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Eckerström F, Dellborg M, Hjortdal VE, Eriksson P, Mandalenakis Z. Mortality in Patients With Ebstein Anomaly. J Am Coll Cardiol 2023; 81:2420-2430. [PMID: 37344044 DOI: 10.1016/j.jacc.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Low birth prevalence and referral bias constitute significant obstacles to elucidating the natural history of Ebstein anomaly (EA). OBJECTIVES An extensive 2-country register-based collaboration was performed to investigate the mortality in patients with EA. METHODS Patients born from 1970 to 2017 and diagnosed with EA were identified in Danish and Swedish nationwide medical registries. Each patient was matched by birth year and sex with 10 control subjects from the general population. Cumulative mortality and HR of mortality were computed using Kaplan-Meier failure function and Cox proportional regression model. RESULTS The study included 530 patients with EA and 5,300 matched control subjects with a median follow-up of 11 years. In the EA cohort, 43% (228) underwent cardiac surgery. Cumulative mortality was lower for patients diagnosed in the modern era (the year 2000 and later) than for those diagnosed in the prior era (P < 0.001). Patients with isolated lesion displayed lower cumulative mortality than patients with complex lesions did (P < 0.001). Patients with a presumed mild EA anatomy displayed a 35-year cumulative mortality of 11% (vs 4% for the matched control subjects; P < 0.001), yielding an HR for mortality of 6.0 (95% CI: 2.7-13.6), whereas patients with presumed severe EA demonstrated an HR of 36.2 (95% CI: 15.5-84.4) compared with control subjects and a cumulative mortality of 18% 35 years following diagnosis. CONCLUSIONS Mortality in patients with EA is high irrespective of presence of concomitant congenital cardiac malformations and time of diagnosis compared with the general population, but overall mortality has improved in the contemporary era.
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Affiliation(s)
- Filip Eckerström
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Peter Eriksson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Adult Congenital Heart Disease Unit, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Adult Congenital Heart Disease Unit, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Phillips KA, Dearani JA, Wackel PL, Stephens EH, Krishnan P, Weaver AL, Cetta F, Johnson JN, Van Dorn CS. Contemporary Early Postoperative Cone Repair Outcomes for Patients With Ebstein Anomaly. Mayo Clin Proc 2023; 98:290-298. [PMID: 36737117 DOI: 10.1016/j.mayocp.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/17/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the early postoperative outcomes after cone repair (CR) for Ebstein anomaly (EA) across the age spectrum. PATIENTS AND METHODS For this study, 284 patients from 1 to 73 years of age who underwent CR at Mayo Clinic from June 1, 2007, to December 21, 2018, were separated by age group (1-<4, 4-<19, 19-<40, and 40+ years) and by disease severity for analysis. Outcomes of interest included death, reoperation, readmission, early postoperative complications, cardiac intensive care unit and hospital length of stay, and need for superior cavopulmonary anastomosis. RESULTS Mortality within 30 days was 0%. The reoperation rate was 4.9% (n=14) and the median hospital length of stay was 5 days, with no statistical difference between ages at time of CR or severity groups. The readmission rate was 2% (n=6). Postoperative complications were seen in 8.8% (n=25) of cases overall, with higher rates in the youngest age group (21%, P<.001). Superior cavopulmonary anastomosis was most common in the youngest age group (37% vs 17% overall, P<.001) and in those with severe disease (35%, P<.001). CONCLUSION Children and adults with Ebstein anomaly have very good early postoperative outcomes with a less than 10% complication and reoperation rate and very low mortality following cone reconstruction. In the setting of good and stable right ventricle function and no symptoms of heart failure or cyanosis, waiting for CR until 4 years of age may minimize early postoperative complications and need for superior cavopulmonary anastomosis.
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Affiliation(s)
- Kari A Phillips
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA; Department of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Joseph A Dearani
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Philip L Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | | | - Prasad Krishnan
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Frank Cetta
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | | | - Charlotte S Van Dorn
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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Bakhshaliyev S, Özalp ZGK, Güneş M, Genç SB, Kamalı H, Şengül FS, Ergün S, Haydin S. Surgical treatment of Ebstein anomaly in pediatric patients: A 10-year single-center study. J Card Surg 2021; 36:3138-3145. [PMID: 34056748 DOI: 10.1111/jocs.15676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We report the early and long-term results of the strategies and surgical methods used in our center to treat pediatric patients who underwent surgical intervention to correct Ebstein anomaly (EA) in our center. MATERIALS AND METHODS In our study, a consecutive sample of 29 patients who underwent surgery for EA between February 2011 and February 2020 in our center were evaluated retrospectively. RESULTS The 29 patients underwent a total of 40 operations. Univentricular repair was performed in 5 (17.2%), 1.5 ventricular repair in 5 (17.2%), and biventricular repair in the remaining 19 (65.5%) patients. Cone reconstruction (CR) was performed in eight (27.5%), non-Cone tricuspid valve (TV) repair technique in five (17.2%), ring annuloplasty in two (6.9%), and TV replacement in two patients (6.9%) who had undergone biventricular repair. In two patients (6.9%), only close an atrial septal defect. Two (6.9%) patients underwent a second operation for advanced tricuspid regurgitation (TR) in the early period. None of the 15 patients who underwent CR and TV plasty had moderate or advanced TR before discharge. Early mortality was seen in 1 (3.4%) patient. The mean follow-up period of the patients was 48.4±27.6 months. Three (10.7%) of the patients who were discharged after their first operation later underwent a second operation for TV regurgitation in the long term. No mortality was observed in any patient during long-term follow-up. CONCLUSION Surgical treatment of EA is difficult, but its overall results are good. The anatomical repair rate is lower in neonatal and infant patients requiring surgery, but most of these patients underwent biventricular repair. Our long-term results demonstrated an acceptable survival rate, low mortality in the early postoperative period, and low incidence of re-intervention and morbidity.
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Affiliation(s)
- Shiraslan Bakhshaliyev
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Zeynep Gülben Kük Özalp
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Güneş
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Serhat Bahadır Genç
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Hacer Kamalı
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Fatma Sevinç Şengül
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Servet Ergün
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Sertaç Haydin
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Eckerström F, Eriksson P, Dellborg M, Lappas G, Rosengren A, Hjortdal VE, Mandalenakis Z. Mortality burden in patients born with Ebstein’s anomaly: a 40-year nationwide cohort study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:312-319. [DOI: 10.1093/ehjqcco/qcz069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Survival rates for unoperated patients with Ebstein’s anomaly (EA) are unknown. We estimated overall long-term mortality in operated and unoperated EA patients, compared with the general population in Sweden.
Methods and results
Using national medical registries, Swedish individuals born 1970–93 and diagnosed with EA between 1970 and 2011 were included. The hazard ratio for overall mortality for EA patients (n = 216) vs. the matched comparison cohort (n = 2160) was 43.7 [95% confidence interval (CI): 24.8–82.5]. Mortality risk for EA patients (vs. controls) decreased as birth period progressed, with hazard ratios declining from 63.6 (95% CI: 26.3–191.8) for those born in the 1970s to 34.4 (95% CI: 15.8–83.1) for those born in the 1980s and 20.2 (95% CI: 1.6–632.5) for those born at the beginning of 1990s. The overall mortality hazard ratios for unoperated and operated patients with EA (vs. controls) were 30.2 (95% CI: 13.8–73.3) and 63.7 (95% CI: 28.1–172.5), respectively. The risk of mortality among unoperated EA patients (vs. controls) declined with progressing birth period, with hazard ratios declining from 58.4 (95% CI: 15.1–415.2) in the 1970s to 22.9 (95% CI: 8.0–75.3) in the 1980s and 10.2 (95% CI: 0.3–395.9) in the 1990s.
Conclusion
Overall all-cause mortality for patients with EA declined dramatically from 64 times to 20 times that of controls without EA, from the 1970s to the early 1990s. Unoperated patients with EA had better survival than did operated patients, possibly reflecting the higher severity of disease or more severe associated cardiac defects in patients undergoing surgery.
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Affiliation(s)
- Filip Eckerström
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, DK-8200 Aarhus, Denmark
| | - Peter Eriksson
- Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, SE-41650 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå䲴råket 5B, SE-41345 Gothenburg, Sweden
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, SE-41650 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå䲴råket 5B, SE-41345 Gothenburg, Sweden
| | - Georgios Lappas
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå䲴råket 5B, SE-41345 Gothenburg, Sweden
| | - Annika Rosengren
- Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, SE-41650 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå䲴råket 5B, SE-41345 Gothenburg, Sweden
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, DK-8200 Aarhus, Denmark
| | - Zacharias Mandalenakis
- Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, SE-41650 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå䲴råket 5B, SE-41345 Gothenburg, Sweden
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Silva GVRD, Miana LA, Caneo LF, Turquetto ALR, Tanamati C, Penha JG, Jatene FB, Jatene MB. Early and Long-Term Outcomes of Surgical Treatment of Ebstein's Anomaly. Braz J Cardiovasc Surg 2019; 34:511-516. [PMID: 31364344 PMCID: PMC6852467 DOI: 10.21470/1678-9741-2018-0333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. METHODS A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. RESULTS Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. CONCLUSION In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.
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Affiliation(s)
- Guilherme Viotto Rodrigues da Silva
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Leonardo Augusto Miana
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Fernando Caneo
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Aída Luiza Ribeiro Turquetto
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Carla Tanamati
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Juliano G Penha
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Marcelo B Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Pornprasertchai V, Vijarnsorn C, Kanjanauthai S, Chungsomprasong P, Chanthong P, Durongpisitkul K, Soongswang J. Contemporary outcomes and mortality risks of Ebstein anomaly: A single-center experience in Thailand. CONGENIT HEART DIS 2019; 14:619-627. [PMID: 30791188 DOI: 10.1111/chd.12759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/16/2018] [Accepted: 01/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The increasing number of patients with Ebstein anomaly (EA) surviving into adulthood implies improvements in the treatments for the complex lesion. We revisited the clinical outcomes of patients with EA to demonstrate their "real world" survival. OBJECTIVES To identify the survival and predictors of mortality in patients with EA who underwent medical or surgical management in the present era. METHODS All patients who had EA with atrioventricular concordance between 1994 and 2016 were retrospectively reviewed. Baseline characteristics, initial echocardiographic findings, treatments, and outcomes were explored. The survival analysis was performed at the end of 2017. A multivariate analysis was used to assess mortality risks. RESULTS A total of 153 patients (25.4 ± 20.4 years, 60% female) were analyzed. Of these, 89 patients had been diagnosed with EA in childhood. During the follow-up [median time of 5.2 years (3 days-23.5 years)], 32 patients (20.9%) died due to major cardiac adverse events. The overall survival at 1, 5, and 10 years were 89%, 82.2%, and 79%, respectively. Of the total 153 patients, 64 patients underwent at least one surgical intervention [median age of 17 years (1 day-64.4 years)]. The survival at 1, 5, and 10 years were 87.5%, 82.4%, and 77.7%, respectively, in patients with EA surgery. This survival is comparable to the survival of 89 nonoperated patients with EA: 89.9%, 87.5%, and 81.8%, at 1, 5, and 10 years, respectively. The significant predictors of mortality were: age at diagnosis ≤2 years, tricuspid valve (TV) z-score >3.80, TV displacement >19.5 mm/m2 , presence of severe tricuspid regurgitation, and absence of forward flow across the pulmonic valve at the initial diagnosis. CONCLUSION Patients with EA had a moderately good survival in this era. In this paper, we report five simple predictors of death in this patient population.
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Affiliation(s)
- Varisara Pornprasertchai
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaluck Kanjanauthai
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paweena Chungsomprasong
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakul Chanthong
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kritvikrom Durongpisitkul
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarupim Soongswang
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Holst KA, Dearani JA, Said SM, Davies RR, Pizarro C, Knott-Craig C, Kumar TS, Starnes VA, Kumar SR, Pasquali SK, Thibault DP, Meza JM, Hill KD, Chiswell K, Jacobs JP, Jacobs ML. Surgical Management and Outcomes of Ebstein Anomaly in Neonates and Infants: A Society of Thoracic Surgeons Congenital Heart Surgery Database Analysis. Ann Thorac Surg 2018; 106:785-791. [DOI: 10.1016/j.athoracsur.2018.04.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 11/27/2022]
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8
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Geerdink LM, Delhaas T, Helbing WA, du Marchie Sarvaas GJ, Heide HT, Rozendaal L, de Korte CL, Peer PGM, Kuipers IM, Kapusta L. Paediatric Ebstein's anomaly: how clinical presentation predicts mortality. Arch Dis Child 2018; 103:859-863. [PMID: 29567665 DOI: 10.1136/archdischild-2017-313482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 02/20/2018] [Accepted: 02/24/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Forecasting the prognosis of a child when diagnosed with Ebstein's anomaly is difficult. We, therefore, studied which factors at the time of diagnosis are associated with death during childhood. METHODS All consecutive patients (0-18 years) diagnosed with Ebstein's anomaly in the Netherlands between 1980 and 2014 were included. Survival curves were obtained using the Kaplan-Meier method. By using the Cox proportional hazard model, we analysed the factors (at diagnosis) that were associated with death. RESULTS We included 176 patients. Thirty-one patients (18%) died before the age of 18 years. The 1-year survival was 84% and remained stable at 82% from 35 months after diagnosis and onwards. Modified Ross Heart Failure Class 4 at the time of diagnosis was the most important risk factor for death during childhood (HR 12.5, 95% CI 4.4 to 35.9). Furthermore, diagnosis in the neonatal period (HR 4.2, 95% CI 1.5 to 12.0), severe tricuspid valve regurgitation (HR 2.4, 95% CI 1.2 to 5.0), severe right ventricular outflow tract obstruction (HR 3.7, 95% CI 1.8 to 7.7) and a patent ductus arteriosus (HR 2.8, 95% CI 1.3 to 6.0) at the time of diagnosis were univariately associated with death. Multivariable analysis showed that presentation with Heart Failure Class 4 and a ventricular septal defect is the strongest predictor of death in childhood and adolescence. CONCLUSION Patients with Ebstein's anomaly presenting with Heart Failure Class 4 and a ventricular septal defect have a high risk of death during childhood.
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Affiliation(s)
- Lianne M Geerdink
- Department of Paediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Paediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Tammo Delhaas
- Department of Paediatric Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Willem A Helbing
- Department of Paediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gideon J du Marchie Sarvaas
- Centre for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henriette Ter Heide
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lieke Rozendaal
- Department of Paediatric Cardiology, Willem Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Centre, Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Petronella G M Peer
- Department of Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Irene M Kuipers
- Department of Paediatric Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Livia Kapusta
- Department of Paediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Paediatrics, Paediatric Cardiology Unit, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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