Tricuspid valve replacement using a cryopreserved mitral homograft. Surgical technique and initial results.
Bibliographic record
Abstract
BACKGROUND AND AIM OF THE STUDY: The surgical management of tricuspid valve endocarditis, especially in patients with positive serology for HIV and hepatitis C, is complicated by the inappropriateness of reconstruction and the late complications of mechanical prostheses and bioprostheses. Late results of mitral homograft replacement of the tricuspid valve have been satisfactory, but evidence of moderate and severe regurgitation appears in some patients. This report presents a novel approach to implantation of a mitral homograft in the tricuspid position. METHODS: Five patients with complications of native tricuspid valve endocarditis underwent mitral homograft replacement of the tricuspid valve, the homograft being implanted with the anterior leaflet orientated to the septum, the papillary muscles exteriorized and sutured to the right ventricular wall, the posteromedial muscle anteriorly, and the anterolateral muscle inferiorly. The annular attachment was reinforced with a rigid mitral annuloplasty ring in the anti-anatomical relationship. RESULTS: There was no early mortality. Among three patients available for echocardiographic assessment during the first year, regurgitation was absent in two cases, and trivial in one case. The latter patient died of a drug overdose after nine months. Two patients required insertion of atrioventricular pacemakers for complete heart block. CONCLUSION: This novel extension to the technique of mitral homograft replacement of the tricuspid valve for uncontrollable native endocarditis in drug abusers makes the procedure more technically feasible, and should be considered a procedure of choice.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".