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S0X�1. Rosenbaum M, Leibel RL, Hirsch J. Obesity. N

Engl J Med 1997; 337: 396-407. 2. Heseker H, Hartmann S, Kubler W, Schneider

R. An epidemiologic study of food consumption habits in Germany. Metabolism 1995; 44: 10-13.

3. Eagle KA, Guyton RA, Davidoff R, Ewy GA, Fonger J, Gardner TJ, et al. ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/American Heart Association Task

Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999; 34: 1262-1347.

4. Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 1989; 79: 3-12.

5. Orhan G, Bicer Y, Aka SA, Sargin M, Simsek S, Senay S, et al. Coronary artery bypass graft

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�� ��������� ���� �� . ��� ����� ��� ��) �� � �(#�

operations can be performed safely in obese patients. Eur J Cardiothorac Surg 2004; 25: 212-217.

6. Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Obesity is not a risk factor for significant adverse outcomes after cardiac surgery. Circulation 1996; 94(9 Suppl): 87-92.

7. Schwann TA, Habib RH, Zacharias A, Parenteau GL, Riordan CJ, Durham SJ, Engoren M.Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001; 71: 521-530.

8. Brandt M, Harder K, Walluscheck KP, Schottler J, Rahimi A, Moller F, et al. Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery. Eur J Cardiothorac Surg 2001; 19: 662-666.

9. Hannan EL, Kumar D, Racz M, Siu AL, Chassin MR. New York State's Cardiac Surgery Reporting System: four years later. Ann Thorac Surg 1994; 58: 1852-1857.

10. Hattler BG, Madia C, Johnson C, Armitage JM, Hardesty RL, Kormos RL, Pham SM, Payne DN, Griffith BP. Risk stratification using the Society of Thoracic Surgeons Program. Ann Thorac Surg 1994; 58: 1348-1352.

11. Grover FL, Hammermeister KE, Burchfiel C.Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery. Ann Thorac Surg 1990; 50: 12-26.

12. O'Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, et al.Multivariate prediction of in-hospital mortality

associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group. Circulation 1992; 85: 2110-2118.

13. Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. JAMA1992; 267: 2344-2348.

14. Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15: 816-22.

15. Hamann A, Sharma AM. Genetics of obesity and obesity-related hypertension. Semin Nephrol 2002; 22: 100-104.

16. Barrett-Connor EL. Obesity, atherosclerosis, and coronary artery disease. Ann Intern Med1985; 103: 1010-1019.

17. Simopoulos AP, Van Itallie TB. Body weight, health, and longevity. Ann Intern Med 1984; 100: 285-295.

18. Kuduvalli M, Grayson AD, Oo AY, Fabri BM, Rashid A. Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 2002; 22: 787-793.

19. Prabhakar G, Haan CK, Peterson ED, Coombs LP, Cruzzavala JL, Murray GF. The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons' database. Ann Thorac Surg 2002; 74: 1125-1130.

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