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DOI: 10.1055/s-0038-1627940
Type of Ebstein’s Surgery Affects Reoperation Rate
Publication History
Publication Date:
22 January 2018 (online)
Objectives: Tricuspid valve (TV) surgery in Ebstein’s anomaly has evolved over the years. In several patients TV-insufficiency recurs either early or late after repair. We aimed to evaluate the influence of the surgical technique on the rate of redo surgery.
Methods: Patients with Ebstein’s anomaly who underwent TV-surgery were identified using the institutional database. Four groups were analyzed according to the initial TV-surgery: valve replacement (group1), monocusp-reconstruction (group 2), cone-reconstruction (group 3), and various others (group 4). The surgical technique in Group 2 and 3 was applied as a standardized method with very few variances. Group 4 includes various techniques such as the Hardy-technique, annuloplasty, valve bicuspidization, closure of fenestrations, modified Alfieri techniques, neochordae and combinations of those techniques.
Results: A total of 186 patients (60% female, age: 26 ± 18y) were included. Median follow-up was 7.8 years [0–41]. There were 22 deaths, 6 (3.2%) within 30 days after TV surgery and 16 during the follow-up. A redo-operation was necessary in 51 patients (14 early and in 37 late). As a redo surgery, a further repair of the TV was performed in 26/51 (51%) patients. Early reoperation rate in Group 2 and 3 was lower than in group 4 (* p = 0.039). 30-days mortality after a redo-surgery was 2%.
Group |
Replacement n = 18 (group 1) |
Monocusp n = 70 (Group 2) |
Cone n = 37 (Group 3) |
Various other n = 61 (group 4) |
Mean FU (y) |
11 ± 12 |
13 ± 10 |
1.5 ± 2 |
10 ± 10 |
Early death (≤30 d) |
1 (5%) |
2 (3%) |
2 (6%) |
1 (2%) |
Late death |
2 (11%) |
11 (16%) |
0 (0%) |
3 (5%) |
Early redo(≤30 d) |
0 (0%) |
3 (3%)* |
2 (6%)* |
9 (15%)* |
Late redo |
4 (22%) |
25 (36%) |
0 (0%) |
8 (13%) |
Conclusion: The Cone procedure for Ebstein’s anomaly shows very low early and late reoperation rates compared with the other techniques. This suggests a definite procedure for this disease; however, long term follow-up needs yet to be determined.