Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial
Por:
Garg, AX, Badner, N, Bagshaw, SM, Cuerden, MS, Fergusson, DA, Gregory, AJ, Hall, J, Hare, GMT, Khanykin, B, McGuinness, S, Parikh, CR, Roshanov, PS, Shehata, N, Sontrop, JM, Syed, S, Tagarakis, GI, Thorpe, KE, Verma, S, Wald, R, Whitlock, RP, Mazer, CD, de Medicis, E, Masse, MH, Marchand, J, Gregory, A, MacAdams, C, Seal, D, Ferland, A, Ali, I, Maier, K, Whitlock, R, Syed, S, Creary, T, Tittley, L, Spence, J, Jaffer, I, Brodutch, S, Lellouche, F, Bussieres, J, Dagenais, F, Lizotte, P, Gagne, N, Tremblay, H, Breton, C, Bouchard, P, Bainbridge, D, Bentall, T, Beique, F, Ramachandran, S, Rochon, A, Vervais, M, Grenier, S, Grocott, H, Kashani, H, Ambrose, E, McVagh, J, Mazer, Hare, Verma, Crescini, C, Yagnik, S, Slabiak, A, Han, K, Fremes, S, Karkhanis, R, Bagshaw, SM, Baig, N, Sidhu, S, MacArthur, R, Reid, K, Boehnke, S, Hudson, C, Rubens, FD, Winch, D, Klein, R, Grey, R, Teoh, K, Wiley, W, Darby, C, Ho, A, Saha, T, Shore, DD, Shelley, J, Lamarche, Y, Sirois, C, Brown, CD, Dube, C, Holden, K, Roy, L, Rolfe, B, Brown, S, Badner, N, Saczkowski, R, Senner, W, Carrier, FM, Noiseux, N, Hebert, P, Benettaib, F, Ghamraoui, A, Lebrasseur, M, Beattie, WS, Carroll, J, Poonawala, H, Zbitnew, G, Howells, S, Mawhinney, R, Sampson, S, Yegappan, C, Schroeder, R, Perfect, S, Jones, M, Leff, J, Nair, S, Moncada, KA, Joco, C, Harrison, M, Greilich, P, Landgraf, K, Kramer, RS, Gallant, B, Fontes, M, Stavris, K, Rosengart, T, Debakey, ME, Omer, S, Coffey, K, Broussard, E, Tseng, E, London, MJ, Stanley, KM, Casson, L, Julien, M, Myles, P, Wallace, S, Galagher, W, Ditoro, A, Royse, A, Royse, C, Williams, Z, Tivendale, L, Dong, N, Judelman, S, Leyden, J, Yarad, E, Doane, M, Player, C, Scott, DA, Slater, B, Corcoran, P, Hu, R, Sidiropoulos, S, Baulch, S, Brewster, D, Simpson, S, Smith, J, Hulley, A, Painter, T, de Prinse, L, Bannon, P, Turner, L, Beattie, L, Eslick, A, Cope, L, Sanderson, B, Baker, RA, Pesudovs, B, Bennetts, JS, Dimovski, D, Duggan, N, Ives, K, Yap, C, Byrne, K, Mans, G, Termaat, J, Young, P, Ridgeon, E, Reddy, S, Hurford, S, Mackle, D, Baker, T, Hunt, A, Cruz, R, Henderson, S, Mehrtens, J, McGuinness, S, Parke, R, Gilder, E, Cowdrey, K, Dalton, J, Butler, M, Long, S, Lammert, A, Blakemore, A, Walker, C, France, D, Hutchison, R, Xue, S, Gu, J, Chen, X, Fan, A, Suraya, S, Raja, N, Yusnida, I, Azura, T, Saibon, T, Bing, MT, Hwang, NC, Tan, RS, Ang, F, Chin, TT, Mehta, C, Jain, A, Sharma, P, Shah, R, Shaikh, P, Kanchi, M, Sigamani, A, Anusha, K, Khanykin, B, Johansson, P, Anderson, T, Olesen, L, Lilleor, N, Rasmussen, S, Fenger, A, Treskatsch, S, Mezger, V, Falk, E, Habicher, M, Sander, M, Edinger, F, Koch, C, Boening, A, Oswald, I, Bulat-Genc, S, Seeberger, DB, Fassl, J, Seeberger, E, Eberle, B, Takala, J, Stucki, M, Mateo, E, Moreno, J, Gabaldon, T, Cobo, I, Pena, JJ, Ferrer, C, Carmona, P, Cantero, ML, Pajares, A, Zarragoikoetxea, I, Galan, J, Urrutia, G, Martinez-Zapata, MJ, Rivilla, M, Cegarra, V, Acosta-Isaac, R, Gajate-Martin, L, Candela-Toha, A, Tagarakis, GI, Simopoulos, V, Karangelis, D, Filipescu, D, Paunescu, A, Fawzy, H, Mawlana, W, Preisman, S, Raanani, E, Kogan, D, Matot, I, Cattan, A, Artsi, H, Galhardo, C, Olival, S, Toledo, R, Villar, JC, Hernandez, E, Montes, FR, Vaquiro, E, Garavito, C, Abello, M, Manrique, EJ, Vasquez, SM, Aguilar, LA, Coral, M, Rodriguez, H, Tellez, JC, Martinez, C, Biccard, BM, Alphonsus, CS, Spiess, BD, Hall, R, Kent, B, Denault, A, Deschamps, A
Publicada:
1 jul 2019
Resumen:
Background Safely reducing red blood cell transfusions can prevent transfusion-related adverse effects, conserve the blood supply, and reduce health care costs. Both anemia and red blood cell transfusion are independently associated with AKI, but observational data are insufficient to determine whether a restrictive approach to transfusion can be used without increasing AKI risk.
Methods In a prespecified kidney substudy of a randomized noninferiority trial, we compared a restrictive threshold for red blood cell transfusion (transfuse if hemoglobin<7.5 g/dl, intraoperatively and postoperatively) with a liberal threshold (transfuse if hemoglobin<9.5 g/dl in the operating room or intensive care unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied 4531 patients undergoing cardiac surgery with cardiopulmonary bypass who had a moderate-to-high risk of perioperative death. The substudy's primary outcome was AKI, defined as a postoperative increase in serum creatinine of >= 0.3 mg/dl within 48 hours of surgery, or >= 50% within 7 days of surgery.
Results Patients in the restrictive-threshold group received significantly fewer transfusions than patients in the liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer transfusions in the restricted threshold group compared with the liberal-threshold group; P<0.001).AKI occurred in 27.7% of patients in the restrictive-threshold group (624 of 2251) and in 27.9% of patients in the liberal-threshold group (636 of 2280). Similarly, among patients with preoperative CKD, AKI occurred in 33.6% of patients in the restrictive-threshold group (258 of 767) and in 32.5% of patients in the liberal-threshold group (252 of 775).
Conclusions Among patients undergoing cardiac surgery, a restrictive transfusion approach resulted in fewer red blood cell transfusions without increasing the risk of AKI.
Filiaciones:
Garg, AX:
Western Univ, Westminster Tower, London, ON N6A 4G5, Canada
London Hlth Sci Ctr, Dept Med, Div Nephrol, London, ON, Canada
Badner, N:
Univ British Columbia, Dept Anesthesia & Clin Pharmacol, Kelowna, BC, Canada
Kelowna Gen Hosp, Kelowna, BC, Canada
Bagshaw, SM:
Univ Alberta, Dept Crit Care Med, Edmonton, AB, Canada
Cuerden, MS:
Western Univ, Westminster Tower, London, ON N6A 4G5, Canada
London Hlth Sci Ctr, Dept Med, Div Nephrol, London, ON, Canada
Fergusson, DA:
Ottawa Hosp, Clin Epidemiol Program, Res Inst, Ottawa, ON, Canada
Gregory, AJ:
Univ Calgary, Dept Anesthesiol Perioperat & Pain Med, Calgary, AB, Canada
Hall, J:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
Hare, GMT:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
Khanykin, B:
Copenhagen Univ Hosp, Cardiothorac Anesthesiol Dept, Copenhagen, Denmark
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
McGuinness, S:
Auckland City Hosp, Cardiothorac & Vasc Intens Care & High Dependency, Auckland, New Zealand
Auckland Hosp, Auckland, New Zealand
Parikh, CR:
Johns Hopkins Sch Med, Dept Med, Div Nephrol, Baltimore, MD USA
Roshanov, PS:
Western Univ, Westminster Tower, London, ON N6A 4G5, Canada
London Hlth Sci Ctr, Dept Med, Div Nephrol, London, ON, Canada
Shehata, N:
Univ Toronto, Mt Sinai Hosp, Dept Med, Toronto, ON, Canada
Sontrop, JM:
Western Univ, Westminster Tower, London, ON N6A 4G5, Canada
London Hlth Sci Ctr, Dept Med, Div Nephrol, London, ON, Canada
Syed, S:
Western Univ, Westminster Tower, London, ON N6A 4G5, Canada
London Hlth Sci Ctr, Dept Med, Div Nephrol, London, ON, Canada
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Tagarakis, GI:
Aristotle Univ Hosp Thessaloniki, Dept Cardiothorac Surg, Thessaloniki, Greece
Thorpe, KE:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
Verma, S:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
Wald, R:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
Whitlock, RP:
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
Mazer, CD:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
de Medicis, E:
CHU Sherbrooke, Sherbrooke, PQ, Canada
Masse, MH:
CHU Sherbrooke, Sherbrooke, PQ, Canada
Marchand, J:
CHU Sherbrooke, Sherbrooke, PQ, Canada
Gregory, A:
Univ Calgary, Dept Anesthesiol Perioperat & Pain Med, Calgary, AB, Canada
Foothills Med Ctr, Calgary, AB, Canada
MacAdams, C:
Foothills Med Ctr, Calgary, AB, Canada
Seal, D:
Foothills Med Ctr, Calgary, AB, Canada
Ferland, A:
Foothills Med Ctr, Calgary, AB, Canada
Ali, I:
Foothills Med Ctr, Calgary, AB, Canada
Maier, K:
Foothills Med Ctr, Calgary, AB, Canada
Whitlock, R:
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Syed, S:
Western Univ, Westminster Tower, London, ON N6A 4G5, Canada
London Hlth Sci Ctr, Dept Med, Div Nephrol, London, ON, Canada
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Creary, T:
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Tittley, L:
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Spence, J:
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Jaffer, I:
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Brodutch, S:
Hamilton Hlth Sci Ctr, Hamilton, ON, Canada
Lellouche, F:
IUCPQ, Quebec City, PQ, Canada
Bussieres, J:
IUCPQ, Quebec City, PQ, Canada
Dagenais, F:
IUCPQ, Quebec City, PQ, Canada
Lizotte, P:
IUCPQ, Quebec City, PQ, Canada
Gagne, N:
IUCPQ, Quebec City, PQ, Canada
Tremblay, H:
IUCPQ, Quebec City, PQ, Canada
Breton, C:
IUCPQ, Quebec City, PQ, Canada
Bouchard, P:
IUCPQ, Quebec City, PQ, Canada
Beique, F:
McGill Univ, Jewish Gen Hosp, Montreal, PQ, Canada
Ramachandran, S:
McGill Univ, Jewish Gen Hosp, Montreal, PQ, Canada
Rochon, A:
Montreal Heart Inst, Montreal, PQ, Canada
Vervais, M:
Montreal Heart Inst, Montreal, PQ, Canada
Grenier, S:
Montreal Heart Inst, Montreal, PQ, Canada
Grocott, H:
St Boniface Gen Hosp, Winnipeg, MB, Canada
Kashani, H:
St Boniface Gen Hosp, Winnipeg, MB, Canada
Ambrose, E:
St Boniface Gen Hosp, Winnipeg, MB, Canada
McVagh, J:
St Boniface Gen Hosp, Winnipeg, MB, Canada
Mazer:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
St Michaels Hosp, Toronto, ON, Canada
Hare:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
St Michaels Hosp, Toronto, ON, Canada
Verma:
Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
St Michaels Hosp, Toronto, ON, Canada
Crescini, C:
St Michaels Hosp, Toronto, ON, Canada
Yagnik, S:
St Michaels Hosp, Toronto, ON, Canada
Slabiak, A:
St Michaels Hosp, Toronto, ON, Canada
Han, K:
St Michaels Hosp, Toronto, ON, Canada
Fremes, S:
Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada
Karkhanis, R:
Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada
Bagshaw, SM:
Univ Alberta, Edmonton, AB, Canada
Baig, N:
Univ Alberta, Edmonton, AB, Canada
Sidhu, S:
Univ Alberta, Edmonton, AB, Canada
MacArthur, R:
Univ Alberta, Edmonton, AB, Canada
Reid, K:
Univ Alberta, Edmonton, AB, Canada
Boehnke, S:
Univ Alberta, Edmonton, AB, Canada
Hudson, C:
Univ Ottawa, Heart Inst, Ottawa, ON, Canada
Rubens, FD:
Univ Ottawa, Heart Inst, Ottawa, ON, Canada
Winch, D:
Univ Ottawa, Heart Inst, Ottawa, ON, Canada
Klein, R:
Vancouver Gen Hosp, Vancouver, BC, Canada
Grey, R:
Vancouver Gen Hosp, Vancouver, BC, Canada
Teoh, K:
Southlake Reg Hlth Ctr, Newmarket, ON, Canada
Wiley, W:
Southlake Reg Hlth Ctr, Newmarket, ON, Canada
Darby, C:
Southlake Reg Hlth Ctr, Newmarket, ON, Canada
Ho, A:
Kingston Gen Hosp, Kingston, ON, Canada
Saha, T:
Kingston Gen Hosp, Kingston, ON, Canada
Shore, DD:
Kingston Gen Hosp, Kingston, ON, Canada
Shelley, J:
Kingston Gen Hosp, Kingston, ON, Canada
Lamarche, Y:
Hop Sacre Coeur Montreal, Montreal, PQ, Canada
Sirois, C:
Hop Sacre Coeur Montreal, Montreal, PQ, Canada
Brown, CD:
St Johns Hosp, St John, NB, Canada
Dube, C:
St Johns Hosp, St John, NB, Canada
Holden, K:
St Johns Hosp, St John, NB, Canada
Roy, L:
St Johns Hosp, St John, NB, Canada
Rolfe, B:
St Johns Hosp, St John, NB, Canada
Brown, S:
St Johns Hosp, St John, NB, Canada
Badner, N:
Univ British Columbia, Dept Anesthesia & Clin Pharmacol, Kelowna, BC, Canada
Kelowna Gen Hosp, Kelowna, BC, Canada
Saczkowski, R:
Kelowna Gen Hosp, Kelowna, BC, Canada
Senner, W:
Kelowna Gen Hosp, Kelowna, BC, Canada
Carrier, FM:
CHUM, Montreal, PQ, Canada
Noiseux, N:
CHUM, Montreal, PQ, Canada
Hebert, P:
CHUM, Montreal, PQ, Canada
Benettaib, F:
CHUM, Montreal, PQ, Canada
Ghamraoui, A:
CHUM, Montreal, PQ, Canada
Lebrasseur, M:
CHUM, Montreal, PQ, Canada
Beattie, WS:
UHN, Toronto Gen Hosp, Toronto, ON, Canada
Carroll, J:
UHN, Toronto Gen Hosp, Toronto, ON, Canada
Poonawala, H:
UHN, Toronto Gen Hosp, Toronto, ON, Canada
Zbitnew, G:
Mem Univ, Hlth Sci Ctr, St John, NF, Canada
Howells, S:
Mem Univ, Hlth Sci Ctr, St John, NF, Canada
Mawhinney, R:
Mem Univ, Hlth Sci Ctr, St John, NF, Canada
Sampson, S:
Mem Univ, Hlth Sci Ctr, St John, NF, Canada
Yegappan, C:
Mem Univ, Hlth Sci Ctr, St John, NF, Canada
Schroeder, R:
Durham VA Med Ctr, Durham, NC USA
Perfect, S:
Durham VA Med Ctr, Durham, NC USA
Jones, M:
Durham VA Med Ctr, Durham, NC USA
Leff, J:
Montefiore Med Ctr, New York, NY USA
Nair, S:
Montefiore Med Ctr, New York, NY USA
Moncada, KA:
Montefiore Med Ctr, New York, NY USA
Joco, C:
Montefiore Med Ctr, New York, NY USA
Harrison, M:
Montefiore Med Ctr, New York, NY USA
Greilich, P:
Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA
Landgraf, K:
Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA
Kramer, RS:
Maine Med Ctr, Portland, ME 04102 USA
Gallant, B:
Maine Med Ctr, Portland, ME 04102 USA
Fontes, M:
Yale New Haven Med Ctr, 20 York St, New Haven, CT 06504 USA
Stavris, K:
Yale New Haven Med Ctr, 20 York St, New Haven, CT 06504 USA
Rosengart, T:
Baylor Med Coll, Houston, TX USA
Debakey, ME:
Baylor Med Coll, Houston, TX USA
Omer, S:
VA Med Ctr, Portland, OR USA
Coffey, K:
VA Med Ctr, Portland, OR USA
Broussard, E:
VA Med Ctr, Portland, OR USA
Tseng, E:
San Francisco VA Med Ctr, San Francisco, CA USA
London, MJ:
San Francisco VA Med Ctr, San Francisco, CA USA
Stanley, KM:
San Francisco VA Med Ctr, San Francisco, CA USA
Casson, L:
San Francisco VA Med Ctr, San Francisco, CA USA
Julien, M:
San Francisco VA Med Ctr, San Francisco, CA USA
Myles, P:
Alfred Hosp, Melbourne, Vic, Australia
Wallace, S:
Alfred Hosp, Melbourne, Vic, Australia
Galagher, W:
Alfred Hosp, Melbourne, Vic, Australia
Ditoro, A:
Alfred Hosp, Melbourne, Vic, Australia
Royse, A:
Royal Melbourne Hosp, Parkville, Vic, Australia
Royse, C:
Royal Melbourne Hosp, Parkville, Vic, Australia
Williams, Z:
Royal Melbourne Hosp, Parkville, Vic, Australia
Tivendale, L:
Royal Melbourne Hosp, Parkville, Vic, Australia
Dong, N:
Royal Melbourne Hosp, Parkville, Vic, Australia
Judelman, S:
Royal North Shore Hosp, St Leonards, NSW, Australia
Leyden, J:
Royal North Shore Hosp, St Leonards, NSW, Australia
Yarad, E:
Royal North Shore Hosp, St Leonards, NSW, Australia
Doane, M:
Royal North Shore Hosp, St Leonards, NSW, Australia
Player, C:
Royal North Shore Hosp, St Leonards, NSW, Australia
Scott, DA:
St Vincents Hosp, Melbourne, Vic, Australia
Slater, B:
St Vincents Hosp, Melbourne, Vic, Australia
Corcoran, P:
St Vincents Hosp, Melbourne, Vic, Australia
Hu, R:
Austin Hlth, Melbourne, Vic, Australia
Sidiropoulos, S:
Austin Hlth, Melbourne, Vic, Australia
Baulch, S:
Austin Hlth, Melbourne, Vic, Australia
Brewster, D:
Cabrini Hosp, Malvern, Vic, Australia
Simpson, S:
Cabrini Hosp, Malvern, Vic, Australia
Smith, J:
Monash Hlth, Melbourne, Vic, Australia
Hulley, A:
Monash Hlth, Melbourne, Vic, Australia
Painter, T:
Royal Adelaide Hosp, Adelaide, SA, Australia
de Prinse, L:
Royal Adelaide Hosp, Adelaide, SA, Australia
Bannon, P:
Royal Prince Alfred, Camperdown, NSW, Australia
Turner, L:
Royal Prince Alfred, Camperdown, NSW, Australia
Beattie, L:
Royal Prince Alfred, Camperdown, NSW, Australia
Eslick, A:
Westmead Hosp, Sydney, NSW, Australia
Cope, L:
Westmead Hosp, Sydney, NSW, Australia
Sanderson, B:
Westmead Hosp, Sydney, NSW, Australia
Baker, RA:
Flinders Med Ctr, Bedford Pk, SA, Australia
Pesudovs, B:
Flinders Med Ctr, Bedford Pk, SA, Australia
Bennetts, JS:
Flinders Med Ctr, Bedford Pk, SA, Australia
Dimovski, D:
Barwon Hlth, Melbourne, Vic, Australia
Duggan, N:
Barwon Hlth, Melbourne, Vic, Australia
Ives, K:
Barwon Hlth, Melbourne, Vic, Australia
Yap, C:
Barwon Hlth, Melbourne, Vic, Australia
Byrne, K:
Waikato Hosp, Hamilton, New Zealand
Mans, G:
Waikato Hosp, Hamilton, New Zealand
Termaat, J:
Waikato Hosp, Hamilton, New Zealand
Young, P:
Wellington Hosp, Wellington, New Zealand
Ridgeon, E:
Wellington Hosp, Wellington, New Zealand
Reddy, S:
Wellington Hosp, Wellington, New Zealand
Hurford, S:
Wellington Hosp, Wellington, New Zealand
Mackle, D:
Wellington Hosp, Wellington, New Zealand
Baker, T:
Wellington Hosp, Wellington, New Zealand
Hunt, A:
Wellington Hosp, Wellington, New Zealand
Cruz, R:
Wellington Hosp, Wellington, New Zealand
Henderson, S:
Christchurch Hosp, Christchurch, New Zealand
Mehrtens, J:
Christchurch Hosp, Christchurch, New Zealand
McGuinness, S:
Auckland City Hosp, Cardiothorac & Vasc Intens Care & High Dependency, Auckland, New Zealand
Auckland Hosp, Auckland, New Zealand
Parke, R:
Auckland Hosp, Auckland, New Zealand
Gilder, E:
Auckland Hosp, Auckland, New Zealand
Cowdrey, K:
Auckland Hosp, Auckland, New Zealand
Dalton, J:
Auckland Hosp, Auckland, New Zealand
Butler, M:
Auckland Hosp, Auckland, New Zealand
Long, S:
Auckland Hosp, Auckland, New Zealand
Lammert, A:
Auckland Hosp, Auckland, New Zealand
Blakemore, A:
Auckland Hosp, Auckland, New Zealand
Walker, C:
Dunedin Publ Hosp, Dunedin, New Zealand
France, D:
Dunedin Publ Hosp, Dunedin, New Zealand
Hutchison, R:
Dunedin Publ Hosp, Dunedin, New Zealand
Xue, S:
Ren Ji Hosp, Shanghai, Peoples R China
Gu, J:
Ren Ji Hosp, Shanghai, Peoples R China
Chen, X:
Shanghai Yodak Cardiothorac Hosp, Shanghai, Peoples R China
Fan, A:
Shanghai Yodak Cardiothorac Hosp, Shanghai, Peoples R China
Suraya, S:
Inst Jantung Negara, Kuala Lumpur, Malaysia
Raja, N:
Inst Jantung Negara, Kuala Lumpur, Malaysia
Yusnida, I:
Inst Jantung Negara, Kuala Lumpur, Malaysia
Azura, T:
Inst Jantung Negara, Kuala Lumpur, Malaysia
Saibon, T:
Inst Jantung Negara, Kuala Lumpur, Malaysia
Bing, MT:
Inst Jantung Negara, Kuala Lumpur, Malaysia
Hwang, NC:
Natl Heart Ctr Singapore, Singapore, Singapore
Tan, RS:
Natl Heart Ctr Singapore, Singapore, Singapore
Ang, F:
Natl Heart Ctr Singapore, Singapore, Singapore
Chin, TT:
Natl Heart Ctr Singapore, Singapore, Singapore
Mehta, C:
SAL Hosp, Ahmadabad, Gujarat, India
Jain, A:
SAL Hosp, Ahmadabad, Gujarat, India
Sharma, P:
SAL Hosp, Ahmadabad, Gujarat, India
Shah, R:
SAL Hosp, Ahmadabad, Gujarat, India
Shaikh, P:
SAL Hosp, Ahmadabad, Gujarat, India
Kanchi, M:
Narayana Hrudayalaya Hosp, Bangalore, Karnataka, India
Sigamani, A:
Narayana Hrudayalaya Hosp, Bangalore, Karnataka, India
Anusha, K:
Narayana Hrudayalaya Hosp, Bangalore, Karnataka, India
Khanykin, B:
Copenhagen Univ Hosp, Cardiothorac Anesthesiol Dept, Copenhagen, Denmark
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Johansson, P:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Anderson, T:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Olesen, L:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Lilleor, N:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Rasmussen, S:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Fenger, A:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Treskatsch, S:
Charite Univ Med Berlin, Berlin, Germany
Mezger, V:
Charite Univ Med Berlin, Berlin, Germany
Falk, E:
Charite Univ Med Berlin, Berlin, Germany
Habicher, M:
Charite Univ Med Berlin, Berlin, Germany
Sander, M:
Giessen Heart Ctr, Giessen, Germany
Edinger, F:
Giessen Heart Ctr, Giessen, Germany
Koch, C:
Giessen Heart Ctr, Giessen, Germany
Boening, A:
Giessen Heart Ctr, Giessen, Germany
Oswald, I:
Giessen Heart Ctr, Giessen, Germany
Bulat-Genc, S:
Giessen Heart Ctr, Giessen, Germany
Seeberger, DB:
Univ Hosp Basel, Basel, Switzerland
Fassl, J:
Univ Hosp Basel, Basel, Switzerland
Seeberger, E:
Univ Hosp Basel, Basel, Switzerland
Eberle, B:
Univ Hosp Bern, Inselspital, Bern, Switzerland
Takala, J:
Univ Hosp Bern, Inselspital, Bern, Switzerland
Stucki, M:
Univ Hosp Bern, Inselspital, Bern, Switzerland
Mateo, E:
Consorcio Hosp Gen Valencia, Valencia, Spain
Moreno, J:
Consorcio Hosp Gen Valencia, Valencia, Spain
Gabaldon, T:
Consorcio Hosp Gen Valencia, Valencia, Spain
Cobo, I:
Consorcio Hosp Gen Valencia, Valencia, Spain
Pena, JJ:
Consorcio Hosp Gen Valencia, Valencia, Spain
Ferrer, C:
Consorcio Hosp Gen Valencia, Valencia, Spain
Carmona, P:
Inst Invest Sanitaria La Fe, Valencia, Spain
Cantero, ML:
Inst Invest Sanitaria La Fe, Valencia, Spain
Pajares, A:
Inst Invest Sanitaria La Fe, Valencia, Spain
Zarragoikoetxea, I:
Inst Invest Sanitaria La Fe, Valencia, Spain
Galan, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Urrutia, G:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Martinez-Zapata, MJ:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Rivilla, M:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Cegarra, V:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Acosta-Isaac, R:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Tagarakis, GI:
Univ Thessaly, Volos, Greece
Simopoulos, V:
Univ Thessaly, Volos, Greece
Karangelis, D:
Univ Thessaly, Volos, Greece
Filipescu, D:
Emergency Inst Cardiovasc Dis, Bucharest, Romania
Paunescu, A:
Emergency Inst Cardiovasc Dis, Bucharest, Romania
Fawzy, H:
Tanta Univ Hosp, Tanta, Egypt
Mawlana, W:
Tanta Univ Hosp, Tanta, Egypt
Preisman, S:
Sheba Med Ctr, Ramat Gan, Israel
Raanani, E:
Sheba Med Ctr, Ramat Gan, Israel
Kogan, D:
Sheba Med Ctr, Ramat Gan, Israel
Matot, I:
Tel Aviv Med Ctr & Sch Med, Tel Aviv, Israel
Cattan, A:
Tel Aviv Med Ctr & Sch Med, Tel Aviv, Israel
Artsi, H:
Tel Aviv Med Ctr & Sch Med, Tel Aviv, Israel
Galhardo, C:
Natl Inst Cardiol, Sao Paulo, Brazil
Olival, S:
Natl Inst Cardiol, Sao Paulo, Brazil
Toledo, R:
Natl Inst Cardiol, Sao Paulo, Brazil
Villar, JC:
Fdn Cardioinfantil Inst Cardiol, Bogota, Colombia
Hernandez, E:
Fdn Cardioinfantil Inst Cardiol, Bogota, Colombia
Montes, FR:
Fdn Cardioinfantil Inst Cardiol, Bogota, Colombia
Vaquiro, E:
Fdn Cardioinfantil Inst Cardiol, Bogota, Colombia
Garavito, C:
Fdn Cardioinfantil Inst Cardiol, Bogota, Colombia
Abello, M:
Fdn Clin SHAIO, Bogota, Colombia
Manrique, EJ:
Inst Corazon Bucaramanga, Bucaramanga, Santander, Colombia
Vasquez, SM:
Inst Corazon Bucaramanga, Bucaramanga, Santander, Colombia
Aguilar, LA:
Inst Corazon Bucaramanga, Bucaramanga, Santander, Colombia
Coral, M:
Hosp San Jose, Bogota, Colombia
Rodriguez, H:
Hosp San Jose, Bogota, Colombia
Tellez, JC:
Marly Clin, Clin Marly SA, Bogota, Colombia
Martinez, C:
Marly Clin, Clin Marly SA, Bogota, Colombia
Biccard, BM:
Univ Kwazulu Natal, Durban, South Africa
Alphonsus, CS:
Univ Kwazulu Natal, Durban, South Africa
Spiess, BD:
Virginia Commonwealth Med Ctr VCU, Cape Town, South Africa
Green Published, Bronze
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