Bi-directional cavopulmonary shunt associated with ventriculo and valvuloplasty in Ebstein's anomaly: benefits in high risk patients

European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
Sylvain M ChauvaudA Carpentier

Abstract

The prognosis for surgical repair of Ebstein's anomaly depends on the tricuspid valve repair and on the right ventricular function. In order to decrease the preload of the compromised right ventricle, a bi-directional cavopulmonary shunt was added to the intracardiac repair. Among 113 patients operated on for Ebstein' s anomaly at our institution from 1980-1997, a cohort of 60 patients was selected for high risk for postoperative complications. Patients presented with one or more several criteria: massive tricuspid valve dysfunction, extended atrialized right ventricle, poor right ventricular contractility, or long standing atrial fibrillation. After prior informed consent, this cohort was divided into two groups. Both groups had similar preoperative clinical patterns: Group I (45 patients), surgical technique included longitudinal right ventricular plication and tricuspid valve valvuloplasty; Group II (15 patients), where the surgical technique was similar to Group I except a bi-directional cavopulmonary shunt was added at the end of the procedure. Operative mortality was 24% (11/45) in Group I and 0% (0/15) in Group II (P < 0.05). The survival at 5 years was 66.1 +/- 14% in Group I and 80 +/- 16% in Group II (not significant)...Continue Reading

Citations

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