Inflow-to-Outflow Stent Frame Expansion, Ellipticity, and Decoupling in Evolut TAVR: Implications for Mid-term Hemodynamic Performance
Bibliographic record
Abstract
Background The native aortic annulus for self-expanding transcatheter aortic valve replacement (TAVR) has variable ellipticity. A noncircular and underexpanded transcatheter aortic valve (TAV) may impact hemodynamic performance. This study aimed to quantify Evolut TAV (Medtronic) frame ellipticity and expansion 30 days post-TAVR and evaluate their impact on 1-year hypoattenuating leaflet thickening and 4-year hemodynamics. Methods We retrospectively evaluated 184 patients from the Evolut Low Risk substudy with high-quality computed tomography images. Frame ellipticity ratio and percent expansion were quantified at each frame node level 30 days after TAVR. Variables associated with frame deformation, 1-year hypoattenuating leaflet thickening, and 4-year hemodynamics were identified. Results Mean Evolut frame ellipticity was highest at the inflow (1.18 ± 0.08) and lowest at the functional leaflet region (1.05 ± 0.03) and frame outflow (1.04 ± 0.03). Frame expansion was lowest at the inflow (83.8% ± 4.9%) and highest at the functional leaflet region (97.8% ± 1.7%). TAV frame circularity and expansion significantly increased from the annular level to the leaflet region ( P < .001). Mean gradient, effective orifice area, and paravalvular regurgitation at 4 years were not affected by Evolut TAV's relative noncircularity and underexpansion at the frame inflow. Frame underexpansion at the leaflet region, however, was associated with a smaller effective orifice area at 4 years. Conclusions Evolut frame deformation at the inflow did not affect the circularity and expansion of the stent at the functional leaflet region. Mid-term (4-year) Evolut hemodynamic performance does not appear to be impacted by frame inflow geometry.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.204 |
| Bibliometrics | 0.000 | 0.001 |
| 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) | 0.000 | 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 teacher head, 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".