Reoperative strategy and mid- to long-term surgical outcomes of Ebstein anomaly_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Bing ,  YANG Keming , LV Xiaodong , LI Shoujun , DAI Dai , AN Kang

Department of Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

YANG Keming, Email: 13801217526@163.com

Keywords：

Ebstein anomaly; tricuspid valve repair; Cone reconstruction; tricuspid valve replacement; surgery

DOI：

10.7507/1007-4848.202004099

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Objective To analyze the Ebstein anomaly's reoperative strategy and mid- to long-term results.Methods We retrospectively reviewed the clinical data of 23 patients who diagnosed with Ebstein anomaly and underwent reoperation for tricuspid valve insufficiency between July 2002 and July 2017 in Fuwai Hospital. There were 9 (39.1%) males and 14 (60.9%) females, with a median age of 28.0 (19.0, 45.0) years.Results Among the 23 patients, 8 (34.8%) underwent tricuspid valvuloplasty and 15 (65.2%) underwent tricuspid valve replacement. The rate of valvuloplasty was 16.7% before 2012, and 54.5% after 2012 (P=0.089) as Cone reconstruction procedure was used. In the valvuloplasty cohort, 3 (37.5%) patients were treated with Danielson or Carpentier technique, and 5 (62.5%) patients were treated with Cone reconstruction procedure. There was no operation-related death. Early complications occurred in 3 (37.5%) patients. The median follow-up was 6.9 years (range, 3.0-15.1 years), and no adverse cardiac events occurred. In the patients with valve replacement, 7 (46.7%) received mechanical prosthesis and 8 (53.3%) received bio-prosthesis. There was no operation-related death. And early complications were observed in 3 (20.0%) patients. The median follow-up was 6.5 years (range, 2.5-15.3 years). One (6.3%) patient died and 4 (26.7%) had long-term complications during the follow-up period.Conclusion The mid- to long-term outcomes are convincing in patients who undergo the second operation due to recurrent tricuspid regurgitation of Ebstein anomaly. A low incidence of reoperation is observed. Cone reconstruction procedure provides possibilities of second tricuspid valvuloplasty, and this technique can reduce the rate of tricuspid valve replacement in the second operation. Tricuspid valve replacement is still an alternative method for the treatment of recurrent tricuspid regurgitation in patients with Ebstein anomaly. The bioprosthetic prosthesis may be a better choice than mechanical prosthesis.

Citation： YU Bing, YANG Keming, LV Xiaodong, LI Shoujun, DAI Dai, AN Kang. Reoperative strategy and mid- to long-term surgical outcomes of Ebstein anomaly. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 48-53. doi: 10.7507/1007-4848.202004099 Copy

1.	Dearani JA, Mora BN, Nelson TJ, et al. Ebstein anomaly review: what's now, what's next? Expert Rev Cardiovasc Ther, 2015, 13(10): 1101-1109.
2.	Mann RJ, Lie JT. The life story of Wilhelm Ebstein (1836-1912) and his almost overlooked description of a congenital heart disease. Mayo Clin Proc, 1979, 54(3): 197-204.
3.	da Silva JP, Baumgratz JF, da Fonseca L, et al. The Cone reconstruction of the tricuspid valve in Ebstein's anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg, 2007, 133(1): 215-223.
4.	Danielson GK, Driscoll DJ, Mair DD, et al. Operative treatment of Ebstein’s anomaly. J Thorac Cardiovasc Surg, 1992, 104(5): 1195-1202.
5.	Hetzer R, Nagdyman N, Ewert P, et al. A modified repair technique for tricuspid incompetence in Ebstein's anomaly. J Thorac Cardiovasc Surg, 1998, 115(4): 857-868.
6.	Carpentier A, Chauvaud S, Macé L, et al. A new reconstructive operation for Ebstein’s anomaly of the tricuspid valve. J Thorac Cardiovasc Surg, 1988, 96(1): 92-101.
7.	Dearani JA, Said SM, Burkhart HM, et al. Strategies for tricuspid re-repair in Ebstein malformation using the cone technique. Ann Thorac Surg, 2013, 96(1): 202-208.
8.	Kim DJ, Suh JW, Shin YR, et al. Tricuspid valve re-repair in Ebstein anomaly using the Cone technique. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 35-38.
9.	Hetzer R, Hacke P, Javier M, et al. The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly. J Thorac Cardiovasc Surg, 2015, 150(5): 1212-1219.
10.	Malhotra SP, Petrossian E, Reddy VM, et al. Selective right ventricular unloading and novel technical concepts in Ebstein's anomaly. Ann Thorac Surg, 2009, 88(6): 1975-1981.
11.	Liu J, Qiu L, Zhu Z, et al. Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair. J Thorac Cardiovasc Surg, 2011, 141(5): 1178-1183.
12.	Vogel M, Marx GR, Tworetzky W, et al. Ebstein's malformation of the tricuspid valve: short-term outcomes of the "cone procedure" versus conventional surgery. Congenit Heart Dis, 2012, 7(1): 50-58.
13.	Silva JP, Silva Lda F, Moreira LF, et al. Cone reconstruction in Ebstein's anomaly repair: early and long-term results. Arq Bras Cardiol, 2011, 97(3): 199-208.
14.	da Silva JP, da Silva Lda F. Ebstein's anomaly of the tricuspid valve: the cone repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15(1): 38-45.
15.	Brown ML, Dearani JA, Danielson GK, et al. The outcomes of operations for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg, 2008, 135(5): 1120-1136.
16.	Brown ML, Dearani JA, Danielson GK, et al. Comparison of the outcome of porcine bioprosthetic versus mechanical prosthetic replacement of the tricuspid valve in the Ebstein anomaly. Am J Cardiol, 2009, 103(4): 555-561.

1. Dearani JA, Mora BN, Nelson TJ, et al. Ebstein anomaly review: what's now, what's next? Expert Rev Cardiovasc Ther, 2015, 13(10): 1101-1109.
2. Mann RJ, Lie JT. The life story of Wilhelm Ebstein (1836-1912) and his almost overlooked description of a congenital heart disease. Mayo Clin Proc, 1979, 54(3): 197-204.
3. da Silva JP, Baumgratz JF, da Fonseca L, et al. The Cone reconstruction of the tricuspid valve in Ebstein's anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg, 2007, 133(1): 215-223.
4. Danielson GK, Driscoll DJ, Mair DD, et al. Operative treatment of Ebstein’s anomaly. J Thorac Cardiovasc Surg, 1992, 104(5): 1195-1202.
5. Hetzer R, Nagdyman N, Ewert P, et al. A modified repair technique for tricuspid incompetence in Ebstein's anomaly. J Thorac Cardiovasc Surg, 1998, 115(4): 857-868.
6. Carpentier A, Chauvaud S, Macé L, et al. A new reconstructive operation for Ebstein’s anomaly of the tricuspid valve. J Thorac Cardiovasc Surg, 1988, 96(1): 92-101.
7. Dearani JA, Said SM, Burkhart HM, et al. Strategies for tricuspid re-repair in Ebstein malformation using the cone technique. Ann Thorac Surg, 2013, 96(1): 202-208.
8. Kim DJ, Suh JW, Shin YR, et al. Tricuspid valve re-repair in Ebstein anomaly using the Cone technique. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 35-38.
9. Hetzer R, Hacke P, Javier M, et al. The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly. J Thorac Cardiovasc Surg, 2015, 150(5): 1212-1219.
10. Malhotra SP, Petrossian E, Reddy VM, et al. Selective right ventricular unloading and novel technical concepts in Ebstein's anomaly. Ann Thorac Surg, 2009, 88(6): 1975-1981.
11. Liu J, Qiu L, Zhu Z, et al. Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair. J Thorac Cardiovasc Surg, 2011, 141(5): 1178-1183.
12. Vogel M, Marx GR, Tworetzky W, et al. Ebstein's malformation of the tricuspid valve: short-term outcomes of the "cone procedure" versus conventional surgery. Congenit Heart Dis, 2012, 7(1): 50-58.
13. Silva JP, Silva Lda F, Moreira LF, et al. Cone reconstruction in Ebstein's anomaly repair: early and long-term results. Arq Bras Cardiol, 2011, 97(3): 199-208.
14. da Silva JP, da Silva Lda F. Ebstein's anomaly of the tricuspid valve: the cone repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15(1): 38-45.
15. Brown ML, Dearani JA, Danielson GK, et al. The outcomes of operations for 539 patients with Ebstein anomaly. J Thorac Cardiovasc Surg, 2008, 135(5): 1120-1136.
16. Brown ML, Dearani JA, Danielson GK, et al. Comparison of the outcome of porcine bioprosthetic versus mechanical prosthetic replacement of the tricuspid valve in the Ebstein anomaly. Am J Cardiol, 2009, 103(4): 555-561.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Reoperative strategy and mid- to long-term surgical outcomes of Ebstein anomaly

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