The importance of the Heart Team evaluation before transcatheter aortic valve replacement: Results from the BRAVO‐3 trial
Bibliographic record
Abstract
Abstract Background/Objectives Clinicians use validated scores to risk‐stratify patients undergoing transcatheter aortic valve replacement (TAVR). However, evaluation by the Heart Team often deems patients to be at higher risk than their formal scores suggest. We sought to assess clinical outcomes of TAVR patients defined as high‐risk by the Heart Team's assessment versus the patient's logistic EuroSCORE (LES). Methods The BRAVO‐3 trial randomized patients at high risk (LES ≥ 18, or deemed inoperable by the Heart Team) to TAVR with periprocedural anticoagulation with unfractionated heparin versus bivalirudin. Endpoints included net adverse cardiac events (NACE: the composite of all‐cause mortality, MI, stroke, or bleeding), major adverse cardiovascular events (MACE: death, MI, or stroke), the individual components of MACE, major vascular complications, BARC ≥ 3b bleeding and VARC life‐threatening bleeding at 30 days. We compared patients deemed high‐risk based on LES ≥ 18 versus high‐risk by the Heart Team despite lower LES. Results A total of 467/800 (58.4%) patients were deemed high‐risk by the Heart Team despite LES < 18. After multivariable analysis, there were no differences in the odds of endpoints between groups (NACE, ORLES≥18: 1.32, 95% CI 0.86‐2.02, p = .21; MACE, ORLES≥18: 1.27, 95% CI 0.72‐2.25, p = .41; major vascular complications, ORLES≥18: 0.97, 95% CI 0.65‐1.44, p = .88; BARC ≥3b, ORLES≥18: 1.38, 95% CI 0.82‐2.33, p = .23; and VARC life‐threatening bleeding, ORLES≥18: 0.99, 95% CI 0.69‐1.41, p = .95). Conclusion Patients undergoing TAVR and labeled high‐risk by LES ≥ 18 or Heart Team assessment despite LES < 18 have comparable short‐term outcomes. Assignment of high‐risk status to over 50% of patients is attributable to Heart Team's clinical assessment.
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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 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".