A challenging Perceval valve implantation during concomitant mitral valve replacement with a bioprosthesis
Bibliographic record
Abstract
In this video tutorial, we emphasize the main pitfalls in adequate sizing and expansion of the Perceval valve during a concomitant mitral valve replacement with a bioprosthetic. Following mitral valve replacement with a tissue-stented bioprosthesis, a transverse aortotomy was performed at 3 cm above the level of the aortic annulus. Three guiding sutures were then placed 120° apart in each valve sinus, 2-3 mm below the leaflet hinge point. The commissural struts of the mitral prosthesis can be seen in the aortic annulus. This positioning minimizes any potential protrusion in the left ventricular outflow tract. Next, sizing of the Perceval was performed. The small transparent sizer fit nicely; however, a clear gap at the annulus could be appreciated with the small white sizer. The medium transparent sizer was then utilized, and it fit nicely; however, the medium white sizer was not able to pass through the aortic annulus. Given the gap present with the small sizer, we opted for a medium-size prosthesis. A medium Perceval prosthesis was parachuted into the aortic annulus with the help of the guiding sutures and the valve was deployed. Next, balloon expansion of the stent was performed. Given the potential concern of under-expansion of the stent, we opted for a longer dilatation at 4 atm for 1 min rather than the usual 30 sec. The aortotomy was then closed.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 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".