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

Khalid S Al-Najashi1, Olga H Balint, Erwin Oechslin

  • 1Toronto Congenital Cardiac Centre for Adults, University Health Network, University of Toronto, Toronto, Canada.

The Annals of Thoracic Surgery
|June 30, 2009
PubMed

Insights

For adults with Ebstein anomaly, tricuspid valve surgery with a cavopulmonary shunt (CPS) carries risks but offers a viable option for those unsuitable for valve surgery alone. Outcomes are comparable to those without a CPS.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Congenital Heart Disease

Background:

  • Ebstein anomaly often involves a poorly functioning right ventricle, necessitating interventions to reduce right ventricular preload.
  • A cavopulmonary shunt (CPS) is a surgical option to alleviate right ventricular strain in these patients.

Purpose of the Study:

  • To evaluate the early and mid-term outcomes of adult patients with Ebstein anomaly who underwent tricuspid valve repair or replacement.
  • To compare outcomes between patients who received a concomitant cavopulmonary shunt (CPS) and those who did not.

Main Methods:

  • A retrospective review of 40 consecutive adult patients with Ebstein anomaly undergoing tricuspid valve surgery.
  • Patients were divided into two groups: those with (n=23) and without (n=17) a concomitant CPS.
  • Mid-term survival was assessed using Kaplan-Meier analysis, with follow-up via chart review or cardiologist contact.

Main Results:

  • Patients receiving a CPS had a higher incidence of preoperative heart failure or cyanosis and worse functional status.
  • Arrhythmias were the most common late complication in both groups.
  • Five-year survival rates were similar between the CPS and no-CPS groups (83% vs. 86%, p=0.85), despite 3 late deaths in the CPS group.

Conclusions:

  • Tricuspid valve surgery with a concomitant CPS in adult Ebstein anomaly patients carries risks of early and mid-term complications.
  • This combined surgical approach appears to be a reasonable strategy for patients not candidates for tricuspid valve surgery alone.
Abstract

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