Abstract 13801: Cardiopulmonary Bypass is Protective Against Shunt Thrombosis in Patients Undergoing Placement of Modified Blalock-Taussig Shunt
Bibliographic record
Abstract
Introduction: Enhancements in surgical technique and cardiopulmonary bypass (CPB) technology have contributed to dramatically improved outcomes of staged palliation for single ventricle patients. However, in-hospital mortality after first stage palliation procedures remains high at 16%. Systemic to pulmonary artery shunt (SPS) thrombosis is a major contributor to morbidity in these patients with an incidence reported between 5 to 37%. Cardiopulmonary bypass is known to have hypocoagulable sequelae. Hypothesis: Hypocoagulable sequelae of CPB are protective against early thrombosis of systemic to pulmonary artery shunts. Methods: We performed a retrospective cohort study from January 2008 through December 2014 of all children undergoing single ventricle palliation with a SPS. Early shunt thrombosis was defined as clinical hypoxemia necessitating cardiac catheterization, with angiographic evidence of a thrombosis within the shunt during the same admission. Cohorts with and without early shunt thrombosis and those with and without CPB were compared using Wilcoxon sign rank sum test, Student’s t-test and Fisher’s exact test as appropriate. Unadjusted logistic regression was used to assess independent predictors for development of shunt thrombosis. Results: Within the study period a total of 75 neonates underwent placement of SPS (with CPB n = 25, without CPB n = 50) with an operative mortality of 11%( 8/75). In this cohort, 12% (9/75) patients developed an early shunt thrombosis during the index admission. All instances of shunt thrombosis were observed in cases performed without CPB (without CPB n = 9; with CPB n =0) (p = 0.03). Unadjusted logistic regression of CPB on early shunt thrombosis yielded an odds ratio of 0.14 (95% CI: 0.01-0.93, p = 0.04). Conclusions: Patient’s undergoing SPS placement without CPB have an increased incidence of shunt thrombosis as compared to those with CPB. Additional studies to understand the hypocoagulable sequelae of CPB are required and may help in preventing shunt thrombosis in patients undergoing SPS.
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 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".