Implications of a Novel Modified Strategy for Combined Coronary Artery Bypass Grafting and Mitral Valve Replacement for Ischaemic Heart Disease Patients
Bibliographic record
Abstract
Background: Conventional coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) is the best definitive treatment for patients with ischemic heart disease (IHD) complicated with severe ischemic mitral regurgitation (IMR). Yet the procedure itself entails high intraoperative and early postoperative risks added to the higher preoperative risk profile of its candidates. The higher risk values are largely attributed to the longer duration taken for the combined procedures with mandatory prolonged aortic cross clamping time with the risk of longer cardiac arrest state and prolonged cardiopulmonary bypass (CPB) time. Objective: This study primarily aimed at tracing the impact of a modified strategy adopting CABG on beating on-pumped non-aortic cross clamped heart conserving cardiac ischemia only for the MVR step of the surgery. Patients and Methods: This retrospective observational non-randomized study included 56 patients presented with IHD complicated with severe IMR. They had been operated upon by CABG and MVR. They had anginal pain grade III according to Canadian Cardiovascular Society (CCS) grading of angina pectoris. Intraoperative aortic cross clamping time, CPB time and mortality, postoperative mortality, morbidity outcomes, overall hospital complications rate, left ventricular ejection fraction per cent (LVEF%), CCS grading and overall one-year survival rate were evaluated. Results: No intraoperative mortality happened. The in-hospital mortality was 5.35%. Multivariable analysis showed that old age (OR: 1.15 (95% CI: 1.090-1.210); p < /em>= 0.001), females (OR: 3.25 (95% CI: 1.030-10.801); p < /em>= 0.041) and critical preoperative condition (OR: 3.78 (95% CI: 1.179-12.798); p < /em>= 0.027) were the foreshows of operative mortality and showed that old age (OR: 1.16 (95% CI: 1.100-1.122); p < /em>= 0.001) and critical preoperative condition (OR: 4.68 (95% CI: 1.378-15.395); p < /em>= 0.008) were those of in-hospital morbidity. The overall hospital complication rate was 23.21%. The overall one-year survival rate was 94.64% with statistically significant improvement of LVEF% with a mean 51.53±3.41 (p < 0.001) and CCS grade whereas 92.45% were in CCS grade I and 7.54% in CCS grade II (p < 0.001). Conclusion: The adopted stepwise approach showed markedly better operative and postoperative outcomes than reported with statistically significant improvement in both functional clinical statuses, LVEF% and survival at one-year follow-up.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| 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".