Abstract 4144744: Sex difference in Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement and long-term clinical outcome
Bibliographic record
Abstract
Importance: Prosthesis-Patients Mismatch (PPM) is associated with multiple adverse event after aortic valve replacement (AVR), especially increased long-term mortality. Despite women are more likely to have PPM, sex-differences in PPM outcomes remain poorly explored. Objectives: To evaluate PPM incidence and sex-differences in PPM impact in a large cohort of patients underwent surgical aortic valve replacement. Design, Setting and Participants: We included 7,319 patients who underwent Surgical AVR between 2000 and 2021. PPM was defined accordingly to Valve-Academic-Research-Consortium-3 criteria, adopting correction for Body Surface Area >30 kg/m2 and retrieving the predicted effective orifice area of the aortic valve prosthesis. The cohort was followed up prospectively from Surgical AVR until November 2023. Main Outcomes and Measures: Primary endpoint was defined as long-term mortality and secondary endpoint as long-term cardiovascular (CV) mortality. Mortality was established and Cardiovascular mortality adjudicated by Quebec national database. Results. Severe PPM incidence was rare (1.1%), more prevalent in women (2.5%) than in men (0.5%, p<0.0001). Any-degree-PPM (22.8% of patients) was also more prevalent in women (31.9% vs. 19.7%, p<0.0001). Over a median follow-up of 13 years, there was 3,231 (44.1%) all-cause deaths, with 1,238 (16.9%) being from CV causes. PPM was associated to excess mortality (HR:1.30[1.20-1.40]; p<0.0001) and CV mortality (HR: 1.39[1.23-1.57]; p<0.0001) in the whole cohort without interaction between sexes (p=0.94 and p=0.74). After comprehensive multivariable adjustment, PPM resulted an independent predictor of long-term mortality and CV mortality in women (both p≤0.04) but no in men (both p≥0.66). Conclusion and relevance: In this large series of AVR patients, PPM was more prevalent in women, in whom it was an independent predictor of mortality. This finding suggests that sex-specific management of aortic valve intervention may be of importance and warrants further studies focusing on this aspect.
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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 | 0.002 |
| 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 | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 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".