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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introdu&#231;&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">Nas &#250;ltimas d&#233;cadas&#44; a esperan&#231;a m&#233;dia de vida aumentou e consequentemente conduziu ao aumento do n&#250;mero de idosos com doen&#231;a valvular<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">1</span></a>&#46; Neste grupo de doentes&#44; a estenose a&#243;rtica &#233; a doen&#231;a valvular mais frequente alcan&#231;ando uma incid&#234;ncia de 8&#44;1&#37; aos 85 anos de idade<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">2</span></a>&#46; Assim&#44; estamos perante um grupo importante de doentes cuja cirurgia de substitui&#231;&#227;o valvular a&#243;rtica &#40;SVA&#41; ainda &#233; negada a uma por&#231;&#227;o significativa &#40;30&#8208;40&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; condicionando um progn&#243;stico sombrio&#44; com taxa de mortalidade a um ano entre 30 a 50&#37;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Neste contexto&#44; a cirurgia de SVA &#233; o tratamento recomendado para a estenose a&#243;rtica severa sintom&#225;tica<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">7&#8211;9</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Apesar dos octogen&#225;rios apresentarem um maior n&#250;mero de comorbilidades e consequentemente maior risco cir&#250;rgico&#44; a evid&#234;ncia cient&#237;fica tem demonstrado que em octogen&#225;rios selecionados&#44; a cirurgia de SVA pode ser realizada com risco cir&#250;rgico aceit&#225;vel&#44; com taxas de mortalidade entre 1&#44;9 e 9&#37;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">10&#8211;18</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Por outro lado&#44; importa salientar que neste grupo et&#225;rio o principal objetivo da cirurgia &#233; melhorar a qualidade de vida mais do que a sobrevida&#44; dado que o aumento na longevidade &#233; marginal<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; Para avaliar a qualidade de vida podem ser utilizados question&#225;rios como &#233; exemplo o <span class="elsevierStyleItalic">Short Form</span>&#8208;36 &#40;SF&#8208;36&#41; do <span class="elsevierStyleItalic">Medical Outcomes Study&#44;</span> um teste de sa&#250;de geral validado&#44; cred&#237;vel e amplamente utilizado<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">18&#44;21&#8211;24</span></a>&#46; No entanto&#44; estudos sobre o impacto na qualidade de vida da cirurgia de substitui&#231;&#227;o valvular a&#243;rtica nos octogen&#225;rios s&#227;o escassos<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">18&#44;25&#8211;27</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objetivo</span><p id="par0155" class="elsevierStylePara elsevierViewall">Determinar o impacto da cirurgia de SVA por EA grave na qualidade de vida dos doentes octogen&#225;rios&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">M&#233;todos</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sele&#231;&#227;o de doentes</span><p id="par0160" class="elsevierStylePara elsevierViewall">Estudo retrospetivo&#44; descritivo e correlacional do Servi&#231;o de Cirurgia Cardiotor&#225;cica do Hospital de Santa Marta do Centro Hospitalar de Lisboa Central&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">No per&#237;odo de janeiro de 2011 a dezembro de 2015&#44; 163 doentes consecutivos com idade igual ou superior a 80 anos com estenose a&#243;rtica grave isolada foram submetidos a cirurgia de SVA&#46; A estenose a&#243;rtica severa foi definida de acordo com as recomenda&#231;&#245;es das <span class="elsevierStyleItalic">guidelines</span> das doen&#231;as valvulares da Sociedade Europeia de Cardiologia&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">7</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de aceita&#231;&#227;o dos doentes para cirurgia fundamentaram&#8208;se na aus&#234;ncia de impossibilidade t&#233;cnica e nas aus&#234;ncias de disfun&#231;&#227;o cognitiva e fragilidade tendo o EuroSCORE log&#237;stico m&#233;dio da amostra sido de 10&#44;7&#37;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A qualidade de vida foi avaliada pelo question&#225;rio SF&#8208;36<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a> em 4 momentos&#44; designadamente no per&#237;odo pr&#233;&#8208;operat&#243;rio &#40;PREOP&#41; e aos 3&#44; 6 e 12 meses ap&#243;s a cirurgia&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Foram exclu&#237;dos os doentes que n&#227;o preencheram o question&#225;rio SF&#8208;36 em todos os momentos supramencionados &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#41;&#44; os doentes que faleceram no internamento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; e no <span class="elsevierStyleItalic">follow&#8208;up</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;<span class="elsevierStyleItalic">&#46;</span> Ap&#243;s aplica&#231;&#227;o dos crit&#233;rios de exclus&#227;o&#44; foram inclu&#237;dos 81 doentes submetidos a cirurgia de SVA por estenose a&#243;rtica grave isolada &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Defini&#231;&#227;o das vari&#225;veis</span><p id="par0185" class="elsevierStylePara elsevierViewall">Foram colhidos dados demogr&#225;ficos &#40;idade e g&#233;nero&#41;&#44; antecedentes pessoais relevantes &#40;antecedentes de insufici&#234;ncia card&#237;aca &#91;IC&#93;&#44; doen&#231;a pulmonar obstrutiva cr&#243;nica &#91;DPOC&#93;&#44; doen&#231;a renal cr&#243;nica &#91;DRC&#93;&#41; e fatores de risco cardiovascular &#40;hipertens&#227;o arterial&#44; diabetes&#44; dislipidemia&#44; obesidade e tabagismo&#41;&#46; Foram avaliados dados cl&#237;nicos pr&#233;&#8208;operat&#243;rios&#44; nomeadamente classe funcional da <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">28</span></a> e classifica&#231;&#227;o da angina da Sociedade Cardiovascular Canadiana &#40;CCS&#41;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">29</span></a>&#46; A fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda pr&#233;&#8208;operat&#243;ria foi avaliada por ecocardiograma transtor&#225;cico e o EuroSCORE log&#237;stico foi calculado<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">A <span class="elsevierStyleItalic">clearance</span> de creatinina foi estimada utilizando a f&#243;rmula de Cokcroft&#8208;Gault&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">31</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Foi considerada doen&#231;a renal cr&#243;nica se <span class="elsevierStyleItalic">clearance</span> de creatinina inferior a 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Foi considerada obesidade se &#237;ndice de massa corporal igual ou superior a 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">A mortalidade intra&#8208;hospitalar foi definida como mortalidade ocorrendo no per&#237;odo de internamento que motivou a cirurgia&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Question&#225;rio de sa&#250;de SF&#8208;36v2</span><p id="par0210" class="elsevierStylePara elsevierViewall">O question&#225;rio de sa&#250;de SF&#8208;36v2 &#233; um question&#225;rio amplamente utilizado proveniente do <span class="elsevierStyleItalic">Medical Outcomes Study</span><a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleItalic">&#46;</span> Ferreira <span class="elsevierStyleItalic">et al</span>&#46; validaram o SF&#8208;36 para a popula&#231;&#227;o portuguesa<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">O question&#225;rio inclui 36 quest&#245;es de escolha m&#250;ltipla relacionadas com a sa&#250;de que s&#227;o agrupadas em oito dimens&#245;es &#40;fun&#231;&#227;o f&#237;sica&#44; desempenho f&#237;sico&#44; dor corporal&#44; sa&#250;de geral&#44; sa&#250;de mental&#44; fun&#231;&#227;o social&#44; desempenho emocional e vitalidade&#41;&#46; As oito dimens&#245;es s&#227;o pontuadas de 0 &#40;pior sa&#250;de poss&#237;vel&#41; a 100 &#40;melhor sa&#250;de poss&#237;vel&#41; e s&#227;o agregadas em duas medidas sum&#225;rias&#44; as componentes f&#237;sica e mental<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a>&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lise estat&#237;stica</span><p id="par0220" class="elsevierStylePara elsevierViewall">Foi efetuada an&#225;lise uma descritiva para a caracteriza&#231;&#227;o do perfil amostral&#46; As vari&#225;veis cont&#237;nuas s&#227;o apresentadas como m&#233;dia e desvio padr&#227;o e as vari&#225;veis categ&#243;ricas s&#227;o apresentadas em percentagem&#46; Relativamente &#224; an&#225;lise estat&#237;stica da qualidade de vida&#44; as oito dimens&#245;es e as duas componentes do SF&#8208;36 n&#227;o apresentaram distribui&#231;&#227;o normal&#44; pelo que foi utilizado um teste n&#227;o param&#233;trico&#46; Quer as dimens&#245;es quer as componentes foram comparadas em quatro momentos temporais &#40;pr&#233;&#8208;operat&#243;rio&#44; aos 3&#44; 6 e 12 meses de p&#243;s&#8208;operat&#243;rio&#41; atrav&#233;s da compara&#231;&#227;o m&#250;ltipla anova <span class="elsevierStyleItalic">one&#8208;way&#46;</span> Considerou&#8208;se como n&#237;vel de signific&#226;ncia valor <span class="elsevierStyleItalic">p</span> inferior a 0&#44;05&#46; A an&#225;lise estat&#237;stica foi realizada utilizando o <span class="elsevierStyleItalic">software</span> IBM SPSS <span class="elsevierStyleItalic">Statistics</span>&#44; vers&#227;o 20&#46;0&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Caracter&#237;sticas demogr&#225;ficas</span><p id="par0225" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas demogr&#225;ficas dos doentes est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">Os 81 doentes tinham uma idade m&#233;dia de 83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 anos e 63&#37; eram do sexo feminino&#46; Quanto aos fatores de risco cardiovascular&#44; 89&#37; dos doentes eram hipertensos&#44; 74&#37; tinham dislipidemia e 25&#37; eram diab&#233;ticos&#46; Relativamente &#224; DRC&#44; 49&#37; dos doentes tinham doen&#231;a renal cr&#243;nica estadio 3 ou superior&#46; Na avalia&#231;&#227;o cl&#237;nica funcional pr&#233;&#8208;cirurgia&#44; 61&#37; dos doentes encontravam&#8208;se em classe NYHA<span class="elsevierStyleHsp" style=""></span>&#62;2 e 20&#37; em classe CCS &#8805; 2&#46; Quanto &#224; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda &#40;FEVE&#41;&#44; 20&#37; tinham FEVE inferior a 50&#37;&#46; O EuroSCORE log&#237;stico foi de 10&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;1&#37;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Vari&#225;veis operat&#243;rias</span><p id="par0235" class="elsevierStylePara elsevierViewall">Todos os doentes foram submetidos a esternotomia convencional&#46; O tempo mediano de circula&#231;&#227;o extracorporal foi de 92 minutos&#46; Relativamente &#224; cardioplegia&#44; a via anter&#243;grada&#47;retr&#243;grada foi a mais utilizada &#40;74 doentes&#41;&#44; seguida da retr&#243;grada &#40;seis doentes&#41; e da anter&#243;grada &#40;um doente&#41;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Foi implantada uma pr&#243;tese biol&#243;gica em 80 doentes&#46; O tamanho mediano do anel prot&#233;sico foi de 21<span class="elsevierStyleHsp" style=""></span>mm&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Complica&#231;&#245;es cl&#237;nicas intra&#8208;hospitalares</span><p id="par0245" class="elsevierStylePara elsevierViewall">O tempo m&#233;dio de internamento foi de 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 dias&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Relativamente &#224;s complica&#231;&#245;es neurol&#243;gicas&#44; 1&#44;2&#37; dos doentes apresentaram acidente vascular cerebral &#40;AVC&#41; e 11&#44;1&#37; apresentaram del&#237;rio&#44; confus&#227;o mental ou acidente isqu&#233;mico transit&#243;rio &#40;AIT&#41;&#46; Como complica&#231;&#245;es cardiol&#243;gicas&#44; 23&#44;5&#37; dos doentes apresentaram fibrilha&#231;&#227;o auricular e 1&#44;2&#37; implantaram <span class="elsevierStyleItalic">pacemaker</span> permanente&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">As complica&#231;&#245;es intra&#8208;hospitalares dos doentes est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Complica&#231;&#245;es cl&#237;nicas no seguimento</span><p id="par0260" class="elsevierStylePara elsevierViewall">No seguimento a um ano&#44; dois doentes &#40;2&#44;5&#37;&#41; apresentaram AVC&#44; um doente &#40;1&#44;2&#37;&#41; apresentou s&#237;ndrome de dificuldade respirat&#243;ria aguda e dois doentes apresentaram internamento hospitalar por motivo desconhecido&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Avalia&#231;&#227;o da qualidade vida pelo question&#225;rio SF&#8208;36</span><p id="par0265" class="elsevierStylePara elsevierViewall">Os resultados relativos &#224;s oito dimens&#245;es &#40;fun&#231;&#227;o f&#237;sica&#44; desempenho f&#237;sico&#44; dor corporal&#44; sa&#250;de geral&#44; sa&#250;de mental&#44; fun&#231;&#227;o social&#44; desempenho emocional e vitalidade&#41; do question&#225;rio SF&#8208;36 est&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#46; Verificou&#8208;se que todas as dimens&#245;es apresentaram melhoria estatisticamente significativa &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; aos 3&#44; 6 e 12 meses quando comparadas com o per&#237;odo pr&#233;&#8208;operat&#243;rio&#46; Quando comparados os per&#237;odos 3&#44; 6 e 12 meses de p&#243;s&#8208;operat&#243;rio entre si&#44; n&#227;o foram encontradas diferen&#231;as estatisticamente significativas&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0270" class="elsevierStylePara elsevierViewall">Os resultados respeitantes &#224;s componentes f&#237;sica e mental do question&#225;rio SF&#8208;36 est&#227;o representados na <a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#46; Verificou&#8208;se que a componente mental apresentou melhoria estatisticamente significativa aos seis meses quando comparada com o per&#237;odo pr&#233;&#8208;operat&#243;rio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#46; Aos 3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;34&#41; e 12 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;076&#41; meses observou&#8208;se melhoria sem resultado estatisticamente significativo&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0275" class="elsevierStylePara elsevierViewall">A componente f&#237;sica apresentou melhoria estatisticamente significativa &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; aos 3&#44; 6 e 12 meses quando comparada com o per&#237;odo pr&#233;&#8208;operat&#243;rio&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Quando comparados entre si os per&#237;odos 3&#44; 6 e 12 meses de p&#243;s&#8208;operat&#243;rio&#44; n&#227;o foram encontradas diferen&#231;as estatisticamente significativas&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discuss&#227;o</span><p id="par0285" class="elsevierStylePara elsevierViewall">O presente estudo teve como objetivo avaliar o impacto da cirurgia de SVA na qualidade de vida de octogen&#225;rios com EA severa isolada ao longo do primeiro ano de p&#243;s&#8208;operat&#243;rio&#46; As taxas de morbilidade e mortalidade cir&#250;rgicas tamb&#233;m foram analisadas&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Nesta s&#233;rie unic&#234;ntrica de doentes octogen&#225;rios&#44; a cirurgia de SVA melhorou a qualidade de vida f&#237;sica e mental comparativamente ao per&#237;odo pr&#233;&#8208;operat&#243;rio com taxas de morbilidade e mortalidade satisfat&#243;rias&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">A taxa de mortalidade intra&#8208;hospitalar foi de 3&#44;1&#37;&#44; sendo um valor sobrepon&#237;vel comparativamente a outras s&#233;ries publicadas que reportam taxas entre 1&#44;9 e 9&#37;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">11&#8211;18</span></a>&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Nas &#250;ltimas d&#233;cadas&#44; registou&#8208;se uma tend&#234;ncia para a redu&#231;&#227;o da taxa de mortalidade associada a cirurgia de SVA neste grupo et&#225;rio&#44; nomeadamente de 7&#44;5&#37; entre os anos de 1982 e 1999 para 5&#44;8&#37; entre 2000 e 2006<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">33&#44;34</span></a>&#46; Estes resultados s&#227;o consequ&#234;ncia das melhorias na t&#233;cnica cir&#250;rgica&#44; metodologia anestesiol&#243;gica&#44; <span class="elsevierStyleItalic">bypass</span> cardiopulmonar&#44; cuidados p&#243;s&#8208;operat&#243;rios e nas tecnologias de prote&#231;&#227;o de &#243;rg&#227;o<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">12&#44;35&#44;36</span></a>&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Relativamente &#224;s complica&#231;&#245;es cl&#237;nicas&#44; no nosso estudo 1&#44;2&#37; dos doentes tiveram AVC&#44; 1&#44;2&#37; implantaram <span class="elsevierStyleItalic">pacemaker</span> permanente e 23&#44;5&#37; apresentaram fibrilha&#231;&#227;o auricular durante o internamento&#46; As taxas apresentadas s&#227;o semelhantes &#224;s descritas por outras s&#233;ries em octogen&#225;rios com EA severa&#44; evidenciando que a cirurgia de SVA pode ser realizada neste grupo de doentes<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">12&#44;14&#44;15</span></a>&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o da qualidade de vida foi utilizado o question&#225;rio SF&#8208;36<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a>&#46; Atrav&#233;s de 36 quest&#245;es relacionadas com a sa&#250;de&#44; ele permite avaliar oito dimens&#245;es &#40;fun&#231;&#227;o f&#237;sica&#44; desempenho f&#237;sico&#44; dor corporal&#44; sa&#250;de geral&#44; sa&#250;de mental&#44; fun&#231;&#227;o social&#44; desempenho emocional e vitalidade&#41;&#44; que posteriormente s&#227;o agregadas em duas componentes sum&#225;rias&#44; a f&#237;sica e a mental<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; avali&#225;mos a qualidade de vida em quatro momentos temporais&#44; nomeadamente&#44; no pr&#233;&#8208;operat&#243;rio e aos 3&#44; 6 e 12 meses de p&#243;s&#8208;operat&#243;rio&#46; A compara&#231;&#227;o com o per&#237;odo pr&#233;&#8208;operat&#243;rio &#233; fundamental para avaliar a evolu&#231;&#227;o da qualidade de vida&#46; Contrariamente&#44; algumas s&#233;ries avaliaram a qualidade de vida apenas no per&#237;odo p&#243;s&#8208;operat&#243;rio&#44; o que consequentemente limitou a sua an&#225;lise e interpreta&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">23&#44;24&#44;37</span></a>&#46; Segundo o nosso conhecimento&#44; existem dois trabalhos na literatura que avaliaram a qualidade de vida com o SF&#8208;36 nos per&#237;odos pr&#233; e p&#243;s&#8208;operat&#243;rios nos doentes octogen&#225;rios com EA severa<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">18&#44;26</span></a>&#46; O motivo de avaliarmos em tr&#234;s momentos temporais no p&#243;s&#8208;operat&#243;rio foi compreender a evolu&#231;&#227;o da qualidade de vida ao longo do primeiro ano&#46; Dado que nas primeiras semanas de p&#243;s&#8208;operat&#243;rio os doentes apresentam&#8208;se pior clinicamente como consequ&#234;ncia do trauma cir&#250;rgico&#44; decidimos analisar o primeiro momento temporal no p&#243;s&#8208;operat&#243;rio aos tr&#234;s meses&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">No que diz respeito &#224; an&#225;lise das oito dimens&#245;es do question&#225;rio SF&#8208;36&#44; os nossos resultados evidenciaram uma melhoria estatisticamente significativa de todas as dimens&#245;es &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; nos tr&#234;s momentos de p&#243;s&#8208;operat&#243;rio relativamente ao per&#237;odo pr&#233;&#8208;operat&#243;rio&#46; Salienta&#8208;se que a melhoria da qualidade de vida foi precoce&#44; estando presente logo aos tr&#234;s meses&#46; Por exemplo&#44; entre o PREOP e os tr&#234;s meses verificou&#8208;se que&#58; na dimens&#227;o do desempenho f&#237;sico houve um aumento de 28 pontos &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; na dimens&#227;o fun&#231;&#227;o f&#237;sica houve um aumento de 26 pontos &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; na dimens&#227;o dor houve um aumento de 20 pontos &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e na dimens&#227;o desempenho emocional houve um aumento de 17 pontos &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Considerando a morbilidade inerente &#224; cirurgia cardiotor&#225;cica&#44; poder&#8208;se&#8208;ia esperar que os resultados fossem estatisticamente significativos mais tardiamente&#44; mas tal n&#227;o se verificou&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Lam <span class="elsevierStyleItalic">et al&#46;</span>&#44; em 20 doentes octogen&#225;rios&#44; verificaram que aos seis meses de p&#243;s&#8208;operat&#243;rio observou&#8208;se melhoria de cinco das oito dimens&#245;es do SF&#8208;36&#44; designadamente da dor&#44; sa&#250;de geral&#44; vitalidade&#44; fun&#231;&#227;o social e sa&#250;de mental<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">26</span></a>&#46; Como pontos negativos do estudo de Lam <span class="elsevierStyleItalic">et al&#46;</span> destacam&#8208;se o pequeno n&#250;mero de doentes&#44; a an&#225;lise em apenas um momento temporal de p&#243;s&#8208;operat&#243;rio e a n&#227;o contempla&#231;&#227;o das componentes do SF&#8208;36<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">Relativamente &#224; an&#225;lise das componentes do SF&#8208;36&#44; na nossa s&#233;rie&#44; a componente f&#237;sica apresentou melhoria significativa em todos os momentos do p&#243;s&#8208;operat&#243;rio quando comparada com o PREOP &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Estes dados revelam que apesar da idade avan&#231;ada dos doentes &#40;idade m&#233;dia de 83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 anos&#41;&#44; a cirurgia melhorou a sua capacidade f&#237;sica&#44; sendo a mesma evidente precocemente&#44; aos tr&#234;s meses de p&#243;s&#8208;operat&#243;rio&#46; Klomp <span class="elsevierStyleItalic">et al&#46;</span>&#44; em 163 doentes octogen&#225;rios submetidos a cirurgia de SVA por EA severa &#40;88 dos quais submetidos a cirurgia isolada&#41;&#44; com avalia&#231;&#227;o do SF&#8208;36 no PREOP&#44; 1 m&#234;s e 12 meses&#44; objetivaram melhoria da componente f&#237;sica aos 12 meses &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">No que se refere &#224; avalia&#231;&#227;o da componente mental&#44; no nosso trabalho verificou&#8208;se melhoria da mesma nos tr&#234;s momentos de p&#243;s&#8208;operat&#243;rio comparativamente ao PREOP&#44; com resultado estatisticamente significativo aos seis meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#46; Na s&#233;rie de Klomp <span class="elsevierStyleItalic">et al&#46;</span>&#44; verificou&#8208;se agravamento da componente mental ao primeiro m&#234;s &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e melhoria aos 12 meses comparativamente ao per&#237;odo pr&#233;&#8208;operat&#243;rio&#44; mas sem resultado estat&#237;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Outros trabalhos tamb&#233;m demonstraram melhoria na qualidade de vida no per&#237;odo p&#243;s&#8208;operat&#243;rio dos octogen&#225;rios submetidos a cirurgia de SVA&#44; atrav&#233;s da utiliza&#231;&#227;o de outros question&#225;rios de sa&#250;de&#44; como s&#227;o exemplo o SF&#8208;12<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">38</span></a>&#44; <span class="elsevierStyleItalic">Kansas City Cardiomyopathy Questionnaire</span><a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">39</span></a> e o score <span class="elsevierStyleItalic">Karnofsky</span><a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">25&#44;27</span></a>&#46; Reynolds <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">25</span></a>&#44; num grupo de 300 doentes submetidos a cirurgia de SVA com a aplica&#231;&#227;o do question&#225;rio SF&#8208;12&#44; verificaram que houve melhoria estatisticamente significativa das componentes mental e f&#237;sica aos 6 meses e 12 meses &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; comparativamente com o per&#237;odo pr&#233;&#8208;operat&#243;rio&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">O nosso estudo avaliou a qualidade vida de doentes octogen&#225;rios com EA severa isolada submetidos a cirurgia de SVA&#46; A avalia&#231;&#227;o pr&#233;&#8208;operat&#243;ria e ao longo do primeiro ano de <span class="elsevierStyleItalic">follow&#8208;up</span> atrav&#233;s de tr&#234;s momentos temporais &#40;3&#44;6 e 12 meses&#41; e a avalia&#231;&#227;o das oito dimens&#245;es e das tr&#234;s componentes do SF&#8208;36 permitiram uma an&#225;lise mais detalhada da qualidade de vida dos doentes&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Num grupo et&#225;rio que atingiu a esperan&#231;a m&#233;dia de vida&#44; e que nesse contexto a longevidade n&#227;o &#233; o objetivo principal da cirurgia de SVA&#44; a avalia&#231;&#227;o da qualidade de vida deve ser valorizada e consequentemente mais frequentemente aplicada&#46; Neste contexto&#44; s&#227;o necess&#225;rios estudos prospetivos com maior n&#250;mero de doentes que avaliem a repercuss&#227;o da cirurgia na sua qualidade de vida&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">Apesar deste estudo n&#227;o ser comparativo entre as diferentes alternativas terap&#234;uticas para este grupo de doentes&#44; as <span class="elsevierStyleItalic">Guidelines</span> da Sociedade Europeia de Cardiologia recomendam que nos doentes com estenose a&#243;rtica severa com risco cir&#250;rgico interm&#233;dio ou elevado &#40;STS ou EuroSCORE II &#8805; 4&#37; ou EuroSCORE log&#237;stico &#8805; 10&#37;&#41;&#44; a escolha entre cirurgia de SVA e implanta&#231;&#227;o de v&#225;lvula a&#243;rtica transcateter &#40;TAVI&#41; deve ser realizada em <span class="elsevierStyleItalic">Heart Team</span>&#44; com favorecimento da TAVI em doentes idosos com via de acesso transfemoral<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">40</span></a>&#46; &#201; importante salientar que as complica&#231;&#245;es associadas &#224; TAVI n&#227;o s&#227;o menosprez&#225;veis&#44; como s&#227;o exemplo as taxas de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> &#40;8&#44;5<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">41</span></a>&#8208;25&#44;9&#37;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">42</span></a>&#41;&#44; <span class="elsevierStyleItalic">leak</span> paravalvular &#40;5&#44;3&#37;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">42</span></a>&#41;&#44; AVC &#40;3&#44;8&#37;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">43</span></a>&#41; e fibrilha&#231;&#227;o auricular &#40;8&#44;6<span class="elsevierStyleSup">43</span>&#8208;12&#44;9&#37;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">42</span></a>&#41;&#46; No nosso estudo&#44; os doentes apresentaram taxas inferiores de AVC &#40;1&#44;2&#37;&#41; e de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> permanente &#40;1&#44;2&#37;&#41; e maior taxa de fibrilha&#231;&#227;o auricular &#40;23&#44;5&#37;&#41;&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">Considerando as recomenda&#231;&#245;es europeias&#44; muitos dos nossos doentes teriam indica&#231;&#227;o para TAVI&#44; mas dados os nossos resultados com baixa taxa de complica&#231;&#245;es e melhoria da qualidade de vida&#44; deveria ser equacionada como primeira op&#231;&#227;o a cirurgia&#46; Na tomada de decis&#227;o tamb&#233;m deve ser ponderado que atualmente a cirurgia de SVA &#233; uma estrat&#233;gia economicamente menos dispendiosa comparativamente &#224; TAVI&#46; N&#227;o obstante&#44; a decis&#227;o entre cada uma das estrat&#233;gias deve ser individualizada e realizada em <span class="elsevierStyleItalic">Heart Team&#46;</span></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Limita&#231;&#245;es</span><p id="par0365" class="elsevierStylePara elsevierViewall">Trata&#8208;se de um estudo retrospetivo&#44; observacional&#44; unic&#234;ntrico e por esses motivos est&#225; sujeito a vi&#233;s inerente&#46; Salientam&#8208;se como outras limita&#231;&#245;es&#44; a amostra de pequena dimens&#227;o&#44; a sele&#231;&#227;o dos doentes pelo centro cir&#250;rgico e a exclus&#227;o de uma percentagem importante de doentes pela aus&#234;ncia do preenchimento do question&#225;rio SF&#8208;36 nos quatro momentos temporais&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclus&#227;o</span><p id="par0370" class="elsevierStylePara elsevierViewall">Nos octogen&#225;rios com EA severa&#44; a cirurgia de SVA pode ser realizada com taxas de mortalidade e de morbilidade aceit&#225;veis&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a cirurgia de SVA melhorou a qualidade de vida f&#237;sica e mental dos doentes octogen&#225;rios&#44; sendo esta evidente logo aos tr&#234;s meses ap&#243;s cirurgia e consistente aos 6 e 12 meses comparativamente ao per&#237;odo pr&#233;&#8208;operat&#243;rio&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">Neste grupo et&#225;rio&#44; a cirurgia deve ser considerada dada a evid&#234;ncia da melhoria cl&#237;nica dos doentes&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflitos de interesse</span><p id="par0385" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A estenose a&#243;rtica &#40;EA&#41; &#233; a doen&#231;a valvular mais prevalente dos idosos e afeta 8&#44;1&#37; dos doentes com 85 anos&#44; condicionando a qualidade de vida&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determinar o impacto da cirurgia de substitui&#231;&#227;o valvular a&#243;rtica &#40;SVA&#41; na qualidade de vida dos octogen&#225;rios&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo unic&#234;ntrico e retrospetivo com octogen&#225;rios submetidos a cirurgia de SVA por EA grave isolada entre 2011 e 2015&#46; A qualidade de vida foi avaliada pelo question&#225;rio <span class="elsevierStyleItalic">Short Form</span> &#40;SF&#41;&#8208;36 no pr&#233;&#8208;operat&#243;rio &#40;PREOP&#41;&#44; aos 3&#44; 6 e 12 meses ap&#243;s cirurgia&#46; As oito dimens&#245;es e as duas componentes do SF&#8208;36 foram comparadas no PREOP e no p&#243;s&#8208;operat&#243;rio com a compara&#231;&#227;o m&#250;ltipla <span class="elsevierStyleItalic">anova one&#8208;way</span>&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No per&#237;odo de cinco anos&#44; 163 octogen&#225;rios foram submetidos a cirurgia de SVA&#44; 3&#44;1&#37; faleceram no internamento&#46; Exclu&#237;ram&#8208;se doentes falecidos e sem SF&#8208;36 preenchido&#46; Foram inclu&#237;dos 81 doentes com 83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 anos&#44; 63&#37; mulheres&#44; 60&#44;5&#37; em classe NYHA<span class="elsevierStyleHsp" style=""></span>&#62;2 e 19&#44;7&#37; com disfun&#231;&#227;o sist&#243;lica ventricular esquerda&#46; O EuroSCORE log&#237;stico foi de 10&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;1&#37;&#46; No internamento&#44; 1&#44;2&#37; tiveram acidente vascular cerebral&#44; 1&#44;2&#37; implantaram <span class="elsevierStyleItalic">pacemaker</span> permanente e 23&#44;5&#37; apresentaram fibrilha&#231;&#227;o auricular&#46; Na avalia&#231;&#227;o da qualidade de vida e na compara&#231;&#227;o com o PREOP&#58; todas as dimens&#245;es do SF&#8208;36 &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e a componente f&#237;sica &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; apresentaram melhoria aos 3&#44; 6 e 12 meses&#46; A componente mental apresentou melhoria&#44; sendo esta significativa aos seis meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A cirurgia de SVA melhorou o estado de sa&#250;de f&#237;sico e mental dos octogen&#225;rios com EA&#44; sendo essa melhoria evidente aos tr&#234;s meses e consistente aos 6 e 12 meses&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introdu&#231;&#227;o"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclus&#227;o"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Aortic stenosis &#40;AS&#41; is the most common valvular disease in the elderly&#44; affecting around 8&#46;1&#37; by the age of 85&#44; with a negative impact on quality of life&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">To determine the impact of surgical aortic valve replacement &#40;SAVR&#41; on quality of life in octogenarians&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">In a single&#8208;center retrospective study of octogenarians undergoing isolated SAVR for symptomatic AS between 2011 and 2015&#44; quality of life was assessed using the Medical Outcomes Study Short Form &#40;SF&#8208;36&#41; at baseline and at three&#44; six and 12 months after surgery&#46; Scores for the eight domains and two components of the SF&#8208;36 were compared at baseline and in the postoperative period by one&#8208;way analysis of variance&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Over a five&#8208;year period&#44; 163 octogenarians underwent SAVR&#44; of whom 3&#46;1&#37; died in the hospital&#46; Deceased patients and those who did not complete the SF&#8208;36 were excluded&#46; A total of 81 patients were included&#44; mean age 83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 years&#44; 63&#37; female&#44; 60&#46;5&#37; in NYHA class II or higher and 19&#46;7&#37; with left ventricular systolic dysfunction&#46; The mean logistic EuroSCORE was 10&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1&#37;&#46; In the hospital&#44; 1&#46;2&#37; suffered stroke&#44; 1&#46;2&#37; received a permanent implantable pacemaker and 23&#46;5&#37; presented atrial fibrillation&#46; In the assessment of quality of life&#44; improvement was seen in all SF&#8208;36 domains &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; and in the physical component &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; at three&#44; six and 12 months compared to baseline&#46; The mental component also showed improvement&#44; which was significant at six months &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">SAVR improved the physical and mental health status of octogenarians with severe AS&#46; This improvement was evident at three months and consistent at six and 12 months&#46;</p></span>"
        "secciones" => array:5 [
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            "titulo" => "Objective"
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            "identificador" => "abst0040"
            "titulo" => "Methods"
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            "identificador" => "abst0045"
            "titulo" => "Results"
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            "titulo" => "Conclusion"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>81<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>G&#233;nero feminino&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Fatores de risco cardiovascular&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">72 &#40;88&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60 &#40;74&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesidade&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">8 &#40;9&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46 &#40;56&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33 &#40;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio 4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EuroSCORE log&#237;stico &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferior a 30&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PREOP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fun&#231;&#227;o f&#237;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desempenho f&#237;sico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sa&#250;de geral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitalidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fun&#231;&#227;o social&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desempenho emocional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sa&#250;de mental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                          "etal" => true
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                      "doi" => "10.1016/j.ejcts.2007.01.055"
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                      "titulo" => "Prevalence of aortic valve abnormalities in the elderly&#58; an echocardiographic study of a random population sample"
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                          "etal" => true
                          "autores" => array:3 [
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                      "doi" => "10.1016/0735-1097(93)90249-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
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