Abstract 18482: Impact of Tricuspid Regurgitation and Tricuspid Annulus Dilation on Mortality After Transcatheter Aortic Valve Replacement
Bibliographic record
Abstract
Background and Objetives: According to the guidelines a concomitant tricuspid annuloplasty should be performed at the time of mitral or aortic valve surgery in presence of: i) severe tricuspid regurgitation (TR) or ii) mild-to-moderate TR with significant tricuspid annulus dilation (TAD, i.e. diameter>40 mm by echo). In patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), no tricuspid annuloplasty or replacement is performed. The objective of this study was to determine the prevalence of TR and TAD and their impact on mortality following TAVR. Methods: TR and TAD were assessed by transthoracic echocardiography in 227 consecutive patients who underwent TAVR at our institution. The primary end-point was all-cause mortality. Results: Figure 1 shows the distribution of the patients according to TR severity and presence of TAD. Overall, very few patients had none or trace TR, 88% had mild or moderate TR, and 7% had severe TR. Furthermore, 73% had TAD. After a mean follow-up of 1.5± 1.2 years, 73 patients died. Two-year survival rate was 52±8% in patients with severe TR, 65±5% in patients with mild/moderate TR and TAD, and 87± 7% in patients with mild/moderate TR and no significant TAD (Figure 2). After adjustment for sex, EuroSCORE, creatinine and other risk factors, mild/moderate TR with TAD had higher risk of mortality (HR : 2.88; 95% CI :1.3-8.9; p=0.025) compared to mild/moderate TR without TAD and similar risk (HR : 1.34; 95% CI :0.6-3.7; p=0.53) compared to severe TR Conclusion: Both TR and TAD are highly prevalent in the patients with severe AS undergoing TAVR. Among patients with mild/moderate TR, those with significant TAD have worse outcomes compared to those with no TAD and similar outcomes compared to those with severe TR. Further studies are needed to determine if concomitant or subsequent transcatheter tricuspid annuloplasty or replacement would improve outcomes of patients undergoing TAVR.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".