Interaction Between Self-Expanding Transcatheter Heart Valves and Coronary Ostia: An Angiographically Based Analysis of the Evolut R/Pro Valve System
Bibliographic record
Abstract
OBJECTIVES: We sought to assess the position of the CoreValve Evolut R/Pro (Medtronic) with respect to the left coronary artery (LCA) ostium and evaluate the impact of implantation depth on this relationship. METHODS: One hundred consecutive patients who received an Evolut R/Pro valve and had an adequate angiography following valve implantation were included. Angiographic measurements included valve implantation depth, the position of the Evolut R/Pro with respect to the LCA, and the distance between the neo-valve cusp and the LCA ostium. Coronary access issues following TAVR were also recorded. RESULTS: Regarding the LCA ostium, the neo-valve of the Evolut R/Pro was supraostial, at the ostial level, and infraostial in 3%, 12%, and 85% of cases, respectively. When beneath the LCA ostium, the mean distance between the neo-valve and the floor of the LCA ostium was 4.1 ± 5.2 mm. An implantation depth ≤6 mm was associated with a higher rate of neo-valve at the ostial level or above (25% vs 4% for implantation depth >6 mm; P=.01). Accessing the coronary arteries was required in 10% of the patients at 12 ± 8 months post TAVR, and selective coronary angiography of the left and right coronary arteries was achieved in 60% and 40% of the cases, respectively. CONCLUSIONS: The Evolut R/Pro neo-valve was positioned below the LCA ostium in the vast majority of cases (85%), but an implantation depth ≤6mm was associated with a higher rate of neo-valve positioning at or above the coronary ostia level. Considering the current tendency of very high (aortic) valve implants to avoid conduction disturbances, future studies should determine the impact of high Evolut R/Pro positioning on coronary access issues post TAVR.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.011 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".