Abstract 20: Outcomes Following Pediatric Coronary Artery Bypass Grafting with Microsurgery
Bibliographic record
Abstract
PURPOSE: Pediatric coronary artery bypass grafting (PCABG) is performed for critical coronary stenosis. PCABG presents unique surgical challenges for surgeons including the small vessel caliber, small areas of vascular access, and the position and distribution of the coronary vasculature. Serious perioperative complications are common, including arrhythmias, myocardial infarction, and sudden death. To reduce technical complications and improve outcomes, the divisions of Cardiothoracic Surgery and Plastic and Reconstructive Surgery at our centre have collaborated during these procedures, to utilize the expertise of the plastic surgeon in performing microvascular anastomosis. We provide a detailed technical description and report our institutional experience for all patients who have undergone PCABG procedures, separately analyzing how these outcomes compare to patients in which microvascular techniques were used. METHODS: The records of all patients who underwent PCABG procedures (either as primary or secondary procedures) from 2000–2017 were retrospectively reviewed. Variables assessed included basic demographic data, diagnosis, pre-operative echocardiography and angiography, details of PCABG and any associated procedures, perioperative complications, graft patency, and clinical and functional outcomes. Left ventricular ejection fraction was compared pre-and post-operatively using a Student’s t test RESULTS: Outcomes were evaluated for a total of 24 patients. The median age was 8.39 years (range, 0.27–16.21 years) and the median weight was 24.2 kg (range, 4.6–71 kg) at operation. Three male and three female patients had microsurgical involvement, comprising the six youngest patients in the cohort, with a median age at operation of 2.01 years (range, 0.27–4.43 years) and a median weight at operation was 10.75 kg (range, 4.6–12.2 kg). Three major anastomotic complications occurred requiring reoperation, although none occurred in the microvascular group. Median follow up was 3.54 years (range, 0.1–12 years) and 5.25 years (range, 1.92–12) for the entire cohort and the microvascular group, respectively. Three patients were symptomatic according to subjective report at last follow-up and two deaths occurred in our series, all in the group without microsurgical involvement. All grafts were patent in both groups. Differences between pre-and post-operative ejection fraction were not statistically different between patients with and without microsurgical involvement. CONCLUSION: Our results demonstrate the positive impact of collaboration between cardiac and microvascular surgeons during PCABG procedures, and the subsequent reduction in complications that can be expected. This highlights the broad utility of microsurgical expertise and how these techniques may be used to improve patient outcomes. Larger studies in the future with age-matched controls are required to determine whether microsurgical involvement in PCABG improves outcomes. M. Shafarenko: None. J. Catapano: None. S. Luo: None. R.M. Zuker: None. G. Van Arsdell: None. G.H. Borschel: None.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".