CAVO-BIPULMONARY ANASTOMOSIS WITH INTRACA RDIAC REPAIR OF EBSTEINS-ANOMALY - VALUE IN HIGH-RISK PATIENTS

The surgical prognosis of Ebstein's anomaly depends on the quality of tricuspid valve repair and right ventricular function. In patients wit h right ventricular failure, a decrease in afterload was attained by a cavo-bipulmonary anastomosis associated with the intraventricular rep air. Fifty-nine cut of 111 patients operated for Ebstein's anomaly wer e considered to be at high risk and were selected for this study. The inclusion criteria were one or more of the following factors: massive tricuspid regurgitation, extensive atrialisation of the right ventricl e, poor right ventricular function, chronic atrial fibrillation. This population was divided into two groups with the same preoperative feat ures : Group 1 (45 operated patients : tricuspid valvuloplasty with lo ngitudinal plicature of the right ventricule; Group II (14 operated pa tients) : same intracardiac repair as Group I and associated cavo-bipu lmonary anastomosis. The operative mortality was 24 % (11/45) in Group I and 7 % (1/14) in Group II (p < 0.05). The 5 year actuarial was 68. 6 % in Group I and 61.8 % in Group II (NS). The reoperation rate was 1 1 % (5/45) in Group I and 0 % in Group II. In Group II, the persistenc e of significant tricuspid regurgitation was better tolerated and the frequence of reoperation was decreased with respect to Group I. The au thors conclude that high risk patients with Ebstein's anomaly have a l ower operative mortality and improved functional tolerance when there is persistent tricuspid regurgitation after cavo-bipulmonary anastomos is.