessed 473 patients with severe symptomatic AS&#46; A total of 383 patients completed the assessment process&#46; Of these&#44; 80 &#40;20&#46;9&#37;&#41; were selected for SAVR&#44; 214 &#40;55&#46;9&#37;&#41; for TAVI and 89 &#40;23&#46;2&#37;&#41; for conservative treatment alone&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients are included in a prospective program that scrutinizes proposed candidates referred by their attending physicians&#46; Briefly&#44; the patient pathway starts with a clinical appointment that is followed by non-invasive and invasive tests and&#44; finally&#44; a multidisciplinary discussion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Candidate assessment is thorough&#44; including the presence of symptoms&#44; comorbidities and functional capacity&#46; If needed&#44; additional exams are requested&#58; transthoracic echocardiography&#44; complete laboratory tests including blood count&#44; coagulation&#44; N-terminal pro-B-type natriuretic peptide &#40;NT-proBNP&#41;&#44; kidney and liver function tests&#44; and a high-resolution thoracic-abdominal-pelvic gated computed tomography &#40;CT&#41; scan&#46; After complete assessment&#44; the data are gathered and the patient is discussed at a dedicated heart team meeting to select the most appropriate therapeutic strategy&#46; The team is composed of cardiologists &#8211; including clinical cardiologists&#44; interventional cardiologists&#44; and experts in cardiac imaging and heart failure &#8211; and cardiac surgeons&#44; who meet fortnightly to discuss clinical cases&#46; Results are continuously monitored for quality assessment&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The TAVI heart team criteria are based on two factors&#58; indication &#40;inoperable or high surgical risk&#44; as approved by heart team consensus&#41; and lack of futility &#40;subjective assessment of significant improvement in quality of life and predicted survival beyond one year&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The possible access routes are determined and the final route is selected according to the first implantation date available in order to intervene as early as possible&#46; Thus&#44; an arterial approach is only considered when there is clinical or anatomical contraindication for any other route&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">If the patient is approved for either of the invasive strategies &#40;SAVR or TAVI&#41;&#44; he or she goes on a waiting list for the procedure&#46; Patients refused for any invasive intervention return to their referring physician to continue on optimal medical therapy&#46; Those selected for SAVR or TAVI are followed at 30 days&#44; six months and one year after the procedure&#44; and then annually&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">All clinical and procedural data are collected in a dedicated database &#40;Cardiobase&#8482;&#41; and a continuous ongoing registry&#44; the Valve Catheter Restorative Operation on Santa Cruz Hospital &#40;VCROSS&#41;&#46; Anonymous data is exported for statistical analysis&#44; performed with SPSS version 20&#46;0 &#40;IBM SPSS&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Continuous variables are expressed as median &#40;interquartile range &#91;IQR&#93;&#41;&#46; Categorical variables are expressed as absolute value and respective percentages&#46; Differences in means between groups were assessed by the Kruskal-Wallis test and differences between categorical variables were assessed by the chi-square test&#46; A p-value of 0&#46;05 or less was considered significant&#46; Mortality during follow-up was analyzed by Kaplan-Meier survival curves&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patient selection</span><p id="par0060" class="elsevierStylePara elsevierViewall">From 2008 up to 2015&#44; 473 patients with severe symptomatic AS were assessed in the TAVI program at Hospital Santa Cruz &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">As at April 2015&#44; the assessment was not completed in 33 patients &#40;7&#46;0&#37;&#41; and 45 died during the initial assessment &#40;9&#46;5&#37;&#41;&#46; An additional 12 &#40;3&#46;0&#37;&#41; patients returned to their physicians because severe AS was not confirmed&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 383 patients with severe AS completed the heart team assessment process&#46; Of these&#44; 80 &#40;20&#46;9&#37;&#41; were selected for SAVR&#44; 214 &#40;55&#46;9&#37;&#41; for TAVI and 89 &#40;23&#46;2&#37;&#41; for medical treatment alone&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Population characteristics</span><p id="par0075" class="elsevierStylePara elsevierViewall">The characteristics of patients in the different treatment groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In all groups patients were mostly female&#46; The medical therapy group had a higher median age than the other groups and patients undergoing SAVR were younger overall &#40;p&#61;0&#46;023&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The most prevalent comorbidities were hypertension&#44; diabetes and coronary artery disease&#46; The TAVI group included a significantly higher number of patients previously treated by coronary angioplasty &#40;p&#61;0&#46;005&#41;&#46; The medical therapy group showed a higher prevalence of comorbidities such as lung disease&#44; history of stroke and chronic kidney disease &#40;stages 4 and 5&#41;&#46; This group also presented a higher incidence of left ventricular dysfunction&#44; followed by the TAVI group &#40;p&#61;0&#46;015&#41;&#46; Comorbidities such as porcelain aorta&#44; liver cirrhosis and prior thoracic radiotherapy were only found in the TAVI and medical therapy groups&#44; since these patients were considered inoperable&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Comparing the most used surgical risk scores&#44; the medical therapy group had a higher median logistic EuroSCORE I &#40;18&#46;4&#37;&#41;&#44; followed by the TAVI group &#40;16&#46;8&#37;&#41; &#40;p&#8804;0&#46;001&#41;&#44; but the median values of both groups were below 20&#37;&#46; Mortality predicted by the EuroSCORE II and Society of Thoracic Surgeons &#40;STS&#41; scores was higher in the TAVI group&#44; followed by the medical therapy group &#40;p&#61;0&#46;005 and p&#60;0&#46;001&#44; respectively&#41;&#46; The SAVR group presented the lowest risk scores&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patient selection for different treatments</span><p id="par0095" class="elsevierStylePara elsevierViewall">In the eight years of the program&#44; 207 TAVI procedures were performed in 202 patients&#46; The procedure was successful in 97&#46;6&#37; of cases &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; A total of five cases needed reintervention&#44; mostly &#40;n&#61;3&#41; due to prosthesis migration&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The median time between the heart team&#39;s decision and bioprosthesis implantation was 70 days &#40;IQR 34-129&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The most frequent implantation route was transfemoral &#40;64&#46;3&#37;&#41;&#44; followed by transapical &#40;30&#46;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The CoreValve<span class="elsevierStyleSup">&#174;</span> system was the most used device &#40;58&#46;0&#37;&#41;&#44; followed by the Edwards Sapiens<span class="elsevierStyleSup">&#174;</span> &#40;39&#46;1&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> describes the main characteristics of the percutaneous aortic valve implantation&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Most of the patients selected for SAVR underwent isolated valvular intervention &#40;85&#46;7&#37;&#41;&#46; Only a minority also underwent associated coronary artery bypass surgery &#40;14&#46;3&#37;&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Patients were refused for any kind of invasive intervention for a variety of reasons &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; The most frequent reason was predicted lack of improvement of quality of life after the procedure due to comorbidities &#40;39&#46;4&#37;&#41;&#44; which included several patients with severe chronic lung disease&#46; The second most frequent cause was life expectancy of less than a year &#40;18&#46;2&#37;&#41;&#44; in most cases due to diagnosed cancer at the time of TAVI assessment&#46; The third most frequent reason was frailty &#40;12&#46;2&#37;&#41;&#44; an extreme vulnerability to adverse events as determined by the heart team&#44; usually based on very low gait speed&#44; severely decreased muscle mass and&#47;or malnutrition&#46; The fourth was the presence of associated severe disease of other valves making a major contribution to the patient&#39;s symptoms &#40;all patients with concomitant severe mitral disease&#41;&#46; Although patients were refused predominantly for clinical reasons&#44; some were also rejected for technical reasons&#44; including inadequate annulus size &#40;3&#46;0&#37;&#41; or the absence of a route for a TAVI procedure &#40;1&#46;5&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Note that a substantial proportion &#40;25&#46;8&#37;&#41; of all patients included in the medical therapy group &#40;89 patients&#41; refused any invasive therapy&#44; either TAVI or SAVR &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Long-term follow-up</span><p id="par0125" class="elsevierStylePara elsevierViewall">Over a median follow-up of 49 months &#40;95&#37; confidence interval 43-55&#41;&#44; comparison of the different therapeutic strategies revealed higher mortality in the medical therapy group &#40;57&#46;6&#37;&#41; followed by the TAVI group &#40;37&#46;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; Mortality at 30 days post-procedure &#40;SAVR vs&#46; TAVI&#41; was almost the same in both groups&#44; slightly higher in the SAVR group&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Analysis of the Kaplan-Meier curves for the different therapeutic strategies shows that after an initial stage in which the surgical procedure and TAVI had higher periprocedural mortality&#44; both subsequently depart from the medical therapy survival curve &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; Although SAVR appears to present a more favorable survival curve&#44; there was no statistically significant difference in comparison with TAVI &#40;p&#61;0&#46;130&#41;&#46; Survival curves for both TAVI and SAVR were significantly different from that of the medical strategy&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">The main contribution of this study is to provide evidence that implementation of a heart team&#44; as recommended by the guidelines for treatment of severe aortic stenosis&#44; should be performed prospectively under a well-defined&#44; ongoing and carefully staged protocol that enables the activation of a multidisciplinary team that can provide all available therapies &#40;TAVI&#44; SAVR and conservative treatment&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our group foresaw that patient selection would have a crucial role in the success of transcatheter aortic valve implantation&#44; and thus a visionary multidisciplinary program was set in place&#46; The heart team has become fundamental in the assessment of patients based on their risk profile and the technical suitability of TAVI&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;4&#8211;6&#44;8&#44;9&#44;11&#8211;16</span></a> In the current context of an increasing elderly population&#44; the availability of new treatments for severe aortic stenosis requires multidisciplinary clinical expertise for the accurate diagnosis of heart valve disease and assessment of comorbidities and risks of intervention&#44; in addition to the rationalization of resources&#44; considering the complexity and high costs of TAVI&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The technique should be performed in centers of excellence with a trained multidisciplinary heart team treating a minimum of 50 cases per year&#44; appropriate technical facilities and a prospective registry for monitoring purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">A broad group of specialists is required to assess these patients and to provide a rapid selection process&#44; since short-term mortality in these patients is significant&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;14&#44;15</span></a> Our experience reports 45 deaths during the assessment phase &#40;9&#46;5&#37;&#41; and 15 deaths in patients after complete assessment awaiting SAVR or TAVI &#40;3&#46;2&#37;&#41;&#46; This highlights the severity of the disease and shows the need for a faster assessment process and treatment&#46; Our median time of 70 days between the decision to perform TAVI and implantation of the bioprosthesis seems excessive&#44; and this recently prompted our center to expand its multislice CT scan facility&#44; which hopefully will reduce this delay&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Multidisciplinary interaction between physicians is needed&#44; enabling all the patient&#39;s biopsychosocial characteristics to be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The clinical cardiologist is responsible for patient selection and indication and for pre- and post-procedure follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The interventional cardiologist is responsible for organizing the heart team and monitoring procedural performance&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> while the cardiovascular surgeon is responsible for performing transaortic and transapical procedures&#44; assisting with the transfemoral approach&#44; and treating possible complications&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The echocardiographer is responsible for anatomical and functional characterization of the diseased valve&#44; intraoperative assessment of correct positioning of the prosthesis&#44; and monitoring of post-procedural complications&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The heart team also includes other professionals such as anesthetists&#44; nurses and physical therapists&#46; The consensus nowadays is not to perform a TAVI procedure in sites lacking a heart team&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">TAVI is currently recommended in symptomatic patients with severe AS who are at high surgical risk or are considered ineligible for SAVR&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;6&#44;8&#44;13&#44;14</span></a> Surgical risk has been traditionally assessed using scores such as EuroSCORE and STS&#46; A logistic EuroSCORE I of over 20&#37; and a STS mortality score of more than 10&#37; have been proposed as indicators of high surgical risk &#40;in combination with clinical judgment&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> A EuroSCORE II cut-off of 7&#37; appears to be equivalent to a Logistic EuroSCORE of 20&#37; or an STS score of 10&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> In our center&#44; both the TAVI and medical therapy groups presented lower values than these&#46; This variability of calculated scores has been described in other TAVI populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#44;11&#44;18&#44;19</span></a> A French center reported only half of patients reaching these threshold values&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> This is explained by the fact that these scoring systems were created on the basis of standard cardiac surgery databases and are thus unable to assess serious conditions that many of these patients suffer from&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;5&#44;18&#44;20&#44;21</span></a> Comparison between the scores shows no significant differences in discriminatory power&#44; and correlation between them appears to be at best modest&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11&#44;20</span></a> In the real world&#44; the available surgical risk scores do not accurately predict mortality after TAVI&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> New promising and more accurate scores are emerging to replace the currently used surgical risk scores&#44; including variables such as porcelain thoracic aorta&#44; anemia&#44; left ventricular dysfunction&#44; recent myocardial infarction and critical aortic valve stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> For this reason&#44; a heart team composed of individuals trained in systematic patient assessment enables better selection of individuals who may benefit from the various treatment strategies until more reliable risk scores become available&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In this cohort the main causes for patients being refused any kind of invasive procedure were low life expectancy and the presence of severe comorbidities which made TAVI unlikely to improve quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> One of these comorbidities is chronic obstructive pulmonary disease&#44; which is associated with higher mortality at mid-term follow-up in patients undergoing TAVI&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> One study has revealed that TAVI was futile in more than one third of these patients and that a shorter distance in the six-minute walk test was a predictor of lack of benefit&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Frailty was the third most common reason for patients being refused for TAVI in our center&#46; Frailty syndrome is characterized by decreased muscle mass and energy expenditure and malnutrition&#44; leading to extreme vulnerability to adverse events&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;24</span></a> A study assessing the frailty status of 159 patients through assessment of gait speed&#44; grip strength&#44; serum albumin and degree of independence in daily activities determined that frailty was not associated with increased periprocedural complications in patients selected for TAVI&#44; but was associated with increased one-year mortality after the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> Our assessment of patients&#8217; frailty was mostly subjective&#46; This is a limitation&#44; and the use of objective measurements and questionnaires has since been implemented&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Other comorbidities not included in current scores are liver cirrhosis&#44; porcelain aorta and prior radiotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;4&#8211;6</span></a> Furthermore&#44; assessment of neurocognitive function&#44; functional status&#44; mobility&#44; and supports is increasingly being recognized as important in patient selection&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> The heart team is thus crucial in individualized patient assessment&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> This is particularly important in the current environment of limited resources&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> In the future a validated risk score for TAVI will probably be created&#44; similar to the logistic EuroSCORE&#44; EuroSCORE II and STS mortality score for surgical procedures&#44; taking into account many variables already considered in the assessment process&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">5&#44;6&#44;18&#44;22</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Another important heart team decision is that of revascularization of coronary artery disease&#44; which is often found coexisting with valvular disease&#44; since they share the same risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">5&#44;7</span></a> Up to three-quarters of patients undergoing TAVI have coronary artery disease&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> The optimal management of these patients is not well defined&#46; Some authors argue that a staged approach &#40;percutaneous coronary intervention followed by TAVI&#41; is prudent in patients with lesions in the left main or proximal arteries &#40;especially if dominant in the case of the right coronary artery or circumflex artery&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> Although this reduces procedure time&#44; radiation and contrast exposure&#44; it requires arterial access twice&#44; with inherent risk for vascular and bleeding complications and additional hospitalization costs&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> In the elderly population with severe AS who undergo TAVI&#44; coronary revascularization is usually incomplete&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> Judicious decisions concerning revascularization &#40;not always deciding on complete revascularization&#41; are more likely to achieve favorable mid-term outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Anatomical assessment of patients is also essential&#44; including arterial vasculature and the aortic valve apparatus &#40;including the left ventricular outflow tract&#44; aortic annulus diameter&#44; sinus of Valsalva&#44; sinotubular junction&#44; ascending aorta and degree of calcification&#41;&#44; to choose the most appropriate access route and transcatheter valve size&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#8211;6&#44;8&#44;15</span></a> Which approach is used &#40;transfemoral vs&#46; transapical&#41; has no prognostic value in acute and late outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> Usually the transfemoral approach is preferred&#44; and an alternative route is only selected if there is a prohibitively small or diseased iliofemoral arterial system&#44; mobile plaque&#44; excessive calcification&#44; or extreme tortuosity of the descending thoracic aorta&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#44;6&#44;8&#44;15</span></a> The fact that the most frequent implantation route was transfemoral &#40;64&#46;3&#37;&#41; reflects our strategy of implanting on the first available date without selecting a route if individually possible&#46; This enabled the earliest treatment for each patient to be chosen&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The choice of prosthetic aortic valve is another important issue&#46; As pointed out above&#44; several devices are currently available with different characteristics that confer benefits in different clinical settings&#46; For example&#44; repositioning features are required for cases of extreme aortic calcification&#44; potential coronary obstruction&#44; bicuspid aortic valve&#44; aortic regurgitation&#44; valve-in-valve technique or left ventricular septal hypertrophy&#46; Radiopaque markers are particularly useful in chronic kidney disease patients&#46; The self-expandable feature is important when there is significant concomitant aortic regurgitation&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">TAVI has been shown to be a feasible procedure&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;4&#8211;6&#44;8</span></a> One-year survival rates of 60-80&#37; are reported&#44; depending on the severity of comorbidities&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;8</span></a> In our population the survival rate of TAVI patients at one-year follow-up was 84&#46;1&#37;&#46; Mortality at 30 days was 4&#46;4&#37;&#44; lower than the 9-10&#37; usually described in other series&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">The literature on TAVI vs&#46; SAVR for patients at high surgical risk shows that major adverse outcomes are similar between the two treatment modalities&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> However&#44; the results are limited by inconsistent patient selection criteria&#44; heterogeneous definitions of clinical endpoints and relatively short follow-up periods&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">As in our population&#44; other studies show that after an initial stage in which the surgical procedure and TAVI had higher periprocedural mortality&#44; both subsequently depart from the conservative therapy survival curve&#44; showing a better outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> Although SAVR appeared to present a more favorable survival curve&#44; this was not statistically significant difference from that of TAVI&#44; both having comparable survival curves at one year&#46; SAVR performed in centers with a TAVI program is associated with significantly lower mortality and complication rates than that performed in centers without a TAVI program&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">A heart team approach is essential for TAVI in the current management of patients with severe aortic stenosis&#46; This applies at each step of the procedure&#58; patient selection&#44; performance of the procedure&#44; post-procedural care and evaluation of the results&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0210" class="elsevierStylePara elsevierViewall">A prospective multidisciplinary heart team program was able to appropriately select candidates for transcatheter aortic valve implantation&#44; surgical aortic valve replacement and conservative treatment&#44; matching the risk of both invasive treatments&#46; The study is unique because it demonstrates the success of a standardized approach that requires continuous monitoring to be efficient in a timely manner&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Key points</span><p id="par0215" class="elsevierStylePara elsevierViewall">What is known about the topic&#63;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0220" class="elsevierStylePara elsevierViewall">The literature available on TAVI vs&#46; SAVR for patients at high surgical risk shows that major adverse outcomes are similar between the two treatment modalities&#46; However&#44; the results are limited by inconsistent patient selection criteria&#44; heterogeneous definitions of clinical endpoints and relatively short follow-up periods&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0225" class="elsevierStylePara elsevierViewall">A heart team assessment is considered central to the selection of patients with severe AS&#46; This applies at each step of the procedure&#58; patient selection&#44; performance of the procedure&#44; post-procedural care and evaluation of the results&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Despite its importance&#44; there is a marked lack of publications in this area&#46;</p></li></ul></p><p id="par0235" class="elsevierStylePara elsevierViewall">What does this study add&#63;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0240" class="elsevierStylePara elsevierViewall">The heart team is crucial for individualized assessment of patients&#46; This is particularly important in the current environment of limited resources&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0245" class="elsevierStylePara elsevierViewall">The main contribution of this study is to provide evidence that implementation of a heart team&#44; as recommended by the guidelines for treatment of severe aortic stenosis&#44; must be performed prospectively under a well-defined&#44; ongoing and carefully staged protocol that enables the activation of a multidisciplinary team that can provide all available therapies &#40;TAVI&#44; SAVR and conservative treatment&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0250" class="elsevierStylePara elsevierViewall">This standardized approach requires continuous monitoring to be efficient in a timely manner&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2016-10-16"
    "fechaAceptado" => "2016-11-09"
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            0 => "Severe aortic stenosis"
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            2 => "Surgical aortic valve replacement"
            3 => "Heart team"
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            0 => "Estenose a&#243;rtica grave"
            1 => "V&#225;lvula a&#243;rtica percut&#226;nea"
            2 => "Substitui&#231;&#227;o valvular a&#243;rtica cir&#250;rgica"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aortic stenosis is the most prevalent type of valvular disease in Europe&#46; Surgical aortic valve replacement &#40;SAVR&#41; is the standard therapy&#44; while transcatheter aortic valve implantation &#40;TAVI&#41; is an alternative in patients at unacceptably high surgical risk&#46; Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject&#46; The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The heart team prospectively assessed 473 patients using a standardized approach&#46; A total of 214 patients were selected for TAVI and 80 for SAVR&#46; Demographic&#44; clinical and procedural characteristics and long-term success rates were compared between the groups&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">TAVI patients were older than the SAVR group &#40;median 83 vs&#46; 81 years&#41;&#44; and had higher surgical risk scores &#40;median EuroSCORE II 5&#46;3 vs&#46; 3&#46;6&#37; and Society of Thoracic Surgeons score 5&#46;1 vs&#46; 3&#46;1&#37;&#41;&#44; as did the patients under medical treatment only&#46; These scores were unable to assess multiple comorbidities&#46; Patients&#8217; outcomes were different between the three groups &#40;mortality with SAVR 25&#37; vs&#46; TAVI 37&#46;6&#37; vs&#46; conservative therapy 57&#46;6&#37;&#44; p&#61;0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The heart team program was able to select candidates appropriately for TAVI&#44; SAVR and conservative treatment&#44; taking into account the risk of both invasive treatments&#46; The use of a prospective standardized heart team approach is recommended&#44; but requires continuous monitoring to ensure effectiveness in a timely manner&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A estenose a&#243;rtica &#233; atualmente a doen&#231;a valvular mais prevalente na Europa&#46; A substitui&#231;&#227;o valvular a&#243;rtica cir&#250;rgica &#40;SVAC&#41; &#233; atualmente considerada a terap&#234;utica de primeira linha&#44; a implanta&#231;&#227;o de v&#225;lvula a&#243;rtica percut&#226;nea &#40;VAP&#41; &#233; considerada uma op&#231;&#227;o em doentes com elevado risco cir&#250;rgico&#46; A avalia&#231;&#227;o dos doentes pelo <span class="elsevierStyleItalic">Heart Team</span> encontra-se preconizada pelas recentes <span class="elsevierStyleItalic">guidelines</span> publicadas de doen&#231;as valvulares&#44; contudo existem poucas publica&#231;&#245;es acerca dessa tem&#225;tica&#46; O objetivo deste manuscrito &#233; descrever a experi&#234;ncia de um programa multidisciplinar VAP&#44; iniciado em 2008&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O <span class="elsevierStyleItalic">Heart Team</span> avaliou de forma prospetiva e padronizada 473 doentes&#46; Desses&#44; 214 foram selecionados para VAP e 80 para SVAC&#46; Os grupos foram comparados no que respeita &#224;s suas caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas&#44; de procedimento e quanto &#224; sua evolu&#231;&#227;o &#40;mortalidade&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O grupo VAP apresentou maior idade do que o grupo SVAC &#40;mediana 83 <span class="elsevierStyleItalic">versus</span> 81 anos&#41; e apresentou <span class="elsevierStyleItalic">scores</span> de risco cir&#250;rgico mais elevados &#40;mediana Euroscore II 5&#44;3 <span class="elsevierStyleItalic">versus</span> 3&#44;6&#37; e STS 5&#44;1 <span class="elsevierStyleItalic">versus</span> 3&#44;1&#37;&#41;&#44; tal como o grupo de doentes apenas sob terap&#234;utica m&#233;dica&#46; Esses <span class="elsevierStyleItalic">scores</span> n&#227;o foram capazes de avaliar m&#250;ltiplas comorbilidades&#46; A mortalidade entre os tr&#234;s grupos apresentou diferen&#231;as com significado estat&#237;stico &#40;SVAC 25&#37; <span class="elsevierStyleItalic">versus</span> VAP 37&#44;6&#37; <span class="elsevierStyleItalic">versus</span> terap&#234;utica conservadora 57&#44;6&#37;&#44; p&#61;0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O programa <span class="elsevierStyleItalic">Heart Team</span> foi capaz de selecionar de forma adequada os doentes para as diversas estrat&#233;gias terap&#234;uticas tendo em conta o risco de ambos os procedimentos invasivos&#46; Uma abordagem eficiente e standardizada pela <span class="elsevierStyleItalic">Heart Team</span> deve ser estimulada&#44; necessitando de reavalia&#231;&#227;o continua&#46;</p></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&#44; n &#40;&#37;&#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">SAVR &#40;n&#61;56&#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">TAVI &#40;n&#61;202&#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 therapy &#40;n&#61;66&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Demographic characteristics</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 in years&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;76-84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;78-87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;80-88&#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;023<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;46&#46;4&#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 &#40;44&#46;1&#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">28 &#40;42&#46;4&#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">0&#46;906<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Anthropometric data</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>BMI in kg&#47;m<span class="elsevierStyleSup">2</span>&#44; median &#40;IQR&#41;&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;4 &#40;22&#46;9-29&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;8 &#40;23&#46;4-28&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;6 &#40;23&#46;3-27&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;435<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">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>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;71&#46;4&#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">157 &#40;77&#46;7&#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">51 &#40;77&#46;3&#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">0&#46;609<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;23&#46;2&#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">71 &#40;35&#46;1&#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">19 &#40;28&#46;8&#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">0&#46;199<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coronary artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;46&#46;4&#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">116 &#40;57&#46;4&#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">35 &#40;53&#46;0&#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">0&#46;329<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;25&#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">86 &#40;42&#46;6&#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 &#40;24&#46;2&#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">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;10&#46;7&#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">43 &#40;21&#46;3&#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 &#40;18&#46;2&#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">0&#46;199<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lung disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;14&#46;3&#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">35 &#40;17&#46;3&#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">19 &#40;28&#46;9&#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">0&#46;072<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;6&#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">45 &#40;22&#46;3&#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 &#40;16&#46;7&#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">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;8&#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">33 &#40;16&#46;3&#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 &#40;24&#46;2&#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">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Porcelain aorta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#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">34 &#40;16&#46;8&#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">2 &#40;3&#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">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Liver cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#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">1 &#40;0&#46;5&#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">2 &#40;3&#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">0&#46;128<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prior thoracic radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#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">4 &#40;2&#46;0&#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">0 &#40;0&#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">0&#46;294<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CrCl &#40;&#8804;30 ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;12&#46;5&#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">46 &#40;22&#46;8&#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">17 &#40;25&#46;8&#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">0&#46;167<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" 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="" 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="5" align="left" valign="top"><span class="elsevierStyleItalic">Left ventricular function</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>Ejection fraction &#8804;40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;7&#46;1&#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">36 &#40;17&#46;8&#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">18 &#40;27&#46;3&#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">0&#46;015<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Surgical risk scores</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>EuroSCORE I&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8 &#40;8&#46;1-16&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;8 &#40;11&#46;4-25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;4 &#40;12&#46;8-31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EuroSCORE II&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6 &#40;2&#46;5-5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3 &#40;3&#46;6-8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8 &#40;3&#46;8-7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>STS mortality&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1 &#40;1&#46;8-5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1 &#40;3&#46;5-7&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6 &#40;2&#46;8-6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&#44; n &#40;&#37;&#41;</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">Procedural success &#40;n&#61;202&#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">197 &#40;97&#46;5&#37;&#41;&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="2" align="left" valign="top"><span class="elsevierStyleItalic">Causes of reintervention &#40;n&#61;5&#41;</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>Prosthesis migration to LVOT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prosthesis embolization to aorta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Access failure<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="char" valign="top">2 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">In two patients the first approach via a transapical route was unsuccessful&#44; so they were later reintervened by another route&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Success of TAVI procedure and causes of reintervention&#46;</p>"
        ]
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        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "identificador" => "at3"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">This table includes the first intervention and the five cases of reintervention&#46;</p>"
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            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">Variable&#44; n &#40;&#37;&#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">n&#61;202 patients&#44; 207 procedures&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="2" align="left" valign="top"><span class="elsevierStyleItalic">Implantation route</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>Transfemoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133 &#40;64&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transapical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;30&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Subclavian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transaortic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" 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="2" align="left" valign="top"><span class="elsevierStyleItalic">Type of valve implanted</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>Medtronic CoreValve<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;54&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Edwards Sapien XT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;37&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>St&#46; Jude Portico<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Boston Lotus Valve<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medtronic CoreValve Evolut<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Edwards Sapien 3<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Implantation route and type of valve implanted in transcatheter aortic valve implantation procedures&#46;</p>"
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      6 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Sc&#58; subclavian&#59; SE&#58; self-expandable&#59; TA&#58; transapical&#59; TAo&#58; transaortic&#59; TF&#58; transfemoral&#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">Features&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">Sapiens XT Ascendra&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">Sapiens Certitude&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">Engager&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">Symetis Acurate&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">Sapiens XT Novoflex&#43;&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">Sapiens Commander&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">CoreValve&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">CoreValve Evolut R&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">Portico&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">Lotus&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">Implantation route&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&#47;TAo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&#47;TAo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TF&#47;TAo&#47;Sc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TF&#47;TAo&#47;Sc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TF&#47;Sc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TF&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">Time of preparation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Slow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Slow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fast&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">Profile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-26F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16-20F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14-16F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18F&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">Repositioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recapture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&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">Release&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mechanical&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">Pericardial tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Porcine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Porcine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Porcine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Porcine &#43; bovine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine&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">Radiopaque marker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Main characteristics of prosthetic aortic valves used in transcatheter aortic valve implantation procedures&#46;</p>"
        ]
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">APT&#58; antiplatelet therapy&#59; TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&#44; n &#40;&#37;&#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">n&#61;66&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">Improvement of quality of life by TAVI unlikely because of comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;39&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Life expectancy &#60;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;18&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frailty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;12&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Associated severe primary disease of other valves making a major contribution to the patient&#39;s symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Significant clinical improvement after medical therapy or angioplasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe left ventricular dysfunction&#44; without contractile reserve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inadequate annulus size &#40;&#60;18 mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe anemia&#44; unable to receive blood transfusions if needed or contraindication to APT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extreme left ventricular hypertrophy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No access for valve implantation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Active endocarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Reasons given by the heart team for rejecting patients for surgical aortic valve replacement or transcatheter aortic valve implantation&#46;</p>"
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">SAVR&#58; surgical aortic valve replacement&#59; TAVI&#58; transcatheter aortic valve implantation&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" 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">SAVR &#40;n&#61;56&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Conservative therapy &#40;n&#61;66&#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&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">Total mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;25&#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">76 &#40;37&#46;6&#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">38 &#40;57&#46;6&#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">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">Mortality 30 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;7&#46;1&#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">9 &#40;4&#46;4&#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">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">Mortality 30 days-1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;6&#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 &#40;11&#46;4&#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">13 &#40;19&#46;7&#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">-&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">Mortality 1-3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#46;4&#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">26 &#40;12&#46;9&#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">19 &#40;28&#46;8&#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">&#60;0&#46;00111&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">Mortality 3-5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;8&#46;9&#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 &#40;7&#46;9&#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">6 &#40;9&#46;1&#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">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">Mortality &#62;5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2 &#40;1&#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">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Mortality in the different treatment groups&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter aortic valve implantation&#58; results of a new therapeutic option for high surgical risk aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Salinas"
                            1 => "R&#46; Moreno"
                            2 => "L&#46; Calvo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2011.12.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2012"
                        "volumen" => "31"
                        "paginaInicial" => "143"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22240099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Cao"
                            1 => "S&#46; Ang"
                            2 => "P&#46; Indraratna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2225-319X.2012.11.09"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Cardiothorac Surg"
                        "fecha" => "2013"
                        "volumen" => "2"
                        "paginaInicial" => "10"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977554"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter aortic valve implantation 10-year anniversary&#58; review of current evidence and clinical implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; G&#233;n&#233;reux"
                            1 => "S&#46; Head"
                            2 => "D&#46; Wood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs220"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2388"
                        "paginaFinal" => "2398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22851654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient selection for transcatheter aortic valve implantation&#58; patient risk profile and anatomical selection criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Piazza"
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                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acvd.2012.02.007"
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                        "tituloSerie" => "Arch Cardiovasc Dis"
                        "fecha" => "2012"
                        "volumen" => "105"
                        "paginaInicial" => "165"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22520800"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0160"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient selection for transcatheter aortic valve implantation&#58; an interventional cardiology perspective"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Mylotte"
                            1 => "G&#46; Martucci"
                            2 => "N&#46; Piazza"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2225-319X.2012.06.08"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Cardiothorac Surg"
                        "fecha" => "2012"
                        "volumen" => "1"
                        "paginaInicial" => "206"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977496"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complete revascularization is not a prerequisite for success in current transcatheter aortic valve implantation practice"
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                          "etal" => true
                          "autores" => array:3 [
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                            1 => "R&#46; Van der Boon"
                            2 => "E&#46; Faqiri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol Interv"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "867"
                        "paginaFinal" => "875"
                      ]
                    ]
                  ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current status of transcatheter aortic valve replacement"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Webb"
                            1 => "D&#46; Wood"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2012.01.071"
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                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2012"
                        "volumen" => "60"
                        "paginaInicial" => "483"
                        "paginaFinal" => "492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22749306"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0175"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Introduction of an interdisciplinary heart team-based transcatheter aortic valve implantation programme&#58; short and mid-term outcomes"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "S&#46; Jaijee"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/imj.12514"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med J"
                        "fecha" => "2014"
                        "volumen" => "44"
                        "paginaInicial" => "876"
                        "paginaFinal" => "883"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24965193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0180"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is heart team fundamental to aortic stenosis transcatheter treatment&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46; Rosa"
                            1 => "A&#46; Lopes"
                            2 => "T&#46; Accorsi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2014"
                        "volumen" => "102"
                        "paginaInicial" => "e51"
                        "paginaFinal" => "e52"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0185"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Agreement between the new EuroSCORE II&#44; the Logistic EuroSCORE and the Society of Thoracic Surgeons score&#58; implications for transcatheter aortic valve implantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Arangalage"
                            1 => "C&#46; Cimadevilla"
                            2 => "S&#46; Alkhoder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acvd.2014.05.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Cardiovasc Dis"
                        "fecha" => "2014"
                        "volumen" => "107"
                        "paginaInicial" => "353"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24996564"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0190"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Position statement for the operator and institutional requirements for a transcatheter aortic valve implantation &#40;TAVI&#41; program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Walters"
                            1 => "M&#46; Webster"
                            2 => "S&#46; Pasupati"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hlc.2014.09.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Lung Circ"
                        "fecha" => "2015"
                        "volumen" => "24"
                        "paginaInicial" => "219"
                        "paginaFinal" => "223"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25488705"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to set up a successful TAVI program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Vallely"
                            1 => "M&#46; Wilson"
                            2 => "M&#46; Adams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2225-319X.2012.06.04"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Cardiothorac Surg"
                        "fecha" => "2012"
                        "volumen" => "1"
                        "paginaInicial" => "185"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23977492"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0200"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Position statement on transcatheter aortic valve implantation in Portugal"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Teles"
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                            2 => "L&#46; Patr&#237;cio"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2013.02.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "801"
                        "paginaFinal" => "805"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23916790"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            14 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "15"
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                    0 => array:2 [
                      "titulo" => "Sustituci&#243;n percut&#225;nea de v&#225;lvula a&#243;rtica&#46; Un enfoque multidisciplinario&#44; la clave del &#233;xito"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.recesp.2012.07.008"
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                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2012"
                        "volumen" => "65"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "29"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22921172"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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            15 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Rod&#233;s-Cabau"
                            1 => "J&#46; Webb"
                            2 => "A&#46; Cheung"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2009.12.014"
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                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "1080"
                        "paginaFinal" => "1090"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20096533"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0215"
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                0 => array:2 [
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                    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;"
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                            2 => "N&#46; Al-Attar"
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                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehn183"
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                        "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"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0220"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting risk in transcatheter aortic valve implantation&#58; comparative analysis of EuroSCORE II and established risk stratification tools"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "M&#46; Seiffert"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Thorac Cardiovasc Surg"
                        "fecha" => "2015"
                        "volumen" => "63"
                        "paginaInicial" => "472"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25191764"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0225"
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                0 => array:2 [
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                    0 => array:2 [
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                    0 => array:2 [
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                        "tituloSerie" => "Catheter Cardiovasc Interv"
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                        "volumen" => "86"
                        "paginaInicial" => "738"
                        "paginaFinal" => "744"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25641398"
                            "web" => "Medline"
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            19 => array:3 [
              "identificador" => "bib0230"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Prediction of 30-day mortality after transcatheter aortic valve implantation&#58; a comparison of logistic EuroSCORE&#44; STS score and EuroSCORE II"
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                            2 => "I&#46; Zindovic"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Valve Dis"
                        "fecha" => "2014"
                        "volumen" => "23"
                        "paginaInicial" => "567"
                        "paginaFinal" => "574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25799705"
                            "web" => "Medline"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Performance of surgical risk scores to predict mortality after transcatheter aortic valve implantation"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2015"
                        "volumen" => "105"
                        "paginaInicial" => "241"
                        "paginaFinal" => "247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26247244"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0240"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Value of the &#8220;TAVI2-SCORe&#8221; versus surgical risk scores for prediction of one year mortality in 511 patients who underwent transcatheter aortic valve implantation"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "115"
                        "paginaInicial" => "234"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25432413"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0245"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation"
                      "autores" => array:1 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcin.2013.06.008"
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                        "tituloSerie" => "JACC Cardiovasc Interv"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "1072"
                        "paginaFinal" => "1084"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24156967"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0250"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis"
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                  "host" => array:1 [
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2017.11.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	2	6
2024 October	34	30	64
2024 September	48	24	72
2024 August	46	29	75
2024 July	36	34	70
2024 June	37	24	61
2024 May	52	24	76
2024 April	41	30	71
2024 March	48	20	68
2024 February	44	23	67
2024 January	41	27	68
2023 December	55	65	120
2023 November	62	35	97
2023 October	25	20	45
2023 September	24	24	48
2023 August	35	19	54
2023 July	40	17	57
2023 June	36	13	49
2023 May	51	88	139
2023 April	30	3	33
2023 March	71	36	107
2023 February	51	26	77
2023 January	40	20	60
2022 December	64	27	91
2022 November	48	28	76
2022 October	57	35	92
2022 September	42	54	96
2022 August	39	36	75
2022 July	49	44	93
2022 June	44	33	77
2022 May	39	23	62
2022 April	48	41	89
2022 March	43	61	104
2022 February	40	39	79
2022 January	56	31	87
2021 December	35	40	75
2021 November	52	39	91
2021 October	69	73	142
2021 September	44	40	84
2021 August	60	39	99
2021 July	54	28	82
2021 June	43	31	74
2021 May	51	42	93
2021 April	72	71	143
2021 March	93	26	119
2021 February	54	12	66
2021 January	46	19	65
2020 December	51	18	69
2020 November	61	20	81
2020 October	79	12	91
2020 September	86	20	106
2020 August	52	8	60
2020 July	48	13	61
2020 June	52	18	70
2020 May	71	7	78
2020 April	44	10	54
2020 March	44	8	52
2020 February	176	33	209
2020 January	42	4	46
2019 December	39	11	50
2019 November	41	15	56
2019 October	47	4	51
2019 September	63	6	69
2019 August	39	12	51
2019 July	27	13	40
2019 June	26	18	44
2019 May	39	18	57
2019 April	30	20	50
2019 March	89	16	105
2019 February	39	5	44
2019 January	27	10	37
2018 December	66	11	77
2018 November	129	17	146
2018 October	375	20	395
2018 September	74	23	97
2018 August	43	8	51
2018 July	30	5	35
2018 June	47	3	50
2018 May	31	5	36
2018 April	21	4	25
2018 March	30	6	36
2018 February	22	3	25
2018 January	25	5	30
2017 December	22	7	29

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