Septal leaflet augmentation during Da Silva cone repair: Valvar function and anatomic features compared to nonpatch...

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Cardiac Repair Techniques

Background:

• Ebstein's anomaly (EA) is a rare congenital heart defect affecting the tricuspid valve (TV).
• Cone repair (CR) is a surgical technique used to address EA, aiming to restore TV function.
• Septal leaflet augmentation is a critical component of CR, and the use of autologous pericardial patches is an evolving strategy.

Purpose of the Study:

• To evaluate the outcomes of Da Silva Cone repair (CR) using autologous pericardial patch for septal leaflet augmentation in Ebstein's anomaly (EA).
• To identify specific tricuspid valve (TV) morphologies associated with the utilization of pericardial patches during CR.
• To compare TV function and re-operation rates between patients who received patch augmentation and those who did not.

Main Methods:

• A single-site retrospective study included 108 patients undergoing CR for EA between January 2016 and November 2024.
• Patients were divided into two groups: those who received an autologous pericardial patch for septal leaflet augmentation and those who did not.
• Outcomes assessed included TV function (stenosis or regurgitation) and a composite of re-operation or >moderate residual tricuspid regurgitation (TR). Adjusted regression analyses were performed.

Main Results:

• Of 108 patients, 50 received a patch. Patch patients were older (13.1 vs. 6.9 years).
• Tricuspid regurgitation (TR) improved significantly post-CR in both groups (78.7% to 79.0%).
• TV function and re-operation rates were comparable between patch and non-patch groups (6.0% vs. 1.7%), with a median follow-up of 1.1 years. Factors associated with patch use included multiple TV orifices, absence of severe inferior leaflet displacement, and absence of extreme TV rotation.

Conclusions:

• Autologous pericardial patch augmentation of the septal leaflet is an effective complementary technique during Cone repair for Ebstein's anomaly.
• This approach provides comparable early tricuspid valve function and freedom from re-operation.
• The findings support the use of pericardial patches in specific EA morphologies to optimize surgical repair outcomes.