Multicenter Comparison of Long-Term Outcomes: Extracardiac Conduit Fontan vs Lateral Tunnel Fontan at 15-Year Follow-Up
Bibliographic record
Abstract
BACKGROUND: The extracardiac conduit (ECC) and lateral tunnel (LT) are the most prevalent strategies for the Fontan operation. We used a multicenter database to compare long-term results. METHODS: First-time LT or ECC Fontans performed after the year 2000 in the Fontan Outcome Registry using Cardiac magnetic resonance Examinations (FORCE) registry were included. Propensity score matching was used. Outcomes were assessed individually as well as in a composite outcome that included death, listing for transplantation, sustained atrial arrhythmias, emergent cardioversion, plastic bronchitis, protein-losing enteropathy, and catheter-based intervention on the Fontan pathway. Cox proportional hazards models were used to compare hazards of outcomes between ECC and LT patients. RESULTS: Among 3072 patients (690 LT and 1182 ECC) in the registry, 1290 patients (645 LT and 645 ECC) were identified after matching. In matched samples, the Fontan composite outcome (32.4% vs 19.8%), sustained atrial arrhythmias (15.0% vs 5.0%), emergent cardioversion, defibrillation, or arrhythmogenic cardiac arrest (2.6% vs 0.8%), and Fontan pathway catheter-based intervention (7.1% vs 3.6%) were significantly higher for LT patients (P < .05 for all). Kaplan-Meier analysis demonstrated the freedom from the composite Fontan outcome at 5, 10, and 15 years was 94.5%, 88.3%, and 79.8%, respectively, for ECC patients compared with 90.2%, 80.9%, and 68.3%, respectively, for LT patients (P < .0001). ECC patients had lower hazards for atrial arrhythmia (hazard ratio, 0.33; 95% CI, 0.20-0.54; P < .0001) and the composite Fontan outcome compared to LT patients (hazard ratio, 0.72; 95% CI, 0.54-0.96; P = .0257). CONCLUSIONS: The ECC has substantially lower hazards for atrial arrhythmias compared with the LT Fontan, whereas other independent measures of longitudinal morbidity are similar.
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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 | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".