[Cavo-pulmonary anastomosis associated with intracardiac repair of Ebstein 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 with right ventricular failure, a decrease in afterload was attained by a cavo-bipulmonary anastomosis associated with the intraventricular repair. Fifty-nine out of 111 patients operated for Ebstein's anomaly were 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 ventricle, poor right ventricular function, chronic atrial fibrillation. This population was divided into two groups with the same preoperative features: Group I (45 operated patients: tricuspid valvuloplasty with longitudinal plicature of the right ventricule: Group II (14 operated patients): same intracardiac repair as Group I and associated cavo-bipulmonary 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 11% (5/45) in Group I and 0% in Group II. In Group II, the persistence of significant tricuspid regurgitation was better tolerated and the frequence of reoperation was decreased with respect to Group I. The authors conclude that high risk patients with Ebstein's anomaly have a lower operative mortality and improved functional tolerance when there is persistent tricuspid regurgitation after cavo-bipulmonary anastomosis.