Multicenter outcomes for ventricular assist device support for failed stage II palliation
Bibliographic record
Abstract
Ventricular assist device (VAD) use for failed stage II palliation (S2P) is increasing with limited data on outcomes. To address this knowledge gap, we conducted a multi-center retrospective review of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry. We leveraged the registry to analyze data on the clinical course, complications, and survival of systemic VADs (SVAD) after S2P. We identified 34 patients from 15 centers between 2012-2022 implanted at median age of 1.8 years [IQR 0.9-2.7]; 85% had systemic right ventricles and all patients underwent at least one sternotomy. Pre-implant, all but one patient had an INTERMACS profile of 1-2, with 62% being on ≥2 inotropes, 50% TPN dependent, 38% mechanically ventilated and 20% on extracorporeal membrane oxygenation in the week preceding implant. Device strategy was variable with 70% being on continuous flow devices and the remaining on pulsatile support. Multiple device strategies were utilized in 32% of patients. Median time on VAD support was 74 days [IQR 30-186]. Adverse events were frequent and included infection (47%), strokes (29%), bleeding (26%), dialysis (15%), respiratory failure (9%). Bleeding complications (p=0.0004), respiratory failure (p=0.04) and multiple inotropes pre-implant (p=0.046) were associated with in-hospital mortality. Overall survival to transplant/recovery was seen in 76% and to 1-year post-explant in 56%. Encouraging clinical outcomes are seen with SVAD use for failed S2P even in the face of frequent adverse events and wide center variability in device strategy. Ongoing multi-institutional collaboration is required to better understand optimal SVAD support strategies.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".