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. 2020 Dec;160(6):1545-1553.
doi: 10.1016/j.jtcvs.2020.05.032. Epub 2020 May 29.

Cone versus conventional repair for Ebstein's anomaly

Melchior Burri  1 , Karim Mrad Agua  2 , Julie Cleuziou  3 , Elisabeth Beran  3 , Nicole Nagdyman  4 , Andreas Kühn  4 , Johannes Amadeus Ziegelmueller  2 , Peter Ewert  4 , Jose Pedro Da Silva  5 , Rüdiger Lange  6
Affiliations
Free article

Cone versus conventional repair for Ebstein's anomaly

Melchior Burri et al. J Thorac Cardiovasc Surg. 2020 Dec.
Free article

Abstract

Objectives: We aimed to investigate tricuspid valve function and adverse events after conventional repair and valve replacement for Ebstein's anomaly and compare them with cone repair.

Methods: The medical records of 151 patients (mean age, 25 years; 62% were female) who underwent operation in a single center from 1985 to 2018 were retrospectively analyzed. To determine tricuspid valve regurgitation during follow-up, serial echocardiographic examination was used (n = 2397, tricuspid regurgitation grades were graphed for every patient).

Results: Thirty-nine patients underwent cone repair, 107 patients underwent other repair techniques, and 5 patients underwent valve replacement. The operative mortality was 1.3% (n = 2). Failed valve repair (defined as in-hospital death, conversion to replacement, or in-hospital reoperation) was less frequent after cone repair than after other repair techniques (5%, n = 2 vs 20%, n = 21, P = .039). Mean follow-up was 12.3 years (cone repair: 3.7 years). The 5-year cumulative incidence of moderate or greater recurrent tricuspid regurgitation was lower after cone repair than after other repair techniques (8% vs 32%, P = .03). Among the patients undergoing other repair techniques, the 15-year cumulative incidence of moderate or greater recurrent tricuspid regurgitation, severe tricuspid regurgitation, and reoperation was 58%, 37%, and 31%, respectively. During follow-up, 18 patients died (13 of cardiac and 5 of noncardiac causes). Among patients who died of cardiac causes, 10 of 13 had all 3 characteristics-moderate or greater tricuspid regurgitation, atrial fibrillation, and New York Heart Association classification III and IV-at their last medical evaluation.

Conclusions: Before cone repair, recurrent tricuspid regurgitation was considerable. Cone repair provided a higher rate of successful repair and a lower incidence of moderate or greater recurrent tricuspid regurgitation at the midterm follow-up.

Keywords: Ebstein's anomaly; congenital heart disease; heart valve repair; tricuspid valve.

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