Abstract 17750: Impact of Ventricular Assist Device Use on Pediatric Heart Transplant Outcomes in a Linked Cohort of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) and Pediatric Heart Transplant Society (PHTS) Databases
Bibliographic record
Abstract
Purpose: Pediatric ventricular assist devices (VAD) improve waitlist mortality. We aimed to compare outcomes after heart transplant (HT) based on pre-HT support in patients (pt) <18 years (yr) at listing. Methods: Prospectively collected VAD and post-HT data were linked between ACTION and PHTS databases, respectively (4/1/2018-6/30/2022). Support groups were defined as medical (MG) and VAD (VG), device groups as paracorporeal pulsatile (PP), paracorporeal continuous (PC), and intracorporeal continuous (IC), and device types as LVAD, BiVAD, RVAD, and systemic VAD (SVAD). Standard descriptive statistical methods were used. The Kaplan Meier Method and log rank test analyzed for univariable graft loss post-HT. Results: The 1360 pt included VG=405 and MG=955. At HT, VG pt were younger (6.7 ± 6.2 vs 7.7 ± 6.4 yr; p=0.008) and waited less time for HT 0.35 +/- 0.9 vs 0.5 +/- 0.82 yr (p=0.0036). More VG pt required mechanical ventilation (15.3% vs 11.0% (p=0.03) and intensive care (67% vs 51% p<0.0001). Proportions of congenital heart disease (CHD) and cardiomyopathy (CM) were different between groups (MG: 64.8% CHD and 32.6% CM vs VG: 35.1%CHD and 65.2% CM; p<0.0001). VG device group and type were PP n=184 (LVAD 62.0%, SVAD 22.3%, BiVAD 15.2%), IC n=154 (LVAD 77.3%, SVAD 12.3%, BiVAD 10.4%), PC n=50 (LVAD 26.0%, SVAD 38%, BiVAD 12%), and other n= 17 (41.2% LVAD, 47.0% unknown, 11.8% BiVAD). Overall, graft survival was similar between MG vs VG (p=0.17). There were significant differences in graft survival when stratified by device group ( Figure 1A, IC 95.5%, PP 78.8%, and PC 65.9% p<0.0001), support group and diagnosis ( Figure 1B MG-CM 95.7%, VG-CM 88.0%, MG-CHD 86.5%, and VG-CHD 82.7% at 3 yr, p=<0.0001), and by device type (LVAD 90.3% vs SVAD 80.0, and BiVAD 70.7% at 3yr; p=0.014). Conclusion: Graft survival varies by pre-HT dx and device type and group. CHD, PC, and BiVAD pt may be at higher risk of graft loss. These may be risk factors to consider for risk stratification in post-HT management.
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 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".