Abstract 3048: Incidence and Management of Procedural Complications Associated with Transcatheter Aortic Valve Implantation
Bibliographic record
Abstract
Background. Transcatheter aortic valve implantation (TAVI) is increasingly recognized as an alternative to surgery for patients with severe, symptomatic aortic stenosis and high or prohibitive operative risk. Despite prospective evidence that TAVI can be performed with acceptable 30-day mortality, the potential for vascular, neurologic or cardiac complications exists. Method. One hundred and sixty-three balloon-expandable TAVIs were performed between November 2005 and February 2008 at St. Paul’s Hospital, Vancouver, Canada. Valves were implanted using a transarterial (n=110) or transpical approach (n=53). Clinical and echocardiographic data was prospectively collected. Results. Overall 30-day mortality rate was 11.0% in this selected high risk population but mortality decreased by 50% in the second half of this cohort. Current systems require a large sheath (22 to 24 Fr) potentially injurious to femoral and iliac arteries. Unplanned percutaneous (n=2) or surgical (n=11) interventions were performed in 14 patients to treat peripheral vascular complications. Temporary endovascular balloon occlusion can provide hemostasis while definitive treatment is implemented. Acute complications associated with apical access include bleeding and tamponade. Intra-procedural deaths occurred in 1.2% of patients due to arterial perforation (n=1) and apical hemorrhage (n=1). Stroke rate was 4.3%. Positioning errors can result in significant paravalvular regurgitation, mitral valve injury (n=1) and valve embolization (n = 7). Paravalvular leak can be reduced by redilation of an under-expanded prosthesis or implantation of a second valve to extend the sealing cuff. Cases of embolization were all satisfactorily managed with re-expansion of the prosthesis distally in the aorta. Coronary ostial obstruction by a bulky leaflet was confirmed in 1 patient. Permanent pacemakers were implanted in 9 patients (5.5%) due to new heart block. Conclusion. This early TAVI experience demonstrated the potential for a variety of potential complications. However as experience and knowledge increased over time the rate of adverse events appeared to fall. Careful screening, technological advances and greater experience will allow for safer procedures.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".