 - Severe chronic renal insufficiency serum creatinine 200 mmoldl or need for dialysis, liver disease, diagnosis of cirrhosis, chronic hepatitis, or elevation of serum transaminases 3 times the upper limit of normal, cerebrovascular disease requiring concomitant carotid endarterectomy, peripheral arterial disease claudication as the primary factor limiting activity, active non-dermatological malignancy requiring on-going treatment, or any other condition that would place the patient at increased risk for complications in the judgment of the attending cardiologist or cardiac surgeon 