Anatomic Repair of Ebstein's Malformation: Lessons Learned With Cone Reconstruction

• Published in: The Annals of thoracic surgery Vol. 95; no. 1; pp. 220 - 228
• Main Authors: Dearani, Joseph A., MD, Said, Sameh M., MD, O'Leary, Patrick W., MD, Burkhart, Harold M., MD, Barnes, Roxann D., MD, Cetta, Frank, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 2013
• Subjects: Adolescent; Adult; Aged; Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Child; Child, Preschool; Ebstein Anomaly - surgery; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Middle Aged; Reconstructive Surgical Procedures - methods; Retrospective Studies; Surgery; Treatment Outcome; Tricuspid Valve - surgery; Young Adult; 20
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.04.146

Background Reproducible repair of Ebstein's malformation is challenging and numerous surgical techniques have been described. We reviewed our experience with the cone reconstruction. Methods Between June 2007 and December 2011, 89 patients (47 female; 53%) underwent cone reconstruction (median age 19 years; range, 19 days to 68 years). Indication for operation was progressive cardiomegaly in 43 (48%), cyanosis in 29 (33%), and heart failure in 13 (15%). Prior tricuspid valve repair was performed in 12 patients (13%). Severe tricuspid regurgitation (TR) was present in 75 patients (84%). Results All patients underwent cone reconstruction (360-degree leaflet tissue repair anchored at true annulus). Modifications included ringed annuloplasty in 57 patients (64%), leaflet augmentation in 28 patients (31%), and autologous chordae in 17 patients (19%). Bidirectional cavopulmonary anastomosis was performed in 21 patients (24%). Early mortality occurred in 1 patient (1%). Early reoperation for recurrent TR occurred in 12 patients (13%); re-repair was performed in 6 patients (50%), and 6 (50%) required replacement. Mean follow-up was 19.7 ± 24.7 months. There was no late mortality or reoperation. At follow-up, 72 patients (87%) had no or mild TR, 9 (11%) had moderate TR, and 2 patients (2%) had severe TR. Ringed annuloplasty was associated with less than moderate TR at dismissal ( p = 0.01). Conclusions The learning curve for cone reconstruction is steep, but early mortality is low. Cone reconstruction with ringed annuloplasty results in less TR and should be used whenever possible. Longer follow-up is essential to determine late durability of cone reconstruction.