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J Thorac Cardiovasc Surg 2008;135:1134-1136
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Vaughan A. Starnes (Los Angeles, Calif). I would like to congratulate Dr Dearani on an excellent and clear presentation. Dr Dearani and his colleagues have presented a comprehensive review of the Mayo Clinic's experience with surgical treatment of 539 patients with Ebstein anomaly over a 34-year period of time. I believe this represents the largest and most comprehensive review thus far. The Mayo operation consisted of TVrpl in 61%, TVrpr in 34%, concomitant ASD closure in 84% and plication of the right ventricle in 35%, and ablation of the pathway in 13%. The early mortality was excellent at a low value of 6%, and the overall survival of the entire cohort treated at 10 and 20 years was 85% and 71%, respectively. An extensive analysis of variables predicting early and late mortality were analyzed. As we have seen in the presentation, a multivariant analysis was performed, and predictors of overall mortality were mitral regurgitation, moderate-to-severe RV dysfunction, RVOT or pulmonary artery reconstruction, and TVrpl.

This leads me to my first question, Joe, which is one of 3.

In your paper and presentation TVrpr is advocated and seems to be related to better survival, and yet it seems you have replaced more valves than you repaired, and this tendency seems to be increasing in the more recent experience. Based on this large experience, what are the determinants currently used to see whether the valve is repairable, and what degree of insufficiency would you accept?

Dr Dearani. Thank you for your remarks, Dr Starnes. We prefer TVrpr when the valve is repairable. In recent years, there has been a tendency for more replacement, which we believe is the result of 2 major reasons. First, in the adult population the durability of a tricuspid bioprosthesis is excellent, and the freedom . . . [Full Text of this Article]

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The outcomes of operations for 539 patients with Ebstein anomaly

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