Improving Results of Surgery for Ebstein Anomaly

Where Are We After 235 Cone Repairs?

Kimberly A. Holst, Joseph A. Dearani, Sameh Said, Roxann B. Pike, Heidi M. Connolly, Bryan C. Cannon, Kristen L. Sessions, Megan M. O'Byrne, Patrick W. O'Leary

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Ebstein anomaly has heterogeneous anatomy and numerous operative techniques are described. Cone repair provides a near anatomic tricuspid valve repair. The purpose of this study was to examine our experience with cone repair. Methods Cone repair was performed in 235 consecutive patients with Ebstein anomaly, 134 children (57%) and 101 adults (43%), from June 2007 to October 2015. Median age was 15.6 years (range, 6 months to 73 years). Cone repair was the first operation in 192 patients (82%), the second in 41 (17%), and the third in 2 (1%). Previous tricuspid valve repair had been performed in 27 (12%). Echocardiograms were obtained preoperatively and at hospital dismissal for all patients and for a subgroup of patients at least 6 months after cone repair (n = 81). Results Leaflet augmentation was done in 67 patients (28%), Sebening stitch in 57 (24.2%), neochordae in 49 (21%), and annuloplasty band in 158 (67%). Bidirectional cavopulmonary shunt was performed in 46 patients (20%). There was 1 early death (0.4%). Early reoperation was required in 14 patients (5.9%); re-repair was possible in 7 (50%). The majority of early reoperations (11 of 14; 79%) occurred in the first third of the series. Mean follow-up was 3.5 ± 2.5 years. There was sustained reduction in tricuspid regurgitation (p < 0.0001), a progressive decline in right ventricle size (p < 0.0001), and late increase in right ventricle fractional area change after initial decline (p < 0.0001). Freedom from late reoperation was 97.9% at 6 years. Conclusions Cone repair is safe, and the learning curve is significant. Sustained reduction in tricuspid regurgitation and favorable changes in the right ventricle at follow-up suggest that cone repair has an advantageous impact on right ventricular remodeling.

Original languageEnglish (US)
Pages (from-to)160-168
Number of pages9
JournalAnnals of Thoracic Surgery
Volume105
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Ebstein Anomaly
Reoperation
Heart Ventricles
Tricuspid Valve Insufficiency
Tricuspid Valve
Fontan Procedure
Ventricular Remodeling
Learning Curve
Anatomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Holst, K. A., Dearani, J. A., Said, S., Pike, R. B., Connolly, H. M., Cannon, B. C., ... O'Leary, P. W. (2018). Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs? Annals of Thoracic Surgery, 105(1), 160-168. https://doi.org/10.1016/j.athoracsur.2017.09.058

Improving Results of Surgery for Ebstein Anomaly : Where Are We After 235 Cone Repairs? / Holst, Kimberly A.; Dearani, Joseph A.; Said, Sameh; Pike, Roxann B.; Connolly, Heidi M.; Cannon, Bryan C.; Sessions, Kristen L.; O'Byrne, Megan M.; O'Leary, Patrick W.

In: Annals of Thoracic Surgery, Vol. 105, No. 1, 01.01.2018, p. 160-168.

Research output: Contribution to journalArticle

Holst, KA, Dearani, JA, Said, S, Pike, RB, Connolly, HM, Cannon, BC, Sessions, KL, O'Byrne, MM & O'Leary, PW 2018, 'Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs?', Annals of Thoracic Surgery, vol. 105, no. 1, pp. 160-168. https://doi.org/10.1016/j.athoracsur.2017.09.058
Holst, Kimberly A. ; Dearani, Joseph A. ; Said, Sameh ; Pike, Roxann B. ; Connolly, Heidi M. ; Cannon, Bryan C. ; Sessions, Kristen L. ; O'Byrne, Megan M. ; O'Leary, Patrick W. / Improving Results of Surgery for Ebstein Anomaly : Where Are We After 235 Cone Repairs?. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 1. pp. 160-168.
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title = "Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs?",
abstract = "Background Ebstein anomaly has heterogeneous anatomy and numerous operative techniques are described. Cone repair provides a near anatomic tricuspid valve repair. The purpose of this study was to examine our experience with cone repair. Methods Cone repair was performed in 235 consecutive patients with Ebstein anomaly, 134 children (57{\%}) and 101 adults (43{\%}), from June 2007 to October 2015. Median age was 15.6 years (range, 6 months to 73 years). Cone repair was the first operation in 192 patients (82{\%}), the second in 41 (17{\%}), and the third in 2 (1{\%}). Previous tricuspid valve repair had been performed in 27 (12{\%}). Echocardiograms were obtained preoperatively and at hospital dismissal for all patients and for a subgroup of patients at least 6 months after cone repair (n = 81). Results Leaflet augmentation was done in 67 patients (28{\%}), Sebening stitch in 57 (24.2{\%}), neochordae in 49 (21{\%}), and annuloplasty band in 158 (67{\%}). Bidirectional cavopulmonary shunt was performed in 46 patients (20{\%}). There was 1 early death (0.4{\%}). Early reoperation was required in 14 patients (5.9{\%}); re-repair was possible in 7 (50{\%}). The majority of early reoperations (11 of 14; 79{\%}) occurred in the first third of the series. Mean follow-up was 3.5 ± 2.5 years. There was sustained reduction in tricuspid regurgitation (p < 0.0001), a progressive decline in right ventricle size (p < 0.0001), and late increase in right ventricle fractional area change after initial decline (p < 0.0001). Freedom from late reoperation was 97.9{\%} at 6 years. Conclusions Cone repair is safe, and the learning curve is significant. Sustained reduction in tricuspid regurgitation and favorable changes in the right ventricle at follow-up suggest that cone repair has an advantageous impact on right ventricular remodeling.",
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T2 - Where Are We After 235 Cone Repairs?

AU - Holst, Kimberly A.

AU - Dearani, Joseph A.

AU - Said, Sameh

AU - Pike, Roxann B.

AU - Connolly, Heidi M.

AU - Cannon, Bryan C.

AU - Sessions, Kristen L.

AU - O'Byrne, Megan M.

AU - O'Leary, Patrick W.

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N2 - Background Ebstein anomaly has heterogeneous anatomy and numerous operative techniques are described. Cone repair provides a near anatomic tricuspid valve repair. The purpose of this study was to examine our experience with cone repair. Methods Cone repair was performed in 235 consecutive patients with Ebstein anomaly, 134 children (57%) and 101 adults (43%), from June 2007 to October 2015. Median age was 15.6 years (range, 6 months to 73 years). Cone repair was the first operation in 192 patients (82%), the second in 41 (17%), and the third in 2 (1%). Previous tricuspid valve repair had been performed in 27 (12%). Echocardiograms were obtained preoperatively and at hospital dismissal for all patients and for a subgroup of patients at least 6 months after cone repair (n = 81). Results Leaflet augmentation was done in 67 patients (28%), Sebening stitch in 57 (24.2%), neochordae in 49 (21%), and annuloplasty band in 158 (67%). Bidirectional cavopulmonary shunt was performed in 46 patients (20%). There was 1 early death (0.4%). Early reoperation was required in 14 patients (5.9%); re-repair was possible in 7 (50%). The majority of early reoperations (11 of 14; 79%) occurred in the first third of the series. Mean follow-up was 3.5 ± 2.5 years. There was sustained reduction in tricuspid regurgitation (p < 0.0001), a progressive decline in right ventricle size (p < 0.0001), and late increase in right ventricle fractional area change after initial decline (p < 0.0001). Freedom from late reoperation was 97.9% at 6 years. Conclusions Cone repair is safe, and the learning curve is significant. Sustained reduction in tricuspid regurgitation and favorable changes in the right ventricle at follow-up suggest that cone repair has an advantageous impact on right ventricular remodeling.

AB - Background Ebstein anomaly has heterogeneous anatomy and numerous operative techniques are described. Cone repair provides a near anatomic tricuspid valve repair. The purpose of this study was to examine our experience with cone repair. Methods Cone repair was performed in 235 consecutive patients with Ebstein anomaly, 134 children (57%) and 101 adults (43%), from June 2007 to October 2015. Median age was 15.6 years (range, 6 months to 73 years). Cone repair was the first operation in 192 patients (82%), the second in 41 (17%), and the third in 2 (1%). Previous tricuspid valve repair had been performed in 27 (12%). Echocardiograms were obtained preoperatively and at hospital dismissal for all patients and for a subgroup of patients at least 6 months after cone repair (n = 81). Results Leaflet augmentation was done in 67 patients (28%), Sebening stitch in 57 (24.2%), neochordae in 49 (21%), and annuloplasty band in 158 (67%). Bidirectional cavopulmonary shunt was performed in 46 patients (20%). There was 1 early death (0.4%). Early reoperation was required in 14 patients (5.9%); re-repair was possible in 7 (50%). The majority of early reoperations (11 of 14; 79%) occurred in the first third of the series. Mean follow-up was 3.5 ± 2.5 years. There was sustained reduction in tricuspid regurgitation (p < 0.0001), a progressive decline in right ventricle size (p < 0.0001), and late increase in right ventricle fractional area change after initial decline (p < 0.0001). Freedom from late reoperation was 97.9% at 6 years. Conclusions Cone repair is safe, and the learning curve is significant. Sustained reduction in tricuspid regurgitation and favorable changes in the right ventricle at follow-up suggest that cone repair has an advantageous impact on right ventricular remodeling.

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