Transcatheter aortic valve replacement with the SAPIEN 3 valve: preparing the field for the final expansion
Bibliographic record
Abstract
The very first transcatheter aortic valve replacement (TAVR) procedure was performed in 2002 (1), and this treatment has now been established as the best option for inoperable patients with symptomatic severe aortic stenosis (2), and as a good alternative for high-risk individuals (3). To date, >200,000 TAVR procedures have already been performed in more than 65 countries (4). As shown in recent publications (5-8), improved transcatheter devices, increasing operator experience, and the very low incidence of significant structural transcatheter heart valve (THV) failure at 5-year follow-up, have provided the rationale for a worldwide shift towards treating lower surgical risk patients with a catheter-based approach. In the 2,032 intermediate risk patients with severe aortic stenosis randomized in the PARTNER 2A trial (9), TAVR was similar to surgical aortic valve replacement (AVR) with respect to the 2-year primary endpoint of death or disabling stroke (19.3% in the TAVR group and 21.1% in the surgery group; HR 0.89; 95% confidence interval: 0.73–1.09; P=0.25). Meanwhile, the results of the prospective randomized all-comers NOTION trial were recently published, showing no significant difference between TAVR and SAVR for the composite outcome of death from any cause, stroke, or myocardial infarction after 1 year in 280 low risk [mean Society of Thoracic Surgeons (STS) score: 3%] patients with aortic stenosis (7). However, the expansion of TAVR towards the treatment of lower risk and younger patients, especially with newer generation devices, definitely mandates continued surveillance and thorough clinical-trial validation.
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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 | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
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".