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Morelli A et al. – Patients with heart failure undergoing non–cardiac surgery still have an unacceptably high morbidity and mortality. Compromised myocardial physiologic reserves in combination with extensive surgery and anesthesia appear to play a crucial role in determining high perioperative morbidity and mortality. Nevertheless, several other mechanisms and pathways such as metabolic factors, ischemia–reperfusion conditions, neurohormonal activation, inflammation and oxidative stress contribute to the adverse outcome.

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