Transcatheter Aortic Valve Replacement in Low-Risk Patients
Notice bibliographique
Résumé
ranscatheter aortic valve replacement (TAVR) has become the preferred therapy over surgical aortic valve replacement (SAVR) in intermediate-or greaterrisk patients with symptomatic severe aortic stenosis (AS).Results from the 2 randomized trials comparing TAVR with SAVR in low-risk patients have been reported.1,2 The PARTNER 3 trial (The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3]) that evaluated the Sapien 3 (S3) valve (Edwards Lifesciences LLC) showed superiority of TAVR over SAVR at 1 year in the primary composite outcome of mortality, stroke, and rehospitalization related to the procedure, valve, or heart failure (8.5% versus 15.1%, P=0.001).The Evolut Low Risk trial (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients [ELR]) that evaluated the Evolut valve (Medtronic Inc) showed the noninferiority of TAVR versus SAVR in the 2-year primary composite end point of mortality or disabling stroke (5.3% versus 6.7%).The 2 trials had similar patient characteristics, with mean age 74 years and the Society of Thoracic Surgeons predicted risk of operative mortality score 1.9% in both groups (Table).At 1 year, mortality rates were 1.0% TAVR versus 2.5% SAVR, P=0.09 in P3, and 2.3% versus 3.0%, log-rank P=0.41 in ELR.Disabling stroke rates trended lower with TAVR than with SAVR (0.2% versus 0.9%, P=0.14 in P3; 0.7% versus 2.4%, log-rank P=0.024 in ELR).In ELR, although no significant difference was found in the primary outcome, the composite outcome of mortality, disabling stroke, or heart failure hospitalization at 1 year showed that TAVR was superior (5.6% versus 10.2%, P=0.002).3 Thus, both trials showed that TAVR was superior to SAVR for clinical outcomes, with remarkable concordance between the 2 trials.Although both TAVR valves were associated with similar rates of new left bundle-branch block, the 1-year permanent pacemaker implantation rate was lower with S3 than Evolut (7.3% versus 19.4%), with differences likely attributed to device design and operator variability.The incidence of mild or greater paravalvular leak associated with S3 or Evolut valves was not different at 1 year (30.0% and 37.5%, respectively).Both TAVR devices had similarly low incidence of coronary obstruction, valve thrombosis, and aortic valve reintervention.However, S3 had a higher incidence of severe prosthesis-patient mismatch than Evolut (8.3% versus 1.1%), likely because of valve design and sizing differences.This difference may be clinically important given the previously reported higher 1-year mortality and heart failure hospitalization in patients with severe mismatch after TAVR (mortality: 17.2% in severe versus 15.6% in moderate versus 15.9% in none, P=0.02).With TAVR showing superiority over SAVR, how should we select the ideal treatment of low-risk patients with symptomatic severe AS?We believe both trials share certain conclusions but also raise new questions.First, in low-risk patients, SAVR has excellent outcomes but is limited by more new-onset atrial fibrillation than TAVR (at 1 year: 40.9% versus 7.0% in P3; 38.3% versus 9.8% in ELR).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».