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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patient flowchart&#46; LCOS&#58; low cardiac output syndrome&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Low cardiac output syndrome &#40;LCOS&#41; is a potential complication in patients that have undergone cardiac surgery &#40;CS&#41;&#46; According to the studies found in the literature&#44; the incidence of the syndrome varies between 3 and 45&#37;&#44; and it is associated to increased morbidity&#8211;mortality&#44; a prolongation of stay in the intensive care unit &#40;ICU&#41;&#44; and increased consumption of resources&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#8211;4</span></a> Low cardiac output syndrome can be regarded as a &#8220;peculiar&#8221; form of acute heart failure &#40;AHF&#41;&#44; characterized by triggering factors&#44; a form of presentation&#44; evolution and treatment that differ from those of AHF of medical origin&#46; The AHF classifications of the European Society of Cardiology and of the American College of Cardiology are not directly applicable to the postoperative period of CS&#59; in fact&#44; they do not contemplate the mentioned syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> Postoperative LCOS involves the association of cardiogenic&#44; distributive and hypovolemic components that affect patient hemodynamics and imply complex management requiring a dynamic clinical approach&#46; In this context&#44; in the year 2012 a consensus document was published specifically defining this clinical condition and offering a series of global recommendations for its treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The present study investigates the possible pre- and intraoperative factors associated to LCOS and which can influence its outcome&#46; The complex postoperative course of these patients is examined&#44; and a study is made of the differences among the different clinical diagnostic subgroups &#40;referred to both the association of predisposing factors and evolution and prognosis&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A prospective&#44; multicenter&#44; observational cohort study was made of a group of patients with LCOS in the postoperative period of CS &#40;the ESBAGA Study&#41;&#44; with the purpose of evaluating the postoperative course and prognosis &#40;clinical evolution&#44; presence of complications and mortality&#41; of the patients&#44; and the differences according to the three different LCOS diagnostic subgroups defined by the SEMICYUC Consensus 2012&#46; The pre- and intraoperative factors associated to development of the syndrome were also analyzed&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study was carried out in 14 Intensive Care Units &#40;ICUs&#41; belonging to hospitals throughout Spain&#44; and involved patients admitted to the ICU during the early postoperative period of CS&#44; with a diagnosis of LCOS&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Inclusion criteria&#58; patients with LCOS as defined by the &#8220;Clinical practice guides for the management of low cardiac output syndrome in the postoperative period of cardiac surgery&#8221; of the SEMICYUC<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Postsurgery LCOS&#58; Monitored cardiac index &#60;2&#46;2<span class="elsevierStyleHsp" style=""></span>l&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#44; without associated relative hypovolemia&#44; secondary to left and&#47;or right ventricular failure&#44; and associated or not to pulmonary and&#47;or systemic congestion&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">LCOS consistent clinical condition&#58; This corresponds to patients not monitored and where the cardiac index is not known&#44; though the clinical manifestations are consistent with low cardiac output&#58; oliguria &#40;diuresis &#60;0&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h&#41;&#44; central venous oxygen saturation &#60;60&#37; &#40;with normal arterial oxygen saturation&#41; and&#47;or lactate &#62;3<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; without relative hypovolemia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Cardiogenic shock &#40;CaS&#41;&#58; This is the most serious scenario in LCOS&#44; and is defined as cardiac index &#60;2&#46;0<span class="elsevierStyleHsp" style=""></span>l&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#44; with systolic blood pressure &#60;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; without relative hypovolemia and with oliguria&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Exclusion criteria&#58; patients rejecting participation in the study</span><p id="par0045" class="elsevierStylePara elsevierViewall">The inclusion period was from June 2014 to June 2015&#46; The intensivist selected the patients as they were subjected to surgery&#44; after confirming compliance with the inclusion and exclusion criteria&#44; and using the consecutive sampling technique&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This was a non-interventional study requiring no complementary laboratory or diagnostic tests other than those contemplated per protocol in each center&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Approval of the study was obtained from the Clinical Ethics Research Committee of each participating center&#46; All the patients &#40;or their representatives&#41; signed the consent form for inclusion in the study&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main study variables were&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Demographic and general information&#58; Gender&#44; age&#44; type of intervention&#44; comorbidities and surgical procedure&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Presurgical variables&#58; Previous surgery&#44; functional class &#40;NYHA&#41;&#44; history of cardiovascular risk and EuroSCORE II data&#44; previous coronary angioplasty &#40;PTCA&#41;&#47;stent placement&#44; left ventricular ejection fraction &#40;LVEF&#41;&#44; preoperative critical condition as defined by the EuroSCORE <span class="elsevierStyleSmallCaps">II</span> &#40;fibrillation or ventricular tachycardia or resuscitated sudden cardiac death&#44; perioperative cardiac massage&#44; previous mechanical ventilation&#44; inotropic drugs&#44; preoperative balloon counterpulsation technique&#44; anuria or oliguria &#60;10<span class="elsevierStyleHsp" style=""></span>ml&#47;h&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Intraoperative variables&#58; Characteristics of surgery&#44; aortic clamping time&#44; extracorporeal circuit &#40;ECC&#41; time&#44; difficulty suspending ECC &#40;defined by the need for more than two vasoactive drugs on emerging from ECC&#44; or the need for pump reentry&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Postoperative variables&#58; Mechanical ventilation time to extubation&#44; use of inotropic&#47;vasoactive drugs&#44; presence of cardiac and surgical complications &#40;repeat surgery due to bleeding or tamponade&#44; acute lung edema&#44; perioperative acute myocardial infarction &#91;AMI&#93;&#44; maximum ultrasensitive troponin T levels&#44; arrhythmias&#41;&#44; renal complications &#40;acute renal dysfunction&#44; need for renal replacement therapy&#41;&#44; neurological&#44; respiratory&#44; infectious and gastrointestinal complications&#44; laboratory test results &#40;maximum lactate&#44; alanine aminotransferase&#41;&#44; multiorgan failure &#40;MOF&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Global evolutive parameters&#58; Stay in ICU and outcome &#40;alive&#47;deceased&#41;&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">The tables and figures were generated from the number of valid cases &#40;n&#41;&#44; and this was the number considered for the calculation of percentages or other statistical applications&#46; Continuous variables were reported as the number of valid cases&#44; the mean and standard deviation&#44; and the maximum and minimum values&#44; while categorical variables were reported as the number of valid cases and the percentage of each category&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Continuous variables were reported as the mean and standard deviation&#44; or as the median and interquartile range &#40;IQR&#41;&#44; and analysis of variance &#40;ANOVA&#41; or the Kruskal&#8211;Wallis test was used for comparison purposes&#44; depending on the nature of the variables &#40;as established by the Kolmogorov&#8211;Smirnov test&#41;&#46; Categorical variables were reported as absolute values and percentages&#44; and the chi-squared test or Fisher exact test was used for comparisons between groups&#44; as applicable&#46; The SPSS version 19&#46;0 statistical package for MS Windows was used throughout&#46; Statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 14 Intensive Care Units belonging to hospitals throughout Spain participated in the ESBAGA study &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; We analyzed a total of 2070 patients subjected to CS&#44; of which 155 presented LCOS in the immediate postoperative period &#40;7&#46;5&#37;&#41;&#46; Eighteen of these subjects declined participation in the study&#59; 137 patients were therefore finally evaluated&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the flowchart of these patients&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The general patient characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Myocardial revascularization&#44; either isolatedly or accompanied by valve treatment&#44; were the most frequent operations&#46; With regard to the most relevant patient antecedents &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#41;&#44; mention must be made of the high percentage of patients presenting serious clinical disease before surgery&#44; with NYHA functional class III and IV&#44; preoperative critical conditions&#44; the need for vasoactive drugs&#44; or ventricular dysfunction with LVEF &#60;35&#37;&#46; Many patients had suffered prior AMI &#40;22 cases in the 90 days preceding surgery&#41;&#44; percutaneous coronary intervention &#40;PTCA&#47;stent&#41;&#44; previous CS&#44; or moderate to severe pulmonary hypertension&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">As intraoperative factors associated to LCOS&#44; we found that 70&#46;1&#37; of the patients required two or more vasoactive drugs on emerging from ECC&#46; Pump reentry to secure definitive suspension of ECC proved necessary in 22 patients &#40;16&#37;&#41;&#46; The mean ECC time was 147<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>min&#44; and the mean aortic clamping time was 105<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>43<span class="elsevierStyleHsp" style=""></span>min&#46; Prolonged surgical times&#44; with ECC &#62;120<span class="elsevierStyleHsp" style=""></span>min&#44; were recorded in 62&#46;5&#37; of the patients&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The above factors were compared among the different LCOS clinical diagnostic subgroups&#46; In this regard&#44; 46 patients met hemodynamic criteria of LCOS &#40;group A&#41;&#44; 50 complied with the clinical criteria &#40;group B&#41;&#44; and the rest &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41; were diagnosed with cardiogenic shock &#40;group C&#41;&#46; No significant differences between groups were observed for most of the factors&#46; However&#44; differences were recorded in those patients with a more serious prior condition&#44; such as the presence of resting angina&#44; presurgical critical condition&#44; NYHA functional class III and IV&#44; the need for emergency surgery&#44; and a high risk EuroSCORE II profile&#46; The percentage of patients with prolonged surgical times &#40;ECC &#62;2<span class="elsevierStyleHsp" style=""></span>h&#41; was greater among those with cardiogenic shock &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46; Likewise&#44; the need for ECC reentry was more frequent in the cardiogenic shock patients &#40;26&#46;8&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the distribution of the patients according to diagnostic group and the pre- and intraoperative variables&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Overall&#44; the postoperative evolution of these patients was complicated&#44; with important morbidity&#8211;mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">We examined whether the three clinical scenarios of LCOS proposed in the diagnostic definition of the consensus document<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> could imply different clinical courses and prognoses&#46; No statistically significant differences were observed between the subgroups regarding the number of patients requiring repeat surgery &#40;due to bleeding or tamponade&#41; or the incidence of arrhythmias or infectious&#44; neurological&#44; respiratory or gastrointestinal complications&#46; It should be mentioned that although statistical significance was not reached&#44; trends were observed&#44; with inter-group differences &#40;LCOS&#44; LCOS consistent clinical condition and cardiogenic shock&#41; in the rates corresponding to perioperative AMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;48&#41;&#44; acute lung edema &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;80&#41; and acute renal impairment &#40;AKI stage 3&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;21&#41;&#46; Significant differences were recorded in the duration of mechanical ventilation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; in the percentage of patients requiring renal replacement therapy &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#44; in the proportion of patients who developed MOF over time &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and therefore also in percentage mortality &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Of note is the fact that the patients who developed MOF &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41; were more numerous in the cardiogenic shock group &#40;19 versus 7 in the LCOS group and 6 in the clinical diagnostic group&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> graphically displays the differences in postoperative complications among the three diagnostic groups&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The analysis of the myocardial damage markers such as ultrasensitive troponin T and I likewise revealed no statistically significant differences&#46; In contrast&#44; the mean maximum lactate concentration &#40;as a perfusion marker&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; and alanine aminotransferase levels were significantly higher in the patients with cardiogenic shock &#40;51&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49 versus 22&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21 in group A and 33&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36 in group B &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#93;&#44; referred to lactate&#44; and 679&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1040 versus 215<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>769 in group A and 167<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>358 in group B &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#93;&#44; referred to alanine aminotransferase&#41;&#46; Lactate concentration reached statistical significance at all measurement timepoints &#40;admission&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; 4<span class="elsevierStyleHsp" style=""></span>h&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#59; 12<span class="elsevierStyleHsp" style=""></span>h&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#59; 24<span class="elsevierStyleHsp" style=""></span>h&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; 48<span class="elsevierStyleHsp" style=""></span>h&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#59; discharge&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The analysis of the above data confirms the existence of increased patient severity&#44; a greater percentage of complications&#44; and a poorer prognosis among the patients with cardiogenic shock&#46; It also must be noted that the evolution of the patients in the clinical diagnostic group was similar to that seen in the patients diagnosed through invasive monitoring&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Despite the many patients subjected to CS and the relative incidence of postsurgery LCOS&#44; few studies involving large patient samples have characterized this clinical form of AHF&#46; The published studies analyze concrete aspects&#44; and none have examined the clinical course according to the different clinical diagnostic subgroups&#46; Our prospective multicenter study has analyzed patients with LCOS&#44; differentiating three subgroups with evolutive and prognostic differences&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The literature describes a range of pre- and intraoperative factors related to LCOS&#46; The study of Rao et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> involving patients in the postoperative period of myocardial revascularization surgery&#44; identified LVEF &#60;20&#37;&#44; repeat surgery&#44; the female gender&#44; diabetes&#44; age &#62;70 years&#44; left coronary trunk stenosis&#44; recent AMI and triple vessel disease as independent predictors of the syndrome&#46; Algarni et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> in patients subjected to revascularization&#44; identified repeat revascularization&#44; surgery in the previous year&#44; depressed LVEF &#40;&#60;40&#37;&#41;&#44; emergency surgery&#44; cardiogenic shock and the female gender as predictive factors&#46; These authors reported a decrease in the prevalence of LCOS over time&#46; Ding et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> analyzed 205 patients with LCOS and found advanced age&#44; depressed LVEF&#44; surgery with ECC&#44; emergency surgery and incomplete revascularization to be the factors associated to LCOS&#46; The authors also described increased morbidity&#8211;mortality in these individuals&#46; Very similar predictive factors were documented by Sa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> in 89 patients with LCOS &#40;14&#46;7&#37; coming from revascularization surgery&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Low cardiac output has also been related to the myocardial protection measures adopted during the surgical procedure&#46; In this regard&#44; Algarni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> found the prevalence of LCOS to be significantly lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the group of patients revascularized using microplegia &#40;2&#46;7&#37;&#41; than in the group in which standard blood cardioplegia was used &#40;5&#37;&#41;&#46; In a study of patients subjected to revascularization in which comparisons were made of the incidence of LCOS using cold &#40;7<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; blood cardioplegia versus warm &#40;29<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; cardioplegy&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> the authors found the incidence of the syndrome to be greater in the latter group&#46; Likosky et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a> in a group of patients subjected to elective revascularization with ECC&#44; examined the degree to which the surgeon and surgical practices influence the incidence of LCOS&#46; The authors found the low cardiac output rates to vary among surgeons&#44; and these variations could not be explained only on the basis of the case mix&#46; This suggested that variability in perioperative practices &#40;surgical times&#44; cardioplegia&#44; etc&#46;&#41; influences the risk of LCOS&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In a group of patients subjected to isolated mitral valve surgery&#44; Maganti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> identified the urgency of the operation&#44; surgery in the previous year&#44; LVEF &#60;40&#37;&#44; NYHA functional class IV&#44; ischemic mitral valve disease and clamping time as predictive factors&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In general&#44; the published reviews<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> contemplate the abovementioned pre- and intraoperative predictors&#46; In our study&#44; the analysis of the factors associated to the development of LCOS yielded results consistent with those found in the literature&#46; Of note in our series is the observed association to pre- and also intraoperative clinical severity factors&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Knowing the risk factors for LCOS implies the need to identify high risk patients for the adoption of possible preventive measures&#46; In this regard&#44; preconditioning strategies are already being adopted in patients with ventricular dysfunction&#46; The first experiences with the preoperative administration of levosimendan in selected patients have been encouraging&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">15&#44;16</span></a> Trials are underway that will provide definitive results on the use of this drug in patient preconditioning&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> Recently&#44; the LEVO-CTS trial has shown that levosimendan&#44; used on a presurgical prophylactic basis in patients with LVEF &#8804;35&#37; subjected to CS&#44; does not result in a decrease in the combined target of diminished mortality&#44; need for renal replacement therapy&#44; perioperative AMI or the need for mechanical assist measures&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> On the other hand&#44; cardioplegia and the different myocardial protection measures adopted during CS can modify the possible development of ventricular myocardial involvement due to ischemia&#47;reperfusion or secondary myocardial stunning&#44; and therefore the incidence of LCOS&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19&#8211;23</span></a> In this way&#44; patients at greater risk of suffering LCOS could be amenable to guided studies&#44; with the adoption of specific cardioprotection measures&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">On the other hand&#44; the LCOS consensus document of the SEMICYUC 2012<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> distinguishes three clinical groups of LCOS&#46; We sought to determine whether these three clinical scenarios proposed in the diagnostic definition of the document are associated to differences in clinical outcome&#46; Comparisons were made of the diagnostic groups&#58; &#40;A&#41; LCOS&#58; &#8220;classical&#8221; definition with direct measurement of the cardiac index&#59; &#40;B&#41; &#8220;consistent clinical condition&#8221; not based on invasive monitoring data&#59; and &#40;C&#41; cardiogenic shock&#46; In addition to the classical definitions of postoperative LCOS and cardiogenic shock&#44; this classification includes a consistent clinical condition group not contemplated in other definitions&#46; These three subgroups were compared in order to determine possible differences in terms of clinical evolution&#44; complications and postoperative mortality&#46; The results are shown in <a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#46; As has been commented under Results&#44; differences between the subgroups were observed in the incidence of perioperative AMI&#44; acute lung edema and acute renal functional impairment on the basis of percentage AKI stage 3 &#8211; though statistical significance was not reached&#44; probably because of the limited number of patients involved&#46; In contrast&#44; statistically significant differences were recorded in the duration of mechanical ventilation&#44; the need for renal replacement measures&#44; the development of MOF and patient mortality&#46; In this respect&#44; the prognosis was clearly poorer among the patients with cardiogenic shock&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Two relevant findings were made in our study&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">1&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">The need to recognize the importance in routine practice of the &#8220;consistent clinical condition&#8221; diagnostic group&#46; The assessment of clinical data such as oliguria and hypoperfusion&#44; and of laboratory test data available in all centers &#40;even on a point of care basis&#41;&#44; such as lactate concentration and central venous oxygen saturation&#44; allows the detection of low cardiac output in these patients&#46; In this respect&#44; advanced invasive monitoring &#40;using a pulmonary artery catheter or transpulmonary thermodilution&#41; might not be strictly necessary in all patients in order to diagnose and treat LCOS&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> In our study this &#8220;clinical&#8221; group showed a postoperative course characterized by a clear increase in morbidity&#8211;mortality very similar to that observed in the group of patients diagnosed on the basis of hemodynamic monitoring&#46; Consequently&#44; in terms of practical clinical management&#44; we always must observe a high level of suspicion in order to start early and adequate treatment in this subgroup of patients &#40;similar to that of the subgroup diagnosed through invasive monitoring&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">2&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">The clearly poorer clinical course and prognosis in the cardiogenic shock group versus the other two groups&#46; Cardiogenic shock implies increased severity&#44; with a poorer postoperative course&#44; a greater incidence of MOF&#44; and higher mortality&#46; In patients that suffer shock&#44; it must be considered that transesophageal echocardiography reveals right ventricular dysfunction in about 40&#37; of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> This situation can imply changes in the management approach&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">26&#44;27</span></a></p></li></ul></p><p id="par0190" class="elsevierStylePara elsevierViewall">In any case&#44; LCOS is associated to important morbidity&#8211;mortality and postoperative complications &#40;as reflected in the corresponding tables and figures&#41;&#46; In our series&#44; mortality was similar to that described in the literature&#44; with significant differences depending on the mentioned diagnostic subgroups&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Limitations</span><p id="par0195" class="elsevierStylePara elsevierViewall">Although our series involves a considerable number of patients&#44; the sample is nevertheless limited and lacks a comparator control group&#46; Furthermore&#44; although over two-thirds of the participating Units claimed to follow the management algorithms of the consensus document&#44; there were probably differences in patient treatment among the different centers&#46; There consequently may have been a certain lack of homogeneity&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusions</span><p id="par0200" class="elsevierStylePara elsevierViewall">The clinical evolution of patients with LCOS is complex&#44; with important morbidity&#8211;mortality&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">It is important to know the pre- and intraoperative factors that can lead to LCOS&#44; with the aim of defining possible preventive strategies&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In our series&#44; differences were found in the postsurgery clinical evolution parameters and in mortality among the different LCOS diagnostic subgroups&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Larger patient samples are required in order to confirm the results obtained&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Authorship</span><p id="par0220" class="elsevierStylePara elsevierViewall">All the signing authors have made substantial contributions to study conception and design&#44; data acquisition&#44; and analysis and interpretation of the results&#46; Likewise&#44; they have participated in drafting of the manuscript or in critical review of its content&#44; and have approved the final version of the article&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">As applicable in the case of a working group&#44; the rest of the participating or collaborating authors reflected in the table &#40;ESBAGA study&#41; and listed at the end of the document have participated in data acquisition&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Collaborators such as Dr&#46; Ana Ochagav&#237;a-Calvo&#44; Dr&#46; Rafael Hinojosa-P&#233;rez&#44; Dr&#46; Juan Jos&#233; Mar&#237;n-Salazar&#44; Dr&#46; M&#46; Victoria Boado-Varela and Dr&#46; Jos&#233; Luis Romero-Luj&#225;n contributed no patients&#44; but participated in the conception and design of the study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An analysis is made of the clinical profile&#44; evolution and differences in morbidity and mortality of low cardiac output syndrome &#40;LCOS&#41; in the postoperative period of cardiac surgery&#44; according to the three diagnostic subgroups defined by the SEMICYUC Consensus 2012&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multicenter&#44; prospective cohort study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Units of Spanish hospitals with cardiac surgery&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A consecutive sample of 2070 cardiac surgery patients was included&#44; with the analysis of 137 patients presenting LCOS&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">No&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The mean patient age was 68&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;3 years &#40;65&#46;2&#37; males&#41;&#44; with a EuroSCORE II of 9&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46; NYHA functional class III and IV &#40;52&#46;9&#37;&#41;&#44; left ventricular ejection fraction &#60;35&#37; &#40;33&#46;6&#37;&#41;&#44; acute myocardial infarction &#40;31&#46;9&#37;&#41;&#44; severe pulmonary hypertension &#40;21&#46;7&#37;&#41;&#44; critical preoperative condition &#40;18&#46;8&#37;&#41;&#44; prior cardiac surgery &#40;18&#46;1&#37;&#41;&#44; PTCA&#47;stent placement &#40;16&#46;7&#37;&#41;&#46; According to subgroups&#44; 46 patients fulfilled hemodynamic criteria of LCOS &#40;group A&#41;&#44; 50 clinical criteria of LCOS &#40;group B&#41;&#44; and the rest &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41; presented cardiogenic shock &#40;group C&#41;&#46; Significant differences were observed over the evolutive course between the subgroups in terms of time subjected to mechanical ventilation &#40;114&#46;4&#44; 135&#46;4 and 180&#46;3<span class="elsevierStyleHsp" style=""></span>min in groups A&#44; B and C&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; renal replacement requirements &#40;11&#46;4&#37;&#44; 14&#46;6&#37; and 36&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#44; multiorgan failure &#40;16&#46;7&#37;&#44; 13&#37; and 47&#46;5&#37;&#41;&#44; and mortality &#40;13&#46;6&#37;&#44; 12&#46;5&#37; and 35&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; The mean maximum lactate concentration was higher in cardiogenic shock patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The clinical evolution of these patients leads to high morbidity and mortality&#46; Differences were found between the subgroups in terms of postoperative clinical course and mortality&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis del perfil cl&#237;nico&#44; la evoluci&#243;n y las diferencias en morbimortalidad en el s&#237;ndrome de bajo gasto cardiaco &#40;SBGC&#41; en el postoperatorio de cirug&#237;a cardiaca&#44; seg&#250;n los 3 subgrupos de diagn&#243;stico definidos en el Consenso SEMICYUC 2012&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo multic&#233;ntrico&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">&#193;mbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">UCI de hospitales espa&#241;oles con cirug&#237;a cardiaca&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Pacientes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Muestra consecutiva de 2&#46;070 pacientes intervenidos de cirug&#237;a cardiaca&#46; An&#225;lisis de 137 pacientes con SBGC&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Intervenciones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">No se realiza intervenci&#243;n&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Edad 68&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3 a&#241;os&#44; 65&#44;2&#37; varones&#44; con un EuroSCORE II de 9&#44;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46; Los antecedentes a destacar fueron&#58; NYHA III-IV &#40;52&#44;9&#37;&#41;&#44; FEVI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35&#37; &#40;33&#44;6&#37;&#41;&#44; IAM &#40;31&#44;9&#37;&#41;&#44; HTP severa &#40;21&#44;7&#37;&#41;&#44; estado cr&#237;tico preoperatorio &#40;18&#44;8&#37;&#41;&#44; cirug&#237;a cardiaca previa &#40;18&#44;1&#37;&#41; y ACTP&#47;<span class="elsevierStyleItalic">stent</span> &#40;16&#44;7&#37;&#41;&#46; Seg&#250;n subgrupos&#44; 46 pacientes cumpl&#237;an criterios hemodin&#225;micos de SBGC &#40;grupo A&#41;&#44; 50 criterios cl&#237;nicos &#40;grupo B&#41; y el resto &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41; fueron shock cardiog&#233;nico &#40;grupo C&#41;&#46; En la evoluci&#243;n&#44; se encontraron diferencias significativas entre los subgrupos en el tiempo de ventilaci&#243;n mec&#225;nica &#40;114&#44;4&#44; 135&#44;4 y 180&#44;3<span class="elsevierStyleHsp" style=""></span>min&#44; para A&#44; B y C&#44; respectivamente&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; la necesidad de reemplazo renal &#40;11&#44;4&#44; 14&#44;6 y 36&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#44; el fracaso multiorg&#225;nico &#40;16&#44;7&#44; 13 y 47&#44;5&#37;&#41; y la mortalidad &#40;13&#44;6&#44; 12&#44;5 y 35&#44;9&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; La media de lactato m&#225;ximo fue mayor en los pacientes con shock cardiog&#233;nico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La evoluci&#243;n cl&#237;nica de estos pacientes con SBGC conlleva una elevada morbimortalidad&#46; Encontramos diferencias entre los subgrupos en el curso cl&#237;nico postoperatorio y la mortalidad&#46;</p></span>"
        "secciones" => array:7 [
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            "titulo" => "Objetivos"
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            "identificador" => "abst0050"
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          3 => array:2 [
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            "titulo" => "Intervenciones"
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            "titulo" => "Conclusiones"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The members of Grupo ESBAGA are listed in the <a class="elsevierStyleCrossRef" href="#sec0060">Annex</a>&#46;</p>"
        "identificador" => "fn0005"
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      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez Vela JL&#44; Jim&#233;nez Rivera JJ&#44; Alcal&#225; Llorente M&#193;&#44; Gonz&#225;lez de Marcos B&#44; Torrado H&#44; Garc&#237;a Laborda C&#44; et al&#46; S&#237;ndrome de bajo gasto cardiaco en el postoperatorio de cirug&#237;a cardiaca&#46; Perfil&#44; diferencias en evoluci&#243;n cl&#237;nica y pron&#243;stico&#46; Estudio ESBAGA&#46; Med Intensiva&#46; 2018&#59;42&#58;159&#8211;167&#46;</p>"
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            "apendice" => "<p id="par0240" class="elsevierStylePara elsevierViewall">Authors&#58;</p> <p id="par0245" class="elsevierStylePara elsevierViewall">Dr&#46; Jos&#233; Luis P&#233;rez-Vela &#40;Hospital Universitario Doce de Octubre&#44; Madrid&#41;&#44; Dr&#46; Juan Jos&#233; Jim&#233;nez-Rivera &#40;Complejo Hospitalario Universitario de Canarias&#44; Tenerife&#41;&#44; Dr&#46; Miguel &#193;ngel Alcal&#225;-Llorente &#40;Fundaci&#243;n Jim&#233;nez D&#237;az&#44; Madrid&#41;&#44; Dr&#46; Bego&#241;a Gonz&#225;lez de Marcos &#40;Hospital Universitario de La Princesa&#44; Madrid&#41;&#44; Dr&#46; Herminia Torrado &#40;Hospital Universitario de Bellvitge&#44; Barcelona&#41;&#44; Dr&#46; Francisco Javier Gonz&#225;lez-Fern&#225;ndez &#40;Hospital Universitario Virgen Macarena&#44; Seville&#41;&#44; Dr&#46; Cristina Garc&#237;a-Laborda &#40;Hospital Universitario Miguel Servet&#44; Zaragoza&#41;&#44; Dr&#46; M&#46; Dolores Fern&#225;ndez-Zamora &#40;Hospital Universitario Carlos Haya&#44; M&#225;laga&#41;&#44; Dr&#46; Juan Carlos Mart&#237;n-Ben&#237;tez &#40;Hospital Cl&#237;nico Universitario San Carlos&#44; Madrid&#41;&#46;</p> <p id="par0250" class="elsevierStylePara elsevierViewall">Collaborators&#44; according to hospitals&#58;</p> <p id="par0255" class="elsevierStylePara elsevierViewall">Hospital de Sabadell&#58; Dr&#46; Ana Ochagav&#237;a-Calvo&#46; Hospital Universitario Virgen del Roc&#237;o&#44; Seville&#58; Dr&#46; Rafael Hinojosa-P&#233;rez&#46; Complejo Hospitalario Universitario de A Coru&#241;a&#58; Dr&#46; Salvador Foj&#243;n-Polanco&#44; Dr&#46; Leticia Seoane-Quiroga&#44; Dr&#46; Miguel A&#46; Solla-Buceta&#44; Dr&#46; M&#46; Luisa Martinez-Rodriguez&#44; Dr&#46; M&#46; Teresa Bouza-Vieiro&#44; Dr&#46; Alexandra Ceniceros-Barros&#46; Hospital Universitario Marqu&#233;s de Valdecilla&#44; Santander&#58; Dr&#46; Miguel F&#46; Llano-Cardenal&#44; Dr&#46; Virginia Burgos-Palacios&#44; Dr&#46; Manuel Cobo-Belaustegui&#44; Dr&#46; Angela Canteli-Alvarez&#44; Dr&#46; Cristina Castrillo-Bustamante&#46; Hospital Universitario Virgen de la Arrixaca&#44; Murcia&#58; Dr&#46; Rub&#233;n Jara-Rubio&#44; Dr&#46; David Bixquert-Genov&#233;s&#44; Dr&#46; Carlos Albacete-Moreno&#46; Hospital Universitario del Vinalop&#243;&#44; Alicante&#58; Dr&#46; Rafael Carrasco-Moreno&#44; Dr&#46; Teresa Arce-Arias&#46; Hospital Universitario Doce de Octubre&#44; Madrid&#58; Dr&#46; Silvia Chac&#243;n-Alves&#44; Dr&#46; Emilio Renes-Carre&#241;o&#44; Dr&#46; Teodoro Grau-Carmona&#46; Complejo Hospitalario Universitario de Canarias&#44; Tenerife&#58; Dr&#46; Jos&#233; Luis Iribarren-Sarrias&#44; Dr&#46; M&#46; Teresa Brouard-Mart&#237;n&#44; Dr&#46; Samantha Huidobro&#44; Dr&#46; Javier M&#225;laga-Gil&#44; Dr&#46; Carolina Garcia-Martin&#44; Dr&#46; Ramon Galvan&#46; Fundaci&#243;n Jim&#233;nez D&#237;az&#44; Madrid&#58; Dr&#46; Anxela Vidal-Gonz&#225;lez&#44; Dr&#46; C&#233;sar P&#233;rez-Calvo&#44; Dr&#46; Renzo Portilla&#46; Hospital Universitario de Bellvitge&#44; Barcelona&#58; Dr&#46; Alain Pinseau-Castillo&#44; Dr&#46; Neus L&#243;pez-Su&#241;&#233;&#44; Dr&#46; Vicente Corral-V&#233;lez&#44; Dr&#46; Nelson Betancur-Zambrano&#44; Dr&#46; Gabriel Moreno-Gonz&#225;lez&#44; Dr&#46; Elisabeth Periche-Pedra&#46; Hospital Universitario Virgen Macarena&#44; Seville&#58; Dr&#46; Sonia Ib&#225;&#241;ez-Cuadros&#44; Dr&#46; Francisco Vela-N&#250;&#241;ez&#44; Dr&#46; Cristina L&#243;pez Mart&#237;n&#46; Hospital Universitario Miguel Servet&#44; Zaragoza&#58; Dr&#46; Pablo Gutierrez-Iba&#241;es&#46; Hospital Universitario de La Princesa&#44; Madrid&#58; Dr&#46; Irene Garcia-Rico&#44; Dr&#46; Ricardo Andino-Ruiz&#44; Dr&#46; Judit Iglesias-Franco&#44; Dr&#46; Esther D&#237;az-Rodriguez&#44; Dr&#46; Nuria Arevalillo-Fern&#225;ndez&#44; Dr&#46; M&#46; Jos&#233; P&#233;rez-San Jos&#233;&#44; Dr&#46; Ana Guti&#233;rrez-Garc&#237;a&#46; Hospital Universitario Carlos Haya&#44; M&#225;laga&#58; Dr&#46; Teresa Garc&#237;a-Paredes&#46; Complejo Asistencial Universitario de Salamanca&#58; Dr&#46; Juan Jos&#233; Mar&#237;n-Salazar&#46; Hospital de Cruces&#44; Barakaldo &#40;Vizcaya&#41;&#58; Dr&#46; M&#46; Victoria Boado-Varela&#46; Hospital Dr&#46; Negr&#237;n&#44; Las Palmas&#58; Dr&#46; Jos&#233; Luis Romero-Luj&#225;n&#46; Hospital General Universitario de Valencia&#58; Dr&#46; Juan Carlos Val&#237;a&#44; Dr&#46; Javier Hern&#225;ndez-Laforet&#46;</p>"
            "etiqueta" => "Annex"
            "titulo" => "List of authors and collaborators"
            "identificador" => "sec0060"
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                  \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">Participating centers&#58; 14&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">Patients&#58; 137<br>n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az&#44; Madrid&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Universitario Doce de Octubre&#44; Madrid&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;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Universitario Virgen de la Macarena&#44; Sevilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Universitario de Bellvitge&#44; Barcelona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Universitario Miguel Servet&#44; Zaragoza&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;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;2&#47;34&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">68&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;33</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EuroSCORE II&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">9&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="7" align="left" valign="top">Comorbidities and risk factors&#44; &#37;</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe pulmonary hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Active endocarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Type of surgery</td><td class="td" title="table-entry  " align="left" valign="top">Elective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urgent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="7" align="left" valign="top">Surgical procedures&#44; &#37;</td><td class="td" title="table-entry  " align="left" valign="top">Myocardial revascularization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Myocardial revascularization<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>valve surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aortic valve surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral valve surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral and aortic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mitral and tricuspid surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;2&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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LCOS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#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">LCOS consistent clinical condition &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#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">Cardiogenic shock &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#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">Total&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>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female gender&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;32&#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">17 &#40;34&#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;36&#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">47 &#40;34&#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">0&#46;925&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male gender&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;67&#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">33 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;63&#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">90 &#40;65&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean age in years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;26&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;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EuroSCORE II&#44; mean&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;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;70&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;63&#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">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;42&#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;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;33&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoker&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;27&#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;26&#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">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;12&#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;12&#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;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recent ischemic damage &#40;3 months&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;22&#41;&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;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#40;24&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous myocardial infarction&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;26&#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;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resting angina &#40;CCS class 4&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#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">3 &#40;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">7 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous PTCA&#47;stent&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;15&#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;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">9 &#40;22&#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;16&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Depressed LVEF &#40;&#60;35&#37;&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;32&#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;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;33&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Presurgical NYHA III and IV&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71 &#40;52&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative critical condition&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;13&#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;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">13 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valve disease with previous moderate-severe pulmonary hypertension&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;33&#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;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;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">44 &#40;33&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous cardiac surgery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#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">11 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;17&#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">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Active endocarditis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#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">6 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;7&#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">11 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency surgery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#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">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">7 &#40;17&#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;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>120<span class="elsevierStyleHsp" style=""></span>min&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;62&#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">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECC reentry&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#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">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time to extubation &#40;h&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;140&#8211;217&#41;&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">17&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multiorgan failure&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICU stay &#40;days&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;12&#46;8&#8211;15&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;7&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0015"
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              "identificador" => "bib0140"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of low cardiac output syndrome after coronary artery bypass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Rao"
                            1 => "J&#46; Ivanov"
                            2 => "R&#46;D&#46; Weisel"
                            3 => "J&#46;S&#46; Ikonomidis"
                            4 => "G&#46;T&#46; Christakis"
                            5 => "T&#46;E&#46; David"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1996"
                        "volumen" => "112"
                        "paginaInicial" => "38"
                        "paginaFinal" => "51"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8691884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0145"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complicaciones hemodin&#225;micas de la cirug&#237;a cardiaca"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Alvarez Escudero"
                            1 => "M&#46; Taboada Mu&#241;iz"
                            2 => "M&#46;J&#46; Rodriguez Forja"
                            3 => "M&#46; Rey Jorge"
                            4 => "B&#46; Ulloa Iglesias"
                            5 => "V&#46; Ginesta Gal&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Riesgo y complicaciones en Cirug&#237;a Cardiaca"
                        "paginaInicial" => "205"
                        "paginaFinal" => "209"
                        "serieFecha" => "2004"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0150"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presentation and outcome of critically ill medical and cardiac-surgery patients with acute heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Rudiger"
                            1 => "F&#46; Businger"
                            2 => "M&#46; Streit"
                            3 => "E&#46;R&#46; Schmid"
                            4 => "M&#46; Maggiorini"
                            5 => "F&#46; Follath"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "smw-12446"
                      "Revista" => array:7 [
                        "tituloSerie" => "Swiss Med Wkly"
                        "fecha" => "2009"
                        "volumen" => "139"
                        "paginaInicial" => "110"
                        "paginaFinal" => "116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19234879"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0025619614008337"
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                          "issn" => "00256196"
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immediate postoperative care of cardiac surgical patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;L&#46; Higgins"
                            1 => "J&#46;P&#46; Yared"
                            2 => "T&#46; Ryan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiothorac Vasc Anesth"
                        "fecha" => "1996"
                        "volumen" => "10"
                        "paginaInicial" => "643"
                        "paginaFinal" => "658"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8841875"
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            4 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practical recommendations on the management of perioperative heart failure in cardiac surgery"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mebazaa"
                            1 => "A&#46;A&#46; Pitsis"
                            2 => "A&#46; Rudiger"
                            3 => "W&#46; Toller"
                            4 => "D&#46; Longrois"
                            5 => "S&#46;E&#46; Ricksten"
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                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc8153"
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                        "tituloSerie" => "Crit Care"
                        "fecha" => "2010"
                        "volumen" => "14"
                        "paginaInicial" => "201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20497611"
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            5 => array:3 [
              "identificador" => "bib0165"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery&#93; Spanish"
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                        0 => array:3 [
                          "colaboracion" => "Grupo de Trabajo de Cuidados Intensivos Cardiol&#243;gicos y RCP de SEMICYUC"
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                          "autores" => array:6 [
                            0 => "J&#46;L&#46; P&#233;rez Vela"
                            1 => "J&#46;C&#46; Mart&#237;n Ben&#237;tez"
                            2 => "M&#46; Carrasco Gonz&#225;lez"
                            3 => "M&#46;A&#46; de la Cal L&#243;pez"
                            4 => "R&#46; Hinojosa P&#233;rez"
                            5 => "V&#46; Sagredo Meneses"
                          ]
                        ]
                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2012.02.007"
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                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2012"
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                    0 => array:2 [
                      "titulo" => "Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery&#58; trends over 20 years"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;D&#46; Algarni"
                            1 => "M&#46; Maganti"
                            2 => "T&#46;M&#46; Yau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2011.06.017"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2011"
                        "volumen" => "92"
                        "paginaInicial" => "1678"
                        "paginaFinal" => "1684"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21939957"
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                          "issn" => "15908658"
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              "identificador" => "bib0175"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Predictors of low cardiac output syndrome after isolated coronary artery bypass grafting"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46; Ding"
                            1 => "Q&#46; Ji"
                            2 => "Y&#46; Shi"
                            3 => "R&#46; Ma"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1536/ihj.14-231"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Heart J"
                        "fecha" => "2015"
                        "volumen" => "56"
                        "paginaInicial" => "144"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25740396"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0180"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;P&#46; S&#225;"
                            1 => "J&#46;R&#46; Nogueira"
                            2 => "P&#46;E&#46; Ferraz"
                            3 => "O&#46;J&#46; Figueiredo"
                            4 => "W&#46;C&#46; Cavalcante"
                            5 => "T&#46;C&#46; Cavalcante"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Cir Cardiovasc"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "217"
                        "paginaFinal" => "223"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22996972"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "etiqueta" => "10"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microplegia during coronary artery bypass grafting was associated with less low cardiac output syndrome&#58; a propensity-matched comparison"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;D&#46; Algarni"
                            1 => "R&#46;D&#46; Weisel"
                            2 => "C&#46;A&#46; Caldarone"
                            3 => "M&#46; Maganti"
                            4 => "K&#46; Tsang"
                            5 => "T&#46;M&#46; Yau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2012.09.056"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2013"
                        "volumen" => "95"
                        "paginaInicial" => "1532"
                        "paginaFinal" => "1538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23608252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0190"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decreased incidence of low output syndrome with a switch from tepid to cold continuous minimally diluted blood cardioplegia in isolated coronary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Rosu"
                            1 => "M&#46; Laflamme"
                            2 => "C&#46; Perrault-H&#233;bert"
                            3 => "M&#46; Carrier"
                            4 => "L&#46;P&#46; Perrault"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivs294"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "15"
                        "paginaInicial" => "655"
                        "paginaFinal" => "660"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22753439"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            11 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variability in surgeon&#39;s perioperative practices may influence the incidence of low output failure after coronary artery bypass grafting surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;S&#46; Likosky"
                            1 => "J&#46;B&#46; Goldberg"
                            2 => "A&#46;W&#46; DiScipio"
                            3 => "R&#46;S&#46; Kramer"
                            4 => "R&#46;C&#46; Groom"
                            5 => "B&#46;J&#46; Leavitt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCOUTCOMES.112.967091"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Qual Outcomes"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "638"
                        "paginaFinal" => "644"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22828825"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0200"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of low cardiac output syndrome after isolated mitral valve surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Maganti"
                            1 => "M&#46; Badiwala"
                            2 => "A&#46; Sheikh"
                            3 => "H&#46; Scully"
                            4 => "C&#46; Feindel"
                            5 => "T&#46;E&#46; David"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2009.11.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2010"
                        "volumen" => "140"
                        "paginaInicial" => "790"
                        "paginaFinal" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20152992"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "S&#237;ndrome de bajo gasto cardiaco postcardiotom&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;E&#46; Reyes-Sanchez"
                            1 => "J&#46;A&#46; Carrillo-Rojas"
                            2 => "M&#46;A&#46; Hernandez-Mercado"
                            3 => "J&#46;A&#46; Amaro-Camacho"
                            4 => "E&#46;H&#46; Herrera-Garza"
                            5 => "D&#46;M&#46; L&#243;pez-Pineda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Cardiol Mex"
                        "fecha" => "2011"
                        "volumen" => "81"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "30"
                        "paginaFinal" => "40"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0210"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Levosimendan pretreatment improves outcomes in patients undergoing coronary artery bypass graft surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Tritapepe"
                            1 => "V&#46; de Santis"
                            2 => "D&#46; Vitale"
                            3 => "F&#46; Guarracino"
                            4 => "F&#46; Pellegrini"
                            5 => "P&#46; Pietropaoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aen367"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2009"
                        "volumen" => "102"
                        "paginaInicial" => "198"
                        "paginaFinal" => "204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19151048"
                            "web" => "Medline"
                          ]
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                        "itemHostRev" => array:3 [
                          "pii" => "S0482500415000236"
                          "estado" => "S300"
                          "issn" => "04825004"
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                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "M&#46; Degrange"
                            2 => "C&#46; del Mazo"
                            3 => "E&#46; Tanus"
                            4 => "R&#46; Porcile"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Exp Clin Cardiol"
                        "fecha" => "2012"
                        "volumen" => "17"
                        "paginaInicial" => "125"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23620700"
                            "web" => "Medline"
                          ]
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                          "pii" => "S154235651630194X"
                          "estado" => "S300"
                          "issn" => "15423565"
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                  ]
                ]
              ]
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              "identificador" => "bib0220"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative and perioperative use of levosimendan in cardiac surgery&#58; European expert opinion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Toller"
                            1 => "M&#46; Heringlake"
                            2 => "F&#46; Guarracino"
                            3 => "L&#46; Algotsson"
                            4 => "J&#46; Alvarez"
                            5 => "H&#46; Argyriadou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2015.02.022"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "184"
                        "paginaInicial" => "323"
                        "paginaFinal" => "336"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25734940"
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                          ]
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                          "pii" => "S0140673613605917"
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                          "issn" => "01406736"
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                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;H&#46; Mehta"
                            1 => "J&#46;D&#46; Leimberger"
                            2 => "S&#46; van Diepen"
                            3 => "J&#46; Meza"
                            4 => "A&#46; Wang"
                            5 => "R&#46;N&#46; Jankowich"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1616218"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2017"
                        "volumen" => "376"
                        "paginaInicial" => "2032"
                        "paginaFinal" => "2042"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28316276"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical evidence for stunned myocardium after coronary artery bypass surgery"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;A&#46; Kloner"
                            1 => "K&#46; Przyklenk"
                            2 => "G&#46;L&#46; Kay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Surg"
                        "fecha" => "1994"
                        "volumen" => "9"
                        "paginaInicial" => "397"
                        "paginaFinal" => "402"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8069026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cellular and molecular therapeutics targets for treatment of contractile dysfunction after cardioplegic arrest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46;G&#46; Spinale"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1999"
                        "volumen" => "68"
                        "paginaInicial" => "1934"
                        "paginaFinal" => "1941"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10585107"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0240"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardioplegia and cardiac surgery&#58; pharmacological arrest and cardioprotection during global ischemia and reperfusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;J&#46; Chambers"
                            1 => "H&#46;B&#46; Fallouh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pharmthera.2010.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pharmacol Ther"
                        "fecha" => "2010"
                        "volumen" => "127"
                        "paginaInicial" => "41"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20398698"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myocardial protection in heart surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;M&#46; Mentzer"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1074248411410318"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiovasc Pharmacol Ther"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "290"
                        "paginaFinal" => "297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21821531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardioprotection during cardiac surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;J&#46; Hausenloy"
                            1 => "E&#46; Boston-Griffiths"
                            2 => "D&#46;M&#46; Yellon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cvr/cvs131"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiovasc Res"
                        "fecha" => "2012"
                        "volumen" => "94"
                        "paginaInicial" => "253"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22440888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pharmacologic support for postoperative low cardiac output"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46;J&#46; DiSesa"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Thorac Cardiovasc Surg"
                        "fecha" => "1991"
                        "volumen" => "3"
                        "paginaInicial" => "13"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2015312"
                            "web" => "Medline"
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                      "titulo" => "Right ventricular dysfunction in low output syndrome after cardiac operations&#58; assessment by transesophageal echocardiography"
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                          "etal" => false
                          "autores" => array:4 [
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                            3 => "B&#46; Barzilai"
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                      ]
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                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1995"
                        "volumen" => "60"
                        "paginaInicial" => "1081"
                        "paginaFinal" => "1086"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7574953"
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "1995"
                        "paginaFinal" => "2014"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26136101"
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                    0 => array:2 [
                      "titulo" => "Contemporay management of acute right ventricular failure&#58; a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology"
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                        0 => array:2 [
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                            3 => "D&#46; Bettex"
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                        "tituloSerie" => "Eur J Heart Fail"
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                        "paginaInicial" => "226"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [
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