Abstract 9363: Intervention for Re-coarctation in the Single Ventricle Reconstruction Trial: Incidence, Risk and Outcomes
Bibliographic record
Abstract
Objectives: To determine the incidence of re-coarctation (re-CoA), risk factors and outcomes in patients with single right ventricle lesions after Norwood. Methods: The cohort included subjects randomized to right ventricle-pulmonary artery shunt (RVPAS) or modified Blalock Taussig shunt (MBTS) in the Single Ventricle Reconstruction (SVR) Trial. Re-CoA was defined by intervention, either catheter-based or surgical. Univariate analysis and multivariable Cox proportional hazard models were performed adjusting for center. Results: Of the 549 SVR subjects, 97 (18%) underwent 137 interventions (92 balloon aortoplasty; 45 surgical) for re-CoA. Intervention typically occurred at pre-stage II catheterization (n=71, 52%) or at stage II surgery (n=44, 32%). Median age and catheterization gradient at first intervention were 4.9 months (range: 1.1-10.5) and 17 mm Hg (range: 0-60) respectively. Center intervention rates varied from 0-50%. In multivariable analysis, re-CoA was not associated with assigned shunt type, but was associated with actual shunt type received (HR 2.0 for RVPAS vs. MBTS, p=0.02), and Norwood discharge peak echo-Doppler arch gradient (HR 1.07 per 1 mm Hg, p<0.01). No other demographic, anatomic or surgical variables predicted intervention. Subjects with re-CoA demonstrated comorbidities at pre-stage II evaluation including higher pulmonary arterial pressures (15.4 ± 3.0 vs. 14.5 ± 3.5 mm Hg; p=0.05), higher pulmonary vascular resistance (2.6 ± 1.6 vs. 2.0 ± 1.0 WU x m²; p=0.04) and increased echocardiographic volumes (end-diastolic volume: 28.0 ± 7.4 vs. 24.9 ± 8.2 ml; p=0.01). There was no difference in 12-month post-randomization transplant-free survival for those with and without re-CoA (83% vs. 86%; p=0.5). Conclusions: Intervention for re-CoA was common and varied by center. The association with receipt of an RVPAS may be due to intra-operative cross-over because of arch anatomy that prohibited use of a MBTS. Those undergoing intervention demonstrated ventricular dilation and worsened hemodynamics prior to stage II surgery. Although intervention was not associated with increased 1-year transplant/mortality, further evaluation is warranted to evaluate effects of morbidity of re-CoA.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".