Statistics

 array:24 [
  "pii" => "S1579212915001512"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2015.05.014"
  "estado" => "S300"
  "fechaPublicacion" => "2015-10-01"
  "aid" => "1095"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Arch Bronconeumol. 2015;51:502-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2887
    "formatos" => array:3 [
      "EPUB" => 149
      "HTML" => 2067
      "PDF" => 671
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S030028961400461X"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2014.11.012"
      "estado" => "S300"
      "fechaPublicacion" => "2015-10-01"
      "aid" => "1095"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Arch Bronconeumol. 2015;51:502-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 10441
        "formatos" => array:3 [
          "EPUB" => 136
          "HTML" => 8939
          "PDF" => 1366
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Tromboendarterectom&#237;a pulmonar en 106 pacientes con hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "502"
            "paginaFinal" => "508"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Pulmonary Thromboendarterectomy in 106 Patients With Chronic Thromboembolic Pulmonary Hypertension"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 1338
                "Ancho" => 1658
                "Tamanyo" => 101234
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Curvas de supervivencia de los pacientes con hipertensi&#243;n pulmonar residual y sin hipertensi&#243;n pulmonar residual&#44; excluida la mortalidad hospitalaria&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Mar&#237;a Jes&#250;s L&#243;pez Gude, Enrique P&#233;rez de la Sota, Alberto Forteza Gil, Jorge Centeno Rodr&#237;guez, Andrea Eixer&#233;s, Mar&#237;a Teresa Vel&#225;zquez, Mar&#237;a Antonia S&#225;nchez Nistal, Jos&#233; Luis P&#233;rez Vela, Mar&#237;a Jos&#233; Ruiz Cano, Miguel &#193;ngel G&#243;mez Sanchez, Pilar Escribano Sub&#237;as, Jos&#233; Mar&#237;a Cortina Romero"
            "autores" => array:12 [
              0 => array:2 [
                "nombre" => "Mar&#237;a Jes&#250;s"
                "apellidos" => "L&#243;pez Gude"
              ]
              1 => array:2 [
                "nombre" => "Enrique"
                "apellidos" => "P&#233;rez de la Sota"
              ]
              2 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Forteza Gil"
              ]
              3 => array:2 [
                "nombre" => "Jorge"
                "apellidos" => "Centeno Rodr&#237;guez"
              ]
              4 => array:2 [
                "nombre" => "Andrea"
                "apellidos" => "Eixer&#233;s"
              ]
              5 => array:2 [
                "nombre" => "Mar&#237;a Teresa"
                "apellidos" => "Vel&#225;zquez"
              ]
              6 => array:2 [
                "nombre" => "Mar&#237;a Antonia"
                "apellidos" => "S&#225;nchez Nistal"
              ]
              7 => array:2 [
                "nombre" => "Jos&#233; Luis"
                "apellidos" => "P&#233;rez Vela"
              ]
              8 => array:2 [
                "nombre" => "Mar&#237;a Jos&#233;"
                "apellidos" => "Ruiz Cano"
              ]
              9 => array:2 [
                "nombre" => "Miguel &#193;ngel"
                "apellidos" => "G&#243;mez Sanchez"
              ]
              10 => array:2 [
                "nombre" => "Pilar"
                "apellidos" => "Escribano Sub&#237;as"
              ]
              11 => array:2 [
                "nombre" => "Jos&#233; Mar&#237;a"
                "apellidos" => "Cortina Romero"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212915001512"
          "doi" => "10.1016/j.arbr.2015.05.014"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001512?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961400461X?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005100000010/v1_201509302001/S030028961400461X/v1_201509302001/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S157921291500275X"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2015.07.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "1189"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "ssu"
    "cita" => "Arch Bronconeumol. 2015;51:509-14"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 5151
      "formatos" => array:3 [
        "EPUB" => 148
        "HTML" => 3932
        "PDF" => 1071
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Pleuroparenchymal Fibroelastosis&#58; Is it also an Idiopathic Entity&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "509"
          "paginaFinal" => "514"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fibroelastosis pleuropulmonar&#58; &#191;es tambi&#233;n una entidad idiop&#225;tica&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1028
              "Ancho" => 1400
              "Tamanyo" => 219879
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography &#40;HRCT&#41;&#44; showing evolution of the above case over a period of 2 years and 2 months&#46; The top image &#40;a&#41; shows only a few discrete elongated opacities in both apices&#59; the lower image &#40;b&#41; shows loss of volume and pleuroparenchymal fibrotic infiltrates&#46; &#40;c&#41; Shows an HRCT slice at the level of the tracheal carina&#46; The image shows architectural distortion&#44; with pleural thickening and elongated fibrotic parenchymal opacities &#40;lung window&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Karina Portillo, Ignasi Guasch Arriaga, Juan Ruiz-Manzano"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Karina"
              "apellidos" => "Portillo"
            ]
            1 => array:2 [
              "nombre" => "Ignasi"
              "apellidos" => "Guasch Arriaga"
            ]
            2 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Ruiz-Manzano"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289615001581"
        "doi" => "10.1016/j.arbres.2015.05.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615001581?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500275X?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005100000010/v1_201509302252/S157921291500275X/v1_201509302252/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1579212915001834"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2015.06.002"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "1092"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2015;51:496-501"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2504
      "formatos" => array:3 [
        "EPUB" => 140
        "HTML" => 1688
        "PDF" => 676
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Age Group Analysis of Psychological&#44; Physical and Functional Deterioration in Patients Hospitalized for Pneumonia"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "496"
          "paginaFinal" => "501"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudio del deterioro psicof&#237;sico y funcional en pacientes ingresados con neumon&#237;a&#46; An&#225;lisis por grupos de edad"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Adelina Mart&#237;n-Salvador, Irene Torres-S&#225;nchez, Germ&#225;n S&#225;ez-Roca, Isabel L&#243;pez-Torres, Elisabeth Rodr&#237;guez-Alzueta, Marie Carmen Valenza"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Adelina"
              "apellidos" => "Mart&#237;n-Salvador"
            ]
            1 => array:2 [
              "nombre" => "Irene"
              "apellidos" => "Torres-S&#225;nchez"
            ]
            2 => array:2 [
              "nombre" => "Germ&#225;n"
              "apellidos" => "S&#225;ez-Roca"
            ]
            3 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "L&#243;pez-Torres"
            ]
            4 => array:2 [
              "nombre" => "Elisabeth"
              "apellidos" => "Rodr&#237;guez-Alzueta"
            ]
            5 => array:2 [
              "nombre" => "Marie Carmen"
              "apellidos" => "Valenza"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S030028961400458X"
        "doi" => "10.1016/j.arbres.2014.11.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961400458X?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001834?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915001834/v1_201509302252/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Pulmonary Thromboendarterectomy in 106 Patients With Chronic Thromboembolic Pulmonary Hypertension"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "502"
        "paginaFinal" => "508"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Mar&#237;a Jes&#250;s L&#243;pez Gude, Enrique P&#233;rez de la Sota, Alberto Forteza Gil, Jorge Centeno Rodr&#237;guez, Andrea Eixer&#233;s, Mar&#237;a Teresa Vel&#225;zquez, Mar&#237;a Antonia S&#225;nchez Nistal, Jos&#233; Luis P&#233;rez Vela, Mar&#237;a Jos&#233; Ruiz Cano, Miguel &#193;ngel G&#243;mez Sanchez, Pilar Escribano Sub&#237;as, Jos&#233; Mar&#237;a Cortina Romero"
        "autores" => array:12 [
          0 => array:4 [
            "nombre" => "Mar&#237;a Jes&#250;s"
            "apellidos" => "L&#243;pez Gude"
            "email" => array:2 [
              0 => "mjgude&#64;gmail&#46;com"
              1 => "mariajesus&#46;lopez&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Enrique"
            "apellidos" => "P&#233;rez de la Sota"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Alberto"
            "apellidos" => "Forteza Gil"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jorge"
            "apellidos" => "Centeno Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Andrea"
            "apellidos" => "Eixer&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Mar&#237;a Teresa"
            "apellidos" => "Vel&#225;zquez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Mar&#237;a Antonia"
            "apellidos" => "S&#225;nchez Nistal"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Jos&#233; Luis"
            "apellidos" => "P&#233;rez Vela"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Mar&#237;a Jos&#233;"
            "apellidos" => "Ruiz Cano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Miguel &#193;ngel"
            "apellidos" => "G&#243;mez Sanchez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Pilar"
            "apellidos" => "Escribano Sub&#237;as"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Jos&#233; Mar&#237;a"
            "apellidos" => "Cortina Romero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Cardiaca&#44; Hospital Universitario&#44; 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Cardiolog&#237;a&#44; Hospital Universitario&#44; 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Radiolog&#237;a&#44; Hospital Universitario&#44; 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario&#44; 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tromboendarterectom&#237;a pulmonar en 106 pacientes con hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 889
            "Ancho" => 1500
            "Tamanyo" => 266694
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Biological material taken during pulmonary thromboendarterectomy&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic thromboembolic pulmonary hypertension &#40;CTEPH&#41; is a rare entity&#44; found in just 0&#46;5&#37;&#8211;9&#37; of patients with pulmonary embolism &#40;PE&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;2</span></a> Various mechanisms behind the development of CTEPH have been suggested&#58; recurrent embolism&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> growth of the thrombus in the bronchial tree<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> and vascular disease secondary to endothelial injury&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> Valvular disease&#44; involving microvascular changes that are indistinguishable from idiopathic pulmonary hypertension &#40;PH&#41;&#44; can occur in areas of the vascular tree unaffected by PE&#46; The treatment of choice for this disease&#44; wherever possible&#44; consists of pulmonary thromboendarterectomy &#40;PTE&#41; to remove obstructive material from the pulmonary arteries&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The intervention pursues three main goals&#58; hemodynamic stability&#44; by reducing the effect of PH on the right ventricle&#59; respiratory stability&#44; improving ventilatory efficiency by relieving alveolar dead space&#59; and prophylaxis&#44; by preventing right ventricle failure&#44; retrograde propagation of thrombi in the bronchial tree&#44; and secondary valvular disease in permeable vessels&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the results of the first 106 PTEs performed in the Hospital Universitario 12 de Octubre&#46; We report the immediate postoperative results in terms of mortality&#44; morbidity and hemodynamic parameters&#46; We also analyze results of long-term follow-up in terms of survival&#44; functional capacity&#44; hemodynamic parameters and right ventricle remodeling&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Population</span><p id="par0020" class="elsevierStylePara elsevierViewall">Indications for surgery were<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#44;10</span></a>&#58; &#40;a&#41; CTEPH at WHO functional class <span class="elsevierStyleSmallCaps">III</span>&#8211;<span class="elsevierStyleSmallCaps">IV</span>&#59; &#40;b&#41; pulmonary vascular resistance &#40;PVR&#41; higher than 300<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span> or below this level but with documented exercise PH &#40;c&#41; surgically accessible thrombi or characteristic lesions &#40;webs&#44; bands&#44; intimal irregularities&#41; in the main bronchial&#44; lobular and proximal segmental branches&#46; The correlation between PVR levels&#44; perfusion defects in the ventilation&#47;perfusion lung scan&#44; and pulmonary angiography findings was considered&#46; As a requirement for surgery&#44; all patients had to have received anticoagulation therapy for at least 3 months prior to the intervention&#46; The decision to operate was always taken in a meeting of members of the Multidisciplinary Pulmonary Hypertension Team&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Exclusion criteria were no surgical access and serious comorbidity &#40;severe pulmonary disease&#44; malignant neoplasm&#44; etc&#46;&#41;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Implantation of an inferior vena cava filter was evaluated on a case-by-case basis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">The initial diagnostic protocol was the same as that used in other PH etiologies&#44; with ventilation&#47;perfusion lung scan as the screening technique for establishing the etiology of the CTEPH&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">10&#8211;12</span></a> Pulmonary angiography with selective catheterization of lobular branches was the gold standard for diagnosis and confirmation of CTEPH<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">13&#8211;15</span></a>&#59; right heart catheterization was performed at the same time&#46; All patients also underwent contrast-enhanced multislice computed tomography&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients aged over 45 years or with risk factors for coronary artery disease underwent coronary angiography&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Functional status was assessed objectively with the 6-min walk test &#40;6MWT&#41; and ergospirometry with oxygen uptake&#46; All patients were also tested for thrombophilia&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Surgical Technique</span><p id="par0050" class="elsevierStylePara elsevierViewall">PTE was performed in accordance with the University of California &#40;San Diego&#44; USA&#41; protocol&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;18</span></a> The two guiding principles of the intervention were that it must involve a bilateral procedure&#44; and consist of a full endarterectomy&#44; not merely an embolectomy&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Surgical approach was through median sternotomy&#44; and the PTE was performed with full cardiopulmonary bypass&#44; aortic cross-clamping and deep&#44; 20<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; hypothermia&#46; Endarterectomy was performed during 10-min periods of circulatory arrest&#44; followed by reperfusion lasting at least 5<span class="elsevierStyleHsp" style=""></span>min&#46; A Hopkins II &#40;Karl Storz&#44; Tuttlingen&#44; Germany&#41; angioscope connected to a Twinvideo &#40;Karl Storz&#44; Tuttlingen&#44; Germany&#41; was used to optimize visibility and illuminate the surgical field&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The biological material extracted during the PTE &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; was grouped according to histopathological prognostic value established by the University of California group &#40;San Diego&#44; USA&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#58; type 1&#44; fresh thrombus in the main-lobar pulmonary arteries&#59; type 2&#44; intimal thickening and fibrosis proximal to the segmental arteries&#44; with no thrombus&#59; type 3&#44; disease within distal segmental arteries only&#59; and type 4&#44; distal arteriolar vascular disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Postoperative Period</span><p id="par0065" class="elsevierStylePara elsevierViewall">We defined lung reperfusion injury as postoperative respiratory failure causing hypoxia and accompanied by pulmonary infiltrates on chest X-ray in some of the surgical areas&#44; needing mechanical ventilation lasting more than 96<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Follow-up</span><p id="par0070" class="elsevierStylePara elsevierViewall">The follow-up protocol was first check-up at 1 month&#44; with physical examination&#44; blood work and 6MWT&#59; second check-up at 6 months&#44; with physical examination&#44; blood work&#44; echocardiogram&#44; ergospirometry with oxygen uptake&#44; and right heart catheterization&#46; Following this&#44; patients attended an annual check-up with physical examination&#44; echocardiogram and 6MWT&#46; We defined diagnosis of residual or persistent post-PTE pulmonary hypertension as a PVP higher than 400<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span> in the 6-month hemodynamic study&#46; Patients meeting this criterion underwent contrast-enhanced multislice chest computed tomography&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">All patients remained on long-term anticoagulant therapy&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistics</span><p id="par0080" class="elsevierStylePara elsevierViewall">Continuous variables are shown as mean&#177;standard deviation&#44; or median and interquartile range &#40;IQR&#41;&#44; and categorical variables are shown as frequencies&#46; Comparison between categorical variables was analyzed with Pearson&#39;s <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> or Fisher&#39;s exact test&#46; Quantitative variables were analyzed using the Student&#39;s t or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> tests&#44; depending on the results of Shapiro&#8211;Wilk normality testing&#46; The impact of the following variables on in-hospital mortality was analyzed&#58; specific bridging treatment&#44; functional class <span class="elsevierStyleSmallCaps">IV</span>&#44; PVR&#62;1000<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span> in preoperative catheterization&#44; development of reperfusion edema&#44; and being among the first 30 patients in this series to undergo surgery&#46; All variables statistically correlated with mortality were analyzed using logistic regression&#44; and univariate and multivariate analyses to calculate their relative risk and 95&#37; confidence interval &#40;95&#37; CI&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Survival curves were calculated using the Kaplan&#8211;Meier method and compared using the log rank test&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Statistical significance was set at <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">We performed 106 consecutive PTEs between February 1996 and June 2014 in our hospital&#46; The mean age of the population was 53&#177;14 years &#40;range 23&#8211;77&#41;&#59; 57&#37; were men&#46; The clinical and hemodynamic characteristics of the patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In 29 patients&#44; PVR was higher than 1000<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#46; Seven patients &#40;6&#46;6&#37;&#41; had undergone previous heart surgery&#59; 3 of these interventions were PTE &#40;one of which was performed in our hospital&#41;&#46; Mean time between diagnosis of CTEPH and surgery was 5 months &#40;IQR 8&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Ninety-six &#40;91&#37;&#41; of the PTEs were bilateral&#46; Mean time with cardiopulmonary bypass&#44; ischemia and circulatory arrest was 205&#177;38&#44; 116&#177;28 and 40&#177;14<span class="elsevierStyleHsp" style=""></span>min&#44; respectively&#46; In 20 patients&#44; PTE was combined with another procedure&#58; 7 tricuspid repairs&#44; 7 myocardial revascularizations&#44; 5 permeable oval foramen closures&#44; and 1 right ventricle thrombectomy&#46; Of the biological material extracted&#44; 49&#37; was classified &#40;under the San Diego system&#41; as type 1&#44; 42&#37; as type 2&#44; and 9&#37; as type 3&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Median time on ventilation in the recovery room was 27<span class="elsevierStyleHsp" style=""></span>h &#40;IQR 92&#41;&#46; The most relevant morbidity was lung reperfusion injury in 21 patients &#40;20&#37;&#41;&#44; pulmonary hemorrhage in 4 patients &#40;4&#37;&#41;&#44; reintervention due to bleeding in 6 patients &#40;6&#37;&#41;&#44; heart failure in 3 patients &#40;3&#37;&#41;&#44; transient ischemic attack in 1 patient &#40;1&#37;&#41;&#44; and need for ECMO or ventricular assist device in 5 patients &#40;5&#37;&#41;&#46; Indication for ECMO was heart failure in 2 patients&#44; and respiratory failure due to pulmonary hemorrhage in 3 patients&#46; Mean ICU stay was 5 days &#40;IQR 7&#41;&#44; and mean hospital stay was 13 days &#40;IQR 9&#41;&#46; In the recovery room&#44; mean PAP was 28&#177;7<span class="elsevierStyleHsp" style=""></span>mmHg and mean PVR was 311&#177;130<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#44; significantly &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41; lower than preoperative levels&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Overall in-hospital mortality for the series was 6&#46;6&#37; &#40;7&#47;106&#44; 95&#37; CI&#58; 2&#46;8&#37;&#8211;13&#46;5&#37;&#41;&#46; Causes of mortality were respiratory failure in 4 patients&#44; pulmonary hemorrhage in 2 patients&#44; and cardiogenic shock in 1 patient&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In the univariate analysis&#44; being among the first 30 cases &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;019&#41;&#44; PVR&#8805;1000<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span> &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;019&#41;&#44; functional class <span class="elsevierStyleSmallCaps">IV</span> &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;006&#41; and postoperative lung reperfusion injury &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41; were associated with in-hospital mortality&#46; Following multivariate analysis&#44; only reperfusion lung injury remained as an independent risk factor for in-hospital mortality &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;015&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Mean follow-up was 31 months &#40;IQR 50&#41;&#46; Survival at 3 and 5 years was 90&#37;&#177;3&#37; and 84&#37;&#177;5&#37; respectively&#44; including in-hospital mortality &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Changes in clinical&#44; echocardiographic and hemodynamic parameters at 1-year follow-up are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">In total&#44; 6 patients died during follow-up&#46; Causes of death were heart failure &#40;3 patients&#41;&#44; infection &#40;1 patient&#41;&#44; adenocarcinoma of the bladder &#40;1 patient&#41; and pulmonary thromboembolism &#40;1 patient&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Fourteen patients were diagnosed with persistent PH following PTE&#46; At 1 year&#44; 64&#37; of these patients were classified as functional class <span class="elsevierStyleSmallCaps">I</span>&#8211;<span class="elsevierStyleSmallCaps">II</span>&#46; Nine &#40;64&#37;&#41; patients required specific treatment for PH&#58; endothelin receptor antagonists&#44; phosphodiesterase type 5 inhibitors&#44; prostacyclin analogs or soluble guanylate cyclase stimulators&#46; Two patients died due to heart failure&#46; Actuarial survival in the persistent PH group is 91&#177;9 at 3 years&#44; and 73&#177;11 at 5 years&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the survival curve for this patient group and that of patients with no residual PH&#44; after adjusting for in-hospital mortality&#46; There is no significant difference between groups&#46; It is interesting to note that despite persistence of PH&#44; PVR was significantly reduced compared to preoperative levels &#40;924&#177;245 vs&#44; 641&#177;269<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;033&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">CTEPH is a rare disease&#44; with only 8&#46;9 cases per million inhabitants in our region&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> Studies have shown that CTEPH is a long-term complication of symptomatic PTE&#44; with an accumulative incidence of 0&#46;1&#37;&#8211;9&#46;1&#37; at 2 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;2</span></a> However&#44; in a significant number of cases&#44; PTE was asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> This is why CTEPH is thought to be under-diagnosed&#44; and patients are all too often referred late for treatment&#46; Clinical guidelines<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> and consensus documents<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> establish the need to form multidisciplinary teams of expert surgeons to treat CTEPH&#46; Surgery should not be definitively ruled out in any patient until they have been assessed by this team&#46; In the international register&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> up to 43&#37; of the patients evaluated were not considered candidates for surgery&#44; and the same was true of 70&#37; of patients in the Spanish register &#40;REHAP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> Our team has performed surgery on 53&#37;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> of cases submitted to the multidisciplinary team meeting&#46; In many patients&#44; however&#44; there was a lengthy delay between diagnosis and surgery due to late referral&#44; and 13&#37; of our patients were classified as functional class <span class="elsevierStyleSmallCaps">IV</span> at the time of surgery&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The results of our series are excellent&#44; and are comparable to the largest series reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">21&#44;23</span></a> Our success is due to the expertise of our surgeons and the procedural protocol developed by the Multidisciplinary Pulmonary Hypertension Team of the Hospital 12 de Octubre&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The PTE series presented in this study is the largest and most consolidated cohort studied in Spain&#46; In 2009&#44; we published the initial<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a> results of a series of 30 PTEs&#46; These findings were similar to those published by the Hospital Cl&#236;nic de Barcelona<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a> in a series of 32 patients&#59; in-hospital mortality was 17&#37; and 18&#46;8&#37;&#44; respectively&#46; Both studies found that surgical outcomes improved as the multidisciplinary team acquired more experience&#46; Greater experience is also a factor in improved survival and a gradual increase in the number of patients considered candidates for surgery&#46; In addition&#44; surgical outcomes are better than those of medical treatment&#46; For all these reasons&#44; PTE is the treatment of choice in this disease&#44; and is associated with good outcomes in our hospital&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The accessibility of lesions varies according to the level of experience of the surgical team&#46; In the most experienced teams&#44; the percentage of patients with segmental branch involvement &#40;San Diego group 3&#41; increases over time&#44; although this is not detrimental to outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">26&#8211;28</span></a> Advances in surgical techniques now enable surgeons to dissect and extract material at both the segmental and subsegmental level&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Although the exact PVR or right ventricular dysfunction level that would rule out surgery is unknown&#44; surgical risk and prognosis in the long-term worsen with higher PVR &#40;above 1000<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">29&#44;30</span></a> Although the risk of surgery is increased in these patients&#44; they can still benefit from the intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a> We did not rule out surgery in any patient on the basis of high PVR or severe ventricular dysfunction&#46; In this study&#44; PVR greater than 1000<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span> was a risk factor for in-hospital mortality in the univariate analysis&#44; but not in the multivariate analysis&#44; even though it is a major risk factor for perfusion injury&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The standard surgical approach to PTE is based on the protocol created by the San Diego group&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> namely&#44; endarterectomy in circulatory arrest with deep hypothermia&#46; This technique has proved both safe and effective&#46; In their most recent series&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> with more than 2700 cases&#44; the group reported a mortality rate of 2&#46;2&#37; in the last 500 patients operated&#46; Although a number of studies have described PTE without circulatory arrest&#44; or at least&#44; with continuous cerebral perfusion&#44;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">31&#8211;34</span></a> these techniques did not improve outcomes or diminish neurological complications&#46; All studies in this field have mentioned the difficulty involved in reaching distal branches in the absence of circulatory arrest&#46; In our series&#44; only 1 transient neurological complication occurred&#44; and this was not solely due to circulatory arrest&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Reperfusion injury is inherent to PTE&#46; Incidence ranges from 5&#37; and 20&#37; of all interventions&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a> according to different series&#44; and it is a risk factor for in-hospital mortality&#46; This was also found to be true in our series&#46; Manifestation of reperfusion injury varies from mild hypoxia with insignificant radiological findings to severe respiratory failure&#44; similar to respiratory distress&#46; For this reason&#44; it is important to establish a definition of reperfusion injury that limits cases to a clinical entity with an impact on the patient&#39;s evolution&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Other series have described the need for extracorporeal membrane oxygenation &#40;ECMO&#41; in heart failure secondary to PH or postcardiotomy syndrome&#44; and severe respiratory failure due to pulmonary hemorrhage or edema&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">35&#44;36</span></a> Berman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a> reported a survival rate of 57&#37; in these patients&#59; in our series&#44; it was 40&#37;&#46; These patients would have died without this treatment&#44; and for this reason ECMO is a therapeutic step that should be available in all PTE units&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Post-PTE survival in our series was excellent&#44; and comparable to that obtained in the most major studies&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a> Moreover&#44; in most of our patients&#44; functional class improved&#44; pulmonary pressure was normalized&#44; and as a result&#44; right ventricular remodeling occurred&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Diagnosis of persistent PH is widely debated&#44; both in terms of its definition &#40;mPAP&#62;25&#44; 30 or 35<span class="elsevierStyleHsp" style=""></span>mmHg&#59; PVR&#62;400&#44; 450&#44; 500 or 550<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">21&#44;30&#44;37</span></a> and the right moment to establish a diagnosis&#46; Incidence varies from 6&#37; to 31&#37;&#44; according to the definition used&#46; Our team decided to define persistent PH as PVR&#62;400<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#44; because unlike mPAP&#44; PVR has both a pre- and postoperative prognostic value&#46; As far as the timing of the diagnosis is concerned&#44; in our series it was made during the 6-month follow-up for two reasons&#58; hemodynamic changes immediately following surgery will affect estimates of PVR&#44; and the prevalence of residual PH increases over follow-up<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> when the cause is distal vascular disease&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Despite persistence of PH&#44; this subgroup showed good survival rates and improved functional class&#44; possibly because PVR decreased significantly even in patients with PH&#46; The findings of other groups&#44; such as Freed et al&#46; in Papworth Hospital<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> &#40;Cambridge&#41; are largely consistent in terms of patients with residual PH&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">Our study contributes further evidence that PTE is the treatment of choice in CTEPH&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> and can be performed successfully in Spain&#46; This surgical intervention has a positive impact on disease prognosis and long-term survival&#46; It also resolves pulmonary hypertension and improves the functional status of most patients&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limitations</span><p id="par0195" class="elsevierStylePara elsevierViewall">This is a retrospective&#44; observational study in the initial series of a single hospital&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">No information was available on the evolution of NO-pro-BNP markers in patients operated prior to 2009&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">One-year follow-up results were analyzed in the 85 patients that reached this stage of the study&#46; Of these&#44; we obtained 76 catheterizations&#59; the remaining 9 were patients that had been referred to their local hospitals&#44; and this information was not forwarded to our group&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authorship</span><p id="par0210" class="elsevierStylePara elsevierViewall">L&#243;pez Gude MJ and Cortina Romero JM collected data&#44; performed the statistical analysis&#44; interpreted the results and drafted the manuscript&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">P&#233;rez de la Sota E&#44; Forteza Gil A and Centeno Rodr&#237;guez J performed the surgical procedures&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Eixeres A collected data&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Ruiz Cano MJ&#44; Vel&#225;zquez MT&#44; G&#243;mez S&#225;nchez MA&#44; P&#233;rez Vela JL&#44; and S&#225;nchez Nistal MA established diagnosis and treated the patients in the clinical setting&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Escribano Sub&#237;as P established diagnosis and treated the patients in the clinical setting&#44; interpreted the results and drafted the manuscript&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">All the authors have reviewed the manuscript&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of Interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres560380"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec576623"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres560381"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec576624"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and Methods"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Diagnosis"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Surgical Technique"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Postoperative Period"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Follow-up"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Statistics"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Limitations"
        ]
        10 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Authorship"
        ]
        11 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflict of Interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-09-09"
    "fechaAceptado" => "2014-11-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec576623"
          "palabras" => array:3 [
            0 => "Pulmonary hypertension"
            1 => "Pulmonary thromboembolism"
            2 => "Pulmonary thromboendarterectomy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec576624"
          "palabras" => array:3 [
            0 => "Hipertensi&#243;n pulmonar"
            1 => "Tromboembolismo pulmonar"
            2 => "Tromboendarterectom&#237;a pulmonar"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pulmonary thromboendarterectomy is the treatment of choice in chronic thromboembolic pulmonary hypertension&#46; We report our experience with this technique&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between February 1996 and June 2014&#44; we performed 106 pulmonary thromboendarterectomies&#46; Patient population&#44; morbidity and mortality and the long-term results of this technique &#40;survival&#44; functional improvement and resolution of pulmonary hypertension&#41; are described&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Subjects&#8217; mean age was 53&#177;14 years&#46; A total of 89&#37; were WHO functional class <span class="elsevierStyleSmallCaps">III</span>&#8211;<span class="elsevierStyleSmallCaps">IV</span>&#44; presurgery mean pulmonary pressure was 49&#177;13<span class="elsevierStyleHsp" style=""></span>mmHg and mean pulmonary vascular resistance was 831&#177;364<span class="elsevierStyleHsp" style=""></span>dynes<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#46; In-hospital mortality was 6&#46;6&#37;&#46; The most important post-operative morbidity was reperfusion pulmonary injury&#44; in 20&#37; of patients&#59; this was an independent risk factor &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;015&#41; for hospital mortality&#46; With a 31-month median follow-up &#40;interquartile range&#58; 50&#41;&#44; 3- and 5-year survival was 90&#37; and 84&#37; respectively&#46; At 1 year&#44; 91&#37; were WHO functional class <span class="elsevierStyleSmallCaps">I</span>&#8211;<span class="elsevierStyleSmallCaps">II</span>&#59; mean pulmonary pressure &#40;27&#177;11<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and pulmonary vascular resistance &#40;275&#177;218<span class="elsevierStyleHsp" style=""></span>dynes<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#41; were significantly lower &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41; than before the intervention&#46; Although residual pulmonary hypertension was detected in 14 patients&#44; their survival at 3 and 5 years was 91&#37; and 73&#37;&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pulmonary thromboendarterectomy offers excellent results in chronic thromboembolic pulmonary hypertension&#46; Long-term survival is good&#44; functional capacity improves&#44; and pulmonary hypertension is resolved in most patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La tromboendarterectom&#237;a pulmonar es el tratamiento de elecci&#243;n en la hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica&#46; Presentamos nuestra serie completa con esta t&#233;cnica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Desde febrero de 1996 hasta junio de 2014&#44; hemos realizado 106 tromboendarterectom&#237;as&#46; Analizamos las caracter&#237;sticas de la poblaci&#243;n&#44; la mortalidad y morbilidad asociadas a la t&#233;cnica y los resultados a largo plazo de supervivencia&#44; mejor&#237;a funcional y resoluci&#243;n de la hipertensi&#243;n pulmonar&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media de la poblaci&#243;n fue 53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14 a&#241;os&#46; El 89&#37; estaba en clase funcional <span class="elsevierStyleSmallCaps">III</span>&#8211;<span class="elsevierStyleSmallCaps">IV</span> de la OMS&#46; La presi&#243;n pulmonar media prequir&#250;rgica fue 49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>mmHg y las resistencias vasculares pulmonares 831<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>364<span class="elsevierStyleHsp" style=""></span>dinas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&#46; La mortalidad hospitalaria fue 6&#44;6&#37;&#46; La morbilidad postoperatoria m&#225;s relevante fue debida al edema pulmonar por reperfusi&#243;n en el 20&#37;&#44; que fue factor de riesgo independiente &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; para mortalidad hospitalaria&#46; Con una mediana de seguimiento de 31 meses &#40;rango intercuartil 50&#41;&#44; la supervivencia a los 3 y 5 a&#241;os es 90 y 84&#37;&#46; Al a&#241;o de seguimiento&#44; el 91&#37; est&#225; en clase funcional <span class="elsevierStyleSmallCaps">I</span>&#8211;<span class="elsevierStyleSmallCaps">II</span> de la OMS&#44; la presi&#243;n pulmonar media en 27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>mmHg y las resistencias pulmonares vasculares en 275<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>218<span class="elsevierStyleHsp" style=""></span>dinas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span> &#40;significativamente menores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; que las basales&#41;&#46; En 14 pacientes se diagnostic&#243; hipertensi&#243;n pulmonar persistente&#59; aun as&#237;&#44; su supervivencia es&#44; a los 3 y 5 a&#241;os&#44; 91 y 73&#37;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La tromboendarterectom&#237;a pulmonar ofrece resultados excelentes en el tratamiento de la hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica&#46; Proporciona una elevada supervivencia a largo plazo&#44; mejora la capacidad funcional y resuelve la hipertensi&#243;n pulmonar en la mayor&#237;a de los pacientes&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#243;pez Gude MJ&#44; P&#233;rez de la Sota E&#44; Forteza Gil A&#44; Centeno Rodr&#237;guez J&#44; Eixer&#233;s A&#44; Vel&#225;zquez MT&#44; et al&#46; Tromboendarterectom&#237;a pulmonar en 106 pacientes con hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;502&#8211;508&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 889
            "Ancho" => 1500
            "Tamanyo" => 266694
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Biological material taken during pulmonary thromboendarterectomy&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1342
            "Ancho" => 1657
            "Tamanyo" => 74997
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Overall survival curve&#44; including in-hospital mortality&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1338
            "Ancho" => 1659
            "Tamanyo" => 96756
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Survival curves in patients with and without residual pulmonary hypertension&#44; excluding in-hospital mortality&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CO&#58; cardiac output&#59; DVP&#58; deep vein thrombosis&#59; mPAP&#58; mean pulmonary artery pressure&#59; PE&#58; pulmonary embolism&#59; RV&#58; right ventricle&#59; RVP&#58; right ventricular pressure&#59; PVR&#58; pulmonary vascular resistance&#59; TAPSE&#58; tricuspid annular plane systolic excursion&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&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">Population &#40;n&#61;106&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">History of PE</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">History of DVP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hypercoagulability</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">WHO functional status</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Stroke</span>&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;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hemoptysis</span>&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;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Six-minute walk test&#44; meters</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">384&#177;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">NT-proBNP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1199&#177;1248&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Heart failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Patients with specific bridging therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Time from diagnosis to surgery&#44; months</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#177;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Echocardiogram</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RV diameter&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#177;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TAPSE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pericardial effusion&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;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Hemodynamics</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RVP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#177;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  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>mPAP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#177;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PVR&#44; dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">831&#177;364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CO&#44; l&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2&#177;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab906580.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Preoperative Characteristics of the Sample&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; PVR&#58; pulmonary vascular resistance&#59; RR&#58; relative risk&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Risk factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col">In-hospital mortality &#40;&#37;&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Univariate analysisRR &#40;95&#37; CI&#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">Multivariate analysisRR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Factor present</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">Yes&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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">First 30 cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4 &#40;1&#46;3&#8211;41&#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" title="table-entry  " align="left" valign="top">PVR&#62;1000<span class="elsevierStyleHsp" style=""></span>dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4 &#40;1&#46;3&#8211;41&#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" title="table-entry  " align="left" valign="top">WHO functional class <span class="elsevierStyleSmallCaps">IV</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;006&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;2&#46;3&#8211;61&#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" title="table-entry  " align="left" valign="top">Reperfusion injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&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;2&#46;3&#8211;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">17 &#40;1&#46;7&#8211;171&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab906581.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Risk Factors for In-hospital Mortality&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; CO&#58; cardiac output&#59; dPAP&#58; diastolic pulmonary artery pressure&#59; mPAP&#58; mean pulmonary artery pressure&#59; PVR&#58; pulmonary venous pressure&#59; RVP&#58; right ventricular pressure&#59; sPAP&#58; systolic pulmonary artery pressure&#59; RV&#58; right ventricle&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&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">Preoperative&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">Postoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">WHO functional class</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">I</span>&#8211;<span class="elsevierStyleSmallCaps">II</span>&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;11&#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">78 &#40;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">III</span>&#8211;<span class="elsevierStyleSmallCaps">IV</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;89&#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;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Six-minute walk test&#44; meters</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">382&#177;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">469&#177;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">NT-pro-BNP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1266&#177;1369&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253&#177;280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Patients with specific preoperative therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Echocardiogram</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RV diameter&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Hemodynamics</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RVP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>sPAP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#177;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#177;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>dPAP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#177;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#177;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>mPAP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#177;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#177;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PVR&#44; dynas<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">789&#177;345&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">275&#177;218&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CO&#44; l&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3&#177;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab906582.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Clinical&#44; Echocardiographic and Hemodynamic Changes Over Preoperative Baseline at 1 Year of Follow-up&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Pengo"
                            1 => "A&#46;W&#46; Lensing"
                            2 => "M&#46;H&#46; Prins"
                            3 => "A&#46; Marchiore"
                            4 => "B&#46;L&#46; Davidson"
                            5 => "F&#46; Tiozzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa032274"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "2257"
                        "paginaFinal" => "2264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15163775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic thromboembolic pulmonary hypertension not so rare after all"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "I&#46;M&#46; Lang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMp048088"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "2236"
                        "paginaFinal" => "2238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15163772"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reoperative pulmonary thormboendarterectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Mo"
                            1 => "D&#46;P&#46; Kaspelanski"
                            2 => "S&#46;N&#46; Mitruka"
                            3 => "W&#46;R&#46; Auger"
                            4 => "P&#46;F&#46; Fedullo"
                            5 => "R&#46;N&#46; Channick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1999"
                        "volumen" => "68"
                        "paginaInicial" => "1770"
                        "paginaFinal" => "1777"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10585057"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary thromboendarterectomy&#58; a clinicopathologic study of 200 consecutive pulmonary thromboendarterectomy cases in one institution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Bernard"
                            1 => "E&#46;S&#46; Yi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.humpath.2006.11.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Pathol"
                        "fecha" => "2007"
                        "volumen" => "38"
                        "paginaInicial" => "871"
                        "paginaFinal" => "877"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17350667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary endarterectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;W&#46; Jamieson"
                            1 => "D&#46;P&#46; Kapelanski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Probl Surg"
                        "fecha" => "2000"
                        "volumen" => "37"
                        "paginaInicial" => "165"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10723452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic thromboembolic pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Dartevelle"
                            1 => "E&#46; Fadel"
                            2 => "S&#46; Mussot"
                            3 => "A&#46; Chapelier"
                            4 => "P&#46; Herve"
                            5 => "M&#46; De Perrot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2004"
                        "volumen" => "23"
                        "paginaInicial" => "637"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15083767"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary endarterectomy&#58; experience and lessons learned in 1500 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;W&#46; Jamieson"
                            1 => "D&#46;P&#46; Kapelanski"
                            2 => "N&#46; Sakakibara"
                            3 => "G&#46;R&#46; Manecke"
                            4 => "P&#46;A&#46; Thistlethwaite"
                            5 => "K&#46;M&#46; Kerr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2003"
                        "volumen" => "76"
                        "paginaInicial" => "1457"
                        "paginaFinal" => "1462"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14602267"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary thromboendarterectomy surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;A&#46; Thistlethwaite"
                            1 => "M&#46; Madani"
                            2 => "S&#46;W&#46; Jamieson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccl.2004.04.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiol Clin"
                        "fecha" => "2004"
                        "volumen" => "22"
                        "paginaInicial" => "467"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15302365"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Est&#225;ndares asistenciales en hipertensi&#243;n pulmonar&#46; Documento de consenso elaborado por la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; y la Sociedad Espa&#241;ola de Cardiolog&#237;a &#40;SEC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Barber&#225;"
                            1 => "P&#46; Escribano"
                            2 => "P&#46; Morales"
                            3 => "M&#46;A&#46; G&#243;mez"
                            4 => "M&#46; Oribe"
                            5 => "A&#46; Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2008"
                        "volumen" => "44"
                        "paginaInicial" => "87"
                        "paginaFinal" => "99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18361875"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the diagnosis and treatment of pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Galie"
                            1 => "M&#46;M&#46; Hoeper"
                            2 => "M&#46; Humbert"
                            3 => "A&#46; Torbicki"
                            4 => "J&#46;L&#46; Vachiery"
                            5 => "J&#46;A&#46; Barbera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehp297"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2009"
                        "volumen" => "30"
                        "paginaInicial" => "2493"
                        "paginaFinal" => "2537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19713419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension&#58; a clinical practice guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Mehta"
                            1 => "D&#46; Helmersen"
                            2 => "S&#46; Provencher"
                            3 => "N&#46; Hirani"
                            4 => "F&#46;D&#46; Rubens"
                            5 => "M&#46; de Perrot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can Respir J"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "301"
                        "paginaFinal" => "334"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21165353"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic thromboembolic pulmonary hypertension &#40;CTEPH&#41;&#58; updated recommendations of the Cologne Consensus Conference 2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Wilkens"
                            1 => "I&#46; Lang"
                            2 => "J&#46; Behr"
                            3 => "T&#46; Berghaus"
                            4 => "C&#46; Grohe"
                            5 => "S&#46; Guth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0167-5273(11)70493-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "154"
                        "paginaInicial" => "S54"
                        "paginaFinal" => "S60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22221974"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic thromboembolic pulmonary hypertension&#58; evaluation with 64-detector row CT versus digital subtraction angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Reichelt"
                            1 => "M&#46;M&#46; Hoeper"
                            2 => "M&#46; Galanski"
                            3 => "M&#46; Keberle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejrad.2008.03.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Radiol"
                        "fecha" => "2009"
                        "volumen" => "71"
                        "paginaInicial" => "49"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18462902"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of chronic thromboembolic pulmonary hypertension&#58; comparison of ventilation&#47;perfusion scanning and multidetector computed tomography pulmonary angiography with pulmonary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; He"
                            1 => "W&#46; Fang"
                            2 => "B&#46; Lv"
                            3 => "J&#46;G&#46; He"
                            4 => "C&#46;M&#46; Xiong"
                            5 => "Z&#46;H&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MNM.0b013e32835085d9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nucl Med Commun"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "459"
                        "paginaFinal" => "463"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22262242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic thromboembolic pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;H&#46; Kim"
                            1 => "M&#46; Delcroix"
                            2 => "D&#46;P&#46; Jenkins"
                            3 => "R&#46; Channick"
                            4 => "P&#46; Dartavell"
                            5 => "P&#46; Jansa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.10.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "D92"
                        "paginaFinal" => "D99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24355646"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "State-of-the-art imaging techniques in chronic thromboembolic pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Coulden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/pats.200605-119LR"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Am Thorac Soc"
                        "fecha" => "2006"
                        "volumen" => "3"
                        "paginaInicial" => "577"
                        "paginaFinal" => "583"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16963537"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High probability perfusion lung scans in pulmonary venoocclusive disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;L&#46; Bailey"
                            1 => "R&#46;N&#46; Channick"
                            2 => "W&#46;R&#46; Auger"
                            3 => "P&#46;F&#46; Fedullo"
                            4 => "K&#46;M&#46; Kerr"
                            5 => "G&#46;L&#46; Yung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.162.5.2003045"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "162"
                        "paginaInicial" => "1974"
                        "paginaFinal" => "1978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11069842"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Technical advances of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;M&#46; Madani"
                            1 => "S&#46;W&#46; Jamieson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.semtcvs.2006.09.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Thorac Cardiovasc Surg"
                        "fecha" => "2006"
                        "volumen" => "18"
                        "paginaInicial" => "243"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17185187"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Operative classification of thromboembolic disease determines outcomes after pulmonary thromboendarterectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;A&#46; Thisthethwaite"
                            1 => "M&#46; Mo"
                            2 => "M&#46;M&#46; Madani"
                            3 => "S&#46;H&#46; Deutsch"
                            4 => "D&#46; Branchard"
                            5 => "D&#46;P&#46; Kapelanski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mtc.2002.127313"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2002"
                        "volumen" => "124"
                        "paginaInicial" => "1203"
                        "paginaFinal" => "1211"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12447188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival in pulmonary hypertension in Spain&#58; insights from the Spanish registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Escribano-Sub&#237;as"
                            1 => "I&#46; Blanco"
                            2 => "M&#46; L&#243;pez-Meseguer"
                            3 => "C&#46;J&#46; L&#243;pez-Guarch"
                            4 => "A&#46; Roman"
                            5 => "P&#46; Morales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00101211"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "596"
                        "paginaFinal" => "603"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22362843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension&#58; results from an international prospective registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Mayer"
                            1 => "D&#46; Jenkins"
                            2 => "J&#46; Lindner"
                            3 => "A&#46; D¿Armini"
                            4 => "J&#46; Kloek"
                            5 => "B&#46; Meyns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2010.11.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2011"
                        "volumen" => "141"
                        "paginaInicial" => "702"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21335128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tratamiento quir&#250;rgico versus m&#233;dico en la hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica&#58; &#191;Cu&#225;l es la mejor opci&#243;n terape&#250;tica&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; D&#237;az Ant&#243;n"
                            1 => "R&#46; del Pozo"
                            2 => "M&#46;J&#46; L&#243;pez Gude"
                            3 => "S&#46; Alonso Chaterina"
                            4 => "M&#46;T&#46; Vel&#225;zquez"
                            5 => "M&#46;J&#46; Ruiz Cano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2014"
                        "volumen" => "67"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "887"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension&#46; A systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Rahnavardi"
                            1 => "T&#46;D&#46; Yan"
                            2 => "C&#46; Cao"
                            3 => "M&#46;P&#46; Vallely"
                            4 => "P&#46;G&#46; Bannon"
                            5 => "M&#46;K&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Cardiovasc Surg"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "435"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21881372"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica&#58; tratamiento mediante tromboendarterectom&#237;a quir&#250;rgica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Bl&#225;zquez"
                            1 => "P&#46; Escribano"
                            2 => "E&#46; P&#233;rez"
                            3 => "M&#46;J&#46; L&#243;pez"
                            4 => "M&#46;A&#46; G&#243;mez"
                            5 => "J&#46;M&#46; Cortina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2009.05.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2009"
                        "volumen" => "45"
                        "paginaInicial" => "496"
                        "paginaFinal" => "501"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19656605"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tratamiento m&#233;dico y quir&#250;rgico de la hipertensi&#243;n pulmonar tromboemb&#243;lica cr&#243;nica&#58; experiencia en un &#250;nico centro"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;L&#46; Coronel"
                            1 => "N&#46; Chamorro"
                            2 => "I&#46; Blanco"
                            3 => "V&#46; Amado"
                            4 => "R&#46; del Pozo"
                            5 => "J&#46;L&#46; Pomar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2014.04.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "521"
                        "paginaFinal" => "527"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24957814"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolving surgical techniques for pulmonary endarterectomy according to the changing features of chronic thromboembolic pulmonary hypertension patients during 17-year single-center experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Morsolini"
                            1 => "S&#46; Nicolardi"
                            2 => "E&#46; Milanesi"
                            3 => "E&#46; Sarchi"
                            4 => "G&#46; Mattiucci"
                            5 => "C&#46; Klersy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2011.11.041"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2012"
                        "volumen" => "144"
                        "paginaInicial" => "100"
                        "paginaFinal" => "107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22498087"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary endarterectomy&#58; recent changes in a single institution&#39;s experience of more than 2700 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Madani"
                            1 => "W&#46;R&#46; Auger"
                            2 => "V&#46; Pretorius"
                            3 => "N&#46; Sakakibara"
                            4 => "K&#46;M&#46; Kerr"
                            5 => "N&#46;H&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2012.04.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "94"
                        "paginaInicial" => "97"
                        "paginaFinal" => "103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22626752"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Madani M&#44; Jamieson S&#44; Pretorius V&#44; Kim N&#44; Kerr K&#44; Fedullo P&#44; et al&#46; Sub-segmental pulmonary endarterectomy&#58; time for a new surgical classification&#46; PC Abstract in International CTEPH Conference 2014&#46; ICA &#40;International CTEPH Association&#41;&#46; Conference Program &#38; Abstracts Book&#46; 2014&#46; p&#46; 21-2&#46; &#91;accessed 31-12-2014&#93;&#46; Available from http&#58;&#47;&#47;www&#46;cteph-association&#46;org&#47;wp-content&#47;uploads&#47;2014&#47;06&#47;ICA-2014-programme-2014&#95;05&#95;16&#46;pdf"
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of pulmonary endarterectomy for treatment of extreme thromboembolic pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;A&#46; Thistlethwaite"
                            1 => "A&#46; Kemp"
                            2 => "L&#46; Du"
                            3 => "M&#46;M&#46; Madani"
                            4 => "S&#46;W&#46; Jamieson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2005.07.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2006"
                        "volumen" => "131"
                        "paginaInicial" => "307"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16434258"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival after pulmonary thromboendarterectomy&#58; effect of residual pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;H&#46; Freed"
                            1 => "B&#46;M&#46; Thomson"
                            2 => "M&#46; Berman"
                            3 => "S&#46;S&#46; Tsui"
                            4 => "J&#46; Dunning"
                            5 => "K&#46;K&#46; Sheares"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2009.12.056"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2011"
                        "volumen" => "141"
                        "paginaInicial" => "383"
                        "paginaFinal" => "387"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20471039"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary endarterectomy is possible and effective without the use of complete circulatory arrest-the UK experience in over 150 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Thomson"
                            1 => "S&#46;S&#46; Tsui"
                            2 => "J&#46; Dunning"
                            3 => "A&#46; Goodwin"
                            4 => "A&#46; Vuylsteke"
                            5 => "R&#46; Latimer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2007.11.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2008"
                        "volumen" => "33"
                        "paginaInicial" => "157"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18077177"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary endarterectomy&#58; is there an alternative to profound hypothermia with cardiocirculatory arrest&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;M&#46; Mikus"
                            1 => "A&#46; Dell&#8217;Amore"
                            2 => "S&#46; Pastore"
                            3 => "N&#46; Gali&#232;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2006.06.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "563"
                        "paginaFinal" => "565"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16884907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Technical advances of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Hagl"
                            1 => "N&#46; Khaladj"
                            2 => "T&#46; Peters"
                            3 => "M&#46;M&#46; Hoeper"
                            4 => "F&#46; Logemann"
                            5 => "A&#46; Haverich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2003"
                        "volumen" => "23"
                        "paginaInicial" => "776"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12754032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Circulatory arrest versus cerebral perfusion during pulmonary endarterectomy surgery &#40;PEACOG&#41;&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Vuylsteke"
                            1 => "L&#46; Sharples"
                            2 => "G&#46; Charman"
                            3 => "J&#46; Kneeshaw"
                            4 => "S&#46; Tsui"
                            5 => "J&#46; Dunning"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(11)61144-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2011"
                        "volumen" => "378"
                        "paginaInicial" => "1379"
                        "paginaFinal" => "1387"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22000135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venovenous extracorporeal life support after pulmonary endarterectomy&#58; indications&#44; techniques&#44; and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;A&#46; Thristlethwaite"
                            1 => "M&#46;M&#46; Madani"
                            2 => "A&#46;D&#46; Kemp"
                            3 => "M&#46; Hartley"
                            4 => "W&#46;R&#46; Anger"
                            5 => "S&#46;W&#46; Jamieson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2006.07.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2006"
                        "volumen" => "82"
                        "paginaInicial" => "2139"
                        "paginaFinal" => "2146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17126125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful extracorporeal membrane oxygenation support after pulmonary thromboendarterectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Berman"
                            1 => "S&#46; Tsui"
                            2 => "A&#46; Vuylsteke"
                            3 => "A&#46; Snell"
                            4 => "S&#46; Colah"
                            5 => "R&#46; Latimer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2008.06.037"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2008"
                        "volumen" => "86"
                        "paginaInicial" => "1261"
                        "paginaFinal" => "1267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18805172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcomes after pulmonary endarterectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;G&#46; Corsico"
                            1 => "A&#46;M&#46; D&#8217;Armini"
                            2 => "I&#46; Cerveri"
                            3 => "C&#46; Klersy"
                            4 => "E&#46; Ansaldo"
                            5 => "R&#46; Niniano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200801-101OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "178"
                        "paginaInicial" => "419"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18556630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:3 [
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0245" class="elsevierStylePara elsevierViewall">Our thanks to the staff of the Hospital Universitario 12 de Octubre Multidisciplinary Pulmonary Hypertension Unit&#44; the medical and nursing staff of the Cardiology Intensive Care Unit&#44; and the medical and nursing staff of the Cardiac Surgery operating theater&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915001512/v1_201509302252/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9374"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000010/v1_201509302252/S1579212915001512/v1_201509302252/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001512?idApp=UINPBA00003Z"
]