Are We Getting Better?: Ongoing Challenges of Atrioventricular Valve Repair in Children With Single Ventricle Physiology
Bibliographic record
Abstract
Background This study aimed to assess impact of atrioventricular valve (AVV) regurgitation onset, timing of AVV repair (AVVr), ventricular morphology, and era effect on AVVr outcomes in a single ventricle population. Methods A retrospective review of 155 patients with single ventricle physiology who underwent AVVr between 1998 and 2022 was conducted. Transplant‐free survival, discharge alive, and AVV reoperation were assessed using the Kaplan–Meier survival method, stratified by the timing of AVVr (Group1 [G1], prebidirectional cavopulmonary shunt, N=33; G2, at or post‐shunt, N=93; G3, at or post‐Fontan, N=29). Cox proportional hazard models were used to assess the association of the timing of AVVr with death or transplant. Results Transplant‐free survival at 10 years was lowest in G1 (G1, 16% [95% CI, 4%–35%]; G2, 65% [95% CI, 53%–74%]; G3, 85% [95% CI, 65%–94%], P <0.001). In the multivariate analysis, AVVr prebidirectional cavopulmonary shunt was an independent risk factor for failure to be discharged alive ( P <0.001) but not for overall survival ( P =0.12). Meanwhile, the likelihood of discharge alive improved over the period in the entire cohort ( P <0.001), and right ventricle morphology ( P =0.02) and weight <5 kg ( P <0.01) at AVVr were significantly associated with death. In the multistate model, persistent or recurrent AVV regurgitation and ventricular dysfunction post‐sAVVr were significantly associated with death, with hazard ratios of 3.8 (95% CI, 2.0–7.3, P <0.001) and 32 (95% CI, 13–77, P <0.001), respectively. Conclusions Patients with single ventricles who required AVVr, particularly before bidirectional cavopulmonary shunt, have poorer transplant‐free survival with no meaningful improvement over the past 2 decades. Small weight and morphologic right ventricle were strongly associated with increased mortality. Alternative treatment strategies should be considered for this high‐risk subgroup.
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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 | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".