Abstract 18833: Annulus Preservation Strategy Improves Late Outcomes in Tetralogy of Fallot: An Anatomical Equivalency Study
Bibliographic record
Abstract
Introduction: Late outcome of repaired TOF is driven by the impact of residual lesions. We shifted strategy from liberal transannular patch (TAP) use to aggressive valve and annulus preservation (AP) hypothesizing that for equivalent anatomy, AP would leave a mixed stenosis regurgitation lesion that would lead to a healthier right ventricle (RV). Methods: Between 1996 and 2002, 185 children underwent TOF repair (median age 7.7 m). A regression equation for predicting annulus preservation, in the AP group, was derived from preoperative anatomic parameters and applied to all. Patients were identified (n=107) that could have had either AP or TAP on the basis of anatomical equivalency (subgroup validation with propensity matching) with 52 having a TAP and 55 having AP. These are the primary study group. Results: Cardiac MRI at mean age 13.1±2.3 yrs (TAP n=28, AP n=23) showed AP was associated with significantly lower indexed RV end diastolic vol (AP: 120±29; TAP: 181±35 mL - Fig. 1), RV end systolic vol (AP: 57±23; TAP: 95±25 mL), RV stroke volume (AP: 64±15; TAP: 86±15 mL), MPA regurgitant fraction (AP: 28±11; TAP: 45±9 %), all p<0.0001, and LV mass (AP: 46±6; TAP: 54±8 gm/m2); p=0.001). Echo RVOT gradient was no different (AP 31 Vs TAP 25 mmHg (p=ns). MRI LVEF (AP: 57±4; TAP: 55±4 %; P=0.031) and RVEF (AP: 54±7; TAP: 48±6 %; p=0.004) was higher after AP. Freedom from surgical reintervention at 15 years was 89.3% (TAP) and 71.7% (AP , P=0.048) (Fig.2) with early reoperation for RVOTO predominating in AP and late pulmonary valve replacement most frequent in TAP. VO2 max for all AP vs TAP was higher in AP (p<0.05). Conclusion: This is the first long-term follow-up study demonstrating that, for equivalent anatomy, an aggressive AP strategy leads to a lower reoperative incidence, less pulmonary insufficiency, smaller indexed RV volumes and better LV function as compared to a standard TAP. Surgical strategy directly impacts ventricular health and should be reflected in practice.
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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 | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| 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) | 0.003 | 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".