Abstract 2345: Improving Outcomes in High Risk Tetralogy of Fallot Patients with Right Ventricular Outflow Tract Stenting
Bibliographic record
Abstract
Background: Symptomatic infants with tetralogy of Fallot (TOF) and hypoplastic pulmonary arteries have higher risk for primary surgical repair. In our institution, palliation with only balloon angioplasty of the right ventricular outflow tract (RVOT) and pulmonary valve has been inconsistent and short-lived. Objectives: To evaluate our experience with percutaneous transcatheter stent implantation in the RVOT in symptomatic TOF patients. Methods: Retrospective review at the Hospital for Sick Children in Toronto, Canada from 1994 until 2007 (Group I). Outcomes were compared with our institutional primary surgical repair patients (n = 44, Group II). Results: Ten stent procedures performed in 8 patients. Median age at first intervention was 22 days (range, 3 to 119). Median weight was 3.2 kg (2.1 to 4.1). Indication for intervention was desaturation below 70% or prostaglandin dependency. Two patients required a second stenting procedure for progressive RVOT obstruction at 67 and 122 days of life. There were no major procedural complications. Discharge post stent implantation occurred at a median of 4 days (1 to 12). Median number of days from initial stent implantation to next intervention was 108 days (44 to 315). Left and right pulmonary artery diameter Z-score increased from a median of −4.3 and −3.5 to −0.9 and −0.8 respectively before surgery. For Group I and II respectively, surgical data were: repair at median age of 142 days (44 to 413) compared to 24 days (5 to 112) (P<0.001), median weight at surgery 5.3 kg (4.0 to 9.3) and 3.2 kg (2.0 to 5.9) (P<0.001), median bypass time 99 minutes (66 to 127) and 118 minutes (54 to 264) (P=0.03), median ventilator days 4 (0 to 11) and 6 (1 to 97) (P=0.08), median days in intensive care unit was 5 (2 to 12) versus 8 (2 to 161) (P=0.09), time to discharge was 16 days (5 to 29) and 16 days (6 to 230) (P=0.35). There was no mortality in Group I and 2 late hospital deaths in Group II. Conclusion: Stenting of the RVOT in TOF patients safely and effectively palliated symptomatic patients. This promoted development of more favourable pre-operative conditions and translated to excellent surgical outcomes. This approach represents a powerful adjunct to the management armamentarium for this challenging patient population.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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".