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J Thorac Cardiovasc Surg 2008;135:1120-1136
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

The outcomes of operations for 539 patients with Ebstein anomaly

Morgan L. Brown, MDa, Joseph A. Dearani, MDa,*, Gordon K. Danielson, MDa, Frank Cetta, MDb, Heidi M. Connolly, MDc, Carole A. Warnes, MDc, Zhuo Li, MSd, David O. Hodge, MSd, David J. Driscoll, MDb Mayo Clinic Congenital Heart Center

a Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minn
b Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minn
c Division of Cardiovascular Medicine, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minn
d Division of Biostatistics, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minn

Received for publication July 31, 2007; revisions received February 28, 2008; accepted for publication February 28, 2008.

* Address for reprints: Joseph A. Dearani, MD, Mayo Clinic, 200 1st St SW, Rochester MN 55905. (Email: jdearani{at}mayo.edu).

Objective: Our objective was to review the long-term outcomes of patients with Ebstein anomaly who underwent cardiac surgery at our institution.

Methods: Patient records were reviewed, and all patients were mailed a medical questionnaire or contacted by means of telephone. Patients who had pulmonary atresia with an intact ventricular septum, complex conotruncal abnormalities, and atrioventricular discordance with ventriculoarterial discordance were excluded.

Results: From April 1, 1972, to January 1, 2006, 539 patients with Ebstein anomaly had 604 cardiac operations. The mean age at the time of the initial operation at our institution was 24 years (range, 8 days–79 years). Three hundred seventeen of the patients were female. One hundred forty-three (26.5%) patients had a prior invasive cardiac procedure before coming to Mayo Clinic. At the time of the first operation at Mayo Clinic, 182 patients had tricuspid valve repair, and 337 had tricuspid valve replacement. The 30-day mortality was 5.9% for the entire cohort (2.7% after 2001). Late survival was 84.7% at 10 years and 71.2% at 20 years. In a multivariate analysis of overall mortality for the patients' first operation at Mayo Clinic, increased hematocrit values, pulmonary valve stenosis, tricuspid valve replacement, absence of ablation of an accessory pathway, miscellaneous arrhythmia procedure, branch pulmonary artery enlargement, need for mechanical support postoperatively, emergency chest opening in the intensive care unit, and absence of sinus rhythm at dismissal were all predictive of mortality. When only preoperative characteristics were included, increased hematocrit values, mitral valve regurgitation requiring surgical intervention, prior cardiac procedure, and moderate-to-severe to severe reduction in right ventricular systolic function were associated with mortality. Preoperative sinus rhythm and an accessory pathway were associated with survival. Patients rated their health as excellent or good (New York Heart Association class I or II) in 83% of surveys returned.

Conclusion: Ebstein anomaly can be surgically treated with low perioperative mortality. Both tricuspid valve repair and tricuspid valve replacement are associated with good long-term survival. Risk factors for poorer outcome included right, and/or left ventricular systolic dysfunction; increased hemoglobin/hematocrit values; male sex; right ventricular outflow tract obstruction; or hypoplastic pulmonary arteries.

Abbreviations and Acronyms ASD = atrial septal defect; ICU = intensive care unit; LV = left ventricular; MV = mitral valve; PFO = patent foramen ovale; RV = right ventricular; RVOT = right ventricular outflow tract; TR = tricuspid regurgitation; TV = tricuspid valve; TVrpl = tricuspid valve replacement; TVrpr = tricuspid valve repair


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J. Thorac. Cardiovasc. Surg. 2008 135: 1134-1136. [Extract] [Full Text] [PDF]





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