Key result
1.5VR yields comparable 10-year survival and freedom from reoperation versus biventricular repair in Ebstein anomaly.
Why the study?
Long-term survival and freedom from reoperation after one-and-a-half and biventricular repair in older children and adults with Ebstein anomaly were not well characterized, and predictors of postoperative RV dysfunction and mortality were unclear.
Does one-and-a-half ventricular repair provide comparable long-term survival and freedom from reoperation compared to biventricular repair in older children and adults with Ebstein anomaly?
Cohort (n=126)
No
Does one-and-a-half ventricular repair provide comparable long-term survival and freedom from reoperation compared to biventricular repair in older children and adults with Ebstein anomaly?
In older children and adults with Ebstein anomaly, one-and-a-half ventricular repair provides comparable long-term survival to biventricular repair with a trend towards fewer reoperations, particularly in patients with poorer baseline RV function.
Answers are grounded in this paper and cite their sources.
Supports 1.5VR in select Ebstein patients; observational data leaves open randomized confirmation of outcomes.
OBJECTIVES: To evaluate long-term survival and freedom from reoperation following one-and-a-half (1.5VR) and biventricular repair (BVR) in older children and adults with Ebstein anomaly (EA) and to identify predictors of postoperative right ventricular (RV) dysfunction and mortality. METHODS: We retrospectively reviewed EA patients who underwent surgery at the National Heart Institute between 2005 and 2023. Clinical, imaging, and surgical data were analysed. Survival and reoperation rates were assessed with Kaplan-Meier method, while logistic and Cox regression were applied to identify predictors of RV dysfunction and mortality. RESULTS: Among 126 EA patients [median age: 19 years (IQR: 11, 33.2)], 98 (77.8%) underwent BVR and 28 (22.2%) underwent 1.5VR. Compared with the BVR group, 1.5VR patients were younger [9.5 vs 15.6 years, P = .03], had lower oxygen saturation, more severe Carpentier types (C/D), and poorer RV function [FAC 25.4% vs 32.6%, P = .01; TAPSE 13.3 vs 17.5 mm, P = .006]. Overall mortality was 6.3%. Ten-year survival rates were 93.5% for BVR and 87% for 1.5VR, while freedom from reoperation rates were 78% and 94.5%, respectively (P > .05). Twelve patients (12.2%) initially intended for BVR required conversion to 1.5VR due to RV failure, with 2 (16.7%) cases of mortality. Independent predictors were: lower preoperative oxygen saturation for postoperative RV dysfunction (OR 0.92, 95% CI 0.85-0.99, P = .04); and New York Heart Association (NYHA) class IV (HR 28.9, P = .035), prior ablation (HR 6.5, P = .02), and cardiothoracic ratio >70% (HR 16.8, P = .004) for mortality. CONCLUSIONS: In older children and adults with EA, 1.5VR provided long-term survival comparable to BVR, with a trend towards fewer reoperations. Low oxygen saturation, advanced NYHA class, prior ablation, and severe cardiomegaly independently predicted adverse outcomes, highlighting the need for careful preoperative assessment to guide surgical strategy.
No takes yet. Share an insight, caveat, or question.
Moses et al. (2025) conducted a cohort in Ebstein anomaly (n=126). One-and-a-half ventricular repair (1.5VR) vs. Biventricular repair (BVR) was evaluated on 10-year survival (p=>.05). One-and-a-half ventricular repair in Ebstein anomaly yielded 10-year survival (87% vs 93.5%) and freedom from reoperation (94.5% vs 78%) comparable to biventricular repair (P > .05).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: