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Preoperative anemia &#40;WHO criteria&#41;&#58; hemoglobin levels &#60;13<span class="elsevierStyleHsp" style=""></span>g&#47;dL in men and &#60;12<span class="elsevierStyleHsp" style=""></span>g&#47;dL in women&#46; Preoperative renal failure&#58; creatinine levels &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Chronic obstructive pulmonary disease is considered only when bronchodilator treatment is required&#46; Severe left ventricular dysfunction corresponds to an ejection fraction &#40;EF&#41; &#60;30&#37;&#46; Transfusion criterion&#58; hematocrit during ECS &#60;21&#37; or &#60;24&#37; after surgery&#46; Intraoperative myocardial protection&#58; intermittent anterior-retrograde blood cardioplegia&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patient follow-up was conducted at outpatient visits or through telephone assessment&#44; referencing survival&#44; cause of death &#40;if applicable&#41; and functional class&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistics</span><p id="par0055" class="elsevierStylePara elsevierViewall">The analyzed variables were collected from the hospital database&#44; with approval from the research committee&#46; The statistical analysis was conducted using the SPSS<span class="elsevierStyleSup">&#174;</span> 20&#46;0 program&#46; The quantitative variables are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or as medians for asymmetric distributions&#46; The qualitative variables are expressed as absolute values and percentages&#46; The association between variables was determined using Student&#39;s <span class="elsevierStyleItalic">t</span>-test and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test &#40;for non-normal distributions&#41; for the quantitative values and the chi-squared test and Fisher&#39;s exact test for the qualitative&#46; The associations between mortality and morbidity for each case &#40;identified using a value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2 in the univariate analysis&#41; were inserted into a multivariate stepwise logistic regression&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The risk factors for mortality and the actuarial survival for the group were analyzed using the Cox proportional-hazards regression model and the Kaplan&#8211;Meier survival analysis&#44; respectively&#46; In all cases&#44; we considered <span class="elsevierStyleItalic">p</span> values &#60;&#46;05 to be statistically significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The main demographic characteristics and surgical procedures are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Hospital mortality</span><p id="par0070" class="elsevierStylePara elsevierViewall">The overall mortality was 11&#46;8&#37;&#58; 8&#37; in isolated valve surgery &#40;IVS&#41; and 18&#46;3&#37; in combined surgery &#40;CS&#41;&#46; The causes of mortality&#44; in order of frequency&#44; were heart failure &#40;3&#46;5&#37;&#41;&#44; multiple organ failure &#40;3&#46;1&#37;&#41;&#44; sepsis&#44; severe respiratory failure and hemorrhage &#40;1&#46;2&#37;&#44; 1&#46;2&#37; and 1&#46;2&#37;&#44; respectively&#41;&#44; neurological damage &#40;0&#46;8&#37;&#41; and mesenteric ischemia and lung thromboembolism &#40;0&#46;4&#37; and 0&#46;4&#37;&#44; respectively&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The multivariate analysis of hospital mortality included minimum hematocrit during ECS &#8804;20&#37;&#44; peripheral vascular disease&#44; combined surgery&#44; urgent surgery&#44; left main coronary artery disease&#44; postoperative hematocrit &#60;24&#37;&#44; need for transfusion of more than 2 red blood cell concentrates and preoperative creatinine levels &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 in the univariate analysis&#41; and diabetes mellitus &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#41;&#46; The mortality factors were urgent surgery &#40;OR&#58; 4&#46;40&#59; 95&#37; CI 1&#46;28&#8211;15&#46;12&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0186&#41;&#44; peripheral vascular disease &#40;OR&#58; 3&#46;42&#59; 95&#37; CI 1&#46;08&#8211;10&#46;81&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0359&#41;&#59; combined surgery &#40;OR&#58; 2&#46;30&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI 1&#46;01&#8211;5&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;046&#41;&#59; postoperative hematocrit &#60;24&#37; &#40;OR&#58; 2&#46;47&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI 1&#46;09&#8211;5&#46;62&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41; and transfusion of more than 2 red blood cell concentrates &#40;OR&#58; 4&#46;29&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI 1&#46;88&#8211;9&#46;82&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0005&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The patients who required CS presented a greater preoperative prevalence of peripheral vascular disease &#40;13&#37; vs&#46; 4&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;020&#41;&#44; myocardial infarction &#40;17&#46;4&#37; vs&#46; 4&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#44; unstable angina &#40;23&#46;2&#37; vs&#46; 3&#46;7&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; and left ventricular dysfunction &#40;32&#46;6&#37; vs&#46; 20&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;028&#41; compared with those who underwent IVS&#46; The most common type of surgery was single-vessel surgery &#40;57&#37;&#41;&#44; with a mortality rate of 13&#46;7&#37;&#44; 24&#37; and 23&#46;1&#37;&#44; depending on whether the number of grafts performed was 1&#44; 2 or 3&#44; respectively&#46; Although within the limits of significance&#44; urgent surgery affected 8&#46;7&#37; of the patients in this group compared with the 3&#46;1&#37; of the IVS group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;050&#41;&#44; increasing the mortality in urgent CS up to 25&#37;&#46; Only 9&#37; of the patients lacked preoperative risk factors&#46; In this group&#44; the mortality rate was 4&#46;3&#37; &#40;0&#37; in the 18 patients with IVS&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The preoperative risk scores on the EuroSCORE I logistics scale for the group of patients who died and for the patients who survived &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; were 17&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;11&#37; and 13&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;46&#37;&#44; respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;061&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 40&#46;7&#37; of the patients were operated on between 2010 and 2013&#46; Although not significant&#44; there was a reduction in mortality during this period &#40;7&#46;7&#37;&#41; compared with 2000&#8211;2004 &#40;14&#46;5&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;07&#41;&#44; despite an increase in left ventricular dysfunction &#40;30&#46;8&#37; vs&#46; 15&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0031&#41; and severe preoperative pulmonary hypertension &#40;7&#46;6&#37; vs&#46; 1&#46;3&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;024&#41;&#46; The reduced mortality during the most recent period could be due to a significant reduction in the number of patients operated on with a diagnosis of unstable angina and in NYHA functional class IV&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The surgical risk&#44; determined by the EuroSCORE II scale &#40;recorded since July 2012&#41; was 5&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;86&#37;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Postoperative morbidity</span><p id="par0095" class="elsevierStylePara elsevierViewall">Some 56&#46;1&#37; of the patients experienced a postoperative complication&#46; The most common complications and the preoperative risk factors significantly related to their onset are listed in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Mortality and postoperative stays vary in the presence of postoperative complications&#46; The former rises to 17&#46;5&#37; compared with 4&#46;5&#37; for the group without complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The median postoperative stay in the ICU and in the ward increases from 2 to 5 days and from 9 to 14 days&#44; respectively&#44; with no differences between the IVS and CS groups&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">High-risk patients</span><p id="par0105" class="elsevierStylePara elsevierViewall">Twelve of the patients who underwent IVS were considered high risk &#40;EuroSCORE &#62;20&#41; &#40;mean EuroSCORE I score&#58; 27&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&#37;&#41;&#46; In these patients&#44; the expected increase in mortality did not occur &#40;there were no deaths&#41;&#46; Although morbidity was higher than that of the population at lower risk &#40;low output&#58; 25&#37;&#46; Postoperative renal impairment&#58; 41&#46;6&#37; Atrial fibrillation&#58; 16&#46;7&#37;&#59; Transfusion&#58; 73&#46;3&#37;&#44; postoperative stroke&#58; 1 case&#59; pacemaker implantation due to postsurgery atrioventricular block&#58; 1 case&#41;&#44; it was also lower than that reported after the implantation of percutaneous aortic prosthesis &#40;pacemaker implantation&#58; 10&#37;&#59; severe residual aortic regurgitation&#58; 6&#37;&#44; vascular complication&#58; 9&#37;&#44; and mortality at 30 days&#58; 9&#37;&#41;&#44; according to data from the Spanish TAVI registry&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Survival</span><p id="par0110" class="elsevierStylePara elsevierViewall">Postoperative follow-up was conducted for 95&#46;53&#37; of the patients&#44; with a mean of 47&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;76 months &#40;range&#58; 1&#8211;141 months&#41;&#46; Survival at 1&#44; 3&#44; 5 and 10 years was 79&#46;5&#37;&#44; 74&#46;3&#37;&#44; 63&#46;6&#37; and 30&#46;5&#37;&#44; respectively&#46; Some 67&#46;3&#37; were in the NYHA functional class I&#44; 24&#46;2&#37; were in class II and 8&#46;5&#37; were in class III&#46; During this period&#44; 66 patients died&#46; The cause of death was unknown for 36&#46;6&#37; of the cases&#59; cardiac for 22&#46;7&#37;&#59; neurological for 13&#46;6&#37;&#59; infections for 10&#46;6&#37;&#59; neoplastic for 4&#46;5&#37;&#59; respiratory&#44; trauma and multiple organ failure each 3&#37; of cases&#59; and 3&#37; for other causes&#46; The preoperative calculation of the mortality risk according to the EuroSCORE I scale did not help predict long-term survival in our cohort&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The survival of the overall group is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; Although the operative mortality was significantly higher in the CS group&#44; there were no differences between the 2 groups during the follow-up &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75&#41;&#46; In accordance with the European Society of Cardiology guidelines&#44; anticoagulant treatment is not administered at discharge to patients with bioprosthesis but rather antiplatelet treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Anticoagulant treatment was administered to patients with paroxysmal atrial fibrillation during the postoperative period in order to prevent cardioembolic events&#46; This treatment was maintained for 3 months and withdrawn if the patient remains in sinus rhythm&#46; During the follow-up&#44; only 5 cases had a problem related to the anticoagulant therapy&#44; which was the cause of death for 1 patient&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The presence of a preoperative left ventricular ejection fraction &#60;50&#37; was the only mortality risk factor identified during this period in the entire group &#40;HR&#58; 2&#46;66&#59; 95&#37; CI 1&#46;58&#8211;4&#46;42&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0002&#41;&#46; In the patient group with CS&#44; mortality was also influenced during the follow-up by the transfusion of 2 or more red blood cell concentrates &#40;HR&#58; 2&#46;83&#59; 95&#37; CI 1&#46;05&#8211;7&#46;58&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;038&#41; and by postoperative respiratory failure &#40;HR&#58; 3&#46;60&#59; 95&#37; CI 1&#46;13&#8211;11&#46;37&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study shows that&#44; despite the increased comorbidity&#44; the mortality of valve surgery in octogenarians decreased at our center by almost half when comparing the first 4 years of this century with the 4 most recent years&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The identified mortality factors were CS&#44; transfusion of blood derivatives&#44; urgent surgery&#44; peripheral vascular disease and postoperative hematocrit levels &#60;24&#37;&#46; As in other series&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9&#8211;13&#44;15&#44;16&#44;19&#44;20</span></a> the mortality was greater for CS &#40;but still decreased from 23&#46;2&#37; to 13&#46;1&#37;&#41;&#44; and it remains high due to the greater prevalence of left ventricular dysfunction&#44; myocardial infarction&#44; unstable angina and peripheral vascular disease in this group&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There is an association between transfusions on one hand and morbidity and mortality on the other&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Transfusing more than 2 red blood cell concentrates quadruples the risk of mortality&#44; and a hematocrit level &#60;24&#37; after disconnecting the ECS doubled the risk&#46; From 2010 to 2013&#44; ultrafiltration during ECS and the restriction of blood loss lowered the number of transfused patients &#40;53&#37; vs&#46; 42&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;094&#41; and postoperative hematocrit levels &#60;24&#37; &#40;91&#46;3&#37; vs&#46; 55&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Both factors presumably influenced the reduced mortality&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In terms of morbidity&#44; we observed an increase in perioperative infarction in IVS&#46; Although not significant&#44; the preoperative aortic valve area in this group was smaller&#46; Perhaps the greater left ventricular hypertrophy increases the probability of a myocardial protection defect and perioperative infarction&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Transfusions were associated with a higher risk of postoperative renal and respiratory failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> Therefore&#44; controlling hemodilution&#44; blood losses and hemoconcentrations are essential to reducing morbidity&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21&#44;25&#44;26</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The EuroSCORE I and II were not useful for our population&#46; EuroSCORE I overestimated the risk of mortality &#40;especially from 2010 to 2013&#41;&#44; and EuroSCORE II underestimated it&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> As isolated tools&#44; both are ineffective in preoperatively assessing surgical risk and for proposing alternatives therapies&#44; including percutaneous aortic prosthesis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Our conclusions are not significant due to the low number of high-risk patients&#44; but we believe it is necessary to complement the decision-making process with other indicators&#58; assessment of frailty or functional impairment in organs or systems not susceptible to improvement after surgery &#40;hepatic cirrhosis&#44; pulmonary dysfunction&#44; serious neurological dysfunction serious&#44; etc&#46;&#41; or specific technical obstacles &#40;porcelain ascending aorta&#44; reoperation of patient with permeable coronary grafts&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> An individual calculation of the patient&#39;s risk is essential and should include&#58; survival among patients treated by the teams with the best results&#44; recent series &#40;similar to the reference population&#41; and our own results&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;28&#44;29</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Our survival rate is comparable to that of other European series&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Preoperative left ventricular dysfunction is the main long-term prognosis factor&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">This study analyzed the largest Spanish series of octogenarians in the past decade&#46; Comorbidity was higher than that of previous studies with fewer cases of CS and those that excluded patients with severe left ventricular dysfunction &#40;almost 25&#37; of our population&#41; or chronic bronchitis&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Our cohort reflects the evolution over time of the comorbidities of octogenarians who are currently undergoing surgery in Spain&#44; observing a progressive increase in the complexity and better results&#46; This trend may not correspond to that of patients from non-Spanish series&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Although the number of patients is high&#44; it represents only our reference population in recent years&#46; The conclusions&#44; especially when divided into CS and IVS groups&#44; should be assessed with caution&#46; Due to the low sample size&#44; we cannot determine the best therapy for high-risk patients&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Based on our results&#44; we recommend TAVI for octogenarians at high risk&#44; who combine factors such as frailty&#44; organ or system dysfunction and technical problems for surgery&#46; It would be advisable to complement the decision-making process with the recent results of the surgical reference group for this population&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0180" class="elsevierStylePara elsevierViewall">Aortic valve surgery mortality for octogenarians has decreased in recent years&#46; Morbidity and survival are currently acceptable&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In the high-risk patient group&#44; the combination of calculating the surgical risk&#44; the individual evaluation of comorbidities and frailty and the accumulated experience and results from each group help determine the most appropriate alternative&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec491228"
          "palabras" => array:4 [
            0 => "Circulaci&#243;n extracorp&#243;rea"
            1 => "Cirug&#237;a"
            2 => "Geriatr&#237;a"
            3 => "V&#225;lvula a&#243;rtica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To understand the risk factors and long-term impact and results of aortic valve surgery in patients over age 80&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We consecutively evaluated 255 octogenarians who were operated on between 2000 and 2013 and referred for aortic valve disease &#40;isolated or combined with coronary artery disease&#41;&#44; which&#44; even when associated with other diseases&#44; was the primary cause of the patient&#39;s functional limitation&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mortality rate decreased from 14&#46;08&#37; &#40;2000&#8211;2004&#41; to 7&#46;7&#37; &#40;isolated valve surgery&#44; 4&#46;4&#37;&#59; with coronary bypass&#44; 3&#46;3&#37;&#41; &#40;2010&#8211;2013&#41;&#46; The independent risk factors associated with mortality were urgent surgery&#44; combined procedures&#44; peripheral vascular disease&#44; a postsurgery hematocrit level &#60;24&#37; and the need for transfusion&#46; More than 50&#37; of the patients experienced a postoperative complication&#46; Blood product transfusions were associated with renal and respiratory failure&#44; and preoperative anemia was associated with an increased rate of myocardial infarction and stroke&#46; Survival at 1&#44; 3&#44; 5 and 10 years was 79&#46;5&#44; 74&#46;3&#44; 63&#46;6 and 30&#46;5&#37;&#44; respectively&#44; with 91&#46;5&#37; of the patients in NYHA functional class I&#8211;II&#46; Long-term survival was lower for cases of preoperative left ventricular dysfunction&#46; The EuroSCORE I logistics score was not useful for our population as a predictor of mortality or of medium to long-term survival&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years&#44; although it remains higher when valve surgery is combined with coronary surgery&#46; The presence of preoperative left ventricular dysfunction decreases long-term survival&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conocer los factores de riesgo&#44; resultados e impacto a largo plazo de la cirug&#237;a valvular a&#243;rtica en pacientes con m&#225;s de 80 a&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluamos 255 octogenarios consecutivos&#44; intervenidos entre 2000 y 2013&#44; y remitidos por valvulopat&#237;a a&#243;rtica &#40;aislada o combinada con enfermedad coronaria&#41; que&#44; aun asociada a otras patolog&#237;as&#44; era la causa principal de limitaci&#243;n funcional del paciente&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La mortalidad se redujo del 14&#44;08&#37; &#40;periodo 2000&#8211;2004&#41; al 7&#44;7&#37; &#40;cirug&#237;a valvular aislada&#44; 4&#44;4&#37; y con bypass coronario&#44; 3&#44;3&#37;&#41; &#40;periodo 2010&#8211;2013&#41;&#46; La cirug&#237;a urgente&#44; los procedimientos combinados&#44; la enfermedad vascular perif&#233;rica&#44; un hematocrito postquir&#250;rgico &#60;24&#37; y la necesidad de transfusi&#243;n&#44; fueron factores de riesgo independientes asociados a la mortalidad&#46; M&#225;s del 50&#37; de los pacientes present&#243; alguna complicaci&#243;n postoperatoria&#46; La transfusi&#243;n de hemoderivados se asoci&#243; a insuficiencia renal y respiratoria&#44; y la anemia preoperatoria a mayor frecuencia de infarto de miocardio e ictus&#46; La supervivencia a 1&#44; 3&#44; 5 y 10 a&#241;os fue del 79&#44;5&#59; 74&#44;3&#59; 63&#44;6 y 30&#44;5&#37;&#44; respectivamente&#44; con un 91&#44;5&#37; de los pacientes en clase funcional NYHA I-II&#46; La supervivencia a largo plazo se redujo en caso de disfunci&#243;n ventricular izquierda preoperatoria&#46; La puntuaci&#243;n EuroSCORE I log&#237;stica no result&#243; &#250;til en nuestra poblaci&#243;n como predictor de mortalidad ni de supervivencia a medio-largo plazo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La morbimortalidad de la cirug&#237;a valvular a&#243;rtica en los pacientes con m&#225;s de 80 a&#241;os ha descendido en los &#250;ltimos a&#241;os&#44; aunque sigue siendo superior cuando la cirug&#237;a valvular se asocia a cirug&#237;a coronaria&#46; La presencia de disfunci&#243;n ventricular izquierda preoperatoria disminuye la supervivencia a largo plazo&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Please cite this article as&#58; Carrascal Y&#44; Valenzuela H&#44; Laguna G&#44; Pareja P&#44; Blanco M&#44; Ortega C&#46; Cirug&#237;a de la v&#225;lvula a&#243;rtica en octogenarios&#58; factores de riesgo e impacto a largo plazo&#46; Rev Clin Esp&#46; 2015&#59;215&#58;148&#8211;155&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1607
            "Ancho" => 2165
            "Tamanyo" => 263094
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentages of each risk factor of the elderly population and their contribution to the EuroSCORE scale in the study population of octogenarians&#44; according to the date of surgery &#40;up to 2009 and after 2010&#41;&#46; The reduced number of surgeries for unstable angina and the reduced number of patients in critical preoperative conditions during the most recent period &#40;2010&#8211;2013&#41; seem to have improved mortality rates&#46; Other risk factors and the percentage of patients who underwent combined surgery remained stable between the 2 periods&#46; Abbreviations&#58; COPD&#44; chronic obstructive pulmonary disease&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1756
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            "Tamanyo" => 158659
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survival for octogenarians after aortic valve surgery &#40;isolated &#91;only on the aortic valve&#93; and combined &#91;valve and coronary surgery&#93;&#41;&#44; discounting hospital mortality&#46; There were no differences in survival when comparing the patients who underwent surgery with and without myocardial revascularization &#40;coronary surgery&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;75&#41;&#46; The table below the graph indicates the number of patients who survived during the follow-up months&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; COPD&#44; chronic obstructive pulmonary disease&#59; IQR&#44; interquartile range&#59; LVEF&#44; left ventricular ejection fraction&#59; NYHA&#44; New York Heart Association&#59; SD&#44; standard deviation&#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">Variables&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"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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="elsevierStyleBold">Qualitative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Preoperative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Female sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;44&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">174 &#40;68&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Peripheral vascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;8&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;22&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;34&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;8&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Previous myocardial infarction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;9&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><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="left" valign="top">14 &#40;5&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Unstable angina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;12&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Preoperative NYHA functional class III-IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">169 &#40;66&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sinus rhythm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">192 &#40;75&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Severe left ventricular dysfunction &#40;LVEF &#60;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;25&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Previous cardiac surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;4&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Urgent surgery<a class="elsevierStyleCrossRef" href="#tblfn0005"><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="left" valign="top">13 &#40;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Left main coronary artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;7&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 &#40;46&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Intraoperative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Combined surgery &#40;aortic and coronary&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;36&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Associated surgery in ascending aorta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;3&#46;5&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Number of coronary grafts</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;21&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;10&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;6&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Use of left internal mammary artery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;19&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type of aortic prosthesis</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mechanical<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;6&#46;2&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bioprosthesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">239 &#40;94&#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:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Quantitative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Preoperative and intraoperative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mean &#40;SD&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;1&#46;7&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Weight&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;11&#46;1&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Height&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">158 &#40;10&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Extracorporeal surgical time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106 &#40;34&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Aortic clamping time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 &#40;28&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>EuroSCORE logistics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;77 &#40;9&#46;7&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Postoperative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Median &#40;IQR&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Length of stay in Intensive Care Unit&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#8211;6&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hospital stay&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;8&#8211;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients older than 80 years undergoing extracorporeal aortic valve surgery between 2000 and 2013&#46;</p>"
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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">Postoperative complication&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">Total <span class="elsevierStyleItalic">n</span> &#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">Isolated valve surgery <span class="elsevierStyleItalic">n</span> &#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">Combined surgery <span class="elsevierStyleItalic">n</span> &#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"><span class="elsevierStyleItalic">p</span>&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  " align="left" valign="top">Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;16&#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;26&#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">&#46;065&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="left" valign="top">Acute myocardial infarction&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;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">6 &#40;6&#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">2 &#40;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">&#46;02&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="left" valign="top">Low output&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;16&#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;18&#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;14&#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;35&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="left" valign="top">Respiratory failure&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;16&#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;18&#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;14&#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;35&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="left" valign="top">Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;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">6 &#40;6&#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">4 &#40;2&#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">&#46;21&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="left" valign="top">Transient ischemic attack&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;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 &#40;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">1 &#40;0&#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">&#46;45&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="left" valign="top">Confusional 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;2&#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">1 &#40;0&#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">5 &#40;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">&#46;55&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="left" valign="top">Surgical wound infection&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;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">2 &#40;0&#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">6 &#40;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">&#46;98&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="left" valign="top">Mediastinitis&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;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">1 &#40;0&#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">2 &#40;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">&#46;62&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="left" valign="top">Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;32&#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">36 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;29&#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;092&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="left" valign="top">Dialysis&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;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">9 &#40;10&#41;&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;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">&#46;23&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="left" valign="top">Hemorrhage&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;6&#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">9 &#40;10&#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;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">&#46;15&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="left" valign="top">Atrioventricular block&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;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 &#40;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">1 &#40;0&#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">&#46;45&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  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative complication&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">Risk factor&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">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&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  " rowspan="6" align="left" valign="top">Renal failure<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;07&#8211;1&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;043&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="left" valign="top">Preoperative renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;23&#8211;11&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;019&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="left" valign="top">Transfusion&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&#8211;1&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;002&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;2 red blood cell concentrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;14&#8211;4&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0194&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#8211;4 red blood cell concentrates&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;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&#8211;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0034&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;6 red blood cell concentrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;96&#8211;39&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;004&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  " rowspan="2" align="left" valign="top">Myocardial infarction<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Preoperative hemoglobin levels &#62;11<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&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;58&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;34&#8211;0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0474&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&#8211;1&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0023&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  " rowspan="4" align="left" valign="top">Respiratory failure<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Transfusion&#58;&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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;2 red blood cell concentrates&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;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;84&#8211;11&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0021&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;4 red blood cell concentrates&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;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;96&#8211;13&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0002&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ECS time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;00&#8211;1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0049&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  " align="left" valign="top">Stroke<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Preoperative anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&#8211;7&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0476&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0015"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#58; preoperative renal failure&#44; age&#44; arterial hypertension&#44; transfusion&#44; ECS time&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#58; intraoperative hematocrit level &#8804;20&#37;&#44; peripheral vascular disease&#46;</p>"
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              "identificador" => "tblfn0020"
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            ]
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              "identificador" => "tblfn0025"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#58; transfusion&#44; ECS time&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#58; female sex&#44; minimum hematocrit during ECS&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#58; preoperative anemia according to WHO criteria&#44; aortic clamping time&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#58; transfusion of &#8805;2 red blood cell concentrates&#44; minimum hematocrit during ECS&#44; peripheral vascular disease&#44; preoperative stroke&#46;</p>"
            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Risk factors for main postoperative complications of octogenarian patients after heart surgery for aortic valve replacement&#44; with or without associated myocardial revascularization&#46; For the multivariate analysis&#44; we included the significant variables &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; in the univariate analysis and those with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#46; The variables included in each case are indicated with an asterisk&#46;</p>"
        ]
      ]
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        "identificador" => "tb0005"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">What we know&#63;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Aortic stenosis is a very common cardiovascular disease in the elderly&#44; and its surgical repair is contraindicated in many patients due to its high comorbidity&#46; In this study&#44; we analyze the risk factors and long-term impact of aortic valve surgery in octogenarians</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">What this article provides&#63;</span><p id="par0045" class="elsevierStylePara elsevierViewall">In a cohort of 255 patients 80 years of age or older who required aortic valve repair&#44; with or without concomitant coronary surgery&#44; the mortality decreased from 14&#46;1&#37; &#40;2000&#8211;2004&#41; to 7&#46;7&#37; &#40;2010&#8211;2013&#41;&#46; The mortality was greater when the surgery was urgent&#44; when peripheral vascular disease was involved&#44; when the hematocrit level was &#60;24&#37;&#44; or when there was a need for transfusion or coronary surgery&#46; More than half of the octogenarians lived to 5 years and 30&#37; lived to 10 years&#46; These figures are lower in the presence of left ventricular dysfunction&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The 2012 ageing report&#58; economic and budgetary projections for the EU27 Member States &#40;2010&#8211;2060&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "EuroHealthNet&#39;s Healthy Ageing Website"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic valve replacement in octogenarians&#58; utility of risk stratification with EuroSCORE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Leontyev"
                            1 => "T&#46; Walther"
                            2 => "M&#46;A&#46; Borger"
                            3 => "S&#46; Lehmann"
                            4 => "A&#46;K&#46; Funkat"
                            5 => "A&#46; Rastan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2009.01.057"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2009"
                        "volumen" => "87"
                        "paginaInicial" => "1440"
                        "paginaFinal" => "1445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19379882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective survey of patients with valvular heart disease in Europe&#58; the euro heart survey on valvular heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Iung"
                            1 => "G&#46; Baron"
                            2 => "E&#46;G&#46; Butchart"
                            3 => "F&#46; Delahaye"
                            4 => "C&#46; Gohlke-B&#228;rwolf"
                            5 => "O&#46;W&#46; Levang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "1231"
                        "paginaFinal" => "1243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12831818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; determinants&#44; and prognostic impact of operative refusal or denial in octogenarians with severe aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Pi&#233;rard"
                            1 => "S&#46; Seldrum"
                            2 => "C&#46; Meester"
                            3 => "A&#46; Pasquet"
                            4 => "B&#46; Gerber"
                            5 => "D&#46; Vancraeynest"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2010.12.052"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2011"
                        "volumen" => "91"
                        "paginaInicial" => "1107"
                        "paginaFinal" => "1112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21310391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement&#58; results from a cohort of 277 patients aged 80 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Varadarajan"
                            1 => "N&#46; Kapoor"
                            2 => "R&#46;C&#46; Bansal"
                            3 => "R&#46;G&#46; Pai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2006.07.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "722"
                        "paginaFinal" => "727"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16950629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cirug&#237;a de recambio valvular por estenosis a&#243;rtica severa en mayores de 80 a&#241;os&#46; Experiencia de un centro en una serie de pacientes consecutivos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Calvo"
                            1 => "I&#46; Lozano"
                            2 => "J&#46;C&#46; Llosa"
                            3 => "D&#46;H&#46; Lee"
                            4 => "M&#46; Mart&#237;n"
                            5 => "P&#46; Avanzas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2006"
                        "volumen" => "60"
                        "paginaInicial" => "720"
                        "paginaFinal" => "726"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17663856"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic valve replacement in the elderly&#58; the real life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Langanay"
                            1 => "E&#46; Fl&#233;cher"
                            2 => "O&#46; Fouquet"
                            3 => "V&#46;G&#46; Ruggieri"
                            4 => "B&#46; de La Tour"
                            5 => "C&#46; F&#233;lix"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2011.07.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "93"
                        "paginaInicial" => "70"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21982149"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporary outcomes of conventional aortic valve replacement in 638 octogenarians&#58; insights from an Italian Regional Cardiac Surgery Registry &#40;RERIC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Di Eusanio"
                            1 => "D&#46; Fortuna"
                            2 => "D&#46; Cristell"
                            3 => "P&#46; Pugliese"
                            4 => "F&#46; Nicolini"
                            5 => "D&#46; Pacine"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezr204"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2012"
                        "volumen" => "41"
                        "paginaInicial" => "1247"
                        "paginaFinal" => "1253"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22241005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic valve replacement in octogenarians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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Original article
Aortic valve surgery in octogenarians: Risk factors and long-term impact
Cirugía de la válvula aórtica en octogenarios: factores de riesgo e impacto a largo plazo
Y. Carrascal
Corresponding author
ycarrascal@hotmail.com

Corresponding author.
, H. Valenzuela, G. Laguna, P. Pareja, M. Blanco, C. Ortega
Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survival for octogenarians after aortic valve surgery &#40;isolated &#91;only on the aortic valve&#93; and combined &#91;valve and coronary surgery&#93;&#41;&#44; discounting hospital mortality&#46; There were no differences in survival when comparing the patients who underwent surgery with and without myocardial revascularization &#40;coronary surgery&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;75&#41;&#46; The table below the graph indicates the number of patients who survived during the follow-up months&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">More than 25&#37; of the octogenarians are functionally limited by a cardiovascular disease&#46; Among these diseases&#44; aortic stenosis is the most common&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Despite the good results of aortic valve surgery&#44; the morbidity&#44; mortality and associated costs are increasing among the most elderly patients&#46; In the Euro Survey registry&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> comorbidity was the reason for contraindicating the surgery in a third of octogenarians with symptomatic aortic stenosis&#46; A number of authors have reported rates of contraindication for this reason of 40&#37;&#8211;80&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Aortic valve disease for octogenarians is beginning to be a common disease in our community&#46; In our center&#44; the number of surgeries went from 2&#37; to 13&#46;5&#37; between 2000 and 2013&#46; Decision making is complex&#44; and the perceived risk of the intervention might not be realistic&#46; There have been few Spanish series published in the last decade&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> the number of analyzed patients is low and the profile of comorbidities has varied in recent years&#46; Additionally&#44; the emergence of percutaneous aortic bioprostheses represents a new alternative for this group&#44; whose results should be compared only with those of the most recent surgical series&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient selection and inclusion criteria vary significantly among groups&#44; as do the reported mortality rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;16</span></a> The aims of our study were to assess the mortality results&#44; identify the risk factors for morbidity and mortality&#44; determine the medium to long-term survival and determine if there is a parameter that would recommend the use of alternatives therapies&#44; all while providing updated data from a national series&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between January 2000 and July 2013&#44; 255 patients aged 80 years or older diagnosed with aortic valve disease &#40;associated with coronary artery disease in 36&#46;5&#37; of cases&#41; were consecutively operated on with extracorporeal surgery &#40;ECS&#41;&#46; These patients represented 6&#46;96&#37; of the total number of patients who underwent surgery during this period&#46; The surgical option was considered for patients with a life expectancy greater than 1 year and with functional class impairment due&#44; exclusively or mainly&#44; to the heart disease that was the reason for the surgery&#46; Patients were not excluded if they had associated heart disease&#44; which could have worsened as a result of the aortic valve disease and was&#44; at least theoretically&#44; reversible&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We retrospectively analyzed the influence of a number of variables &#40;collected prospectively&#41; and their relationship to postoperative morbidity and mortality and medium to long-term survival&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Definitions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Hospital mortality&#58; that which occurs during the first 30 days after surgery or during the hospital stay&#44; whichever is greater&#46; Urgent surgery&#58; that conducted within 24<span class="elsevierStyleHsp" style=""></span>h of the surgical indication&#46; Emergency&#58; that which is performed immediately&#46; Preoperative anemia &#40;WHO criteria&#41;&#58; hemoglobin levels &#60;13<span class="elsevierStyleHsp" style=""></span>g&#47;dL in men and &#60;12<span class="elsevierStyleHsp" style=""></span>g&#47;dL in women&#46; Preoperative renal failure&#58; creatinine levels &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Chronic obstructive pulmonary disease is considered only when bronchodilator treatment is required&#46; Severe left ventricular dysfunction corresponds to an ejection fraction &#40;EF&#41; &#60;30&#37;&#46; Transfusion criterion&#58; hematocrit during ECS &#60;21&#37; or &#60;24&#37; after surgery&#46; Intraoperative myocardial protection&#58; intermittent anterior-retrograde blood cardioplegia&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patient follow-up was conducted at outpatient visits or through telephone assessment&#44; referencing survival&#44; cause of death &#40;if applicable&#41; and functional class&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistics</span><p id="par0055" class="elsevierStylePara elsevierViewall">The analyzed variables were collected from the hospital database&#44; with approval from the research committee&#46; The statistical analysis was conducted using the SPSS<span class="elsevierStyleSup">&#174;</span> 20&#46;0 program&#46; The quantitative variables are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or as medians for asymmetric distributions&#46; The qualitative variables are expressed as absolute values and percentages&#46; The association between variables was determined using Student&#39;s <span class="elsevierStyleItalic">t</span>-test and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test &#40;for non-normal distributions&#41; for the quantitative values and the chi-squared test and Fisher&#39;s exact test for the qualitative&#46; The associations between mortality and morbidity for each case &#40;identified using a value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2 in the univariate analysis&#41; were inserted into a multivariate stepwise logistic regression&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The risk factors for mortality and the actuarial survival for the group were analyzed using the Cox proportional-hazards regression model and the Kaplan&#8211;Meier survival analysis&#44; respectively&#46; In all cases&#44; we considered <span class="elsevierStyleItalic">p</span> values &#60;&#46;05 to be statistically significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The main demographic characteristics and surgical procedures are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Hospital mortality</span><p id="par0070" class="elsevierStylePara elsevierViewall">The overall mortality was 11&#46;8&#37;&#58; 8&#37; in isolated valve surgery &#40;IVS&#41; and 18&#46;3&#37; in combined surgery &#40;CS&#41;&#46; The causes of mortality&#44; in order of frequency&#44; were heart failure &#40;3&#46;5&#37;&#41;&#44; multiple organ failure &#40;3&#46;1&#37;&#41;&#44; sepsis&#44; severe respiratory failure and hemorrhage &#40;1&#46;2&#37;&#44; 1&#46;2&#37; and 1&#46;2&#37;&#44; respectively&#41;&#44; neurological damage &#40;0&#46;8&#37;&#41; and mesenteric ischemia and lung thromboembolism &#40;0&#46;4&#37; and 0&#46;4&#37;&#44; respectively&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The multivariate analysis of hospital mortality included minimum hematocrit during ECS &#8804;20&#37;&#44; peripheral vascular disease&#44; combined surgery&#44; urgent surgery&#44; left main coronary artery disease&#44; postoperative hematocrit &#60;24&#37;&#44; need for transfusion of more than 2 red blood cell concentrates and preoperative creatinine levels &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 in the univariate analysis&#41; and diabetes mellitus &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#41;&#46; The mortality factors were urgent surgery &#40;OR&#58; 4&#46;40&#59; 95&#37; CI 1&#46;28&#8211;15&#46;12&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0186&#41;&#44; peripheral vascular disease &#40;OR&#58; 3&#46;42&#59; 95&#37; CI 1&#46;08&#8211;10&#46;81&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0359&#41;&#59; combined surgery &#40;OR&#58; 2&#46;30&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI 1&#46;01&#8211;5&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;046&#41;&#59; postoperative hematocrit &#60;24&#37; &#40;OR&#58; 2&#46;47&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI 1&#46;09&#8211;5&#46;62&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41; and transfusion of more than 2 red blood cell concentrates &#40;OR&#58; 4&#46;29&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI 1&#46;88&#8211;9&#46;82&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0005&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The patients who required CS presented a greater preoperative prevalence of peripheral vascular disease &#40;13&#37; vs&#46; 4&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;020&#41;&#44; myocardial infarction &#40;17&#46;4&#37; vs&#46; 4&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#44; unstable angina &#40;23&#46;2&#37; vs&#46; 3&#46;7&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; and left ventricular dysfunction &#40;32&#46;6&#37; vs&#46; 20&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;028&#41; compared with those who underwent IVS&#46; The most common type of surgery was single-vessel surgery &#40;57&#37;&#41;&#44; with a mortality rate of 13&#46;7&#37;&#44; 24&#37; and 23&#46;1&#37;&#44; depending on whether the number of grafts performed was 1&#44; 2 or 3&#44; respectively&#46; Although within the limits of significance&#44; urgent surgery affected 8&#46;7&#37; of the patients in this group compared with the 3&#46;1&#37; of the IVS group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;050&#41;&#44; increasing the mortality in urgent CS up to 25&#37;&#46; Only 9&#37; of the patients lacked preoperative risk factors&#46; In this group&#44; the mortality rate was 4&#46;3&#37; &#40;0&#37; in the 18 patients with IVS&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The preoperative risk scores on the EuroSCORE I logistics scale for the group of patients who died and for the patients who survived &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; were 17&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;11&#37; and 13&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;46&#37;&#44; respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;061&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 40&#46;7&#37; of the patients were operated on between 2010 and 2013&#46; Although not significant&#44; there was a reduction in mortality during this period &#40;7&#46;7&#37;&#41; compared with 2000&#8211;2004 &#40;14&#46;5&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;07&#41;&#44; despite an increase in left ventricular dysfunction &#40;30&#46;8&#37; vs&#46; 15&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0031&#41; and severe preoperative pulmonary hypertension &#40;7&#46;6&#37; vs&#46; 1&#46;3&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;024&#41;&#46; The reduced mortality during the most recent period could be due to a significant reduction in the number of patients operated on with a diagnosis of unstable angina and in NYHA functional class IV&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The surgical risk&#44; determined by the EuroSCORE II scale &#40;recorded since July 2012&#41; was 5&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;86&#37;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Postoperative morbidity</span><p id="par0095" class="elsevierStylePara elsevierViewall">Some 56&#46;1&#37; of the patients experienced a postoperative complication&#46; The most common complications and the preoperative risk factors significantly related to their onset are listed in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Mortality and postoperative stays vary in the presence of postoperative complications&#46; The former rises to 17&#46;5&#37; compared with 4&#46;5&#37; for the group without complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The median postoperative stay in the ICU and in the ward increases from 2 to 5 days and from 9 to 14 days&#44; respectively&#44; with no differences between the IVS and CS groups&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">High-risk patients</span><p id="par0105" class="elsevierStylePara elsevierViewall">Twelve of the patients who underwent IVS were considered high risk &#40;EuroSCORE &#62;20&#41; &#40;mean EuroSCORE I score&#58; 27&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&#37;&#41;&#46; In these patients&#44; the expected increase in mortality did not occur &#40;there were no deaths&#41;&#46; Although morbidity was higher than that of the population at lower risk &#40;low output&#58; 25&#37;&#46; Postoperative renal impairment&#58; 41&#46;6&#37; Atrial fibrillation&#58; 16&#46;7&#37;&#59; Transfusion&#58; 73&#46;3&#37;&#44; postoperative stroke&#58; 1 case&#59; pacemaker implantation due to postsurgery atrioventricular block&#58; 1 case&#41;&#44; it was also lower than that reported after the implantation of percutaneous aortic prosthesis &#40;pacemaker implantation&#58; 10&#37;&#59; severe residual aortic regurgitation&#58; 6&#37;&#44; vascular complication&#58; 9&#37;&#44; and mortality at 30 days&#58; 9&#37;&#41;&#44; according to data from the Spanish TAVI registry&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Survival</span><p id="par0110" class="elsevierStylePara elsevierViewall">Postoperative follow-up was conducted for 95&#46;53&#37; of the patients&#44; with a mean of 47&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;76 months &#40;range&#58; 1&#8211;141 months&#41;&#46; Survival at 1&#44; 3&#44; 5 and 10 years was 79&#46;5&#37;&#44; 74&#46;3&#37;&#44; 63&#46;6&#37; and 30&#46;5&#37;&#44; respectively&#46; Some 67&#46;3&#37; were in the NYHA functional class I&#44; 24&#46;2&#37; were in class II and 8&#46;5&#37; were in class III&#46; During this period&#44; 66 patients died&#46; The cause of death was unknown for 36&#46;6&#37; of the cases&#59; cardiac for 22&#46;7&#37;&#59; neurological for 13&#46;6&#37;&#59; infections for 10&#46;6&#37;&#59; neoplastic for 4&#46;5&#37;&#59; respiratory&#44; trauma and multiple organ failure each 3&#37; of cases&#59; and 3&#37; for other causes&#46; The preoperative calculation of the mortality risk according to the EuroSCORE I scale did not help predict long-term survival in our cohort&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The survival of the overall group is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; Although the operative mortality was significantly higher in the CS group&#44; there were no differences between the 2 groups during the follow-up &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;75&#41;&#46; In accordance with the European Society of Cardiology guidelines&#44; anticoagulant treatment is not administered at discharge to patients with bioprosthesis but rather antiplatelet treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Anticoagulant treatment was administered to patients with paroxysmal atrial fibrillation during the postoperative period in order to prevent cardioembolic events&#46; This treatment was maintained for 3 months and withdrawn if the patient remains in sinus rhythm&#46; During the follow-up&#44; only 5 cases had a problem related to the anticoagulant therapy&#44; which was the cause of death for 1 patient&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The presence of a preoperative left ventricular ejection fraction &#60;50&#37; was the only mortality risk factor identified during this period in the entire group &#40;HR&#58; 2&#46;66&#59; 95&#37; CI 1&#46;58&#8211;4&#46;42&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0002&#41;&#46; In the patient group with CS&#44; mortality was also influenced during the follow-up by the transfusion of 2 or more red blood cell concentrates &#40;HR&#58; 2&#46;83&#59; 95&#37; CI 1&#46;05&#8211;7&#46;58&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;038&#41; and by postoperative respiratory failure &#40;HR&#58; 3&#46;60&#59; 95&#37; CI 1&#46;13&#8211;11&#46;37&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study shows that&#44; despite the increased comorbidity&#44; the mortality of valve surgery in octogenarians decreased at our center by almost half when comparing the first 4 years of this century with the 4 most recent years&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The identified mortality factors were CS&#44; transfusion of blood derivatives&#44; urgent surgery&#44; peripheral vascular disease and postoperative hematocrit levels &#60;24&#37;&#46; As in other series&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9&#8211;13&#44;15&#44;16&#44;19&#44;20</span></a> the mortality was greater for CS &#40;but still decreased from 23&#46;2&#37; to 13&#46;1&#37;&#41;&#44; and it remains high due to the greater prevalence of left ventricular dysfunction&#44; myocardial infarction&#44; unstable angina and peripheral vascular disease in this group&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There is an association between transfusions on one hand and morbidity and mortality on the other&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Transfusing more than 2 red blood cell concentrates quadruples the risk of mortality&#44; and a hematocrit level &#60;24&#37; after disconnecting the ECS doubled the risk&#46; From 2010 to 2013&#44; ultrafiltration during ECS and the restriction of blood loss lowered the number of transfused patients &#40;53&#37; vs&#46; 42&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;094&#41; and postoperative hematocrit levels &#60;24&#37; &#40;91&#46;3&#37; vs&#46; 55&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Both factors presumably influenced the reduced mortality&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In terms of morbidity&#44; we observed an increase in perioperative infarction in IVS&#46; Although not significant&#44; the preoperative aortic valve area in this group was smaller&#46; Perhaps the greater left ventricular hypertrophy increases the probability of a myocardial protection defect and perioperative infarction&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Transfusions were associated with a higher risk of postoperative renal and respiratory failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> Therefore&#44; controlling hemodilution&#44; blood losses and hemoconcentrations are essential to reducing morbidity&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21&#44;25&#44;26</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The EuroSCORE I and II were not useful for our population&#46; EuroSCORE I overestimated the risk of mortality &#40;especially from 2010 to 2013&#41;&#44; and EuroSCORE II underestimated it&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> As isolated tools&#44; both are ineffective in preoperatively assessing surgical risk and for proposing alternatives therapies&#44; including percutaneous aortic prosthesis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Our conclusions are not significant due to the low number of high-risk patients&#44; but we believe it is necessary to complement the decision-making process with other indicators&#58; assessment of frailty or functional impairment in organs or systems not susceptible to improvement after surgery &#40;hepatic cirrhosis&#44; pulmonary dysfunction&#44; serious neurological dysfunction serious&#44; etc&#46;&#41; or specific technical obstacles &#40;porcelain ascending aorta&#44; reoperation of patient with permeable coronary grafts&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> An individual calculation of the patient&#39;s risk is essential and should include&#58; survival among patients treated by the teams with the best results&#44; recent series &#40;similar to the reference population&#41; and our own results&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;28&#44;29</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Our survival rate is comparable to that of other European series&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Preoperative left ventricular dysfunction is the main long-term prognosis factor&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">This study analyzed the largest Spanish series of octogenarians in the past decade&#46; Comorbidity was higher than that of previous studies with fewer cases of CS and those that excluded patients with severe left ventricular dysfunction &#40;almost 25&#37; of our population&#41; or chronic bronchitis&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Our cohort reflects the evolution over time of the comorbidities of octogenarians who are currently undergoing surgery in Spain&#44; observing a progressive increase in the complexity and better results&#46; This trend may not correspond to that of patients from non-Spanish series&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Although the number of patients is high&#44; it represents only our reference population in recent years&#46; The conclusions&#44; especially when divided into CS and IVS groups&#44; should be assessed with caution&#46; Due to the low sample size&#44; we cannot determine the best therapy for high-risk patients&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Based on our results&#44; we recommend TAVI for octogenarians at high risk&#44; who combine factors such as frailty&#44; organ or system dysfunction and technical problems for surgery&#46; It would be advisable to complement the decision-making process with the recent results of the surgical reference group for this population&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0180" class="elsevierStylePara elsevierViewall">Aortic valve surgery mortality for octogenarians has decreased in recent years&#46; Morbidity and survival are currently acceptable&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In the high-risk patient group&#44; the combination of calculating the surgical risk&#44; the individual evaluation of comorbidities and frailty and the accumulated experience and results from each group help determine the most appropriate alternative&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres468587"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background and objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Patients and methods"
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            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
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            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec491227"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres468588"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Antecedentes y objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Pacientes y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec491228"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Definitions"
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistics"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Hospital mortality"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Postoperative morbidity"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "High-risk patients"
            ]
            3 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Survival"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-05-13"
    "fechaAceptado" => "2014-07-29"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec491227"
          "palabras" => array:4 [
            0 => "Extracorporeal circulation"
            1 => "Surgery"
            2 => "Geriatric medicine"
            3 => "Aortic valve"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec491228"
          "palabras" => array:4 [
            0 => "Circulaci&#243;n extracorp&#243;rea"
            1 => "Cirug&#237;a"
            2 => "Geriatr&#237;a"
            3 => "V&#225;lvula a&#243;rtica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To understand the risk factors and long-term impact and results of aortic valve surgery in patients over age 80&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We consecutively evaluated 255 octogenarians who were operated on between 2000 and 2013 and referred for aortic valve disease &#40;isolated or combined with coronary artery disease&#41;&#44; which&#44; even when associated with other diseases&#44; was the primary cause of the patient&#39;s functional limitation&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mortality rate decreased from 14&#46;08&#37; &#40;2000&#8211;2004&#41; to 7&#46;7&#37; &#40;isolated valve surgery&#44; 4&#46;4&#37;&#59; with coronary bypass&#44; 3&#46;3&#37;&#41; &#40;2010&#8211;2013&#41;&#46; The independent risk factors associated with mortality were urgent surgery&#44; combined procedures&#44; peripheral vascular disease&#44; a postsurgery hematocrit level &#60;24&#37; and the need for transfusion&#46; More than 50&#37; of the patients experienced a postoperative complication&#46; Blood product transfusions were associated with renal and respiratory failure&#44; and preoperative anemia was associated with an increased rate of myocardial infarction and stroke&#46; Survival at 1&#44; 3&#44; 5 and 10 years was 79&#46;5&#44; 74&#46;3&#44; 63&#46;6 and 30&#46;5&#37;&#44; respectively&#44; with 91&#46;5&#37; of the patients in NYHA functional class I&#8211;II&#46; Long-term survival was lower for cases of preoperative left ventricular dysfunction&#46; The EuroSCORE I logistics score was not useful for our population as a predictor of mortality or of medium to long-term survival&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years&#44; although it remains higher when valve surgery is combined with coronary surgery&#46; The presence of preoperative left ventricular dysfunction decreases long-term survival&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conocer los factores de riesgo&#44; resultados e impacto a largo plazo de la cirug&#237;a valvular a&#243;rtica en pacientes con m&#225;s de 80 a&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluamos 255 octogenarios consecutivos&#44; intervenidos entre 2000 y 2013&#44; y remitidos por valvulopat&#237;a a&#243;rtica &#40;aislada o combinada con enfermedad coronaria&#41; que&#44; aun asociada a otras patolog&#237;as&#44; era la causa principal de limitaci&#243;n funcional del paciente&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La mortalidad se redujo del 14&#44;08&#37; &#40;periodo 2000&#8211;2004&#41; al 7&#44;7&#37; &#40;cirug&#237;a valvular aislada&#44; 4&#44;4&#37; y con bypass coronario&#44; 3&#44;3&#37;&#41; &#40;periodo 2010&#8211;2013&#41;&#46; La cirug&#237;a urgente&#44; los procedimientos combinados&#44; la enfermedad vascular perif&#233;rica&#44; un hematocrito postquir&#250;rgico &#60;24&#37; y la necesidad de transfusi&#243;n&#44; fueron factores de riesgo independientes asociados a la mortalidad&#46; M&#225;s del 50&#37; de los pacientes present&#243; alguna complicaci&#243;n postoperatoria&#46; La transfusi&#243;n de hemoderivados se asoci&#243; a insuficiencia renal y respiratoria&#44; y la anemia preoperatoria a mayor frecuencia de infarto de miocardio e ictus&#46; La supervivencia a 1&#44; 3&#44; 5 y 10 a&#241;os fue del 79&#44;5&#59; 74&#44;3&#59; 63&#44;6 y 30&#44;5&#37;&#44; respectivamente&#44; con un 91&#44;5&#37; de los pacientes en clase funcional NYHA I-II&#46; La supervivencia a largo plazo se redujo en caso de disfunci&#243;n ventricular izquierda preoperatoria&#46; La puntuaci&#243;n EuroSCORE I log&#237;stica no result&#243; &#250;til en nuestra poblaci&#243;n como predictor de mortalidad ni de supervivencia a medio-largo plazo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La morbimortalidad de la cirug&#237;a valvular a&#243;rtica en los pacientes con m&#225;s de 80 a&#241;os ha descendido en los &#250;ltimos a&#241;os&#44; aunque sigue siendo superior cuando la cirug&#237;a valvular se asocia a cirug&#237;a coronaria&#46; La presencia de disfunci&#243;n ventricular izquierda preoperatoria disminuye la supervivencia a largo plazo&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Please cite this article as&#58; Carrascal Y&#44; Valenzuela H&#44; Laguna G&#44; Pareja P&#44; Blanco M&#44; Ortega C&#46; Cirug&#237;a de la v&#225;lvula a&#243;rtica en octogenarios&#58; factores de riesgo e impacto a largo plazo&#46; Rev Clin Esp&#46; 2015&#59;215&#58;148&#8211;155&#46;</p>"
      ]
    ]
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentages of each risk factor of the elderly population and their contribution to the EuroSCORE scale in the study population of octogenarians&#44; according to the date of surgery &#40;up to 2009 and after 2010&#41;&#46; The reduced number of surgeries for unstable angina and the reduced number of patients in critical preoperative conditions during the most recent period &#40;2010&#8211;2013&#41; seem to have improved mortality rates&#46; Other risk factors and the percentage of patients who underwent combined surgery remained stable between the 2 periods&#46; Abbreviations&#58; COPD&#44; chronic obstructive pulmonary disease&#46;</p>"
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survival for octogenarians after aortic valve surgery &#40;isolated &#91;only on the aortic valve&#93; and combined &#91;valve and coronary surgery&#93;&#41;&#44; discounting hospital mortality&#46; There were no differences in survival when comparing the patients who underwent surgery with and without myocardial revascularization &#40;coronary surgery&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;75&#41;&#46; The table below the graph indicates the number of patients who survived during the follow-up months&#46;</p>"
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      ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; COPD&#44; chronic obstructive pulmonary disease&#59; IQR&#44; interquartile range&#59; LVEF&#44; left ventricular ejection fraction&#59; NYHA&#44; New York Heart Association&#59; SD&#44; standard deviation&#46;</p>"
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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&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"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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="elsevierStyleBold">Qualitative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Preoperative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Female sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;44&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">174 &#40;68&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Peripheral vascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;8&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;22&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;34&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;8&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Previous myocardial infarction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;9&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><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="left" valign="top">14 &#40;5&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Unstable angina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;12&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Preoperative NYHA functional class III-IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">169 &#40;66&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sinus rhythm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">192 &#40;75&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Severe left ventricular dysfunction &#40;LVEF &#60;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;25&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Previous cardiac surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;4&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Urgent surgery<a class="elsevierStyleCrossRef" href="#tblfn0005"><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="left" valign="top">13 &#40;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Left main coronary artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;7&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 &#40;46&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Intraoperative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Combined surgery &#40;aortic and coronary&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;36&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Associated surgery in ascending aorta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;3&#46;5&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Number of coronary grafts</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;21&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;10&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;6&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Use of left internal mammary artery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;19&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type of aortic prosthesis</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mechanical<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;6&#46;2&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bioprosthesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">239 &#40;94&#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:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Quantitative</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Preoperative and intraoperative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mean &#40;SD&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;1&#46;7&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Weight&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;11&#46;1&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Height&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">158 &#40;10&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Extracorporeal surgical time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106 &#40;34&#46;5&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Aortic clamping time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 &#40;28&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>EuroSCORE logistics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;77 &#40;9&#46;7&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Postoperative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Median &#40;IQR&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Length of stay in Intensive Care Unit&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#8211;6&#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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hospital stay&#44; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;8&#8211;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients older than 80 years undergoing extracorporeal aortic valve surgery between 2000 and 2013&#46;</p>"
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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">Postoperative complication&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">Total <span class="elsevierStyleItalic">n</span> &#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">Isolated valve surgery <span class="elsevierStyleItalic">n</span> &#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">Combined surgery <span class="elsevierStyleItalic">n</span> &#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"><span class="elsevierStyleItalic">p</span>&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  " align="left" valign="top">Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;16&#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;26&#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">&#46;065&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="left" valign="top">Acute myocardial infarction&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;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">6 &#40;6&#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">2 &#40;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">&#46;02&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="left" valign="top">Low output&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;16&#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;18&#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;14&#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;35&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="left" valign="top">Respiratory failure&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;16&#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;18&#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;14&#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;35&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="left" valign="top">Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;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">6 &#40;6&#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">4 &#40;2&#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">&#46;21&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="left" valign="top">Transient ischemic attack&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;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 &#40;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">1 &#40;0&#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">&#46;45&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="left" valign="top">Confusional 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;2&#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">1 &#40;0&#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">5 &#40;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">&#46;55&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="left" valign="top">Surgical wound infection&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;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">2 &#40;0&#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">6 &#40;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">&#46;98&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="left" valign="top">Mediastinitis&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;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">1 &#40;0&#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">2 &#40;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">&#46;62&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="left" valign="top">Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;32&#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">36 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;29&#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;092&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="left" valign="top">Dialysis&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;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">9 &#40;10&#41;&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;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">&#46;23&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="left" valign="top">Hemorrhage&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;6&#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">9 &#40;10&#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;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">&#46;15&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="left" valign="top">Atrioventricular block&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;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 &#40;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">1 &#40;0&#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">&#46;45&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  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative complication&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">Risk factor&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">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&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  " rowspan="6" align="left" valign="top">Renal failure<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;07&#8211;1&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;043&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="left" valign="top">Preoperative renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;23&#8211;11&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;019&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="left" valign="top">Transfusion&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&#8211;1&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;002&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;2 red blood cell concentrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;14&#8211;4&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0194&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#8211;4 red blood cell concentrates&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;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&#8211;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0034&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;6 red blood cell concentrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;96&#8211;39&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;004&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  " rowspan="2" align="left" valign="top">Myocardial infarction<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Preoperative hemoglobin levels &#62;11<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&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;58&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;34&#8211;0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0474&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="left" valign="top">ECS time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&#8211;1&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0023&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  " rowspan="4" align="left" valign="top">Respiratory failure<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Transfusion&#58;&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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;2 red blood cell concentrates&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;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;84&#8211;11&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0021&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;4 red blood cell concentrates&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;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;96&#8211;13&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0002&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="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ECS time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;00&#8211;1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0049&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  " align="left" valign="top">Stroke<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Preoperative anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&#8211;7&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;0476&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"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#58; preoperative renal failure&#44; age&#44; arterial hypertension&#44; transfusion&#44; ECS time&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#58; intraoperative hematocrit level &#8804;20&#37;&#44; peripheral vascular disease&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#58; ECS time&#44; aortic clamping time&#44; preoperative hemoglobin level &#62;11<span class="elsevierStyleHsp" style=""></span>g&#47;mL&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#58; transfusion of &#8805;2 red blood cell concentrates&#44; preoperative anemia according to WHO criteria&#44; minimum hematocrit during ECS&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#58; transfusion&#44; ECS time&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#58; female sex&#44; minimum hematocrit during ECS&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#58; preoperative anemia according to WHO criteria&#44; aortic clamping time&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#58; transfusion of &#8805;2 red blood cell concentrates&#44; minimum hematocrit during ECS&#44; peripheral vascular disease&#44; preoperative stroke&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Risk factors for main postoperative complications of octogenarian patients after heart surgery for aortic valve replacement&#44; with or without associated myocardial revascularization&#46; For the multivariate analysis&#44; we included the significant variables &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; in the univariate analysis and those with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;2&#46; The variables included in each case are indicated with an asterisk&#46;</p>"
        ]
      ]
      5 => array:5 [
        "identificador" => "tb0005"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">What we know&#63;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Aortic stenosis is a very common cardiovascular disease in the elderly&#44; and its surgical repair is contraindicated in many patients due to its high comorbidity&#46; In this study&#44; we analyze the risk factors and long-term impact of aortic valve surgery in octogenarians</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">What this article provides&#63;</span><p id="par0045" class="elsevierStylePara elsevierViewall">In a cohort of 255 patients 80 years of age or older who required aortic valve repair&#44; with or without concomitant coronary surgery&#44; the mortality decreased from 14&#46;1&#37; &#40;2000&#8211;2004&#41; to 7&#46;7&#37; &#40;2010&#8211;2013&#41;&#46; The mortality was greater when the surgery was urgent&#44; when peripheral vascular disease was involved&#44; when the hematocrit level was &#60;24&#37;&#44; or when there was a need for transfusion or coronary surgery&#46; More than half of the octogenarians lived to 5 years and 30&#37; lived to 10 years&#46; These figures are lower in the presence of left ventricular dysfunction&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The 2012 ageing report&#58; economic and budgetary projections for the EU27 Member States &#40;2010&#8211;2060&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "EuroHealthNet&#39;s Healthy Ageing Website"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic valve replacement in octogenarians&#58; utility of risk stratification with EuroSCORE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Leontyev"
                            1 => "T&#46; Walther"
                            2 => "M&#46;A&#46; Borger"
                            3 => "S&#46; Lehmann"
                            4 => "A&#46;K&#46; Funkat"
                            5 => "A&#46; Rastan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2009.01.057"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2009"
                        "volumen" => "87"
                        "paginaInicial" => "1440"
                        "paginaFinal" => "1445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19379882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective survey of patients with valvular heart disease in Europe&#58; the euro heart survey on valvular heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Iung"
                            1 => "G&#46; Baron"
                            2 => "E&#46;G&#46; Butchart"
                            3 => "F&#46; Delahaye"
                            4 => "C&#46; Gohlke-B&#228;rwolf"
                            5 => "O&#46;W&#46; Levang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "1231"
                        "paginaFinal" => "1243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12831818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; determinants&#44; and prognostic impact of operative refusal or denial in octogenarians with severe aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Pi&#233;rard"
                            1 => "S&#46; Seldrum"
                            2 => "C&#46; Meester"
                            3 => "A&#46; Pasquet"
                            4 => "B&#46; Gerber"
                            5 => "D&#46; Vancraeynest"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2010.12.052"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2011"
                        "volumen" => "91"
                        "paginaInicial" => "1107"
                        "paginaFinal" => "1112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21310391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement&#58; results from a cohort of 277 patients aged 80 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Varadarajan"
                            1 => "N&#46; Kapoor"
                            2 => "R&#46;C&#46; Bansal"
                            3 => "R&#46;G&#46; Pai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2006.07.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "722"
                        "paginaFinal" => "727"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16950629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cirug&#237;a de recambio valvular por estenosis a&#243;rtica severa en mayores de 80 a&#241;os&#46; Experiencia de un centro en una serie de pacientes consecutivos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Calvo"
                            1 => "I&#46; Lozano"
                            2 => "J&#46;C&#46; Llosa"
                            3 => "D&#46;H&#46; Lee"
                            4 => "M&#46; Mart&#237;n"
                            5 => "P&#46; Avanzas"
                          ]
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