Cardiac MRI predictors of right ventricular dysfunction after the Da Silva cone operation for Ebstein's anomaly

Q: What are the key findings of this study?

Higher preoperative right ventricular ejection fraction was associated with decreased odds of significant right ventricular dysfunction after the cone operation (OR 0.61 per 5% increase).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Ebstein's anomaly (n=26). Intervention: Preoperative right ventricular ejection fraction (per 5% increase) vs. Lower preoperative right ventricular ejection fraction. Primary outcome: Significant right ventricular dysfunction (moderate or severe) on discharge echocardiogram (OR 0.61, 95% CI 0.48-0.76, p=0.04).

Q: What does this research mean for the field?

Significant right ventricular dysfunction occurs in a majority of patients following the Da Silva cone operation for Ebstein's anomaly and is predicted by lower preoperative right ventricular ejection fraction, cardiothoracic enlargement, and more severe tricuspid valve abnormalities. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tarek Alsaied; Carlos Eduardo Diaz-Castrillon; Adam B. Christopher; Jose Da Silva; Victor O. Morell; Lizabeth M. Lanford; Bryan H. Goldstein; Brian Feingold; Thomas Joseph Seery; Gaurav Kumar Arora; Arvind Hoskoppal; Jennifer A. Johnson; Sameh S. Tadros; Laura Olivieri

doi:10.1016/j.ijcchd.2022.100342

January 31, 2022International Journal of Cardiology Congenital Heart DiseaseOpen Access

Cardiac MRI predictors of right ventricular dysfunction after the Da Silva cone operation for Ebstein's anomaly

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Key result

Higher preoperative RVEF linked to ~39% lower odds of post-cone RV dysfunction per 5% increase.

OR 0.61
95% CI 0.48-0.76
P=0.04
n=26

Figures

Why the study?

Significant right ventricular dysfunction frequently occurs immediately after the cone operation for Ebstein's anomaly and may predict worse long-term outcomes, but predictors using preoperative CMR are not well defined.

Study Design

Type

Observational (n=26)

Multicenter

No

PICO

P

Population

26 patients with Ebstein's anomaly who underwent the cone operation and had preoperative cardiac magnetic resonance imaging, evaluated for short-term postoperative right ventricular dysfunction.

E

Exposure / Comparator

Preoperative right ventricular ejection fraction (per 5% increase) vs Lower preoperative right ventricular ejection fraction

O

Primary Outcome

Significant right ventricular dysfunction (moderate or severe) on discharge echocardiogram — OR 0.61 (0.48-0.76), p=0.04

Main Result

Odds Ratio: 0.61 (95% CI 0.48–0.76)

p-value: p=0.04

Limitations

Single center cohort
Potential selection bias as only subjects with pre-operative CMR were included
Did not evaluate long-term outcomes for right ventricular dysfunction

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Implication

Preoperative RV assessment may inform risk stratification but should not change practice; leaves open need for prospective validation in Ebstein's cohorts.

Abstract

Introduction: Despite the clinical benefits of the cone operation for Ebstein's anomaly, significant right ventricular (RV) dysfunction is frequently seen immediately after the procedure and if persistent may portend worse long-term outcomes. In this study we sought to evaluate the predictors of RV dysfunction after the cone operation using preoperative CMR. Methods: This was a retrospective review of 26 consecutive patients who had the cone operation. Patients with significant RV dysfunction (RVD), defined as moderate or severe dysfunction by discharge echocardiogram, were compared to patients with no or mild dysfunction (no RVD). Results: The median age at the operation was 12.2 years (interquartile range (IQR): 4.9-31.7 years). Eighteen patients (69%) had RVD. Patients with RVD had worse preoperative RV ejection fraction (36 ± 15 vs 49 ± 11%, p = 0.02) and a larger cardiothoracic (CT) index (44 ± 8 vs 37 ± 6, p = 0.03). The tricuspid valve was more severely abnormal in the RVD group with higher rotational angle (45 ± 17 vs 23 ± 10°, 0.03) and higher displacement index (39 ± 18 vs 23 ± 12%, p = 0.02). RVD associated with a higher vasoactive inotropic score (P < 0.01) and a trend towards a longer intensive care stay (p = 0.07). Conclusion: RVD is common after the cone operation and associated with higher need for postoperative inotropes. Predictors include lower preoperative RV ejection fraction, a more dilated heart and more severe tricuspid valve abnormality. Preoperative CMR is an important tool in preoperative assessment and helps predict RVD.

Discussion

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Cite This Study

Alsaied et al. (2022) conducted an observational in Ebstein's anomaly (n=26). Preoperative right ventricular ejection fraction (per 5% increase) vs. Lower preoperative right ventricular ejection fraction was evaluated on Significant right ventricular dysfunction (moderate or severe) on discharge echocardiogram (OR 0.61, 95% CI 0.48-0.76, p=0.04). Higher preoperative right ventricular ejection fraction was associated with decreased odds of significant right ventricular dysfunction after the cone operation (OR 0.61 per 5% increase).

synapsesocial.com/papers/6ac4a616bc05875bc9a54d92 https://doi.org/10.1016/j.ijcchd.2022.100342

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Cardiac MRI predictors of right ventricular dysfunction after the Da Silva cone operation for Ebstein's anomaly

Figures

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiac MRI predictors of right ventricular dysfunction after the Da Silva cone operation for Ebstein's anomaly

Figures

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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