Abstract 16639: Outcome of Cardiac Surgery in Ebstein Patients Over Age 50 Years: Excellent Survival and Improvement in Cardiac Symptoms
Background: Data on management and surgical outcome of patients (pt) with Ebstein anomaly (EA) over age 50 years are limited.
Methods: All 89 pt with EA (57 females, 64%) who underwent cardiac surgery at our center between 1975 and January 2010 at >50 years of age were included in this retrospective study. All operative reports and clinical charts were analyzed.
Results: Age at EA diagnosis in these pt was 43±19 years, mean age at surgery 59 ± 8 years (range: 50-79). Preoperative symptoms included palpitations (69 pt), edema (30 pt), previous stroke/transient ischemia attack (21 pt) and/or a history of heart failure (13 pt). Preoperatively, patients showed severe functional limitation; 79 pt (89%) had NYHA class III or IV dyspnea. Atrial fibrillation was found in 10 pt; a paced rhythm was present in 3 pt, one patient had a cardioverter defibrillator. Twelve patients had previous cardiac surgery. Tricuspid valve replacement was performed in 65 pt, and repair in 22 pt. Simultaneous cardiac procedures included closure of an interatrial communication in 54 pt, coronary artery bypass in 7 pt, ligation of accessory conduction tissue/MAZE procedure in 22 pt, 4 pt with mitral valve repair/replacement and other operations in 13 pt. There were 3 perioperative deaths (perioperative mortality 3 %). Long-term follow-up was available in 81 of 86 survivors at 83±68 months. Improvement in functional class was reported in 67 of 79 pt (85%). Postoperatively, only 8 pt remained in NYHA class III/IV. Fourteen pt died during follow-up; lack of postoperative improvement was seen in 5 of these pt and was a predictor of late mortality (p=0.02).
Conclusion: Cardiac surgery in EA pt over age 50 years is often complex and involves other cardiac procedures. However, if it is performed at an experienced center for congenital heart disease, perioperative mortality is low (3 %) and long-term outcome shows impressive and sustained improvement in functional class.
- © 2010 by American Heart Association, Inc.