Abstract 16725: Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Small Aortic Annulus: Propensity-Matched Comparison to Standard Aortic Valve Replacement
Bibliographic record
Abstract
Background: Few data exist on the results of transcatheter aortic valve implantation(TAVI) in patients with a small aortic annulus(AA) compared to standard aortic valve replacement(SAVR). We sought to examine valve hemodynamics and clinical outcomes of patients with a small AA who underwent TAVI versus SAVR. Methods: Between 2007 and 2011, 46 patients (mean age 79.1±9.4 years) with severe aortic stenosis and an AA diameter <19.5 mm (mean 18.3±0.85 mm) underwent TAVI with a 23-mm Edwards SAPIEN bioprosthesis. These patients were compared to 217 propensity-matched patients who underwent SAVR with a 19-mm valve (78% bioprosthesis). Echocardiographic parameters and clinical outcomes were assessed prior to discharge and at follow-up. Results: There was a greater incidence of postoperative atrial fibrillation (34.6% vs 15.2%, p=0.02), acute kidney injury (12.4% vs 8.7%, p=0.05), and blood product transfusion (83% vs 46%, p<0.001) in the SAVR group compared to the TAVI group. In-hospital mortality was 2.2% in the TAVI group and 6.5% in the SAVR group (p=0.06). One-year survival rate was similar between groups (TAVI 91.3% vs SAVR 87.1%, p=0.20). At hospital discharge, mean transaortic gradients were greater in the SAVR group (18.3 ± 7.2 vs 14.9 ± 9.3 mmHg, p=0.006). Mean indexed effective orifice area (IEOA) was lower in the SAVR group (0.66 ± 0.16 vs 0.84 ± 0.2 cm2/m2, p<0.001), and severe prosthesis-patient mismatch (IEOA < 0.65 cm2/m2) occurred more frequently in the SAVR group (53.3%) than in the TAVI group (9.3%) (p<0.001). Aortic regurgitation(AR) occurred in 72% of the patients in the TAVI group (trivial or mild: 70%, moderate: 2%) compared to 28% of the patients in the SAVR group (trivial or mild in all cases), p<0.001. Echocardiographic results remained unchanged at 1-year follow-up. Conclusion: In patients with severe AS and a small AA, TAVI is associated with lower postoperative morbidity and better valve hemodynamics but a higher incidence of trivial/mild residual AR as compared to SAVR. These results suggest that TAVI is a reasonable alternative to SAVR in elderly patients with small AA.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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 | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".