(BQ) Part 2 book “Coronary artery bypasses” has contents: Coronary artery bypass grafting for chronic and acute heart failure, postoperative constrictive pericarditis –present approach, myocardial revascularization with and without extracorporeal circulation,… and other contents.
In: Coronary Artery Bypasses Editors: Russell T Hammond and James B Alton ISBN: 978-1-60741-064-5 ©2009 Nova Science Publishers, Inc Chapter V Coronary Artery Bypass Grafting for Chronic and Acute Heart Failure Marco Pocar, Andrea Moneta, Davide Passolunghi, Alessandra Di Mauro, Alda Bregasi, Roberto Mattioli and Francesco Donatelli Unit of Cardiac Surgery and Echo-Lab; Scientific Institute MultiMedica Hospital; University of Milan; Milan, Italy Abstract The techniques and reproducibility of surgical coronary revascularization rely on over forty-year experience However, surgery for ischemic heart disease with associated left ventricular dysfunction carried high if not prohibitive operative risk during the pioneering and early era of coronary surgery Although the benefits of revascularization in this context have been well documented, the propensity to operate on patients with heart failure still often relies on concurrent anginal symptoms Similarly, many surgeons are reluctant to offer surgery aimed to reverse low cardiac output during acute or evolving myocardial infarction The purpose of this chapter is to depict up-to-date strategies and attitudes toward coronary operations in chronic or acute heart failure, focusing on personal experience with ischemic cardiomyopathy and acute coronary syndromes complicated by pump dysfunction or shock Emphasis will be given to the selection of patients, evolving technology, technical strategies, and ultimately to the limitations of isolated coronary revascularization and the increasing role of associated surgical procedures in ischemic cardiomyopathy 112 Marco Pocar, Andrea Moneta, Davide Passolunghi et al Coronary artery bypass grafting (CABG) relies on worldwide experience gained during over forty years since the first clinical successful series of patients [1] In spite of technical reproducibility, low risks and predictable results, patients with associated left ventricular (LV) dysfunction carried a high if not prohibitive operative risk during the pioneering and early era of coronary surgery Indications for CABG have broadened during the last two decades, but many institutions are still reluctant to offer surgery in higher-risk settings, namely, severely depressed systolic function, overt heart failure and acute coronary syndromes complicated by low cardiac output Ischemic Cardiomyopathy and Chronic Ischemic Heart Failure The most common modality of cardiovascular death is refractory heart failure secondary to coronary artery disease Although patients undergoing isolated CABG represent a lowerrisk population among cardiac surgical candidates, LV dysfunction represents an independent risk factor for hospital and 30-day mortality This is most often depicted by a poor LV ejection fraction (LVEF), particularly when lower than 30-35%, a higher New York Heart Association functional class or, even more dramatically, a low output state and the requirement for inotropic support, which all represent typical variables included in widely employed risk-scoring systems [2, 3] Benefits of revascularization outweigh by far the risks of surgery in patients with LV dysfunction and concurrent angina pectoris, which traditionally underlies a potential for viability and thus for contractile recovery [4] Conversely, indications for CABG in case of prevalent heart failure symptoms have been outlined more recently [5-7] Indications for Revascularization Selection of patients remains controversial, and is even more complex in the younger age group with advanced heart failure, which might be potentially considered for transplantation However, good long-term survival, as late as 10-to-15 years after CABG, can be anticipated in selected subgroups of patients [7] Coronary Targets The vast majority of patients with LV dysfunction considered for CABG have triplevessel disease, whereas the severity and distribution of coronary atherosclerosis well correlates with LV dysfunction The quality of distal coronary territories is an obvious issue and diffuse distal disease with poor peripheral run-off, which is worsened by higher intraventricular diastolic pressures, has been outlined as a strong pedictor of a poor outcome in these patients [6] However, the definition of an unfavourable surgical anatomy cannot be standardized and must be judged on an individual basis Furthermore, vascular wall Coronary Artery Bypass Grafting for Chronic and Acute Heart Failure 113 remodeling has been outlined in experimental animals and may correlate with reduced perfusion after CABG [8] As a general rule, more severe LV dysfunction implies more graftable targets, and more severe and proximal coronary stenoses as a pre-requisite to render CABG equally appealing The best candidates are those presenting with left main or triplevessel disease, severe and proximally-located stenoses, and undiseased distal branches Myocardial Viability Different imaging techniques may be employed for the detection and quantification of myocardial viability These include single photon emission tomography, positron emission tomography, magnetic resonance imaging techniques, and echocardiography [9-13] Stresstests are often performed following inotrope infusion, typically dobutamine, or exercise A detailed description of the single diagnostic tools is beyond the scope of this chapter, but the differentiation into viable and non-viable myocardium may not always be clear-cut The degree of segmental viability is derived measuring respective uptake of specific tracers, which indicate a metabolic shift toward glucose consumption (positron emission tomography), the integrity of cellular and mitochondrial membranes (nuclear scintigraphy), or the amount of tissue fibrosis (magnetic resonance) Wall motion segmental assessment can also be performed with various techniques, but is more straighforward with echocardiography The latter and magnetic resonance also allow the analysis of ventricular wall thickening during the cardiac cycle The detection of myocardial viability plays a substantial role not only in the stratification of operative risk, but also in the prediction of the probability of reverse LV remodeling, irrespective of associated angina [14] Some institutions indicate CABG without preoperative viability testing [6], but the absence of akinetic and viable segments, commonly termed hibernating myocardium, correlates with a worse outcome Particular efforts have been devoted to quantify the amount of hibernating myocardium to predict a successful operation and thus to serve as a reference for appropriate selection of patients At the beginning of our experience in the late Eighties, screening for myocardial viability in angina-free patients was undertaken with positron emission tomography in case of LVEF < 40%, and CABG was planned on the basis of a minimum of of viable and akinetic segments (anterior, septal, apical, lateral, inferior) with critically stenotic coronary tributaries [7] Nowadays, the LV is subdivided into the 16 segments which abitually serve for regional wall motion analysis at echocardiography, and the presence of a minimum of akinetic and viable segments has been identified as a predictor of reverse LV remodeling after CABG During decision making, however, the surgeon should keep in mind the limitations of isolated CABG in patients with more advanced cardiomyopathy This point is discussed in a separate section Surgical Technique Basic principles of CABG technique are well established, but specific aspects concerning myocardial protection, the choice of conduits and distal target vessels, and, ultimately, the 114 Marco Pocar, Andrea Moneta, Davide Passolunghi et al decision whether to employ or not cardiopulmonary bypass are of utmost importance in case of LV dysfunction Cardiopulmonary Bypass and Myocardial Protection Although off-pump operations have been reported in patients with poor LVEF [15], displacement maneuvers or prolonged exposure of the lateral and posterior LV are undoubtedly less tolerated in case of dilated hearts During off-pump operations patients are more prone to intraoperative hypotension or electrical instabilization, which may be as detrimental as ischemia-reperfusion injury due to conventional aortic cross-clamping and cardioplegia arrest Furthermore, a lower patency rate of distal anastomoses and a reduced number of grafts-per-patient have been reported after off-pump operations when compared to conventional CABG [16], and this is likely to represent an even more critical issue in case of LV dysfunction Thus, traditional CABG with extracorporeal circulation is the favored strategy at our institution Operations are performed on moderately hypothermic (32-33 °C core temperature) cardiopulmonary bypass with blood antegrade and retrograde cardioplegia, normothermic induction, cold maintaining doses every 20 minutes, and substrate-enriched controlled reperfusion, following Buckberg’s protocols for energy-depleted hearts [17] The LV can be vented, typically through the right superior pulmonary vein, to prevent rewarming from extracoronary collateral blood flow during construction of the anastomoses or to avoid inadvertent LV distension, especially during the reperfusion phase, but this adjunct is generally unnecessary and is now seldom applied by our team Unusual exceptions may include, for example, disturbing collateral flow obscuring the surgical field or mild aortic insufficiency Finally, off-pump CABG is reserved to the rare occurrence of isolated revascularization in the left anterior descending (LAD) and proximal-to-mid right coronary territories, whereas beating-heart CABG with cardiopulmonary bypass support – i.e., conventional CABG without cardioplegia – can be an attractive alternative in the presence of a severely calcified ascending aorta In the latter case, our preferred arterial cannulation site is the undersurface of the distal arch Strategy of Revascularization The importance of complete revascularization cannot be overemphasized in patients with LV dysfunction Our policy is to bypass all stenoses ≥50% on all technically graftable targets In view of the high prevalence of triple-vessel disease in case of poor LV function, the majority of patients receive three or more distal bypass grafts Bilateral internal thoracic artery (ITA) grafts are applied in as many as 50% of the patients and maintained pedicled whenever possible Although this represents a debated issue, we believe this may be beneficial irrespectively of late outcome, when considering that distal run-off is often reduced in dilated hearts with higher filling pressures, particularly in the left coronary territories, and in branches supplying hibernating myocardium [18, 19] Speculatively, this policy is likely to Coronary Artery Bypass Grafting for Chronic and Acute Heart Failure 115 yield lower graft failure rates when compared to a traditional wider use of saphenous vein grafts Consequently, we generally graft the left ITA to the LAD, avoiding sequential grafts on diagonal branches, and the right ITA to the circumflex territory with a course in the transverse sinus ITAs (especially the right) are often harvested with a skeletonized technique In case of inadequate right ITA length – a not infrequent occurrence when dealing with dilated hearts – conduits may be switched, i.e., grafting the right ITA to the LAD and the left ITA to the circumflex, thus avoiding free arterial grafts In spite of a relatively low probability of reintervention in patients with poor LV function, this combination is generally avoided in patients younger than 65 years because of the obvious hazards of a right ITA-toLAD graft crossing the midline between a dilated heart and the sternum Alternatively, a dominant right coronary artery may be chosen as the target for the second ITA, even though grafts in this territory are most often constructed on the posterior descending branch The remaining target vessels are bypassed with traditional saphenous vein grafts, which are usually constructed first We often employ sequential venous grafts, provided that the caliber of the most distal target is not diminutive Proximal anastomoses are completed during a single period of aortic cross-clamping, generally immediately after the corresponding distal anastomosis/-es, to ensure the widest possible delivery of cardioplegia during infusion of maintaining doses and, most importantly, during myocardial reperfusion and rewarming In view of the potential hazards of spasm, which might be triggered by hypotension or, more in general, by perioperative instability, we not favor alternative arterial grafts, such as the radial artery, in patients with LV dysfunction unless adequate veins are unavailable Intensive and Perioperative Care Perioperative care, both before and after surgery, is of obvious importance in patients with LV dysfunction When excluding acute coronary syndromes, intensive management is usually required only postoperatively in isolated CABG operations Preoperative invasive hemodynamic monitoring with a Swan-Ganz catheter, inotropic pharmacologic support or aortic balloon counterpulsation may occasionally be indicated in decompensated patients Nowadays, however, the latter are most often candidates for additional procedures, such as mitral or left ventricular restoration surgery Our policy is to employ inotropes and IABP preoperatively only in hemodynamically unstable patients In rare instances, pre-treatment with intravenous levosimendan has been initiated 24 hours before surgery With respect to the intraoperative and early postoperative course we usually employ low-dose dopamine (≤ mcg/Kg/min), epinephrine as a secondline inotropic agent, and phosphodiesterase inhibitors (milrinone) as additional resort The theoretical advantage of milrinone is to improve contractility without a significant increase in myocardial oxygen consumption, whereas the combination of a different class of drugs allows a lower dose of catecholamines Milrinone is generally associated when higher-dose epinephrine infusion rates (≥ 0.08-0.1 mcg/Kg/min) are necessary IABP is considered when low cardiac output (< 2L/min/m2) persists in spite of multiple inotropes or, more rarely, in case of electrical instability Most patients with severe LV dysfunction receive double arterial invasive monitoring − radial and femoral − before skin incision This facilitates expeditious 116 Marco Pocar, Andrea Moneta, Davide Passolunghi et al IABP insertion when needed Finally, Swan-Ganz monitoring is seldom used in patients undergoing isolated CABG at our institution Direct left atrial catheterization is sometimes used intraoperatively for temporary monitoring of left-sided filling pressures during weaning from cardiopulmonary bypass All patients with ischemic LV dysfunction start medical heart failure therapy with ACE-inhibitors or anti-angiotensin receptor inhibitors, and beta-blockers as soon as possible, almost invariably before discharge from the intensive care unit Associated Procedures Limitations of isolated CABG in patients with poor LV function are controversial and the attitude toward additional surgical procedures varies widely between institutions It must be stressed that the vast majority of late deaths (> 80%) are cardiac-related, with progressive heart failure and sudden death as predominating causes, with a near-equal proportion [7] In a minority of cases acute myocardial infarction is the modality of cardiac death during followup In addition, other cardiovascular complications (neurologic, peripheral, renal) are the main cause of death in another subgroup of patients, most commonly in diabetics Our general policy has changed over time Schematically, the essential points are addressed here: Patients with a preoperative widened QRS complex are evaluated for LV dyssynchrony and functional mitral regurgitation at echocardiography, eventually with stress testing In cases of widened QRS, an epicardial lead is implanted on the lateral LV wall and drawn subcutaneously to the left subclavicular region This adds minimal surgical invasiveness to the operation and greatly facilitates subsequent resynchronization therapy In addition, a temporary pacing wire may be connected to the permanent lead to allow perioperative atrio-biventricular pacing to improve cardiac output [20] Similarly, indications for implantation of an automatic cardioverter defibrillator is evaluated in all patients with LV function The role of associated mitral valve surgery for functional insufficiency is a controversial issue, especially with respect to the potential for improved late survival [21-25] However, the correlation between ischemic mitral regurgitation and reduced life expectancy in patients with coronary artery disease and prior myocardial infarction is well-established [26] and operative risk for associated undersized mitral annuloplasty appear to be low As a consequence, we now tend to implant a prosthetic ring in the presence of moderate or severe mitral insufficiency An exaustive discussion regarding left ventricular reduction surgery is beyond the objectives of this chapter However, a number of variables describing systolic or diastolic dysfunction, and correlated with the degree of LV remodeling have been recently outlined as independent predictors of late outcome in heart failure, including patients undergoing cardiac operations The former include LV end-diastolic pressure, end-systolic volume index, atrial volume index and diastolic filling patterns [7, 27, 28] In particular, LV end-systolic volume index is a resultant of cardiac dilatation and LVEF, and well depicts LV systolic dysfunction irrespective of the Coronary Artery Bypass Grafting for Chronic and Acute Heart Failure 117 severity of associated mitral insufficiency In this respect patients with an enlarged LV and previous are increasingly being scheduled for LV reconstruction, most often for the Dor procedure or LV restoration, in the presence of an LV end-systolic volume index > 45 or 50 mL/m2 Ongoing trials will better define the respective benefits (and risks) of this approach Heart Failure and Cardiogenic Shock in Acute Myocardial Infarction Since the early reports concerning CABG for acute coronary syndromes in the late Sixties [29], indications and results have been impressively influenced by the introduction of systemic thrombolysis, percutaneous coronary interventions (PCI) and coronary stenting in clinical practice In parallel, revascularization performed within to hours from the onset of ischemia has been well correlated with a higher probability of survival and recovery of LV function [30] Consequently, indications for CABG played a substantial part in the early era, but have been confined as a last-line resort with the progressive development of medical and interventional reperfusion strategies However, mortality rates below 5% have been reported in randomized trials since the late Eighties when emergency CABG is indicated as firstchoice option in non-selected patients [31] Nowadays, indications for emergency CABG may vary considerably between institutions and are dictated not only by the general attitudes of a particular cardiovascular department and team but also by logistic problems, especially when transportation of an unstable patients is required Surgery almost unvariably requires longer time intervals to achieve reperfusion and the availability of an invasive cardiology laboratory or cardiac surgical unit on site is a major determinant of clinical decision making in this setting However, CABG offers the following advantages: it allows complete revascularization in virtually all patients that could benefit from PCI or thrombolysis, and reduces 1-year mortality from 10% to 2-3% [32]; myocardial and end-organ protection and perfusion can be selectively applied with extracorporeal perfusion techniques; in spite of suboptimal mortality rates, the two previous points renders surgsry as the preferred approach for patients with heart failure or in cardiogenic shock [33-34] Importantly, pump failure is the most common modality of death in this population, whereas mortality approaches 100% in case of medical management of postinfarction cardiogenic shock Indications for Operation Indications for CABG in acute myocardial infarction, other than failed PCI or postinfarction mechanical complications, are essentially dictated by the following variables: 118 Marco Pocar, Andrea Moneta, Davide Passolunghi et al Extent of myocardium at risk It should be stressed that this issue pertains not only to the infarcted territory, but also to the remote myocardium Longer intervals from onset of ischemia progressively render the remote areas hypercontractile and, consequently, crucial for global LV function; Extent and severity of coronary artery disease; Unfavourable anatomy for PCI; Severity of LV dysfunction determined by the acute ischemic insult Emergent CABG has been indicated as first-choice treatment in selected patients since the early Nineties at our institution Schematically, we now consider CABG in the following settings: Left main or left main equivalent disease; extensive infarction within 6-8 hours from onset, multivessel disease and critical LAD stenosis; postinfarction pump failure or cardiogenic shock The latter often ensues after 6-8 hours from the onset of ischemia and usually relates to failing remote myocardium in multivessel disease The vast majority of patients who undergo emergency CABG have an acutely occluded LAD and left main or three-vessel disease A very complex point concerns the definition of contraindications for salvage CABG True quantification of operative risk and risk-to-benefit ratio is difficult in very high-risk surgical candidates, and valid criteria to deny surgery must be identified on an individual basis Contraindications cannot be generalized and are often related to very advanced age, extremely poor LV function, repeated or prolonged cardiopulmonary resuscitation for arrest due to non-electrical causes (refractory pump failure), or comorbidities Surgical Technique The constant phylosophy of our group has been to provide controlled reperfusion of ischemic myocardium at time of reperfusion, and complete revascularization This distinction is important because the strategy in acute ischemia (within 6-8 hours) conceptually differs from the approach to cardiogenic shock In the former, controlled reperfusion is primarily indicated for salvage revascularization of the infarcted area In the latter, CABG is indicated even beyong the 6-8 hours from onset, and is performed for salvage reperfusion of the failing remote myocardium Since the early phase of our personal experience with emergency CABG for acute myocardial infarction [35], the surgical strategy has gradually changed Operations are performed on cardiopulmonary bypass hypothermic with routine LV venting through the right superior pulmonary vein Until recently, we applied mild-to-moderate systemic hypothermia (32-34 °C core temperature) and followed a modified Buckberg protocol for energy-depleted hearts, consisting of substrate-enriched (aspartate and glutamate) antegrade Coronary Artery Bypass Grafting for Chronic and Acute Heart Failure 119 and retrograde cold blood cardioplegia, normothermic induction, and a 20-minute controlled reperfusion period [36] The essential modification relates to a wider use of retrograde cardioplegia, which may prove superior after acute coronary occlusion, especially during reperfusion, in view of the probability of concomitant remote myocardial stunning [37] As a result, maintaining doses are delivered retrograde only, avoiding interrupting the operation, the 20-minute reperfusion is performed retrogradely with the aorta clamped during construction of the proximal anastomoses, and, usually, the LAD is bypass with the internal mammary artery If necessary, the latter is harvested after institution of cardiopulmonary bypass More recently, improved results have been described with on-pump beating-heart revascularization in patients with acute coronary syndromes [38-40] Consequently, we investigated a strategy to provide controlled reperfusion, which represents the key of sophisticated cardioplegic protocols, on the beating heart CABG is performed on full conventional cardiopulmonary bypass The LV is vented and an intraaortic ballon pump (IABP) is routinely inserted preoperatively Counterpulsation is maintained to provide pulsatile flow The LAD, which is generally acutely occluded, is bypassed first The heart is subsequently tilted and saphenous vein grafts are anastomosed to the other coronary targets Intracoronary shunts are not used, whereas a coronary stabilizer is employed as needed After completion of the distal anastomosis, each graft is connected proximally to the cardioplegia circuit, and controlled selective perfusion started by the perfusionist with the implementation of glutamate and asparate, for a minimum a of 20 minutes Veins are subsequently anastomosed to the ascending aorta during a single period of side-biting clamping Initial results with this approach have been encouraging showing a trend toward reduced perioperative myocardial damage and enzyme release Thus, unless judged unadvisable for technical reasons, cardioplegia is now avoided, with particular emphasis on patients with ongoing heart failure and cardiogenic shock Conclusion Summarizing, CABG has an established role in patients with poor LV function and heart failure in the chronic and acute setting One-stage complete revascularization and controlled reperfusion are unique features of a surgical approach to myocardial ischemia, which are likely to be most benficial in the sickest patients References [1] [2] Favaloro RG Saphenous vein graft in the surgical treatment of coronary artery disease Operative technique J Thorac Cardiovasc Surg 1969;58:178-85 Nilsson J, Algottson L, Höglund P, Lührs C, Brandt J Early mortality in coronary bypass surgery: the EuroSCORE versus The Society of Thoracic Surgeons risk algorithm Ann Thorac Surg 2004;77:1235-40 120 [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] Marco Pocar, Andrea Moneta, Davide Passolunghi et al Hannan EL, Wu C, Bennett EW, et al Risk stratification for in-hospital mortality for coronary artery bypass graft surgery J Am Coll Cardiol 2006;47:661-8 Solomon SD, Anavekar NS, Greaves S, Rouleau JL, Hennekens C, Pfeffer MA, for the HEART Investigators Angina pectoris prior to myocardial infarction protects against subsequent left ventricular remodeling J Am Coll Cardiol 2004;43:1511-4 Dreyfus G, Duboc D, Blasco A, et al Coronary surgery can be an alternative to heart transplantation in selected patients with end-stage ischemic heart disease Eur J Cardiothorac Surg 1993;7:482-8 Elefteriades J, Edwards R Coronary bypass in left heart failure Semin Thorac Cardiovasc Surg 2002;14:125-32 Pocar M, Moneta A, Grossi A, Donatelli F Coronary artery bypass for heart failure in ischemic cardiomyopathy: 17-year follow-up Ann Thorac Surg 2007;83:468-74 Hong H, Aksenov S, Guan X, Fallon JT, Waters D, Chen C Remodeling of small intramyocardial coronary arteries distal to a severe epicardial coronary artery stenosis Arterioscler Thromb Vasc Biol 2002;22:2059-65 Senior R, Kaul S, Raval U, Lahiri A Impact of revascularization and myocardial viability determined by nitrate-enhanced Tc-99m sestamibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy J Nucl Cardiol 2002;9:454-62 Murashita T, Makino Y, Kamikubo Y, Yasuda K, Mabuchi M, Tamaki N Quantitative gated myocardial perfusion single photon emission computed tomography improves the prediction of regional functional recovery in akinetic areas after coronary bypass surgery: useful tool for evaluation of myocardial viability J Thorac Cardiovasc Surg 2003;126:1328-34 Wu YW, Tadamura E, Yamamuro M, et al Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease J Nucl Med 2007;48:1096-103 Erratum in: J Nucl Med 2007;48:1789 Samady H, Liu YH, Choi CJ, et al Electromechanical mapping for detecting myocardial viability and ischemia in patients with severe ischemic cardiomyopathy Am J Cardiol 2003;91:807-11 Ogawa M, Doi K, Fukumoto A, Yaku H Reverse-remodeling after coronary artery bypass grafting in ischemic cardiomyopathy: assessment of myocardial viability by delayed-enhanced magnetic resonance imaging can help cardiac surgeons Interact Cardiovasc Thorac Surg 2007;6:673-5 Rizzello V, Poldermans D, Boersma E, et al Opposite patterns of left ventricular remodeling after coronary revascularization in patients with ischemic cardiomyopathy Role of myocardial viability Circulation 2004;110:2383-8 Meharwal ZS, Mishra YK, Kohli V, Bapna R, Singh S, Trehan N Off-pump multivessel coronary artery surgery in high-risk patients Ann Thorac Surg 2002;74:S1353-7 Balacumaraswami L, Abu-Omar Y, Selvanayagam J, Pigott D, Taggart DP The effects of on-pump and off-pump coronary artery bypass grafting on intraoperative graft flow Index filtration, 86, 87, 89, 91, 92, 93, 97, 104, 152 first-time, 152 flexibility, 219 flexor, 3, 19, 45 flexor digitorum superficialis, flow, vii, xii, 5, 6, 18, 19, 20, 21, 22, 23, 24, 26, 27, 29, 35, 36, 37, 40, 41, 45, 46, 47, 54, 58, 64, 66, 70, 72, 73, 76, 83, 84, 85, 86, 87, 89, 90, 91, 93, 95, 98, 99, 108, 114, 119, 120, 121, 126, 144, 211, 212, 218, 219, 222, 223, 224, 225, 227, 228 flow rate, 73, 76, 91 fluid, 9, 61, 95, 127 fluorescence, 54, 64 focus group, 145 focus groups, 145 focusing, x, 111, 169 Ford, 142, 173, 200 Fox, 4, 41, 98 France, v, 69, 78, 81, 111 free radical, 88, 94 free radicals, 88, 94, 148, 151 freedom, 38, 149, 150 friction, frontal cortex, 219 frontal lobe, 218 frontal lobes, 218 functional imaging, 224 fundus, 137 fusion, 129 G gas, 62 gastrointestinal, 151, 236 gelatin, 90, 95, 102 gender, ix, xii, 6, 81, 82, 83, 164, 177, 181, 206, 229, 230, 231, 232, 233, 234, 237, 238, 239, 241, 242 gender differences, 229, 238, 242 gender role, 234 gene, 17, 18, 45, 76, 88, 99, 104, 153 gene expression, 76 gene therapy, 17, 18, 45 general anesthesia, 60, 224 generation, genes, 231 genetic, 169 genetic marker, 169 genetics, 136, 164 Germany, 217 glomerulonephritis, 83 249 glomerulus, 91 glucose, 83, 94, 107, 113, 136, 143, 231 glutamate, 118, 119, 121 glutathione, 92, 95 glycemia, 94 glycerine, 10 glycerol, 10, 11 glycolysis, 225 glycoprotein, 91, 92 glycoproteins, 91 goals, 72, 87, 96 gold, 6, 54 gold standard, 6, 54 Gore, 200 government, iv grading, 37 grafting, viii, 2, 8, 11, 19, 20, 22, 24, 25, 27, 28, 32, 35, 38, 40, 41, 42, 43, 44, 45, 47, 48, 49, 51, 52, 55, 56, 64, 65, 66, 78, 79, 80, 84, 95, 98, 99, 100, 101, 105, 106, 107, 112, 115, 120, 121, 122, 124, 127, 129, 130, 148, 155, 156, 157, 158, 160, 198, 199, 202, 203, 204, 207, 208, 209, 220, 225, 226, 228, 235, 236, 237, 241, 242 grafts, vii, viii, 1, 2, 3, 4, 6, 7, 8, 10, 14, 15, 17, 20, 21, 22, 23, 24, 26, 27, 28, 29, 30, 31, 32, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 51, 52, 54, 55, 56, 57, 60, 64, 79, 114, 119, 121, 150, 151, 154, 166, 167, 181, 183, 200, 215, 226, 230, 236, 238 granulocyte, 76 graph, 127 Great Britain, 41, 166, 207 green tea, 95 Greenland, 164, 190, 201 groups, 10, 12, 15, 16, 17, 31, 36, 37, 38, 39, 59, 61, 85, 90, 138, 149, 150, 151, 152, 153, 154, 155, 183, 184, 192, 216, 217, 225, 226, 230, 232 growth, 76 growth factor, 76 GTN, vii, 2, 11 guidelines, 82, 147, 155, 164, 190, 205 guilt, 173 gut, 108 H haemoglobin, 83 half-life, 92 handling, 8, 39, 104 hands, 9, 19, 20 250 haptoglobin, 88 harvest, 3, 9, 10, 19, 41, 43, 45, 148 harvesting, vii, viii, 2, 3, 4, 7, 8, 9, 10, 11, 14, 15, 19, 20, 26, 40, 42, 43, 45, 46, 76 hazards, 115 HDL, 231 HEA, 193 healing, 9, 10, 200 health, xi, xii, 83, 154, 158, 161, 162, 163, 164, 165, 168, 169, 170, 171, 172, 173, 175, 177, 178, 179, 180, 181, 184, 185, 190, 191, 192, 193, 194, 195, 196, 197, 199, 200, 202, 203, 204, 205, 206, 207, 208, 209, 229 health care, 154, 178, 200, 205, 207 health care system, 154 health education, 196 health problems, 171, 179, 193, 196 health services, 177 health status, 170, 179, 204, 207 healthcare, xii, 154, 162, 163, 169, 194, 197 hearing, 217 heart disease, vii, x, xi, 100, 111, 120, 127, 130, 135, 137, 138, 142, 144, 161, 170, 174, 191, 197, 200, 201, 203, 205, 209, 232 heart failure, x, 58, 61, 86, 111, 112, 116, 117, 119, 120, 123, 124, 125, 126, 127, 128, 129, 138, 141, 142, 144, 153, 163, 238, 242 heart rate, 23, 86, 175, 180 heart transplantation, 120, 124 heart valves, 126 heat, heat capacity, height, 163 hematocrit, 54, 83, 85, 95, 97, 99 hematologic, 151 hematoma, 106, 125, 131, 132, 133 heme, 76 hemisphere, 219, 223 hemodynamic, 29, 53, 62, 73, 78, 82, 83, 85, 86, 87, 95, 115, 127, 130, 131, 152, 158, 224, 233 hemodynamics, 73, 95, 225 hemoglobin, 83 Hemoglobin, 90 hemopericardium, 131 hemorrhages, 137 hemostasis, 55, 100, 108 hepatocytes, 88 hepatomegaly, 127 hepatorenal syndrome, 104 heterogeneity, 150 Index high blood cholesterol, 205 high blood pressure, 164 high risk, 61, 84, 141, 224, 238 high-frequency, 9, 42 high-risk, viii, 61, 62, 66, 69, 76, 77, 93, 98, 103, 106, 108, 118, 120, 139, 141, 152, 155, 232 histological, 10 holistic, 197 holistic care, 197 homeostasis, 80, 88, 100, 107, 152 horizon, viii, 52 hormones, 94 hospital, ix, 59, 60, 69, 76, 82, 83, 96, 97, 106, 107, 112, 120, 151, 153, 154, 155, 157, 158, 167, 168, 178, 182, 183, 189, 196, 204, 206, 219, 224, 234, 236, 239, 241 hospital death, 106 hospital stays, 241 hospitalization, ix, 69, 149 hospitalized, 92, 103, 241 hospitals, 154, 167 host, 18, 88, 198 human, 7, 29, 42, 45, 47, 90, 95, 96, 101, 102, 105, 107, 217 hybrid, viii, 51, 52, 54, 55, 56, 58, 59, 60, 61, 62, 65, 66, 67 hybrid coronary revascularization, viii, 51, 52, 58, 59, 60, 61, 62, 66 hydration, 61, 68 hydrocortisone, 153 hydrogen, hydrogen bonds, hypercholesteremia, 232 hyperglycemia, 230 hyperplasia, 15, 17, 23, 26, 40 hypersomnia, 173 hypertension, 87, 138, 148, 163, 164, 214, 232 hypertensive, 183 hypertrophy, viii, 69, 232, 236 hypoperfusion, 7, 151, 153, 224 hypotension, 10, 86, 93, 94, 114, 115 hypothermia, 84, 85, 87, 118 hypothesis, 73, 165, 177, 192 hypovolemia, 87, 90 hypoxia, 225 hypoxic, 76, 85, 225 I ICAM, 95 Index ICD, 183 ICE, 190 ICU, ix, 81, 94, 106 ideal body weight, 164 identification, viii, 51, 74, 93 idiopathic, 121, 124, 127, 132 IEA, vii, 1, 23 IL-1, 88, 92, 95, 103, 154 IL-6, x, 82, 83, 88, 153, 154 IL-8, x, 82, 88, 154 IMA, 60, 166 images, 218 imaging, 52, 54, 61, 62, 64, 113, 120, 130, 131, 132, 224, 227 imaging techniques, 64, 113 immune system, 89, 96 immunohistochemistry, 7, 10 immunomodulatory, 101 impairments, xii, 212, 216 implementation, 91, 119, 195, 196 in vitro, 12, 14, 16, 17, 18, 44, 45 incidence, vii, ix, 1, 4, 8, 9, 19, 23, 25, 26, 35, 36, 53, 56, 57, 59, 60, 61, 62, 67, 76, 81, 82, 83, 84, 85, 93, 96, 97, 124, 137, 138, 142, 151, 152, 153, 159, 162, 163, 166, 167, 168, 169, 173, 181, 183, 190, 191, 212, 224, 225, 226, 231 inclusion, 170, 182, 187, 188, 191 income, 162 incubation, 45 independent variable, xiii, 229 India, 199 indication, 4, 5, 52, 142 indicators, 166, 170, 242 indices, 19, 73 induction, 72, 76, 114, 119 infarction, ix, xii, 56, 70, 75, 76, 118, 121, 128, 136, 137, 138, 139, 152, 154, 162, 198, 200, 202, 204, 207, 213, 215 infection, 19, 82, 85, 124, 149, 236 infections, 92, 154 inferior parietal region, 222 inferior vena cava, 71, 72 inflammation, 84, 86, 88, 94, 95, 98, 106, 125, 137, 156, 200 inflammatory, ix, 81, 82, 83, 85, 86, 87, 88, 89, 90, 92, 94, 95, 96, 100, 101, 102, 104, 108, 109, 128, 147, 148, 149, 151, 152, 153, 154, 158, 164, 173 inflammatory mediators, x, 82, 88, 154 251 inflammatory response, ix, 81, 83, 85, 87, 89, 90, 95, 96, 100, 101, 102, 108, 109, 147, 148, 149, 151, 154, 158, 164 inflammatory responses, 148 infusions, 21 inhibition, 18, 60 inhibitors, 115, 183, 190 injection, 218, 227 injuries, 85, 91 injury, iv, ix, x, 8, 9, 11, 26, 44, 64, 73, 74, 75, 79, 80, 81, 82, 83, 85, 86, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 99, 100, 101, 103, 104, 105, 107, 108, 114, 121, 122, 129, 148, 151, 153, 157, 159, 164, 196, 212, 225, 231 insertion, 116, 133, 166, 225 insomnia, 173 inspection, 57 inspiration, 125, 126 instability, 53, 83, 86, 90, 115, 149, 151, 152, 153, 233 instenon, xii, 211, 212, 216, 219, 221, 225, 226 institutions, 112, 113, 116, 117 instruction, 218 insulin, 94, 107, 137, 144, 163 integration, 177 integrity, 2, 11, 52, 53, 89, 113 intellectual functioning, 170 intensity, 225 intensive care unit, ix, 55, 81, 116, 151, 216, 234 intensive care unit (ICU), ix, 81 intentions, 199 interaction, 60, 163, 226 interactions, 151, 170 intercellular adhesion molecule, 10, 107, 108 interest, 218 interleukin, x, 82, 105, 154, 203 interleukin-1, 105, 154 interleukin-6, 203 International Classification of Diseases, 183 interpretation, 190, 200, 202, 209 interstitial, 76 interval, 35, 52, 124, 175, 183, 197 intervention, viii, xii, 51, 52, 60, 62, 63, 65, 66, 67, 68, 93, 96, 98, 122, 139, 145, 149, 150, 169, 190, 196, 199, 209, 216, 229, 230 interview, 171 interviews, 170 intima, 6, 19, 48 intra-aortic balloon pump, 89 intramyocardial, 58, 79, 120 Index 252 intraoperative, ix, 60, 62, 64, 68, 69, 72, 74, 75, 105, 107, 114, 115, 120, 234, 236 intravascular, 21, 22, 48, 231 intravenous, 10, 115, 153, 216, 236 intrinsic, 232 inulin, 91 invasive, x, 62, 65, 66, 67, 98, 115, 117, 123, 157, 159, 166 iodine, 125 ions, 14 ipsilateral, Ireland, 41, 166, 207 irradiation, 58, 124 irrigation, 125 IRS, 151 ischaemic heart disease, 203 ischemia, viii, ix, 4, 20, 32, 41, 54, 69, 74, 80, 81, 86, 87, 88, 89, 91, 95, 105, 114, 117, 118, 120, 151, 153, 154 ischemic, viii, x, 19, 27, 41, 59, 69, 73, 76, 77, 85, 86, 87, 88, 92, 95, 100, 101, 105, 108, 111, 116, 118, 120, 121, 142, 148, 154, 159, 219, 225 ischemic heart disease, x, 100, 111, 120 isolation, 193 isomers, 92 isotopic methods, 91 Israel, 109, 123 ITA, 6, 7, 8, 10, 40, 114 Italy, 69, 111 J JAMA, 122, 142, 157, 159 Japan, 135 Japanese, 136, 142 jaundice, 125 Jun, 107 K K+, 12 kidney, ix, x, 64, 81, 82, 85, 86, 91, 92, 94, 95, 96, 97, 102, 103, 105, 108, 158 kidneys, 89 kinase, 154 kinetics, 218 King, 131, 155, 157, 170, 206, 208 kinks, 58 L lamina, 20, 29 laminar, 20, 29 laser, 61 LDL, 231 lead, 166, 177, 189, 190 leakage, viii, 14, 69, 73, 74, 77 leaks, 61, 125 learning, 150, 180, 219, 221, 222 left atrium, 70 left ventricle, 70, 127 left ventricular, viii, x, 36, 69, 77, 79, 83, 94, 107, 111, 112, 115, 116, 120, 121, 138, 154, 159, 160, 167, 171, 190, 213, 222, 223, 225, 232, 236, 238 lesions, viii, 19, 26, 51, 52, 56, 58, 59, 63, 76, 85, 86, 87, 88, 89, 93, 230, 231 leucocyte, 228 leukocyte, 18 leukotrienes, 101 life expectancy, x, 116, 135 life stressors, 177 lifestyle, 164, 193, 196, 197 life-threatening, 122 lifetime, 175 limbic system, 225 limitation, 35, 72, 73, 226 limitations, x, 29, 32, 91, 111, 113, 170, 171, 172, 176, 179, 184, 189, 195, 224 linear, 186, 221, 223 linear regression, 186, 221, 223 lipid, 89, 102, 163, 183, 205, 225 Lipid, 164, 190, 205 lipoprotein, 48, 231 Lipoprotein, 240 lipoproteins, 199 LITA graft, vii, 1, 3, 20, 22, 23, 32, 36, 39 literature, 166, 167, 168, 169, 170, 175, 176, 178, 180, 189, 190, 192, 194 liver, 124 local anesthetic, 93, 139 localised, 9, 164 location, 3, 28, 39, 47, 54, 61, 163, 164, 165, 230, 231 logistics, viii, 52 London, 35, 181, 197, 204, 205, 207, 209, 228 longitudinal study, 175 long-term, 166, 168, 170, 172, 196, 198, 202, 203, 209, 210 long-term impact, 58, 168 Index loss of appetite, 180 low birthweight, 163 low molecular weight, 91, 92 low risk, 89, 112 low-density, 48, 199 low-density lipoprotein, 48, 199 lumen, 6, 56, 213, 217 luminal, 23, 234 lung, 58, 128, 157, 217, 221, 223, 224 lung disease, 58 M macrophages, 88 magnesium, 153, 159 magnetic, 113, 120, 132 magnetic resonance, 113, 120, 132 magnetic resonance imaging, 46, 113, 120, 132 maintenance, 71, 77, 85, 87 major depression, 173, 201, 203 males, xii, 176, 178, 182, 211, 213, 232, 237 malignant, 236 management, 55, 62, 82, 98, 107, 115, 117, 121, 131, 154, 158, 164, 175, 190, 206, 227, 230 manipulation, 225 mannitol, 107 mapping, 120 marital status, 177 masking, 130 matrix, 218 MBP, 88 MCS, xi, xii, 162, 172, 179, 181, 184, 185, 186, 187, 188, 189, 193, 194 mean arterial pressure, 84, 85, 217 measurement, 6, 54, 64, 79, 91, 104, 105, 126, 170, 180, 195, 199, 205, 207 measures, 4, 6, 54, 155, 177, 181, 185, 186, 194, 200, 202, 208, 224 mechanical energy, mechanical ventilation, 94 media, 6, 7, 15, 19, 23, 68 median, 8, 61, 125, 148, 166 mediators, x, 15, 82, 86, 87, 88, 95, 151, 154, 165, 177 medication, 163, 164, 175, 183, 189, 190, 224 medications, 62, 145, 175, 181, 190, 201 medicine, 106, 131, 225 membranes, 113 memory, 168, 219, 221, 222, 223, 224, 226 253 men, xii, 92, 142, 144, 164, 175, 176, 177, 178, 200, 205, 207, 209, 210, 229, 230, 231, 232, 233, 234, 235, 236, 238, 239, 240, 241, 242 mental health, 171, 172, 177, 179, 181, 184, 191, 195, 209 meta-analysis, 56, 63, 65, 94, 98, 106, 145, 149, 150, 152, 156, 159, 207 metabolic, 74, 79, 86, 87, 91, 113, 183, 190, 230, 231 metabolic disorder, 183 metabolic rate, 86 metabolic shift, 113 metabolism, 73, 74, 77, 79, 88, 91, 148, 225 metabolites, 76, 79 methylprednisolone, 94 mice, 95, 230, 231 microaneurysms, 137 microcirculation, 76, 86, 99 microcirculatory, 85, 86, 87, 89 microscopy, 10 microspheres, 76 microvascular, 73, 79, 136, 137, 143 microvasculature, 70, 72 Middle East, 106 middle income, 162 middle-aged, 205 midlife, 209 mimicking, 124 Minnesota, 200 minority, 116 mitochondrial, 113 mitochondrial membrane, 113 mitogenic, 47 mitral, 115, 116, 117, 121, 126, 127, 130, 138, 201 mitral insufficiency, 116, 117 mitral regurgitation, 116, 121 mitral valve, 116, 121, 126, 127, 130, 201 mitral valve repair, 121 modality, 112, 116, 117, 128 models, 87, 95, 101, 181, 230, 231 modulation, 101 molecular weight, 91, 92 molecules, 88, 91 Møller, 121 momentum, 164 monoclonal, 107 monoclonal antibody, 107 monocyte, 88 monocytes, 88 mood, 170, 172, 173, 178, 179, 180, 185, 193, 196 Index 254 Moon, 48, 121 morbidity, xi, 10, 19, 59, 62, 66, 82, 83, 84, 96, 98, 103, 105, 124, 139, 145, 147, 148, 149, 154, 155, 156, 157, 159, 166, 167, 168, 170, 174, 175, 194, 198, 199, 200, 201, 227, 232, 241 morphine, 217 morphological, 126 morphology, vii, mortality, ix, xi, xii, 39, 56, 59, 62, 67, 81, 82, 83, 85, 94, 96, 97, 98, 103, 112, 117, 119, 120, 121, 136, 137, 138, 139, 143, 144, 147, 148, 149, 151, 152, 155, 156, 157, 159, 163, 166, 167, 170, 172, 173, 175, 177, 178, 189, 190, 198, 199, 200, 201, 202, 204, 206, 207, 209, 229, 230, 232, 233, 234, 235, 236, 237, 238, 239, 241, 242 mortality rate, ix, 81, 82, 96, 117, 137, 149, 151, 163, 166, 167, 189, 209, 234, 238 mortality risk, 166, 173, 198 moths, 227 motion, 53, 77, 113, 150, 154 mouse, 231 mouse model, 231 movement, 55, 126 MRI, 120, 126, 130 mRNA, 47 multiple regression, 174, 193 multiple regression analysis, 174 multivariate, 28, 172 muscle, vii, 3, 4, 8, 18, 23, 40, 47, 91 muscle cells, 47 muscle mass, 91 muscles, musculoskeletal, 183, 190 myocardial infarction, ix, x, xii, 53, 56, 69, 70, 74, 75, 76, 79, 80, 88, 99, 104, 111, 116, 117, 118, 120, 121, 122, 135, 136, 137, 138, 139, 140, 142, 143, 145, 149, 150, 152, 153, 158, 162, 163, 198, 200, 202, 204, 207, 213, 215, 232, 234, 236 myocardial ischemia, 75, 77, 79, 108, 119, 159 myocardial tissue, 70, 74 myocardium, viii, ix, 69, 70, 73, 74, 76, 77, 113, 114, 118, 120, 128, 129 myocyte, 80, 154 myoglobin, 74, 90 N Na+, 92, 105 N-acety, 61, 68, 95, 103, 106, 108 NaCl, 216 natural, 19, 72, 130 necrosis, x, 20, 82, 85, 87, 89, 107, 148, 151, 152, 154 negative consequences, x, 82 neoangiogenesis, 76 nephron, 87 nephropathy, 60, 61, 67, 68, 102, 136, 143 nephrotoxic, 82, 92 nephrotoxicity, 102, 103, 104 nerve, 3, nerves, 8, nervous system, 173, 199, 227 network, 4, 86, 89, 177 neurohormone, 127 neurological disorder, 217 neurological injury, 43 neurons, 225 neuroprotection, 169 neuroprotective, 169, 181 neuropsychologic testing, xii, 211, 212 neuropsychological assessment, xii, 162, 195, 197 neuropsychological tests, xi, 161, 180, 182, 186, 217, 218, 224, 225 neutrophil, x, 23, 47, 82, 88, 100, 103, 105 neutrophils, ix, 82, 88, 94 New England, 200, 202, 205, 209, 239 New York, 68, 80, 112, 123, 128, 154, 165, 179, 184, 198, 203, 208, 209, 227, 229, 233 New Zealand, 34, 198, 206 NFkB, 88 NHP, 171 nifedipine, 10 nitrate, 22, 120 nitrates, 10 nitric oxide, 2, 7, 14, 18, 45, 90, 101, 148, 151, 152, 158 nitric oxide (NO), nitric oxide synthase, 7, 18, 45 NO synthase, 17 non-steroidal anti-inflammatory drugs, 89 nonverbal, 219 norepinephrine, 7, 11, 12, 15, 93 normal, vii, 4, 11, 12, 13, 14, 24, 54, 61, 73, 76, 84, 85, 89, 91, 97, 107, 124, 125, 127, 128, 132, 138, 142, 173, 175, 178, 224 normal conditions, 91 normalization, 225 North America, 200, 242 North Carolina, 208 NOS, 18 Index Nottingham Health Profile (NHP), 171 NSAIDs, 89 nuclear, 113 nucleus, 92 nurse, 195, 196, 197 nurses, 169 nutrient, 87 O obese, 163 obesity, 59, 142, 163 observations, 26, 40 obstruction, 77, 86, 89, 90, 94 occipital lobe, 218 occipital regions, 221, 222 occluding, 5, occlusion, 2, 4, 7, 24, 26, 27, 28, 33, 34, 35, 36, 37, 47, 52, 54, 76, 119, 122, 151, 164, 165, 167 oedema, 88 old age, 217 older adults, 201, 203, 207 online, 79, 197 open heart surgery, 100, 126, 224 optic disc, 137 optimal health, 184 optimization, 93 oral, 10, 11 organ, 7, 82, 86, 98, 101, 108, 117, 148, 149 organism, 92 orthopnea, 125 osmotic, 94 osteoarthritis, 190 overload, 85, 95 overweight, 163 oxidants, 95 oxidation, 231 oxidative, 79, 148 oxidative stress, 148 oxide, 7, 14, 18, 45, 90, 101, 148, 151, 152, 158 oxygen, 5, 14, 70, 76, 85, 86, 87, 88, 93, 115, 148, 151, 165 oxygen consumption, 115 oxygen saturation, oxygenation, 76, 95, 106, 108 P pacemaker, 61, 124, 133 255 pacing, 23, 116, 121 paclitaxel, 52, 63, 65 pain, 142, 165, 167, 170, 171, 174, 178, 179, 185, 194, 208 palpation, 71 panic disorder, 175 PAO, 228 papaverine, vii, 2, 10, 11, 42, 44 paper, 167, 170, 172, 176 paradoxical, 167 parenchymal, 83 Parietal, 223 parietal cortex, 219 particles, 89, 231 password, 182 patency rates, vii, viii, 1, 2, 3, 27, 29, 34, 35, 36, 39, 40, 56, 59, 238 pathogenesis, 87, 96, 125, 152, 153, 154 pathogenic, 225 pathology, 6, 90, 92, 132 pathophysiological, 224 pathophysiological mechanisms, 224 pathophysiology, 159 pathways, 151, 230 patient care, 61, 155, 197 PCS, xi, xii, 162, 172, 179, 181, 184, 185, 186, 187, 188, 189, 193, 194 pediatric, 92, 95, 103, 108 peptide, 47, 94, 129, 133 peptides, 101 perception, 169, 192 perceptions, 170, 171, 176, 179, 192 percutaneous coronary intervention, viii, 51, 52, 60, 63, 65, 66, 67, 68, 98, 117, 122, 139 performance, 168, 170, 186, 192, 196 performers, 226 perfusion, vi, xii, 70, 71, 77, 78, 79, 84, 85, 86, 87, 90, 93, 94, 98, 99, 108, 113, 117, 119, 120, 128, 152, 211, 212, 216, 219, 221, 222, 223, 224, 225, 226, 227 pericardial, x, 89, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132 pericardial effusion, 125, 128 pericardial sac, 124, 129 pericardial tamponade, 127, 130 pericardiocentesis, 127 pericarditis, x, 123, 124, 126, 127, 128, 129, 130, 131, 132, 133 pericardium, x, 123, 124, 126, 127, 128, 129, 130, 132 256 peripheral, 27, 28, 214 peripheral vascular disease, 27, 28, 36, 59, 232, 233, 236, 238 permeability, 108 personal, 197 personality, 176, 179, 194 personality type, 194 perturbation, 87 PET, 120, 228 pH, 79, 227 pharmacological, 39, 93, 166, 216 pharmacology, 164 phosphate, 14 phosphodiesterase, 115 photon, 113, 120 physical activity, xii, 142, 162, 163, 164, 166, 171, 178, 181, 186, 187, 188, 189, 193, 194, 207 physical health, 165, 168, 170, 171, 172, 173, 178, 191, 193, 196 physical well-being, 194 physicians, x, 123, 129, 179 Physicians, 199, 229 physiological, 15, 17, 20, 26, 27, 92, 151, 163, 175, 191 physiological factors, 163 physiology, x, 123, 127, 128, 133 physiopathology, 86, 88, 93 pilot study, 66, 103, 107 placebo, 107, 201 planning, 61 plaque, 26, 32, 56, 89, 164, 225, 231 plaques, 6, 19, 32 plasma, 7, 90, 91, 92, 97, 100, 104, 107, 163, 203 plasma levels, 100, 104, 203 platelet, 18, 26, 60, 67, 89, 95, 108, 164, 173, 175, 203, 225 platelet aggregation, 18, 60, 164, 225 platelet-activating factor, 95 platelets, ix, 82, 151, 191 play, xii, 153, 177, 193, 196, 197, 229, 230, 231 pleasure, 172 plethysmography, plexus, 70 PM, 46, 131, 157, 242 PN, 239 polarity, 89 polymorphism, 88, 92, 104, 153 polymorphisms, ix, 81, 83, 97, 99, 101 poor, viii, 4, 5, 10, 24, 25, 26, 28, 36, 57, 58, 61, 69, 73, 74, 94, 112, 114, 116, 118, 119, 141, 149, Index 159, 163, 168, 170, 171, 172, 177, 184, 191, 192, 196, 232, 233, 238, 242 poor health, 177 population, viii, x, 29, 34, 52, 69, 94, 112, 117, 135, 136, 138, 139, 142, 143, 150, 152, 163, 164, 166, 171, 173, 191, 195 population group, 164 ports, 52 positron, 113 positron emission tomography, 113 postoperative, x, xii, 7, 10, 44, 47, 55, 56, 61, 66, 68, 73, 74, 77, 80, 82, 83, 84, 89, 90, 94, 96, 97, 98, 99, 101, 105, 115, 123, 124, 125, 126, 127, 148, 149, 151, 153, 160, 202, 208, 212, 218, 219, 221, 222, 223, 224, 225, 234, 236, 237, 241 postoperative outcome, 241 post-traumatic stress, 175 post-traumatic stress disorder, 175 potassium, 7, 8, 11, 12, 14, 15, 73 poverty, 177 power, 19, 39, 45 preconditioning, 80 prediction, 104, 113, 120, 186, 200, 233, 235, 236 predictors, xiii, 116, 171, 189, 194, 204, 229, 230, 233, 236, 238, 241 pre-existing, 6, 61, 83 premature death, xi, 161, 162 preoperative, 186, 202 preoperative screening, pressure, 6, 15, 16, 17, 18, 45, 54, 71, 73, 76, 84, 85, 86, 87, 93, 95, 98, 99, 116, 121, 125, 126, 127, 128, 129, 164, 217 pressure groups, 15 prevention, xii, 44, 60, 61, 63, 74, 82, 108, 159, 190, 201, 202, 212, 216, 225, 242 preventive, ix, xii, 61, 69, 75, 212, 219, 221, 225, 226 primary care, 199 priming, 94, 95, 108 probability, 77, 113, 115, 117, 119 procedures, 166, 167, 181 production, ix, 7, 26, 45, 70, 74, 77, 88, 101, 148 productivity, 170 prognosis, x, 74, 97, 123, 141, 143, 200 prognostic value, 80 program, 93, 105 progressive, 196 proinflammatory, 88, 89, 101, 108, 148, 159 pro-inflammatory, 87 pro-inflammatory, 152 Index proliferation, 18, 23, 37, 47 pronator teres, 3, prophylaxis, 93 propofol, 106 propylene, 228 prostaglandin, 11, 23 proteases, 88 protection, viii, 69, 72, 73, 74, 75, 76, 77, 78, 79, 80, 84, 86, 95, 96, 106, 108, 113, 117, 153, 216, 217 protein, ix, 47, 81, 83, 88, 91, 92, 104, 105, 159, 173, 191, 203 protein synthesis, 47 proteins, 88, 230, 231 proteinuria, 104 proteomics, 105 protocol, xi, 33, 34, 107, 118, 122, 135, 142, 213, 217 protocols, 90, 108, 114, 119 psychiatric disorder, 176 psychiatric illness, 217 psychiatric patients, 173 psychological, xi, xii, 161, 162, 164, 169, 170, 171, 175, 177, 178, 179, 181, 186, 189, 191, 192, 194, 195, 199, 205 psychological distress, 199 psychological problems, 170 psychological variables, 175 psychological well-being, xi, xii, 161, 162, 164, 170, 178, 179, 181, 186, 189, 191, 192, 194 psychologist, 179 psychologists, 180, 182 psychopathology, 177 psychosocial, 163, 170, 174, 194, 199, 202, 206, 208 psychosocial functioning, 174 psychosomatic, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209 public, xii, 197, 229 public interest, xii, 229 pulmonary embolism, 128, 132 pulmonary hypertension, 128 pulse, 5, 41, 125 Q QRS complex, 116 quality improvement, 93, 105 quality of life, xi, 149, 153, 158, 161, 169, 182, 189, 193, 197, 199, 201, 202, 203, 204, 205, 206, 207, 208, 209, 226, 227, 238 Quality of life, 155, 200, 201, 204, 209 257 questionnaire, xi, 161, 171, 172, 173, 176, 179, 180, 181, 186, 189, 193, 199, 203, 204 questionnaires, xi, 142, 161, 170, 172, 173, 178, 179, 182, 191, 196 R RA graft, vii, viii, 1, 2, 3, 6, 7, 10, 14, 15, 17, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 38, 39 race, 91, 163, 236 radial artery graft, 21, 40, 41, 43, 44, 46, 47 radiation, 124, 127 Radiation, 125 radiofrequency, 124, 131 radius, 3, Raman, 49 random, 34, 36 randomized controlled clinical trials, range, 4, 38, 52, 59, 61, 90, 124, 167, 168, 173 rat, 230 ratings, 184 rats, 108 reaction time, 168, 180 reactive oxygen, 76 reactivity, 7, 17, 20, 27, 42, 45, 67, 228 reading, 142 real numbers, 124 recall, 208 Receiver Operating Characteristic (ROC), 75 receptor blockers, vii, receptors, 230, 231 recognition, 131, 206 reconstruction, 41, 117 recovery, ix, 59, 70, 74, 79, 87, 95, 108, 112, 117, 120, 121, 172, 173, 178, 196, 200, 203, 210 recurrence, 152, 175 redistribution, 14 reduction, 171, 172, 173, 175, 199, 225 reflection, 90, 193, 225 refractoriness, 153, 154 refractory, 112, 118, 149 regional, xii, 53, 79, 85, 86, 113, 120, 212, 218, 219, 222, 223, 228 Registry, 143 regression, xii, 26, 162, 174, 181, 186, 187, 189, 193, 218, 221, 223, 226, 227 regression analysis, xii, 162, 174, 181, 186, 218, 221, 223 regressions, 187, 188 258 regular, 196 regulation, 76, 231 rehabilitation, 195, 196, 197, 199, 203 rehabilitation program, 195, 196 rejection, 130 relationship, xii, 67, 84, 92, 173, 174, 177, 178, 181, 186, 191, 192, 193, 194, 204, 211, 212, 218, 221, 223, 237 relationships, 163, 177, 178, 210 relatives, 178, 193 relaxation, 7, 13, 14, 15, 17, 18, 40, 42, 126, 217 relevance, 101, 159, 176, 208 reliability, 41, 53, 165, 173, 198, 224 Reliability, 201 remodeling, 45, 113, 116, 120 remodelling, 23 renal, ix, x, 56, 61, 67, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 116, 127, 132, 138, 141, 143, 149, 151, 152, 154, 158, 233, 236 renal artery stenosis, 83 renal disease, 104, 105 renal dysfunction, x, 56, 61, 82, 84, 85, 88, 90, 94, 97, 99, 100, 101, 102, 103, 106, 107, 138, 151 renal failure, 56, 67, 83, 84, 85, 89, 92, 95, 96, 97, 98, 99, 100, 101, 103, 127, 149, 154, 233, 236 renal function, 84, 85, 86, 89, 90, 91, 93, 94, 95, 97, 98, 99, 100, 102, 104, 106, 107, 141, 143, 158 renal medulla, 85 renal replacement therapy, 94, 97, 98, 106 repair, 52, 61, 121 reperfusion, ix, 4, 5, 72, 74, 80, 81, 86, 87, 88, 105, 108, 114, 115, 117, 118, 119, 121, 122, 151 research, 165, 167, 173, 176, 180, 191, 192, 194, 195, 198, 207 researchers, 164, 167, 170, 171, 172, 174, 178, 181, 182, 190, 191, 192, 194, 196 resistance, 54, 67, 85, 87, 95, 106, 198 resolution, 27, 218 resource allocation, 169 resources, 163, 177, 196 respiration, 126 respiratory, 127, 165, 171, 183, 196, 225, 236 respiratory disorders, 196 respiratory dysfunction, 171 respiratory failure, 236 restenosis, 59, 63, 64 restrictive cardiomyopathy, 127, 128, 129, 130, 131 retardation, 173 Index retina, 137 retinol, 92, 104 retinol-binding protein, 104 retinopathy, x, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145 retirement, 177 revaluation, 85 rheumatoid arthritis, 179 right atrium, 70, 71, 72 right hemisphere, 219 right ventricle, 70, 73, 126, 128 rigidity, 126 rings, 12, 14, 16, 17, 18 risk, viii, ix, x, xi, xii, 27, 29, 35, 39, 56, 60, 61, 62, 63, 66, 67, 69, 76, 77, 81, 82, 83, 84, 85, 86, 93, 94, 96, 97, 98, 99, 101, 103, 106, 108, 111, 112, 113, 116, 118, 119, 120, 135, 136, 137, 139, 140, 141, 142, 144, 147, 149, 152, 153, 155, 156, 158, 163, 164, 166, 167, 169, 170, 172, 173, 174, 175, 177, 190, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 209, 212, 214, 224, 226, 229, 230, 232, 233, 234, 235, 236, 237, 238, 239, 242 risk assessment, 106, 238 risk factors, xii, 39, 60, 67, 83, 84, 86, 96, 97, 138, 142, 152, 158, 163, 164, 172, 190, 195, 201, 204, 209, 214, 226, 229, 230, 232, 233, 236, 237 risk profile, 174, 175, 230, 232 risks, 83, 112, 117, 166, 169, 177, 200, 242 robotic, 52, 66, 67 room temperature, Rouleau, 120 Royal Society, 199 Russia, 211 S safety, ix, 36, 61, 63, 69, 75, 78, 156 saline, 11, 12, 13, 14, 61, 125 salt, 128 sample, 182, 191, 195 sampling, 74, 75, 107 sarcoidosis, 128 satisfaction, 154, 170 saturated fat, 163 saturated fatty acids, 163 saturation, 5, 45 scaffolds, 89 Scandinavia, 197 scanning electron microscopy, 45 scavenger, 18 Index scepticism, 39 Schmid, 64, 103, 200 science, 202 scintigraphy, 113, 128 scleroderma, 20, 28 sclerosis, scores, xi, xii, 154, 162, 172, 174, 179, 180, 181, 184, 185, 186, 187, 188, 189, 191, 193, 194, 203, 209, 218, 221, 224, 225, 226, 233 SD, 35, 36, 103, 120, 130, 185 SE, 48, 49, 64, 80, 103, 143, 235, 239, 240, 241, 242 search, 193 secretion, 47, 87, 91 sedentary, 180 selecting, 136, 141 self-report, 137, 142, 177, 180, 190, 195 sensitivity, 5, 54, 75, 180 separation, 14, 102 sepsis, 93, 236 septic shock, 95, 105 septum, 73, 126 sequencing, 226 series, 2, 19, 23, 54, 59, 61, 62, 112, 149, 152, 154, 193, 218 serotonin, 7, 11, 12, 15, 16, 22, 46 Serotonin, 16 serum, 56, 61, 74, 77, 83, 90, 97, 103, 104, 164, 190, 199, 231 services, iv, 177 severity, x, 26, 82, 92, 102, 112, 117, 118, 135, 136, 137, 140, 141, 143, 144, 145, 165, 170, 171, 173, 177, 201, 202, 230, 231 sex, 91, 137, 163, 217, 236, 242 shear, 18, 23, 26, 29, 47 shock, ix, x, 69, 70, 76, 78, 95, 105, 111, 117, 118, 119, 122, 136, 138, 143, 233 shortness of breath, 125, 129 short-term, ix, xii, 69, 124, 144, 155, 166, 169, 176, 202, 212, 234 Short-term, 209, 228 shunts, 73, 87, 119 side effects, 19, 93 sign, 23, 24, 25, 26, 27, 28, 29, 32, 33, 34, 35, 36, 37, 125, 126, 129, 136 signaling, 108, 231 signals, 225 significance level, 186 signs, x, 32, 36, 53, 123, 124, 125, 126, 127, 128, 129, 131, 165, 172, 174 259 sinus, viii, ix, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 115, 128 sites, 231 skills, 168 skin, 3, 8, 115 sleep, 173, 224 sleep disturbance, 224 smokers, 238 smoking, 163, 164, 177, 232 smooth muscle, 18, 23, 40, 47 smooth muscle cells, 47 smoothing, 218 SNP, 14, 17 social, 163, 170, 171, 172, 174, 177, 178, 180, 186, 189, 193, 198, 205, 207, 209, 210 social activities, 170 social class, 163 social integration, 177 social isolation, 193 social network, 177, 198 social roles, 170 social support, 170, 174, 177, 178, 180, 186, 189, 193, 198, 205, 207, 209, 210 socially, 171, 177, 199 society, 164 sodium, 14, 15, 17, 61, 83 specificity, 5, 54, 75, 92 SPECT, xii, 120, 211, 212, 217, 218, 219, 224, 227, 228 spectrum, 189 speed, 9, 168, 219, 221, 222, 223 spelling, 40 sports, 142 spousal support, 178 spouse, 177, 178, 180, 193 SPSS, 182 stability, 87, 95, 170, 227 stabilize, 217 stable angina, 200, 213, 239 stages, 125 STAI, 176, 178, 179, 181, 184, 185, 187, 188, 191 standard deviation, 184, 185, 216, 226 staphylococcus, 130 starch, 102 State Trait Anxiety Inventory, 176 statin, 48 statins, 190 Statins, 26, 183 statistics, 162, 163, 197, 218 STD, 75 260 stenosis, 24, 25, 26, 27, 28, 29, 32, 34, 35, 36, 37, 39, 47, 52, 54, 56, 58, 62, 63, 64, 65, 73, 118, 120, 152, 165, 201, 213, 214, 217 stenotic lesions, 26 stent, viii, 51, 59, 60, 63, 64, 65, 166, 202 sternum, 115 steroids, 128 Stimuli, 87 storage, 11, 12, 13, 14, 44 strategies, ix, x, 52, 61, 69, 74, 90, 101, 111, 117, 122, 148, 149, 152, 154, 155, 196, 202 stratification, 97, 113, 120, 172 strength, 19 stress, xi, 18, 23, 26, 29, 47, 95, 116, 135, 142, 148, 163, 175, 176, 177, 224 stressors, 177 stretching, 153 stroke, 101, 149, 150, 152, 154, 156, 159, 162, 168, 204, 217, 219, 233, 236 strokes, 88, 219 subgroups, viii, 39, 69, 73, 112 subjective, 19, 169, 175, 177, 178, 195, 197 subjective experience, 175, 197 substances, 21 suffering, 88, 145, 163 suicidal, 173 suicide, 20 suicide attempts, 20 summaries, xi, 162, 181, 185, 186, 193 Sun, 239 superiority, viii, 51 superoxide, 18 supervisors, 40 supply, 4, 14, 225 suppression, 87 surface area, 70, 231, 234 surgeons, x, 54, 70, 72, 76, 77, 111, 120, 123, 129, 137, 147, 155 Surgeons, 41, 90, 119, 135, 166, 207, 229, 239, 241 surgical, viii, x, xii, xiii, 8, 9, 10, 41, 51, 52, 55, 57, 60, 61, 66, 69, 72, 74, 76, 77, 78, 83, 85, 87, 97, 99, 100, 102, 106, 111, 112, 114, 116, 117, 118, 119, 120, 121, 122, 123, 130, 148, 151, 153, 155, 162, 166, 189, 192, 204, 206, 212, 216, 217, 225, 229, 230, 232, 234, 237, 242 surgical intervention, 216 survival, vii, 1, 17, 29, 34, 38, 39, 48, 52, 64, 74, 80, 91, 97, 104, 112, 116, 117, 121, 122, 129, 137, 139, 140, 141, 142, 143, 149, 150, 154, 158, 166, Index 167, 170, 172, 173, 178, 193, 200, 203, 204, 210, 233, 234, 235, 236, 237, 238, 242 survival rate, 39, 137, 166, 167 suture, 71, 72, 217 Swan-Ganz catheter, 115 sympathetic, 173 sympathetic nervous system, 173 symptom, 30, 142, 165, 174, 191, 195 symptomology, 19, 176 symptoms, x, xi, xii, 19, 32, 111, 112, 124, 125, 129, 155, 161, 162, 164, 165, 166, 167, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 181, 184, 186, 188, 189, 190, 191, 192, 193, 194, 196, 197, 201, 202, 204, 207, 233, 238, 242 syndrome, ix, 7, 20, 28, 70, 81, 86, 92, 96, 101, 107, 108, 122, 128, 151, 208, 234 synthesis, ix, 2, 26, 47, 81, 83, 88 systematic, 209 systematic review, 209 systems, 58, 70, 88, 112, 151 systolic pressure, 125 T tachycardia, 128, 148 targets, 3, 25, 27, 57, 113, 114, 119 task force, 131 tea, 108 technetium, 227 technological developments, 212 technological progress, 149 technology, x, 59, 111 telephone, 171 temperature, 4, 95, 99, 114, 118, 217 temporal, 218, 222 tendon, 3, tension, territory, 23, 28, 34, 54, 58, 115, 118 test scores, 218, 224, 225 testosterone, 230 test-retest reliability, 224 Texas, 197 therapy, 17, 18, 44, 48, 52, 59, 60, 94, 96, 102, 106, 107, 116, 145, 151, 206 thoracic, vii, x, 1, 42, 48, 52, 56, 65, 93, 105, 114, 123, 202, 208, 228, 238 thoracic surgeon, x, 123 thoracotomy, viii, 51, 52, 59, 65, 67, 130 threat, 175, 176 threatening, 142, 145 Index threshold, 95 thrombosis, 15, 60, 167 thromboxane, 7, 10, 104 thrombus, 26, 89, 128 thyroid, 92, 183, 190 tight junction, 89 time, vii, ix, xi, 1, 4, 5, 6, 20, 22, 23, 25, 26, 28, 30, 31, 33, 36, 39, 40, 46, 52, 53, 54, 55, 59, 60, 62, 64, 69, 74, 76, 77, 82, 84, 92, 94, 116, 117, 118, 124, 126, 147, 150, 152, 153, 162, 163, 166, 167, 168, 172, 174, 176, 180, 181, 182, 183, 186, 187, 188, 189, 192, 194, 196, 203, 212, 216, 217, 225, 226, 230, 232 time commitment, 189 time constraints, 189 time consuming, 196 time periods, 150 timing, 142 tissue, 9, 45, 47, 70, 74, 85, 88, 89, 108, 113, 126, 137 tissue plasminogen activator, 47 TLR, 57 TNF, x, 82, 88, 95, 101, 151, 154 TNF-alpha, 95 TNF-α, 151, 154 tobacco, 92, 238 Tokyo, 135 tolerance, 68, 166 total cholesterol, 163, 231 toxic, 76, 90, 101 toxicity, 86, 88 tracers, 113 tracking, 205 training, 203 trait anxiety, 176, 179 trans, 124 transcription, 63, 88 transcription factor, 63, 88 transcription factors, 88 transduction, 76 transesophageal echocardiography, 56, 61 transfer, 167 transference, transformation, 129 transfusion, 59, 62, 83, 84, 85, 90, 149, 157, 234 transfusions, 99, 234 transient ischemic attack, 219 translation, 207 transmembrane, 92 transplantation, 112, 120, 124 261 transport, 62, 88, 108, 231 transportation, 117 trauma, 2, 26, 87, 125, 151 travel, 3, 189 travel time, 189 trial, 27, 28, 32, 34, 35, 36, 39, 43, 48, 49, 52, 57, 61, 63, 64, 65, 78, 100, 102, 103, 106, 107, 108, 122, 136, 145, 149, 153, 155, 157, 158, 159, 181, 197, 201, 203, 209, 226, 227 triangulation, 170, 204 tricuspid valve, 128 triggers, 76, 151 triglyceride, 231 troponin I, ix, 69, 74, 75, 77, 78, 79, 80 trust, 54 tuberculosis, 124 tubular, x, 82, 85, 87, 88, 89, 90, 91, 92, 93, 94, 101, 104, 107, 126 tumor, 148, 151, 154 tumor necrosis factor, 148, 151, 154 turbulence, 20 type diabetes, 137, 138, 143, 144, 154 type diabetes, 136, 137, 138, 142, 143, 145 type diabetes mellitus, 143, 145 U ultrasound, 5, 32, 48, 206, 225, 231 unemployment, 177 uniform, 72 United Kingdom, xi, 161, 166, 203 United States, 96, 136, 162, 163 univariate, 233, 237 unmarried men, 178 unstable angina, 76, 136, 143, 201, 206, 232 unstable patients, 115, 117, 122 urinary, x, 82, 83, 85, 90, 91, 92, 100, 105, 107 urinary tract, 92 urinary tract infection, 92 urine, 91, 92, 94, 103, 104, 105 URL, 197, 200, 201, 205, 207, 209 V validation, 203 validity, 103, 148, 149, 165, 173 values, 54, 75, 77, 90, 91 variability, 54, 67, 68, 92, 187, 188, 189, 193, 194, 224 Index 262 variable, 187 variables, 112, 116, 117, 154, 167, 171, 174, 175, 177, 181, 186, 187, 188, 192, 193, 213, 224, 226 variance, xii, 162, 188, 189, 193, 194 variation, xii, 4, 5, 46, 83, 101, 126, 218, 229 vascular cell adhesion molecule, 10 vascular disease, 27, 28, 36, 42, 59, 83, 214, 232, 233, 236, 238 vascular endothelial growth factor, 76 vascular surgery, 68 vascular wall, 112 vasculature, 6, 70 vasoconstriction, ix, 4, 11, 18, 22, 82, 83, 87, 89, 90, 152 vasoconstrictor, 90, 230 vasodilatation, 8, 22, 23, 90 vasodilation, 87 vasodilator, 10, 11, 18, 44 vasomotor, 87, 89, 225 vasorelaxants, vii, vasospasm, vii, 2, 7, 9, 10, 15, 18, 39, 44 vein, viii, 2, 3, 4, 21, 37, 39, 45, 48, 49, 51, 52, 54, 57, 58, 63, 70, 71, 79, 114, 115, 118, 119, 121, 126, 148, 200, 201 velocity, 19, 20, 21, 22, 23, 26, 29, 46, 126 venous pressure, 72, 125, 128, 129 ventilation, 58, 128, 221, 223, 224 ventricle, 70, 83, 126 ventricles, 126, 128 ventricular arrhythmia, 236 ventricular septal defect, 127 verapamil, 8, 10, 11, 13, 14, 42, 44 vessels, viii, 8, 9, 26, 27, 28, 40, 51, 62, 113, 115, 137, 139, 166, 183, 215, 225, 234, 237, 241 vibration, viscosity, 85 visible, 6, 7, 14, 15, 17 vision, 10, 145 visual attention, 219 visual memory, 219, 221 visualization, 72, 126, 128 vitamin E, 108 vitreous, 137, 143 voiding, 103 vulnerability, 192 W walking, 171 war, 167 warrants, 192 weight gain, 172 weight loss, 172 Weinberg, 241 well-being, xi, xii, 161, 162, 164, 169, 170, 172, 176, 178, 179, 181, 185, 186, 189, 191, 192, 193, 194, 208 Western Europe, 173 WHO, 162, 173, 209 Wisconsin, 137, 143 wives, 178, 206 women, xii, 39, 142, 144, 164, 174, 176, 177, 205, 209, 226, 229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241, 242 work activity, 176 workers, 149 workload, 165 World Health Organisation, 162, 209 worry, 176 wound infection, 19, 154, 236 writing, 40 X xenon, 76 X-ray, 178 X-rays, 126 Y yield, 15, 115 young women, 232 ... coronary artery bypass grafting on intraoperative graft flow Coronary Artery Bypass Grafting for Chronic and Acute Heart Failure [17] [18] [19] [20 ] [21 ] [22 ] [23 ] [24 ] [25 ] [26 ] [27 ] [28 ] [29 ]... [37] 135 33 18 13 33 Oh et al (20 01) [ 52] 143 49 30 0.6 11 .2 9 .2 Bertog et al. (20 04) [4] Marshall et al (20 06) [44] 163 46* 37 25 40 32 16 Talreja et al (20 08) [66] 59 25 .4 47.5 6.8 15.3 * Including... Surg 1993;7:4 82- 8 Elefteriades J, Edwards R Coronary bypass in left heart failure Semin Thorac Cardiovasc Surg 20 02; 14: 125 - 32 Pocar M, Moneta A, Grossi A, Donatelli F Coronary artery bypass for