Valve-sparing aortic root replacement in bicuspid aortic valves—the reimplantation technique: A multicenter study
Bibliographic record
Abstract
OBJECTIVE: Reported outcomes in patients with bicuspid aortic valves (BAVs) undergoing valve-sparing aortic root replacement (VSRR) are scarce. This study aims to evaluate outcomes in patients with BAV using the reimplantation (David) technique. METHODS: Consecutive adult patients with BAV, aortic root aneurysm, and/or aortic valve insufficiency (AI) undergoing VSRR (reimplantation) were included from 5 centers experienced in reimplantation procedures. Patients were subcategorized into 2 groups with different primary indications for operation: (1) aneurysm, and (2) isolated AI. Exclusion criteria included acute aortic dissection, endocarditis, and valvular-stenosis. RESULTS: In total, 498 patients were included. Mean age was 45.4 years (±11.8 years); median follow-up was 5.4 years (interquartile range, 2.3-8.7 years). Group 1 included aneurysm (n = 144) and group 2 included AI (n = 354). There was 1 in-hospital death. Survival (overall) was 93.4% (95% confidence interval [CI], 92-97%) at 10 years, with no difference between groups (P = .93) observed. Freedom from reintervention at 1 year was 99.1% (95% CI, 99%-100%), at 5 years 95.4% (95% CI, 93%-97%), and at 10 years 89.2% (95% CI, 86%-93%) for patients with aneurysm 100% at 1 year and 95.4% (95% CI, 92%-98%) at 10 years; and for AI 98.9% (95% CI, 98%-99%) at 1 year and 86.4% (95% CI, 83%-91%) at 10 years. Cusp fenestrations (P = .01), prolapse (P = .04), and isolated AI (0.03) were associated with greater hazard of reintervention. CONCLUSIONS: This multicenter study shows excellent results after VSRR reimplantation procedure in patients with BAV and aortic aneurysm and/or valve insufficiency. Isolated AI and cusp abnormalities are associated with greater reintervention rates and may reflect more advanced leaflet disease. The reimplantation technique, when performed in expert centers, appears to be an excellent treatment strategy in BAV.
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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 | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".