Strategies for tricuspid re-repair in Ebstein malformation using the cone technique

Joseph A. Dearani, Sameh M. Said, Harold M. Burkhart, Roxann B. Pike, Patrick W. O'Leary, Frank Cetta

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Background: Successful tricuspid repair for Ebstein malformation (EM) is challenging. Cone repair has recently emerged as the most anatomic repair technique. There are no data on tricuspid re-repair in EM. We reviewed our experience with tricuspid valve (TV) re-repair using a cone technique. Methods: Between June 2007 and October 2012, 134 patients underwent cone repair. Prior TV repair was performed in 20 patients (10 female, 50%). Median age was 15 years (range, 4 to 68 years). Four patients (20%) had prior bidirectional cavopulmonary anastomosis (BDCPA). Preoperative heart failure was present in 8 patients (40%). Recurrent tricuspid regurgitation (TR) was due to incomplete leaflet coaptation with tethered anterior leaflet in all patients; and 10 patients (50%) had diminutive septal leaflet. Prior repair techniques consisted of annuloplasty maneuvers in all patients with no or incomplete surgical delamination in all patients. Results: The TV re-repair using cone technique was possible in all patients. Plication of atrialized right ventricle was done in 6 patients (30%). Modifications included annuloplasty band in 16 patients (80%) and TV leaflet augmentation in 8 (40%). The BDCPA was performed in 3 patients (15%) and modified Cox-maze procedure was done in 10 (50%). There were no mortalities or reoperations. Mean follow-up was 7.7 ± 10.7 months; during follow-up, 18 patients had no or mild TR and 2 had moderate TR. Conclusions: TV re-repair in EM using the cone technique is feasible, particularly when there has been no surgical leaflet delamination at initial operation. Leaflet augmentation facilitates and annuloplasty band stabilizes a competent TV re-repair. Longer follow-up is required to assess durability.

Original languageEnglish (US)
Pages (from-to)202-210
Number of pages9
JournalAnnals of Thoracic Surgery
Volume96
Issue number1
DOIs
StatePublished - Jul 1 2013

ASJC Scopus subject areas

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

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    Dearani, J. A., Said, S. M., Burkhart, H. M., Pike, R. B., O'Leary, P. W., & Cetta, F. (2013). Strategies for tricuspid re-repair in Ebstein malformation using the cone technique. Annals of Thoracic Surgery, 96(1), 202-210. https://doi.org/10.1016/j.athoracsur.2013.02.067