Early Reoperation for Iatrogenic Left Main Stenosis after Aortic Valve Replacement: A Perilous Situation
Bibliographic record
Abstract
Background. Iatrogenic left main coronary artery (LMCA) stenosis secondary to direct ostial cannulation during aortic valve replacement still occurs and is a morbid situation due to the difficulties of early reoperation and in providing adequate myocardial protection. Methods. A retrospective analysis was performed and identified seven patients with an iatrogenic LMCA stenosis, after 2158 aortic valve replacements (AVR) (0.3%) in our institution since 1987. Results. All patients with LMCA stenosis after AVR had undergone direct ostial cannulation with self-inflating balloon cannulas at the time of AVR. At reoperation for LMCA stenosis, severe ischemia developed in one patient and injury to cardiac structures occurred in four patients. Four patients suffered a perioperative myocardial infarction and congestive heart failure developed in two patients at late follow-up. Conclusions. LMCA stenosis following coronary ostial cannulation at the time of AVR is a rare yet morbid complication. Reoperation for this condition is fraught with a high operative morbidity rate and poor long-term outcome. Prevention of this complication is quintessential, avoiding ostial cannulation with self-inflating balloons.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".