Cone Type Repair Has Become Our First Option in the Treatment of Adult Ebstein Anomaly

Abstract

Purpose: Different surgical procedures were defined due to degree of Ebstein anomaly. In this study, we are reporting our surgical experience of adult patients with Ebstein anomaly.Methods: We analyzed the patients, who had operated with the diagnosis of Ebstein anomaly from March 2011 through February 2018, retrospectively. We evaluated patients in two groups: patients with cone type surgical repair were in Group 1 and patients with other surgical (Danielson, Carpentier) procedures were in Group 2.Results: There were 23 patients in the study; 9 (39%) were in Group 1 and 14 (61%) were in Group 2. In the comparison of preoperative data, groups were statistically similar. Aortic cross clamp and cardiopulmonary bypass (CPB) times, need for inotropic agents, intubation time, postoperative >2 tricuspid regurgitation incidence, intensive care unit, and hospital staying times were statistically significantly higher in Group 2. There was one mortality (4.3%) in Group 2 due to sepsis.Conclusion: Cone type repair can safely be performed in the repair of Ebstein anomaly with acceptable results. Our results are encouraging to prefer this technique as one of the first-line treatment of Ebstein anomaly. However, further randomized controlled studies are recommended to evaluate the efficacy of this surgical procedure.

Comparative outcomes and risk analysis after cone repair or tricuspid valve replacement for Ebstein's anomaly

“…Our series redemonstrates the excellent long-term overall survival of patients undergoing cone repair, in keeping with other large institutions. 3 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 20 , 21 We showed excellent long-term survival with no early or late mortalities in our cohort. Additionally, we demonstrated acceptable levels of TR that remained stable over time and the feasibility of using annuloplasty rings as a protective measure without increasing the risk of TS.…”

“…Short- and midterm results at global major institutions using the cone repair technique have shown uniformly positive results with low morbidity and mortality. 6 , 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 However, long-term outcomes for the cone repair are still needed, and questions remain surrounding the effect of the cone repair on biventricular function and remodeling, valve durability, and echocardiographic follow-up with regard to residual and recurrent TR. 8 , 15 , 21 Of note, predictors of reoperation among those undergoing cone repair compared with those undergoing TVR are as yet unelucidated, and there are relatively few studies comparing midterm outcomes between cone repair and TVR.…”

Impact of Cone vs. Hetzer Repair on Postoperative Outcomes in Patients With Ebstein's Anomaly: 10-Year Experience From a Single Institution

“…They found that the cone repair provided a higher rate of successful repair and a lower rate of moderate/severe TR ( p = 0.03). Ozbek and his associates ( 12 ) reached a similar conclusion that the rate of moderate/severe TR of cone repair was lower than other repairs in patients with EA postoperatively ( p = 0.009). Vogel et al ( 20 ) found that the cone repair had a higher rate of reduction in TR than conventional surgery in patients with EA ( p = 0.004).…”

“…Different surgical interventions are defined due to leaflet hypoplasia and the degree of cardiac malformation. TV repair, TV replacement, ventricular plication, ASD closure, bidirectional cavopulmonary shunt (BCPS), and cryoablation are the most common surgical procedures ( 12 ). When technically feasible, repair of the TV is usually preferable to replacement ( 9 , 13 , 14 ).…”

“…The cone modification is a surgical technique that aims at reducing the severity of TR by constructing a funnel-like valve which is most similar to the physiological TV. Recently, favorable short-term outcomes with the cone repair have been demonstrated by a series of reports (9,12,(16)(17)(18). However, there is no study comparing the specific repair techniques for patients with EA.…”