Objective To evaluate the effect of treating Ebstein ’s anomaly w ith tricuspid valve replacement (TVR), and analyze the indications and personali ze the surgical methods of TVR. Methods 35 TVR in 32 cases of Eb stein’s anomaly not amenable to repair from May 1993 to June 2007 in An zhen Hospital were retrospectively. The mortality and complication incidence wer e estimat ed and the KaplanMeier survival curves were constructed to estimate actual sur vival and freedom from thrombus embolism rate, and comparative studies were unde rtaken to e valuate the clinical effect between implanting the prosthesis in the original tr icu spid ring or above the coronary sinus, and between fold the atrialized ventricle or not, and between preserve the autologous tricuspid or not. The univariate an alysis and logistic regression were used to explore the early and late death ris k factors. Results There were 2 early hospital death (6.25%). Followup of 30 patients who survived 30 days ra nged up to 14 years (4.2±3.5years)，there were 3 TVR reoperation due to the pro sthesis deterioration. There were 2 late deaths（6.67%）, and the actuarial surv i val at 5,10 year was 92.1%±4.6%, 86.5%±5.8% respectively in KaplanMeier cu rve. There were 2 events of thrombus embolism that were cured through thromboly tic therapy, thus the freedom from thrombus embolism at 5 and 10 yers reached 91 . 3%±4.5%,82.3%±4.2% respectively. 24 late survivors were in New York Heart Ass ociation(NYHA) functional cl ass I, and 4 in NYHA functional class II. The incidence of atria ventricular nod e rhythm in patients with the prosthesis implanted in original tricuspid ring wa s statistically higher than that of prosthesis implanted above the coronary sinus,and the incidence of paradoxical ventricular septal motion in patients wi thout folding the atrialized ventricle was statistically higher that of with fol ding the atrialized ventricle, but the NYHA functional class was not affected by these factors.The univariate analysis and logistic regres sion revealed that preoperative functional right ventricle/atrialized ventriclelt; 1 and ascites were the independent risk factor for the early death (P=0.023, 0.025), whereas preoperative ascites and edema in lower extremities were the in dependent risk factors for late death (P=0.026, 0.019). Conclusion TVR is a good therapeutically option for Ebstein’s anomaly si nce the operative risk is low, the functional status improved in all patients an d the durability of prosthesis in tricuspid position has been good. In order to maximize the effect of the TVR in Ebstein’s anomaly, personalized procedure sho uld be adopted in deciding whether to fold the atrialized ventricle or not, to p reserve the autologous tricuspid valve or not, and to implant the prosthesis in the original tricuspid ring or above the coronary sinus.
So far, there have been several kinds of valvuloplasty techniques for Ebstein's anomaly. Cone reconstruction which was developed by Da Silver and his coworkers has attracted much attention from worldwide cardiac surgeons. Because this technique could reconstruct the leaflet to leaflet coapatation which permits central blood flow during diastole period. It is probably the most efficient anatomical correction method. We make a comprehensive literature retrieval concerning the Cone reconstruction for Ebstein's anomaly. Its development, key points of technique skills and prognosis evaluation are reviewed meticulously.
ObjectiveTo summarize the early and mid-term surgical outcomes of cone reconstruction for Ebstein’s anomaly. MethodsPatients with Ebstein’s anomaly who underwent cone reconstruction at Guangdong Provincial People’s Hospital from 2015 to 2024 were retrospectively enrolled. Baseline characteristics, echocardiographic parameters before and after surgery, and follow-up results were collected and analyzed. ResultsA total of 115 patients were included, comprising 28 males and 87 females, with a mean age of (33.29±15.72) years. There were 94 patients in the adult group (>14 years old), and 21 patients in the pediatric group (≤14 years old). Severe or greater tricuspid regurgitation was present in 98.3% of patients preoperatively, and 89.6% were in New York Heart Association (NYHA) functional class Ⅱ. All patients successfully underwent cone reconstruction. The in-hospital reoperation rate for tricuspid valve disease was 1.7%, and no in-hospital death occurred. In the pediatric group, tricuspid regurgitation area and right atrial longitudinal dimension were significantly smaller at 5 days, 6 months, and 1 year postoperatively than preoperative values (P<0.05). In the adult group (n=92, excluding 2 patients who underwent in-hospital reoperation for tricuspid valve disease), tricuspid regurgitation area, pulmonary artery systolic pressure, right atrial longitudinal dimension and anteroposterior diameter of the right ventricular outflow tract were significantly decreased at 5 days, 6 months, and 1 year after surgery (P<0.05), while the right ventricular longitudinal dimension was significantly increased (P<0.001) compared to preoperative levels. The left ventricular end-diastolic and end-systolic diameters were significantly increased at 6 months and 1 year postoperatively (P<0.001). Right heart functional parameters (right ventricular fractional area change, tricuspid annular plane systolic excursion, and tricuspid annular myocardial systolic velocity) demonstrated a trend of gradual recovery after an initial decline in the early postoperative period. The median follow-up duration was 1.8 years, with a follow-up rate of 95.7%. During the follow-up, 3 patients underwent repeated tricuspid valve surgery and 1 patient died. ConclusionCone reconstruction is safe and effective for Ebstein’s anomaly, and can significantly alleviate tricuspid regurgitation and reverse right heart structural remodeling. Both pediatric and adult patients achieve marked improvements in tricuspid regurgitation and right heart morphology, additionally, adult patients also gain obvious benefits in left heart function. Postoperative right heart function shows a gradual recovery trend, with favorable mid-term follow-up outcomes.