Venous Access Alone Versus Arterial and Venous Access for Patent Arterial Duct Device Closure in Childhood
Bibliographic record
Abstract
BACKGROUND: The persistently patent arterial duct accounts for ~12% of congenital heart lesions. Untreated, it may result in heart failure due to volume loading of the left heart, pulmonary hypertension, and infective endarteritis. Percutaneous device closure is the preferred occlusion technique, with the standard approach consisting of femoral artery access for angiography and venous access for device delivery (AA). A venous-only strategy (VA) for angiography and device delivery can also be employed. HYPOTHESIS: We hypothesized that VA would eliminate the need of arterial entry, reduce procedure times and radiation exposure compared to standard AA. METHODS: This is a retrospective cohort study of isolated arterial duct device closure at the Hospital for Sick Children from January 1, 2011, through December 31, 2022. Exclusions included premature neonates, children requiring arterial access for monitoring, and those who underwent other procedures. Children were categorized based upon initial access determined by operator preference into VA or AA groups. RESULTS: The cohort consisted of 405 children, 252 (62.2%) females, with a median age of 3.1 years (IQR 1.30-5.84), median weight 13.2 kg (IQR 9.0-19.5), and duct diameter of 2.9 mm (IQR 2.0-3.5) with no significant differences between the groups. Type A ducts were more frequent in the AA group (90% vs. 72%). The VA group included 106 children, of which 14 (13.2%) required AA conversion for angiography due to complex ductal anatomy, to assess device position before release, but remained in the VA group for analysis. Children in the VA group had lower dose area product (DAP) (p < 0.001), fluoroscopy times (p = 0.025), contrast volumes (p < 0.001), procedure times (p < 0.001), and recovery room lengths of stay (LOS) (p < 0.001). Six (5.7%) VA children required admission compared to 44 (14.7%) in the AA group (p = 0.015) with no difference in reintervention rates. Weighted regression analysis showed VA was associated with reduced admission likelihood (OR: 0.354 [0.131, 0.822], p = 0.024), DAP (coef -126.4 [-213.3, -39.4], p = 0.004), and contrast volumes (coef 31.2 [-36.6, -25.9], p < 0.001) compared to AA. CONCLUSIONS: Venous-only access was associated with lower DAP and recovery room LOS. Additionally, VA was associated with a lower likelihood of admission with no difference in reintervention rates, suggesting procedural safety. These findings support the consideration of VA as a preferred approach for appropriate cases.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".