Isolated Aortic Valve Replacement in Patients with Small Aortic Annulus—A High-Risk Group on Long-Term Follow-Up
Bibliographic record
Abstract
BACKGROUND: Patients with small aortic annulus undergoing isolated aortic valve replacement face an often underestimated surgical risk. We describe initial clinical results and long-term follow-up of this particular high-risk group. METHODS: Between January 1998 and December 2004, 148 consecutive patients with small aortic annulus underwent isolated aortic valve replacement by implantation of a Mitroflow Aortic Pericardial Heart Valve (Sorin S.p.A., Milano, Italy) 19 or 21 mm bioprostheses. Mean age was 75.4 ± 6.2 years. Female gender, obesity, and multiple comorbidities were predominant. Mean logistic euroSCORE for mortality was 18.5 ± 2.3%. Follow-up time was 7.2 ± 2.0 years, with a total of 1,066 patient years. RESULTS: Postoperative course and outcome during follow-up were strongly influenced by extracardiac morbidities. Hospital mortality was 6.1%, 5-year survival 71.9%, and 10-year survival 40.9%. Most patients (70.0%) died because of extracardiac reasons. Significant reasons for death were age, pre-existing atrial fibrillation, diabetes mellitus type 2, chronic renal failure, extracardiac vascular disease, history of stroke, and preoperative presentation at Canadian Cardiovascular Society class III and IV (p < 0.05). Freedom from valve-related reoperation was 99.1% at 5 years and 93.4% at 10 years. Prosthesis-patient mismatch occurred in 12.2% and was not affected with any adverse outcome (p = nonsignificant). Echocardiographic data demonstrated a significant reduction of mean transvalvular gradients in all patients (61.2 ± 19.7 mm Hg preoperatively; 18.0 ± 8.0 mm Hg during follow-up; p < 0.05). All patients reported a significant improvement in New York Heart Association functional class (p < 0.05). CONCLUSION: Patients with small aortic annulus are predominantly small, obese, and old-aged females with multiple comorbidities. Mitroflow valve avoids prosthesis-patient mismatch and provides excellent hemodynamics. Observed long-term results were disappointing, but they were mainly limited by extracardiac comorbidities and advanced age.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".