Evaluation of Gold Marker Orientation in the Three-Cusp Coplanar View After Evolut FX Transcatheter Aortic Valve Implantation
Bibliographic record
Abstract
Background: Obtaining commissural alignment in transcatheter aortic valve replacement (TAVR) is important for ensuring coronary access and coronary artery filling, reducing the risk of central leaks, and minimizing leaflet stress. The Evolut FX system has the gold markers placed at the neo-commissures and has demonstrated favorable outcomes. We investigated whether evaluating the orientation of the gold markers in a three-cusp coplanar view (3-CV) after Evolut FX implantation was useful for assessing commissural misalignment (CMA). Methods: Between April 2023 and December 2024, we included 25 patients who underwent transfemoral TAVR using the Evolut FX for symptomatic severe aortic stenosis. All patients underwent multidetector computed tomography (CT) after TAVR. The native-prosthetic gap (NPG) was defined as the distance between the center of the transcatheter heart valve stent frame and the central gold marker in a 3-CV. We evaluated the association between the NPG and CMA, which was derived from the average misalignment deviation on post-TAVR CT. Results: The median age was 84 years, 36% were male, and 8% had coronary artery disease. The implanting view was the cusp overlap view (COV) in 11 patients, the near-COV in 11 patients, and the left anterior oblique view in three patients. Of the 22 patients implanted using the COV or near-COV, the gold markers were positioned at "2 left-1 right" in 17 patients. The average misalignment deviation was 18.0° (commissural alignment: eight patients, mild CMA: 13 patients, moderate CMA: two patients, and severe CMA: two patients) and the median NPG was 0.11. In cases with commissural alignment and mild CMA, NPG showed a significant positive correlation with the average misalignment deviation (r = 0.68, P < 0.01), whereas in cases with moderate and severe CMA, the relationship was inverse (r = -0.38, P = 0.62). Further, in cases with commissural alignment and mild CMA, a clockwise misalignment occurred when the central marker was positioned closer to the non-coronary cusp side, while a counterclockwise misalignment was observed when positioned closer to the left-coronary cusp side. Conclusions: Evaluating the orientation of the gold markers in a 3-CV after Evolut FX implantation is useful for assessing CMA.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| 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".