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Preoperative predictability of right ventricular failure following surgery for Ebstein's anomaly
Kariem Mrad Agua1,2, Melchior Burri1,2, Julie Cleuziou1,2
1Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
Insights
Preoperative right ventricular (RV) size, RV ejection fraction (EF), and age over 50 predict complications after tricuspid valve surgery in Ebstein's anomaly. Identifying these risk factors aids in managing surgical outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Postoperative right ventricular (RV) failure is a significant complication following tricuspid valve (TV) surgery in patients with Ebstein's anomaly.
- Predicting mortality and morbidity is crucial for optimizing patient management.
Purpose of the Study:
- To investigate the preoperative predictors of in-hospital mortality and intensive care unit (ICU) stay after TV surgery in Ebstein's anomaly.
- To assess the influence of age, RV size, and RV function on postoperative outcomes.
Main Methods:
- Retrospective analysis of 70 patients with Ebstein's anomaly who underwent TV surgery between 2005 and 2018.
- Inclusion criteria: preoperative cardiac magnetic resonance imaging (MRI) scans.
- Risk factors evaluated: RV end-diastolic volume index >200 ml/m², RV ejection fraction (EF) <40%, and age >50 years.
Main Results:
- Four in-hospital deaths (6%) occurred, primarily in patients with multiple risk factors.
- Patients with two or more risk factors had a significantly higher odds ratio for primary endpoints (18.5, P=0.001).
- Increased risk factors correlated with prolonged ventilation time, ICU stay, and hospital stay.
Conclusions:
- Preoperative RV end-diastolic volume index, RV-EF, and age are valuable indicators for identifying patients at increased risk.
- Earlier surgical intervention may lead to improved outcomes for patients with Ebstein's anomaly.
Objectives:
Postoperative right ventricular (RV) failure is a severe complication after tricuspid valve (TV) surgery in patients with Ebstein's anomaly. We investigated the preoperative predictability of postoperative mortality and morbidity by assessing the influence of age, RV size and RV function on in-hospital mortality and on the clinical course during the intensive care unit (ICU) stay.
Methods:
We retrospectively analysed 189 patients who had undergone TV surgery for Ebstein's anomaly at our centre. For this study, only patients with preoperative cardiac magnetic resonance imaging (MRI) scans, who were operated on from 2005 to May 2018, were included. Three potential risk factors were proposed: (i) RV end-diastolic volume index >200 ml/m2, (ii) RV ejection fraction (EF) <40% and (iii) age at operation >50 years. Primary end points were death or the need for extracorporeal membrane oxygenation. Secondary end points were postoperative inotropic therapy, ventilation time, renal failure and duration of ICU stay and hospital stay.
Results:
A total of 70 patients with preoperative cardiac MRI scans were included: 57 had undergone TV repair and 13 TV replacement. Thirty patients exhibited none of the defined risk factors, 24 patients exhibited 1 risk factor, 13 patients exhibited 2 risk factors and 3 patients exhibited 3 risk factors. There were 4 in-hospital deaths (6%): 3 of these patients had 3 risk factors, and 1 patient had 2 risk factors. In patients with 1 or more risk factors, the odds ratio for primary end point was 2.5 (P = 0.43) and in patients with 2 or more risk factors, the odds ratio was 18.5 (P = 0.001). Patients with at least 1 risk factor required prolonged inotropic drug administration and required a longer hospital stay (median 20 days vs 14 days, P = 0.029). Patients with at least 2 risk factors showed a significantly prolonged ventilation time (median 10 h vs 6 h, P = 0.001). Time in the ICU was longer in patients with 2 or more risk factors (median 9 days vs 4.5 days, P = 0.003).
Conclusions:
RV end-diastolic volume index >200 ml/m2, RV-EF <40% and age >50 years are helpful factors to identify patients with an increased perioperative risk. The results also suggest that earlier surgery may yield more favourable results in patients with Ebstein's anomaly.