4994Transcatheter versus surgical aortic valve replacement in patients with prior cardiac surgery in the randomized PARTNER 2A Trial
Bibliographic record
Abstract
Background: Prior cardiac surgery (PCS) is associated with increased risk and post-op complications following surgical aortic valve replacement (SAVR), but whether this risk is similar in transcatheter aortic valve replacement (TAVR) is unclear. Purpose: To evaluate clinical outcomes in pts with and without PCS undergoing TAVR or SAVR. Methods: In the PARTNER 2A trial, 2032 pts with severe AS at intermediate surgical risk (STS 4–8) were randomized to TAVR with SAPIEN XT or SAVR. Outcomes at 30d and 2y were compared using KM event rates, and association of PCS with outcomes was assessed using multivariable Cox models. The primary endpoint was all cause death and disabling stroke. Results: 509 pts (25.1%) had PCS. Pts with PCS were younger, with higher BMI and STS score, and were more often male and diabetic. There were no significant differences between TAVR and SAVR in patients with or without PCS, in rates of the primary endpoint or its components at 30d (Table). Bleeding was significantly higher in SAVR in both PCS groups (Figure), but an interaction between PCS group and treatment arm was observed for bleeding, driven by life threatening or disabling bleeding, such that the gap between bleeding rates was more profound in PCS pts (adjusted TAVR vs SAVR HR [95% CI]: 0.13 [0.08, 0.21] for PCS vs 0.24 [0.19, 0.31] for no-PCS; adj p-interaction=0.02). 2-year clinical outcomes did not differ significantly between TAVR and SAVR, in pts with or without PCS.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
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".