057-I * IATROGENIC AORTIC ROOT AND LEFT MAIN DISSECTION IN CORONARY ARTERY BYPASS GRAFT SURGERY: AN UNCONVENTIONAL FIX
Bibliographic record
Abstract
Objectives: To rescue a 74-year-old woman with iatrogenic aortic and left main (LM) dissection during coronary artery bypass graft (CABG) surgery. Methods: During a quadruple CABG operation, when performing the proximal anastomoses, and during cardioplegia infusion of the vein grafts, a double lumen was seen with blood coming from the false lumen. The culprit marginal graft was redone, but when the cross-clamp was removed, the left ventricle (LV) was akinetic, with an intimal flap seen intermittently closing the LM orifice. The heart was re-arrested and a fifth bypass was placed to the mid left anterior descending (LAD) coronary artery by carving an ellipse of calcium. (This patient had extensive calcification.) The vein graft was placed into the true lumen of the LAD artery, obliterating the false lumen. Results: After the cross-clamp was removed a second time, LV function normalized, all evidence of dissection disappeared, and the patient was discharged home at eight days. One year postoperative angiography showed patent bypasses to distal LAD (left internal mammary artery), mid LAD and right coronary artery (vein) and occluded marginal vein grafts. Ten years later the patient is 84, living on her own, has minimal angina, and is more limited by arthritis. Conclusions: Transoesophageal echo is as important in pure CABG surgery as it is for valve surgery. The pressure in cardioplegia delivery is now kept at a maximum of 80 mm Hg. Calcified coronary arteries can be bypassed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".