Abstract 11125: Is the Rastelli Procedure Falsely Maligned?
Bibliographic record
Abstract
Background: Surgical options for transposition left ventricular outflow tract obstruction (TGA/LVOTO) are multiple. We and others have noted the Rastelli has high late mortality/morbidity for TGA/VSD/LVOTO. This led to a change in strategy in 2000. Objective: We hypothesized that patients undergoing a Nikaidoh would have superior outcomes to the Rastelli procedure. Methods: From ’82-‘13, 157 patients with TGA/LVOTO were operated. Of which 133 (84.7%) had associated VSD. Procedures were: Rastelli (n=41), Mustard ± LVOTO relief (n=41), ASO ± LVOTO relief (n=36), single V (n=26), REV (n=7), and Nikaidoh (n=6). Stratification by era was performed: era 1, ‘82-‘89 (n=70); era 2, ‘90-‘99 (n=50); era 3 ‘00-‘13 (n=37). Results: Survival at 10 years was not different by strategy: Rastelli 77.9%, Mustard 82.3%, ASO 85.5%, single V 96.2%, REV 100%, and Nikaidoh 83.3% , P=0.24. Survival after the Rastelli improved over eras (at 9 years: era 1=45%, era 2=93%, and era 3=100%, P=0.01) (fig 1A). At 23 years, it was 45% for era 1 and 93% for era 2. Late mortality was independently associated with arrhythmia (OR 3.50; 95% CI 1.15-10.67, P=0.03) but not LVOT gradient (OR 0.95; 95% CI 0.89-1.01, P=0.13) though the first era had a positive time relationship (P=0.01) to increasing gradient (slope 0.49, SE=0.19, 95% CI 0.11-0.88) (LVOT reop fig 1B). The Rastelli and REV were independently associated with all reoperation (OR 10.58; 95% CI 4.23-26.46, P<0.001) and (OR 8.33; 95% CI 1.60-43.17, P=0.01) respectively. The Nikaidoh, Rastelli, and REV had similar RVOT reoperation. Conclusion: The Rastelli since 1990, had a different outcome than a generation ago potentially suggesting a difference in starting physiologic substrate and or the operation. Greater sample size and follow up will be required to determine if long term outcome differs between the modern Rastelli and Nikaidoh. Given the significant improvement in survival over eras, the current Rastelli remains a viable strategy and is not inferior. ![][1] [1]: /embed/graphic-1.gif
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".