Study On The Early And Mid-term Clinical Effects Of Surgical Treatment Of Ebstein Anomaly In Adults

Objective:The aim of this study is to provide patients with more optimized surgical treatment strategies in the future by analyzing the early and mid-term clinical effects of surgical treatment of adult patients with Ebstein anomaly in the Department of Cardiovascular Surgery,Yan’an Hospital,Kunming Medical University.Methods:Sixty-four patients with Ebstein’s anomaly who underwent surgery in the Department of Cardiovascular Surgery of our hospital from April 2013 to October 2020 were followed up.The clinical data of 64 cases of Ebstein’s anomaly were collected and divided into tricuspid valvuloplasty(TVP)group and tricuspid valve replacement(TVR)group according to different surgical methods.We collected perioperative,intraoperative,and postoperative relevant data of the two groups of patients.We followed up patients’ clinical symptoms,echocardiography results,complications,and cardiac function(New York Heart Association,NYHA)by outpatient clinics,WeChat,and telephone after they discharged from the hospital at 3 months,6 months,1 year,2 years,and 3 years respectively.The survival rate,mortality,reoperation rate,cardiac function and incidence rate of complications were compared between the two groups.Early and mid-term outcomes of surgical treatment of adult patients with Ebstein’s anomaly are reported.Results:Of the 64 adult patients with Ebstein’s anomaly who underwent surgical treatment,there were 30 males(46.9%)and 34 females(53.1%).The average surgical age is(37.06±10.845)years.Among them,41 cases underwent tricuspid valvuloplasty and 23 underwent tricuspid valve replacement.There was no operative death in the whole group.Preoperative echocardiography showed the degree of tricuspid regurgitation in 64 patients,including 15 cases of moderate,19 cases of moderate to severe,and 30 cases of severe.In the TVP group,there were 9 cases of moderate,12 cases of moderate to severe,and 20 cases of severe tricuspid regurgitation.In the TVR group,there were 6 cases of moderate,7 cases of moderate-severe,and 10 cases of severe tricuspid regurgitation.Among the TVP patients,36 cases were performed by Danielson’s procedure and 5 cases were performed by Carpentier’s procedure.Of the 41 patients with TVP,3 patients underwent intraoperative re-conversion to re-repair.Among the patients with TVP,31 patients were treated with annuloplasty ring,and the remaining 10 patients without this treatment were treated with vascular graft.Among TVR patients,13 cases were folded by Danielson’s procedure,6 cases were folded by Carpentier’s procedure,and 4 cases were not folded.Of the patients with TVR,5 cases were converted to tricuspid valve replacement again after failed tricuspid valvuloplasty.Besides 1 case was found to have left outflow tract obstruction(LVOTO)by echocardiography on the second day after TVP,and tricuspid valve replacement was performed by reopening the chest.Among the patients underwent tricuspid valve replacement,the artificial valve was replaced by a mechanical valve in 1 case,and the biological valve was replaced in the remaining 22 cases.Other cardiac malformations in the two groups of patients were treated simultaneously,such as atrial septal defect(ASD),patent foramen ovale(PFO)and so on.Of the patients with TVP,the postoperative ICU stay was(50.68± 14.66)h,the ventilator use time was(30.73± 54.25)h,and the postoperative hospital stay was(11.22 ± 3.97)d.Of the patients with TVR,the postoperative ICU stay was(87.35 ±64.30)h,the ventilator use time was(35.91±24.17)h,and the postoperative hospital stay was(17.00 ± 8.57)d.There was a statistically significant difference in postoperative ICU stay(p=0.013)and postoperative hospital stay(p=0.005)between the TVP and the TVR groups,but not in ventilator use time(p=0.666).The follow-up time was 4 to 93 months,and the average follow-up time was(48.80±27.33)months.In the TVP group,38 patients had New York Heart Association(NYHA)class I,and 3 patients had class Ⅱ at 3 months postoperatively.In the TVP group,38 patients had cardiac function(NYHA)class I and 3 patients had class Ⅱ at 3 months after surgery.In the TVR group,21 patients had cardiac function(NYHA)class Ⅰ and 2 patients had class Ⅱ at 3 months after surgery.The cardiac function of the two groups improved significantly after surgery.During the follow-up period,postoperative complications occurred in 10(24.39%)of 41 TVP patients and 2(8.70%)of 23 TVR patients.The incidence of postoperative complications was higher in the TVP group than in the TVR group(24.39%vs.8.70%,P>0.05).Fifteen patients(36.6%)had TR≥moderate in TVP and 2 patients(8.7%)had TR≥ moderate in TVR throughout the postoperative discharge follow-up period.There was no death or reoperation of the all surgical patients during the follow-up period.Conclusions:(1)Through surgical treatment of adult patients with Ebstein’s anomaly,tricuspid valvuloplasty and tricuspid valve replacement have better early and mid-term results,the quality of life and cardiac function of patients have been significantly improved,and there is no significant difference in the early and mid-term survival rate of patients.(2)Patients who received tricuspid valvuloplasty have a shorter hospital stay than those who received tricuspid valve replacement,Patients with tricuspid valvuloplasty have a shorter hospital stay than those with tricuspid valve replacement,and there is no significant difference in the incidence of complications,but long-term follow-up is still needed.(3)In adult Ebstein’s anomaly,tricuspid valvuloplasty is the first choice for surgical treatment,and tricuspid valve replacement is used when tricuspid valvuloplasty fails or cannot be repaired.