Mid-term outcomes in adults with ebstein anomaly and cavopulmonary shunts.

Abstract

BACKGROUND:

In patients with Ebstein anomaly and poorly functioning right ventricles, a cavopulmonary shunt (CPS) can be created to reduce the preload on the right ventricle. The purpose of this study was to examine the early and mid-term outcomes in adults with Ebstein anomaly who have undergone tricuspid valve repair or replacement with or without a concomitant CPS.

METHODS:

We examined the outcomes of 40 consecutive patients seen at our center with Ebstein anomaly who had undergone tricuspid valve repair or replacement with (n = 23) or without (n = 17) concomitant CPS. Follow-up data were obtained by either chart review or contacting the referring cardiologist. Mid-term survival was examined using Kaplan-Meier curves.

RESULTS:

The mean age at surgery was similar in patients with and without CPS (42 +/- 12 versus 39 +/- 19 years; p = 0.63). There were 2 early postoperative deaths owing to refractory right-sided heart failure. Mid-term follow-up data were available in 95% of patients. The mean follow-up time was 6.7 +/- 4.8 years. Patients who received a CPS more commonly had preoperative heart failure or cyanosis (p = 0.04) and had worse preoperative functional status (p = 0.09). In both groups, arrhythmias were the most common late complication. There were 5 late deaths, 3 of which occurred in patients with CPS. Five-year survival with or without CPS was comparable (83% +/- 9% versus 86% +/- 10%; p = 0.85).

CONCLUSIONS:

Adolescent and adult patients with Ebstein anomaly undergoing tricuspid valve replacement or repair and concomitant CPS are at risk for early and mid-term complications. However, Ebstein surgery along with CPS appears to be a reasonable surgical strategy in patients not thought to be suitable for tricuspid valve surgery alone.

• Authors: Khalid S Al-Najashi, Olga H Balint, Erwin Oechslin, William G Williams, Candice K Silversides
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 88 Issue 1 Pg. 131-6 (Jul 2009) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 19559211 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Age Factors
• Cardiac Surgical Procedures (adverse effects, methods)
• Cohort Studies
• Ebstein Anomaly (diagnosis, mortality, surgery)
• Education, Medical, Continuing
• Female
• Follow-Up Studies
• Heart Bypass, Right (methods)
• Heart Valve Prosthesis Implantation (methods)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Probability
• Risk Assessment
• Statistics, Nonparametric
• Survival Analysis
• Time Factors
• Treatment Outcome
• Tricuspid Valve (surgery)
• Ventricular Dysfunction, Right (diagnosis, mortality, surgery)
• Young Adult