Abstract 19213: Establishment of Mechanically-Assisted Primary Bidirectional Cavopulmonary Shunt in Neonates and Infants: An Acute Human Pilot Study
Bibliographic record
Abstract
Background: One year survival for stage 1 palliation in hypoplastic left heart syndrome (HLHS) is 69%. We hypothesized that primary ‘in-series’ palliation (neonatal bidirectional cavopulmonary shunt - BCPS) with mechanical assist would provide more stable physiology. This is the first human study of an acute intraoperative BCPS model. Methods: Two types of intraoperative, tubing configured, pump-assisted BCPS circulations [superior vena cava (SVC) to pulmonary artery (PA) pump assist at stage I Norwood, and SVC to right atrium (RA) pump with oxygenation at stage II BCPS] were established in the operating room for 20 minutes at the time of modified ultrafiltration (Figure 1A). Hemodynamics and cerebral blood flow were continuously recorded. Arterial and venous blood gases were analyzed every 5-10 minutes. Results: All six patients (3 in each group) completed 20 minutes of mechanical support without hemodynamic compromise. In the SVC-PA pump assist (n=3), the pump generated effective pulmonary blood flow of 335+/-53ml/min while the BT shunt was occluded. Compared to Norwood physiology, the SVC-PA pump-assisted BCPS had a higher mean arterial pressure (median 33 vs. 44 mmHg, p=0.02), lower central venous pressure (CVP) (12 vs. 10 mmHg, p=0.03), and higher cerebral perfusion pressure (33 vs. 46 mmHg, p=0.01) (Figure 1B). In the SVC-RA oxygenation assist (pump and oxygenator assisted BCPS), the pump generated blood flow of 536+/176ml/min with oxygenation. Compared to baseline BCPS physiology, SVC-RA oxygenation-assisted BCPS had a lower CVP (14 vs. 7 mmHg, p=0.05). Conclusion: The study demonstrates the physiologic feasibility of mechanically assisted neonatal in-series single ventricle circulation. Both assist systems attained equivalent or better hemodynamics, stable ventilation and oxygenation, and a more favorable cerebral perfusion profile. This human proof of concept study raises the possibility of a potential paradigm shift for the treatment of HLHS.
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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 | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 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".