‘Incidence and impact of structural valve deterioration following TAVI: a multicenter real-world study’
Bibliographic record
Abstract
AIMS: Valve durability becomes a major issue as transcatheter aortic valve implantation (TAVI) is expanding to populations with longer life expectancy. We sought to (i) determine the incidence of structural valve deterioration (SVD), (ii) compare the incidence of SVD between balloon-expandable (BE) and self-expandable (SE) valves, and (iii) analyse the impact of SVD. METHODS AND RESULTS: 2040 patients who underwent TAVI (2007-2020) from 9 centres were included. After inverse probability treatment weighting (IPTW), 1848 patients were selected (973 BE and 875 SE). SVD was defined using recent echocardiographic definitions according to VARC-3 criteria: Median follow-up was 4.2 (IQR: 2.5-5.7) years. The estimated incidence of SVD and bioprosthetic valve failure (BVF) at 8 years follow-up for the overall cohort were 13.3% [95% confidence interval (CI) 9.8-18%] and 11.5% (95% CI 8.9-14.8%), respectively. After IPTW and a median follow-up of 4 years, the risk of SVD (5.25% vs. 1.19%; HR 10.25, 95% CI 3.79-27.71, P < 0.001), and all-cause BVF (6.41% vs. 3.2%; HR 2.1, 95% CI 1.27-3.47 P = 0.004), was significantly higher for BE compared with SE recipients. Patients developing SVD had a trend towards a higher incidence of cardiovascular death (P = 0.06), as well as a significantly higher risk of heart failure rehospitalization (P = 0.048). After IPTW, there were no differences between BE and SE recipients in the combined endpoint of cardiovascular death, heart failure rehospitalization and valve reintervention (P = 0.46). CONCLUSION: In this real-world registry, the incidence of SVD at 8 years after TAVI was relatively low. The risk of SVD was higher among BE compared with SE valve recipients. SVD was associated with an increased risk of heart failure rehospitalization and a trend towards a higher risk of cardiovascular death.
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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) | 0.001 | 0.005 |
| 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) | 0.000 | 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".