Valve-sparing root replacement. Toronto General Hospital experience
Bibliographic record
Abstract
Aortic valve-sparing operations were developed at Toronto General Hospital in early 90's in an aim to preserve normal native aortic valve in the setting of root disease. This procedure has been mastered over the last 30 years. In this manuscript, we present our clinical and long-term outcomes using the implantation technique for both tricuspid and bicuspid valves, along with a detailed step-by-step explanation of the surgical technique, based on our experience. The reimplantation technique can be performed in many elective and urgent situations, but not all valves are suitable for optimal repair and an extensive valve morphology assessment using echocardiogram or intraoperative direct assessment, has been the key to achieve excellent long-term results. Our group showed 1% postoperative death with low pacemaker implantation (1.9%) and stroke rates (0.6%). All patients left the operating room with mild or less aortic regurgitation. Excellent perioperative results are achieved with a perfect and careful surgical technique. A detailed step-by-step description of the reimplantation technique is provided in this manuscript. Important technical considerations are included. Our series showed 84% 15-year survival and less than 10% recurrence of more than mild aortic regurgitation. The valve-sparing root replacement procedure provides excellent long-term clinical outcomes in terms of survival, freedom from reoperation and valve-related complications, along with stable aortic valve function, for both tricuspid and bicuspid aortic valve with favorable cusp morphology. La operación de preservación de la válvula aórtica fue desarrollada en el Hospital General de Toronto a inicios de los años noventa con el objetivo de preservar las válvulas aórticas nativas normales en el contexto de la enfermedad de la raíz. Este procedimiento se ha ido perfeccionado en los últimos 30 años. En este manuscrito presentamos nuestros resultados clínicos perioperatorios y a largo plazo utilizando la técnica de implantación aórtica tanto para válvulas tricúspides como bicúspides, junto con una explicación detallada paso a paso de la técnica quirúrgica, basada en nuestra experiencia. La técnica de reimplantación aórtica puede emplearse en situaciones electivas y urgentes, pero no todas las válvulas son aptas para una reparación óptima, haciendo necesaria una evaluación exhaustiva de la morfología valvular mediante ecocardiograma y mediciones directas intraoperatorias, siendo la clave para lograr excelentes resultados a largo plazo. Nuestro grupo presentó el 1% de muerte postoperatoria, con una baja tasa de implantación de marcapasos (1,9%) y de accidentes cerebrovasculares (0,6%). Todos los pacientes abandonaron el quirófano con regurgitación aórtica ligera o menor. Para unos resultados postoperatorios excelentes es necesario completar una técnica quirúrgica pulida y cuidadosa. En este manuscrito se ofrece una descripción detallada paso a paso de la técnica de reimplantación, incluyendo consideraciones técnicas importantes. Nuestra serie mostró una supervivencia a los 15 años del 84% y menos del 10% de recidiva de insuficiencia aórtica mayor a ligera. La operación de preservación de la válvula aórtica proporciona excelentes resultados clínicos a largo plazo en términos de supervivencia, tasa de reintervención y complicaciones relacionadas con la válvula, junto con una función estable de la válvula aórtica, tanto para válvulas aórticas tricúspides como para las bicúspides, con morfología de cúspide favorable.
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 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".