The Impact of Fontan Circulatory Failure on Heart Transplant Survival: A 20 Center Retrospective Cohort Study
Notice bibliographique
Résumé
Abstract Background Fontan circulatory failure (FCF) is a chronic state in palliated single ventricle heart disease with high morbidity and mortality including heart failure, multisystem end-organ disease, and need for heart transplant. Specific FCF morbidities have not been rigorously defined, limiting study of how FCF morbidities impact pre- and post-HT outcomes. We hypothesized that FCF-related morbidities affect survival from heart transplant waitlisting through 1-year post-heart transplant. Methods This 20-center, retrospective cohort study collected demographic, medical/surgical history, waitlist data, and peri- and post-heart transplant data, and a priori defined FCF-specific morbidities in Fontan patients who were listed for heart transplant from 2008-2022. Univariate 2-group statistics compared surviving individuals with those who 1) died anytime from waitlisting to 1-year post-heart transplant, 2) died on the waitlist, 3) underwent transplant and died within 1-year post-transplant. Using covariates from both univariate analyses, multivariable logistic regression determined the primary study outcome of independent FCF risk factors for mortality between waitlist and 1-year post-heart transplant Results Of 409 waitlisted patients, 24 (5.9%) died on the waitlist. Of the 341 (83.4%) who underwent HT, 27 (8.5%) did not survive to 1-year. Univariate risk factors for waitlist death included higher aortopulmonary collateral burden, > 1 hospitalization in prior year, younger age, sleep apnea, higher NYHA class, non-enrollment in school or work, and single-parent home. Risk factors for 1-year post-heart transplant mortality included hypoplastic left heart syndrome diagnosis, patent fenestration, anatomic Fontan obstruction, clinical cyanosis (pulse oximetry < 90%), polycythemia, portal variceal disease, mental health condition requiring treatment, and higher HLA class II PRA. Of the patients not surviving from waitlisting to 1-year post-heart transplant, independent risk factors for mortality included >1 hospitalization in the year prior to waitlisting (adjusted odds ratio 2.0, p=0.05) and clinical cyanosis (adjusted odds ratio 5.0, p=0.002). Conclusions Patients with Fontan palliation selected for heart transplant have significant mortality from waitlisting through transplant. Among FCF specific morbidities, cyanosis is associated with worsened survival and necessitates further study. Clinical morbidity of any type requiring repeated hospital admission also should prompt consideration of heart transplant. Clinical Perspective What is new? Survival through heart transplant in patients with Fontan physiology selected for waitlisting has increased from previous reports, but this patient group still has significant risk of mortality. Risk factors for waitlist mortality and post-transplant mortality are different. Cyanosis and repeated hospitalizations prior to listing are independent risk factors for mortality between waitlisting and 1-year post-heart transplant. What are the clinical implications? To successfully manage a patient through the entire transplant process, attention to mitigating different risks in the waitlist and post-transplant phase is necessary. Repeated hospitalization or significant cyanosis in a patient with Fontan physiology should prompt consideration of heart transplant.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».