Modified repair in patients with Ebstein's anomaly

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Adult Congenital Heart Disease

Background:

• Ebstein's anomaly is a rare congenital heart defect affecting the tricuspid valve.
• A modified surgical repair technique has been utilized since 1988.
• This technique focuses on valve mechanism restructuring without atrialized chamber plication.

Purpose of the Study:

• To present the long-term results of a modified tricuspid valve repair technique for Ebstein's anomaly.
• To evaluate the efficacy and safety of the surgical approach.
• To assess clinical outcomes and functional parameters post-repair.

Main Methods:

• A cohort of 50 patients with Ebstein's anomaly underwent tricuspid valve repair between 1988 and 2008.
• The modified technique involved valve reconstruction and, in some cases, Sebending's stitch.
• Follow-up data included survival rates, reoperations, NYHA class, maximal VO2, and right ventricular function (VTI-PA).

Main Results:

• Low early (7.1%) and late (2.4%) mortality, with deaths primarily in older, symptomatic patients.
• Significant improvements observed in NYHA class (3.1 to 1.8) and tricuspid valve insufficiency (3.2 to 1.9).
• Increased velocity-time integral of pulmonary artery flow (VTI-PA) indicating improved right ventricular function; no right ventricular aneurysms reported.

Conclusions:

• The modified tricuspid valve repair technique provides durable, positive clinical outcomes for Ebstein's anomaly.
• The approach is effective even in complex cases, potentially avoiding tricuspid valve replacement.
• Older patients with advanced NYHA class may face higher surgical risks.