Abstract 20112: Lateral Tunnel and Extra-Cardiac Fontan Operations Have Equivalent Early and Late Outcomes in the Modern Era
Bibliographic record
Abstract
Introduction: Controversy continues regarding lateral tunnel (LT) versus extra-cardiac (EC) Fontan’s. Although we currently perform EC, there was a broad transition period. We aimed to compare long-term outcomes after LT or EC. Methods A. Total surgical experience: Of 906 Fontan operations (1976-2014), 223 were LT (1987-2005) and 412 EC (1995-2014) (median f/u 8.3 years; range 0-29). Survival and re-operations (including revisions, transplants and pacemakers) were compared. B. Adults: Our ACHD program follows 102 LT and 78 EC (median 23 years post-Fontan; range 18-40). All were reviewed and risk-adjusted comparisons were made. Additional comparisons used propensity-matched pairs near-identical by diagnosis, morphology, age and era (LT=36, EC=36, parametric greedy matching, c-statistic .885). Risk-adjustment was via parametric multivariable models and competing risks techniques, with bootstrapping. Results A. Early peri-operative mortality after Fontan was strongly era-dependent ( P P B. Adults with LT and EC exhibit comparable risk-adjusted late outcomes (table, figure) by i) unadjusted comparisons, ii) risk-adjusted comparisons and iii) propensity-matched comparisons. Conclusions: LT and EC in the modern era have equivalent early and late outcomes to 30 years including survival, re-operation, cardiopulmonary function, arrhythmia and Fontan failure.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 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".