LuX-Valve Plus transcatheter tricuspid valve replacement for massive tricuspid flail after lead extraction
Bibliographic record
Abstract
A 71-year-old male presented with New York Heart Association (NYHA) III dyspnoea and peripheral oedema. Medical history included primary prevention implantable cardioverter-defibrillator (ICD) with endocarditis requiring lead extraction resulting in torrential tricuspid regurgitation (Panels A and B; Supplementary data online, Videos S1 and S2). Surgical risk was prohibitive, and 2.2 cm flail gap precluded tricuspid transcatheter edge-to-edge repair (T-TEER). Massive tricuspid annular dilatation (52 mm) with flail leaflet resulted in screen failure for several radial force-dependent transcatheter tricuspid valve replacement (TTVR) devices. The patient was subsequently accepted for LuX-Valve Plus TTVR (Jenscare Biotechnology, Ningbo, China). Transoesophageal echocardiography (TEE) demonstrated complex interaction between ICD lead and flail segment, with lead-induced and functional components. Using fluoroscopic and TEE guidance, the 60 mm LuX delivery system was introduced via the right internal jugular vein. Given the proximity to the valve anchoring site, the ICD lead was snared into the posteroseptal commissure with an Agilis catheter (St. Jude Medical, Minnetonka, MN, USA; Panel C; Supplementary data online, Video S3). The atrial skirt and septal anchor were deployed followed by release of the ICD lead (Panel D; Supplementary data online, Video S4). Stable valve position was demonstrated (Panel E; Supplementary data online, Videos S5 and S6) with mild paravalvular regurgitation (Panel F; Supplementary data online, Videos S7 and S8). At follow-up, the patient reported NYHA I status with trace paravalvular regurgitation and stable ICD function. Massive tricuspid flail after lead extraction can be treated with LuX-Valve Plus TTVR, with repositioning of an ICD lead using a steerable catheter. The unique anchoring mechanism and larger valve sizes may allow treatment of patients that screen fail for other devices.1 LuX-Valve Plus transcatheter tricuspid valve replacement. (Panel A) Baseline transoesophageal echocardiogram 2D view demonstrating tricuspid leaflet flail segment and implantable cardioverter-defibrillator lead interaction. (Panel B) Baseline transoesophageal echocardiogram 2D view demonstrating torrential tricuspid regurgitation. (Panel C) Fluoroscopy demonstrating steerable sheath traction on implantable cardioverter-defibrillator lead to facilitate transcatheter tricuspid valve replacement prosthesis positioning and leaflet capture. (Panel D) Fluoroscopy view post-transcatheter tricuspid valve replacement implantation. (Panel E) Intraprocedural transoesophageal echocardiogram demonstrating mild tricuspid regurgitation after transcatheter tricuspid valve replacement deployment. (Panel F) 3D transoesophageal echocardiogram view demonstrating mild paravalvular tricuspid regurgitation. ICD, implantable cardioverter-defibrillator; RV, right ventricle; TR, tricuspid regurgitation. Supplementary data are available at European Heart Journal online. N.P.F. is a consultant for Edwards Lifesciences, Abbott, and Cardiovalve. No data were generated or analysed for or in support of this paper. All authors declare no funding for this contribution.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".