P3524Outcome after ross procedure in adult patients: a systematic review, meta-analysis and microsimulation
Bibliographic record
Abstract
Background: Contemporary data suggest that aortic valve replacement with biological and mechanical prostheses reduces life expectancy in non-elderly adults compared to age and gender matched controls. The Ross procedure may yield outcomes more similar to an age- and gender- matched general population. Purpose: We conducted a systematic review and meta-analysis to estimate the risk of adverse events and event-free life expectancy after the Ross procedure in adult patients. Methods: We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to June 2017 for reports evaluating the Ross procedure in patients ≥16 years of age. We performed screening, full-text assessment, risk-of-bias evaluation and data collection independently and in duplicate. We pooled data using a random effects model for the outcome-based analysis. We used a microsimulation model to evaluate age- and gender-specific life expectancy. Results: We pooled data from 66 articles, totalling 21348 participants in 20 countries. We judged thirty-seven papers to be at low risk of bias, 21 at high risk and 8 at unclear risk. Twenty-eight studies reported on early mortality (N=10041), with a rate of 2.47% (95% CI [1.89, 3.13]). At a mean of 7.2 years of follow-up (N=7635), we found a mortality risk of 5.89% (95% CI [4.74; 7.15%]) based on 33 studies. The rate of early clinically significant bleeding was 1.36% (95% CI [0.37, 2,96]), 13 studies (N=4217); re-exploration for bleeding 4.58% (95% CI [3.10, 6.32]), 20 studies (N=7563); clinically significant bleeding occurring from 30 days until a mean of 7.1 years post-operative was 0.54%, (95% CI[0.24,0.97]), 10 studies (N=3634). At a mean of 6.9 years of follow-up, 29 studies reported on aortic (N=7600) and pulmonary re-interventions (N=7087), the re-intervention rate of any operated valve site was 7.85% (95% CI [5.69, 10.32]) based on 25 studies (N=7767): 5.75% (95% CI [4.41, 7.25]) at the aortic site and 3.53% (95% CI [2.76, 4.40]) at the pulmonary site. The risk of valve thrombosis was 0.28% (95% CI [0.15, 0.46]) at 7.6 years, 15 studies (N=4377); peripheral embolism, 0.27% (95% CI [0.15, 0.43]) at 6.4 years, 18 studies (N=5091); and stroke 0.91% (95% CI [0.65, 1.22]) at 6.5 years, 19 studies (N=5506). We present microsimulation-based estimates of age-specific life-expectancy in Figure 1.
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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 | 0.017 | 0.041 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.043 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 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".