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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Operative treatment of Ebstein's anomaly
G K Danielson1, D J Driscoll, D D Mair
1Department of Surgery, Mayo Medical School, Mayo Foundation, Rochester, Minn. 55905.
The Journal of Thoracic and Cardiovascular Surgery
|November 11, 1992
Summary
Surgical repair of Ebstein's anomaly significantly improves patient outcomes, with most patients achieving excellent functional status and reduced arrhythmias post-operation. This includes successful management of associated Wolff-Parkinson-White syndrome and improved exercise capacity.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pediatric Cardiology
Background:
- Ebstein's anomaly is a rare congenital heart defect affecting the tricuspid valve.
- Surgical intervention is often necessary for symptomatic patients.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical repair for Ebstein's anomaly.
- To assess the efficacy of surgical techniques, including tricuspid valve reconstruction and prosthetic valve insertion.
- To analyze the impact on functional status, arrhythmias, and exercise capacity.
Main Methods:
- Retrospective review of 189 patients undergoing surgical repair between April 1972 and February 1991.
- Analysis of surgical techniques: tricuspid valve reconstruction, prosthetic valve replacement, modified Fontan procedure.
- Assessment of hospital mortality, late mortality, functional class (New York Heart Association), arrhythmia recurrence, and exercise performance (maximal oxygen consumption).
- Inclusion of patients with accessory conduction pathways (Wolff-Parkinson-White syndrome) undergoing pathway ablation.
Main Results:
- Hospital mortality was 6.3% (12 deaths).
- Tricuspid valve reconstruction was performed in 58.2%, prosthetic valve insertion in 36.5%.
- 92.9% of patients followed >1 year were in NYHA class I or II.
- Significant improvement in maximal oxygen consumption (47% to 72% predicted).
- Successful ablation of accessory pathways in all 28 patients with Wolff-Parkinson-White syndrome.
- Low reoperation rate (3.6%) after valve reconstruction.
- Reduced atrial arrhythmias and improved heart size post-surgery.
- 12 successful pregnancies reported in 9 patients.
Conclusions:
- Surgical repair of Ebstein's anomaly offers favorable long-term outcomes.
- The procedures lead to significant functional improvement, enhanced exercise capacity, and reduced arrhythmias.
- Associated conduction abnormalities can be effectively managed concurrently.
- Surgical repair is a viable option for improving quality of life and enabling successful pregnancies.
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