Impact of residual regurgitation after aortic valve replacement
Bibliographic record
Abstract
OBJECTIVES: Mild-to-moderate aortic regurgitation (AR) is not infrequently encountered after standard aortic valve replacement, and reportedly more often following transcatheter aortic valve implantation. Patients are usually managed by observational follow-up, but the clinical significance and natural history of residual AR are unknown. The goal of this study was to determine its impact on the outcome of these patients. METHODS: Between 1992 and 2011, 3201 consecutive patients underwent isolated standard aortic valve replacement in our institution. Of these, 135 patients (4.2%) were found to have paravalvular leak >1/4. Clinical, intraoperative as well as early and late postoperative outcome variables were studied. Factors associated with residual AR and their impact on survival were assessed by multivariate analysis. RESULTS: Mean follow-up was 4.5 ± 3.4 years. The use of a bioprosthesis, longer cardiopulmonary bypass duration and preoperative atrial fibrillation were associated with a higher risk of presenting residual AR. Survival was negatively affected by commonly identified comorbidities (diabetes, stroke, pulmonary disease, renal failure, peripheral vascular disease) but also by the presence of >1/4 residual AR. Survival in the latter group was lower than for patients with ≤1/4 AR at all time points: 91.4 vs 96.7%, 77.5 vs 82.4% and 44.1 vs 54.5% at 1, 5 and 10 years, respectively (P < 0.01). CONCLUSIONS: Postoperative residual AR >1/4 is an independent predictor of postoperative mortality and should be considered in the selection of surgical approach and management strategy for patients in need of standard and transcatheter aortic valve replacement.
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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 | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| 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".