Tricuspid valve repair for Ebstein's anomaly in young children

A 30-year experience

Umar S. Boston, Joseph A. Dearani, Patrick W. O'Leary, David J. Driscoll, Gordon K. Danielson

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background. The purpose of this study was to examine early and late outcome of tricuspid valve repair for Ebstein's anomaly in young children. Methods. Between October 1974 and November 2003, 52 children (25 boys) underwent tricuspid valve repair and annuloplasty for Ebstein's anomaly. Mean age was 7.1 ± 3.9 years (range, 5 months to 12 years). Concomitant procedures included atrial septal defect closure (n = 46), division of accessory conduction pathways (n = 4), ventricular septal defect closure (n = 3), and other (n = 7). Results. Early mortality was 5.8% (3 of 52 patients; no mortality since 1984, n = 31). Risk factors were age younger than 2.5 years (p = 0.03) and weight less than 10.7 kg (p = 0.03). Morbidity included transient atrial (n = 11) and ventricular arrhythmias (n = 5), and early reoperation in 3 patients. There was no need for a permanent pacemaker. Mean follow-up was 12.2 ± 7.4 years (maximum, 24.3 years). Actuarial survival at 5, 10, and 15 years was 92.3% ± 3.7%, 89.9% ± 4.3%, and 89.9% ± 4.3%, respectively. Freedom from all reoperations at 5, 10, and 15 years was 91.0% ± 4.3%, 76.9% ± 6.8%, and 61.4% ± 8.8%, respectively. Moderate (grade II) or more tricuspid regurgitation on dismissal echocardiogram was the only risk factor for reoperation (p = 0.04). Tricuspid stenosis did not occur in any patient. At late follow-up, 89% of patients were in New York Heart Association class I or II. Conclusions. Ebstein's anomaly in young children can now be repaired with low mortality and good tricuspid valve durability. Tricuspid regurgitation at the completion of operation should be mild or less to minimize need for reoperation. Tricuspid valve repair and annuloplasty did not result in stenosis despite somatic growth. Most patients enjoy an excellent quality of life.

Original languageEnglish (US)
Pages (from-to)690-696
Number of pages7
JournalAnnals of Thoracic Surgery
Volume81
Issue number2
DOIs
StatePublished - Feb 2006

Fingerprint

Ebstein Anomaly
Tricuspid Valve
Reoperation
Tricuspid Valve Insufficiency
Mortality
Pathologic Constriction
Atrial Heart Septal Defects
Ventricular Heart Septal Defects
Cardiac Arrhythmias
Quality of Life
Morbidity
Weights and Measures
Survival
Growth

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Boston, U. S., Dearani, J. A., O'Leary, P. W., Driscoll, D. J., & Danielson, G. K. (2006). Tricuspid valve repair for Ebstein's anomaly in young children: A 30-year experience. Annals of Thoracic Surgery, 81(2), 690-696. https://doi.org/10.1016/j.athoracsur.2005.08.011

Tricuspid valve repair for Ebstein's anomaly in young children : A 30-year experience. / Boston, Umar S.; Dearani, Joseph A.; O'Leary, Patrick W.; Driscoll, David J.; Danielson, Gordon K.

In: Annals of Thoracic Surgery, Vol. 81, No. 2, 02.2006, p. 690-696.

Research output: Contribution to journalArticle

Boston, US, Dearani, JA, O'Leary, PW, Driscoll, DJ & Danielson, GK 2006, 'Tricuspid valve repair for Ebstein's anomaly in young children: A 30-year experience', Annals of Thoracic Surgery, vol. 81, no. 2, pp. 690-696. https://doi.org/10.1016/j.athoracsur.2005.08.011
Boston, Umar S. ; Dearani, Joseph A. ; O'Leary, Patrick W. ; Driscoll, David J. ; Danielson, Gordon K. / Tricuspid valve repair for Ebstein's anomaly in young children : A 30-year experience. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 2. pp. 690-696.
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title = "Tricuspid valve repair for Ebstein's anomaly in young children: A 30-year experience",
abstract = "Background. The purpose of this study was to examine early and late outcome of tricuspid valve repair for Ebstein's anomaly in young children. Methods. Between October 1974 and November 2003, 52 children (25 boys) underwent tricuspid valve repair and annuloplasty for Ebstein's anomaly. Mean age was 7.1 ± 3.9 years (range, 5 months to 12 years). Concomitant procedures included atrial septal defect closure (n = 46), division of accessory conduction pathways (n = 4), ventricular septal defect closure (n = 3), and other (n = 7). Results. Early mortality was 5.8{\%} (3 of 52 patients; no mortality since 1984, n = 31). Risk factors were age younger than 2.5 years (p = 0.03) and weight less than 10.7 kg (p = 0.03). Morbidity included transient atrial (n = 11) and ventricular arrhythmias (n = 5), and early reoperation in 3 patients. There was no need for a permanent pacemaker. Mean follow-up was 12.2 ± 7.4 years (maximum, 24.3 years). Actuarial survival at 5, 10, and 15 years was 92.3{\%} ± 3.7{\%}, 89.9{\%} ± 4.3{\%}, and 89.9{\%} ± 4.3{\%}, respectively. Freedom from all reoperations at 5, 10, and 15 years was 91.0{\%} ± 4.3{\%}, 76.9{\%} ± 6.8{\%}, and 61.4{\%} ± 8.8{\%}, respectively. Moderate (grade II) or more tricuspid regurgitation on dismissal echocardiogram was the only risk factor for reoperation (p = 0.04). Tricuspid stenosis did not occur in any patient. At late follow-up, 89{\%} of patients were in New York Heart Association class I or II. Conclusions. Ebstein's anomaly in young children can now be repaired with low mortality and good tricuspid valve durability. Tricuspid regurgitation at the completion of operation should be mild or less to minimize need for reoperation. Tricuspid valve repair and annuloplasty did not result in stenosis despite somatic growth. Most patients enjoy an excellent quality of life.",
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T2 - A 30-year experience

AU - Boston, Umar S.

AU - Dearani, Joseph A.

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AU - Driscoll, David J.

AU - Danielson, Gordon K.

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N2 - Background. The purpose of this study was to examine early and late outcome of tricuspid valve repair for Ebstein's anomaly in young children. Methods. Between October 1974 and November 2003, 52 children (25 boys) underwent tricuspid valve repair and annuloplasty for Ebstein's anomaly. Mean age was 7.1 ± 3.9 years (range, 5 months to 12 years). Concomitant procedures included atrial septal defect closure (n = 46), division of accessory conduction pathways (n = 4), ventricular septal defect closure (n = 3), and other (n = 7). Results. Early mortality was 5.8% (3 of 52 patients; no mortality since 1984, n = 31). Risk factors were age younger than 2.5 years (p = 0.03) and weight less than 10.7 kg (p = 0.03). Morbidity included transient atrial (n = 11) and ventricular arrhythmias (n = 5), and early reoperation in 3 patients. There was no need for a permanent pacemaker. Mean follow-up was 12.2 ± 7.4 years (maximum, 24.3 years). Actuarial survival at 5, 10, and 15 years was 92.3% ± 3.7%, 89.9% ± 4.3%, and 89.9% ± 4.3%, respectively. Freedom from all reoperations at 5, 10, and 15 years was 91.0% ± 4.3%, 76.9% ± 6.8%, and 61.4% ± 8.8%, respectively. Moderate (grade II) or more tricuspid regurgitation on dismissal echocardiogram was the only risk factor for reoperation (p = 0.04). Tricuspid stenosis did not occur in any patient. At late follow-up, 89% of patients were in New York Heart Association class I or II. Conclusions. Ebstein's anomaly in young children can now be repaired with low mortality and good tricuspid valve durability. Tricuspid regurgitation at the completion of operation should be mild or less to minimize need for reoperation. Tricuspid valve repair and annuloplasty did not result in stenosis despite somatic growth. Most patients enjoy an excellent quality of life.

AB - Background. The purpose of this study was to examine early and late outcome of tricuspid valve repair for Ebstein's anomaly in young children. Methods. Between October 1974 and November 2003, 52 children (25 boys) underwent tricuspid valve repair and annuloplasty for Ebstein's anomaly. Mean age was 7.1 ± 3.9 years (range, 5 months to 12 years). Concomitant procedures included atrial septal defect closure (n = 46), division of accessory conduction pathways (n = 4), ventricular septal defect closure (n = 3), and other (n = 7). Results. Early mortality was 5.8% (3 of 52 patients; no mortality since 1984, n = 31). Risk factors were age younger than 2.5 years (p = 0.03) and weight less than 10.7 kg (p = 0.03). Morbidity included transient atrial (n = 11) and ventricular arrhythmias (n = 5), and early reoperation in 3 patients. There was no need for a permanent pacemaker. Mean follow-up was 12.2 ± 7.4 years (maximum, 24.3 years). Actuarial survival at 5, 10, and 15 years was 92.3% ± 3.7%, 89.9% ± 4.3%, and 89.9% ± 4.3%, respectively. Freedom from all reoperations at 5, 10, and 15 years was 91.0% ± 4.3%, 76.9% ± 6.8%, and 61.4% ± 8.8%, respectively. Moderate (grade II) or more tricuspid regurgitation on dismissal echocardiogram was the only risk factor for reoperation (p = 0.04). Tricuspid stenosis did not occur in any patient. At late follow-up, 89% of patients were in New York Heart Association class I or II. Conclusions. Ebstein's anomaly in young children can now be repaired with low mortality and good tricuspid valve durability. Tricuspid regurgitation at the completion of operation should be mild or less to minimize need for reoperation. Tricuspid valve repair and annuloplasty did not result in stenosis despite somatic growth. Most patients enjoy an excellent quality of life.

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