The Influence of Indication on Intermediate-term Survival after Full Root Freestyle Implantation: A Multicenter Study
Bibliographic record
Abstract
Objective: An important property of the Medtronic Freestyle Stentless Bioprosthesis® (Medtronic Inc. Minnesota, US) is its versatility when used as a full root. Indications range from aneurysms, valve replacement in small aortic roots, complex endocarditis, type A dissections to other technically challenging cases as e.g. redo surgery. After surgery for isolated valve lesions or aneurysms, numerous studies have shown very good survival and durability. There is little evidence on implications of more heterogeneous patient populations. In a previous single center study, we showed that survival varies significantly with surgical indication. We aimed to broaden the knowledge by quantifying this difference in a multicenter North-western population. Methods: Medical records were reviewed for consecutive full root Freestyle implantations in four centers since 1999 to mid-2017. Survival and hazard ratio (HR) by indication was estimated by Kaplan-Meier analysis and age-adjusted Cox regression. Results: 843 full root Freestyle were implanted in 825 patients, followed for a total of 3344 patient-years. Age at surgery ranged from 14-86 years (median 66, IQR 58-72). Euroscore II ranged from 1.0-74.2% (median 5.6%, IQR 2.7-13.2). Proportions of indications and corresponding age-adjusted HR (95% confidence interval) were: aneurysm 39% HR 1.0; valve replacement in a small root 9%, HR 1.5 (0.79-2.77); complex endocarditis 28%, HR 3.4 (2.44-4.84); type A dissection 12%, HR 4.0 (2.69-5.93); other, including redo, 13%, HR 1.9 (1.19-3.01). See Figure 1 for Kaplan-Meier survival analysis. Conclusions: We found substantial intermediate-term survival differences between indications, with a HR up to 4.0 (type A dissection) compared to aneurysm surgery. Mortality after surgery for small root tapers off after two years, possibly reflecting a more benign underlying pathophysiology compared to those of the other indications. When reporting on the Freestyle in a mixed population, this report strongly supports stratification for indication, or possibly surgical priority. The influence of indications on durability awaits investigation. KEYWORD: e-P-14 The authors do not declare any conflict of interest.
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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 | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".