Abstract 4565: Optimal Timing Of Stage-2 Palliation For Hypoplastic Left Heart Syndrome
Bibliographic record
Abstract
Background Because optimal timing of stage-2 palliation of HLHS is contentious, we explored associations between length of time between stage-1 and stage-2 (“interstage interval”) and survival. Methods A multi-institutional cohort of neonates (N=703;1994 –2001) who underwent Norwood palliation for HLHS was studied. Survival models were constructed for each of stage-1 and stage-2 and their combined cumulative hazard was defined. Results A constant, persisting hazard for death was prominent ≈2 months after Norwood (“interstage death”). Risk factors for interstage death included: smaller weight at diagnosis, longer DHCA duration, smaller indexed tricuspid annulus, mitral stenosis, older age at Norwood, smaller distal arch dimension and sternal splinting (all P <.01, >50% bootstrap reliability). Following stage-2 palliation (N=404, median interval 5.8 months after Norwood), 32 died before subsequent Fontan completion. Risk factors for these deaths included: earlier stage-2 ( P <.0001, 60% reliability), younger age at Norwood and smaller RV dimensions at diagnosis. Performing stage-2 within 2 months of Norwood conferred exponential increased risk of death. Cumulative hazard exposure (figure ) was minimized with interstage interval ≈ 3 months. For low risk patients intervals >4 months were optimal. For high-risk children survival was optimized with ≈ 2 month interstage interval. Conclusions Optimal timing of stage-2 palliation is dependent on patients’ risk category. High-risk children may have improved survival by early progression to stage-2; no such benefits are seen for lower risk children. The interstage interval will not be safely reduced below 2 months.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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) | 0.001 | 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".