Our objective was to determine the relative merits of using a bioprosthetic porcine valve (BPV) versus a mechanical valve (MechV) when tricuspid valve (TV) replacement is required in patients with Ebstein anomaly. From 1972 to 2006, 333 patients received a BPV and 45 received a MechV. Patient records were reviewed, vital status ascertained, and all patients not known to be deceased were mailed a medical questionnaire or contacted by telephone. Early mortality was not statistically higher for patients who had a MechV (11%) than for those who had a BPV (5%) inserted in the TV position (p = 0.173). The only independent preoperative predictor of operative mortality was moderate to severe left ventricular dysfunction (odds ratio 3.1, p = 0.03); 20-year survival was better in patients who had a BPV (75%) than for those who had a MechV (43%, p = 0.003). On multivariate analysis, after adjusting for ablation of accessory pathways, sinus rhythm at dismissal, and concomitant repair of pulmonary valve stenosis, a BPV remained a predictor of late survival (hazard ratio 0.42, p = 0.004). Survival free of reoperation on the TV at 20 years postoperatively was similar for patients who had a MechV (49%) compared with those who had a BPV (42%) inserted (p = 0.941). A greater percentage of patients who had a MechV reported endocarditis (12% vs 2%), bleeding requiring hospitalization (6% vs 3%), and thrombosis (12% vs 6%); however, none of these differences were statistically significant. In conclusion, a BPV in the tricuspid position was an independent predictor of improved survival. This may be related to the higher incidence of bleeding and thrombotic complications in the patients with MechVs or may be related to differences between the 2 groups. A BPV may offer superior late survival when compared with a MechV when TV replacement is required in patients with Ebstein anomaly, but patient selection must be individualized.
Objective Our objective was to review the long-term outcomes of patients with Ebstein anomaly who underwent cardiac surgery at our institution. Methods Patient records were reviewed, and all patients were mailed a medical questionnaire or contacted by means of telephone. Patients who had pulmonary atresia with an intact ventricular septum, complex conotruncal abnormalities, and atrioventricular discordance with ventriculoarterial discordance were excluded. Results From April 1, 1972, to January ...
Ebstein's malformation is a congenital anomaly of the tricuspid valve and right ventricle that is characterized by several features, each of which can exhibit a spectrum of malformation. The first is adherence of the leaflets of the tricuspid valve to the underlying myocardium, this representing failure of delamination during development. This feature involves the septal and inferior leaflets, but rarely the anterior leaflet ( Fig. 1 ). The second feature is anterior and apical rotational displa...
Background Tricuspid valve replacement (TVR) has been performed with mechanical or bioprosthetic valves. However, the relative advantages of the two types are incompletely known. Methods Between 1978 and 2003, we performed 138 TVR (35 bioprosthetic, 103 mechanical) in 125 patients (50 men, 75 women), with a mean age of 43.7 ± 16.6 years. The diseases that required TVR were rheumatic (94), prosthetic valve failure (14), congenital (14), infective endocarditis(5), isolated tricuspid regurgitation ...
Background Regardless of the indication, tricuspid valve replacement (TVR) has historically been associated with high mortality and morbidity. We report the results of our experience in a high-risk patient population with an emphasis on operative mortality, long-term survival, and valve related events according to the type of prosthesis. Methods Between 1985 and 1999 TVR was performed in 81 patients (isolated n=25, combined with valve surgery n=44, combined with CABG or other n=12). The mean age...
Last. Laura Schiavon(UNIPD: University of Padua)H-Index: 14
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Abstract Background Tricuspid valve replacement (TVR) is an uncommon procedure. The use of biological vs mechanical prostheses in TVR has pros and cons. Therefore, we debate the choice between the different types of valves by means of a meta-analysis of studies of the last decade. Methods The heading "tricuspid valve replacement and (bio* or mec*)" was used to retrieve studies from Medline, Current Contents, and Embase. Eight out of 11 studies met the preset strict criteria: intra-institutional ...
#1Michel Carrier(MHI: Montreal Heart Institute)H-Index: 55
#2Yves Hébert(MHI: Montreal Heart Institute)H-Index: 24
Last. Nancy Poirier(MHI: Montreal Heart Institute)H-Index: 25
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Abstract Background Tricuspid valve replacement is seldom used in clinical practice, but the choice between mechanical and biologic prostheses remains controversial. Methods Between 1977 and 2002, 97 patients underwent tricuspid valve replacement and were followed at the Montreal Heart Institute Valve Clinic. Patients underwent replacement with bioprostheses (n = 82) and mechanical valves (n = 15). Results Patients with bioprosthetic tricuspid replacements averaged 53 ± 13 years of age compared ...
Abstract Background . Tricuspid valve replacement is one of the most challenging operations in cardiac surgery. Selection of the suitable prosthesis is still debatable. Methods . In our institution, between January 1980 and December 2000, 129 tricuspid valve replacements were performed in 122 patients (14.7%). Bioprosthetic valves were used in 32 patients, whereas 97 patients had mechanical valve implantation. Twenty-two percent of replacements were done on men. Mean age was 35.27 ± 11.56 years....
Abstract To examine the early and late results of isolated tricuspid valve replacement (TVR). All isolated TVRs performed at the Montreal Heart Institute, Montreal, Quebec between January 1978 and January 1998 were retrospectively reviewed. Follow-up data on patients were obtained through the valve clinic. From a total of 79 TVR and 375 tricuspid annuloplasties performed during the study period, 29 patients who underwent 32 isolated TVRs (six mechanical valves and 26 bioprostheses) were included...
Abstract Tricuspid valve replacement (TVR) is rarely undertaken, most surgeons preferring to use conservative tricuspid valve procedures. Thus, limited data are available in patients following TVR. The purpose of this study was to analyze the early and late results in 87 patients (52 tissue valves, 35 mechanical prostheses) who underwent TVR between January 1973 and September 1996. The patient group comprised 74 (85%) females and 13 (15%) males; mean (+/- SD) age was 59.4 +/- 12.8 years; range: ...
Ebstein anomaly comprises approximately 1% of all congenital heart diseases. It occurs when the tricuspid valve fails to properly delaminate from the right ventricle, resulting in a clinical spectrum of abnormal tricuspid valve morphology and right ventricular dysfunction. Due to the anatomy of the tricuspid valve and right ventricle, as well as associated right- and left-sided pathology, patients are at risk for both right and left ventricular failure and the associated symptoms of each. Ebstei...
#2Stephanie Fuller(Children's Hospital of Philadelphia)H-Index: 20
Technical and medical improvements for congenital cardiac disease in children have contributed to an increasing population of patients who survive into adulthood. These patients may be prone to progression of their native palliated disease or suffer from sequelae of their childhood repair that requires repeat surgical intervention. Surgery for adult congenital cardiac disease poses unique challenges and risks.
Ebstein anomaly is a congenital malformation involving primarily the tricuspid valve, with failure of delamination from the underlying myocardium and right ventricular myopathy. Echocardiography is diagnostic in most patients and demonstrates apical displacement of the septal leaflet and variable tethering of leaflet tissue to the right ventricular myocardium. Operative intervention is considered for exertional symptoms, progressive right ventricular enlargement, or right ventricular dysfunction...
Congenital heart defects (CHDs) are recognized as the most common type of congenital pathology. The frequency of CHDs reaches 2.4–14.2 % per 1 000 newborns. Ebstein’s anomaly is a rare and complex pathology that can be manifested clinically at any age. Drug treatment is ineffective in patients with this pathology. Preference in this case should be given to surgical treatment. Cardiac surgeons must know basic methods of correction of this pathology, their advantages, and disadvantages. The litera...
Objective. To evaluate the results of surgical correction of Ebstein anomaly by cone reconstruction in the early and late postoperative periods of observation. Material and Methods. The study included 35 patients with Ebstein anomaly aged 18 years and younger. The average age of patients was 5.5 [2; 10] years; weight was 23.4 [12.5; 27.5] kg; and height was 112.7 [90; 137] cm. All patients underwent surgical treatment for Ebstein anomaly by cone reconstruction, including four cases (11.4%) requi...
OBJECTIVE: The ideal alternative for tricuspid valve replacement (TVR) in patients with severe isolated tricuspid regurgitation remains unclear. The aim of the present study was to retrospectively investigate the outcomes of using bioprosthetic and mechanical valves at the tricuspid position. METHODS: A total of 98 consecutive patients without left-side cardiac disease or history of heart surgery who underwent first-time TVR between January 2010 and March 2017 at the West China Hospital, China w...
Last. Azeem Latib(Montefiore Medical Center)H-Index: 73
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Highlights •TVIV implantation is an attractive alternative to high-risk redo surgery. •The authors discuss the procedural technique and principles of TVIV implantation. •Selection of transcatheter valve type should be individualized.
Ebsteinova anomalie (EA) je vzacna vrozena srdecni vada, charakterizovana změnou polohy trojcipe chlopně posunute směrem k hrotu prave komory (PK); jejim doprovodným znakem je obvykle nedomykavost chlopně. Zatimco jeji zavažne formy s extremně dilatovanou funkcni PK a utlakem levých srdecnich oddilů vedou k rozvoji těžkeho srdecniho selhani v nizkem věku a - v některých připadech - dokonce již prenatalně, mohou se osoby s mirnou EA dožit vysokeho věku, aniž by byla tato vada diagnostikovana. Pop...
Background Transcatheter tricuspid valve-in-valve replacement (TVIV) is an emerging therapy for dysfunctional surgical valves in patients with congenital and acquired TV disease. The present study was performed to establish baseline quantitative data for echocardiographic and invasive parameters obtained pre- and immediately post-TVIV. Methods Patients were drawn from the VIVID Registry. This study included two cohorts. The registry cohort included all patients entered in the VIVID registry thro...
Last. Ju Mei(SJTU: Shanghai Jiao Tong University)H-Index: 15
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The variable anatomy of Ebstein’s anomaly leads to its various surgical procedures. The long-term outcomes of different operations were not well established. Thirty-five patients with Ebstein’s anomaly who underwent operations from 2006 to 2018 in our department were retrospectively reviewed. Individualized surgical plans were performed according to the preoperative echocardiography and surgeons’ preference. Tricuspid repair, either Danielson’s or Carpentier’s technique, was the primary choice i...