Variability in Surgical Referral Patterns for Pulmonary Valve Replacement in Adults with Repaired Tetralogy of Fallot
Bibliographic record
Abstract
BACKGROUND: Individuals with repaired tetralogy of Fallot (TOF) comprise a substantial proportion of the current adult congenital heart disease population. Pulmonary regurgitation (PR) is one of the most prevalent postoperative sequelae, but timing of pulmonary valve replacement (PVR) in the asymptomatic TOF patient remains controversial. OBJECTIVE: We sought to explore thresholds for PVR referral among adult congenital physicians. METHODS: Physicians attending an international adult congenital cardiac disease conference were given a survey focusing on PVR referral patterns for the asymptomatic individual with repaired TOF. Survey questions related to an asymptomatic adult with repaired TOF, at least moderate PR, and varying degrees of right ventricular (RV) dilation and RV dysfunction. RESULTS: A total of 128 surveys were completed. Nine percent did not feel that PVR was indicated in the asymptomatic patient. Of those practitioners who felt that PVR was indicated, many [(69%, [74/107]) relied on RV end-diastolic volumes (RVEDV) to guide decision making. Fewer relied on RVEDV for surgical referral as RV ejection fraction (EF) decreased. RVEDV thresholds for PVR referral varied depending on the RV function: with normal RVEF, 180 cc/m(2) was the most commonly used cutoff; if RV dysfunction was significant, 150 cc/m(2) was the threshold most often cited. Physicians who utilized RV volumes to guide decision making tended to work in a tertiary care setting (P= 0.008). CONCLUSIONS: PVR referral patterns for an asymptomatic TOF patient with significant PR and important RV dilation are variable among adult congenital cardiologists. Uncertainty regarding thresholds for PVR referral underscores the need for further study of this important issue.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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 | 0.000 | 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".