Abstract 10383: Patent Ductus Arteriosus Stent versus Blalock-Thomas-Taussig Shunt for Initial Palliation of Cyanotic Congenital Heart Disease with Ductal Dependent Pulmonary Blood Flow: Results of a Meta-Analysis
Bibliographic record
Abstract
Introduction: In patients with cyanotic congenital heart disease (CHD) and ductal-dependent pulmonary blood flow (DDPBF), initial palliation may include patent ductus arteriosus (PDA) stent or Blalock-Thomas-Taussig shunt (BTTS). This meta-analysis aimed to compare outcomes after PDA stent and BTTS. Methods: A comprehensive search of PubMed and Embase databases was performed. Newcastle-Ottawa tool assessed risk of bias in observational studies. Odds ratios and hazard ratios were pooled. Adjusted hazard ratios controlled for covariates and assessed time to event in survival analysis. Meta-analysis was performed using DerSimonian-Laird random-effects models. Results: Six retrospective observational studies were included, all low risk of bias. Of 757 patients, 243 (32.1%) had PDA stent and 514 (67.9%) had BTTS. There was no significant difference in mortality between PDA stent (HR 0.71; 95% CI: 0.26-1.93, p=0.50; I 2 =54%) and BTTS. PDA stent was associated with lower risk of complications (OR 0.45; 95% CI: 0.25-0.81, p=0.008; I 2 =0%) and post-procedural mechanical circulatory support (OR 0.27; 95% CI: 0.09-0.79, p=0.02; I 2 =0%). PDA stent was associated with shorter intensive care unit (-4.03 days; 95% CI: -5.99 to -2.07, p<0.001; I 2 =66%) length of stay (LOS), hospital LOS (-5.54 days; 95% CI: -9.20 to -1.88, p=0.003; I 2 =78%) and duration of mechanical ventilation (-3.41 days; 95% CI -5.29 to -1.52, p<0.001; I 2 =88%). There were no differences in pulmonary artery growth or hazard of unplanned reinterventions to treat cyanosis between groups. Conclusions: In this large meta-analysis of cyanotic CHD and DDPBF, initial palliation with PDA stent or BTTS demonstrated similar risks of mortality and unplanned reintervention to treat cyanosis. PDA stent was associated with fewer complications and shorter hospital LOS. Given limitations inherent to observational study, this analysis supports the development of a randomized clinical trial in this population.
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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 | 0.009 | 0.016 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.046 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".