Impact of supra-aortic vessel false lumen communications on aortic remodeling: Analysis from the PERSEVERE trial
Bibliographic record
Abstract
Objective The PERSEVERE (ProspEctive, Single ARm, Multi-center Clinical InveStigation to EValuatE the Safety and Effectiveness of AMDS in the TREatment of Acute DeBakey Type I Dissection) Trial is a US investigational device exemption study designed to evaluate the Ascyrus Medical Dissection hybrid prosthesis in the open repair of patients with acute DeBakey type I dissection with preoperative malperfusion. We sought to determine the impact of false lumen (FL) communications within the supra-aortic vessels (SAV) on aortic remodeling by analyzing total aortic diameter (TAD), FL diameter, and true lumen (TL) diameter. Methods Ninety-three patients were enrolled from July 2022 to November 2023. Anatomic measurements were made by a core laboratory using computed tomography angiogram (CTA). For this study, analysis was limited to zones 2, 3, and 4. TAD was assessed on first postoperative CTA and at 1-year postoperatively, and growth was defined as >1.0 cm. In addition, the percent of patients with FL diameter larger than TL diameter were compared on the basis of the presence or absence of any FL communications in the SAV. Results Fifty-five patients had a preoperative, first postoperative CTA, and 1-year CTA scan and were included in the analysis. SAV FL communications were present on preoperative computed tomography scan in 35% (19/55) and absent in 65% (36/55). In those with SAV FL communications, TAD growth occurred in 0%, 5.3%, and 21.1% in zones 2, 3, and 4, respectively. In those without SAV FL communications, TAD growth occurred in 2.8%, 2.8%, and 8.3% in zones 2, 3 and 4, respectively; the difference did not reach statistical significance. The FL was larger than TL in significantly more patients in zones 3 and 4 in those with compared with those without SAV FL communications (zone 3, 53% vs 18%; zone 4, 58% vs 18%; P < .05). Conclusions The presence of preoperative SAV FL communications has a significant impact on aortic remodeling at 1-year postoperatively. The presence of these communications is associated with a trend toward negative remodeling in zones 2, 3, and 4, in addition to a significantly larger FL compared with TL diameter, likely representing ongoing FL pressurization. Techniques to better identify SAV FL communications preoperatively may lead to a more tailored approach to operative management and more targeted postoperative surveillance in these patients.
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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 | 0.006 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".