Outcome analysis of bioprosthetic valve replacement in patients aged ≥ 50 years with Ebstein's anomaly

Cone reconstruction has become the preferred surgical technique for Ebstein's anomaly (EA). However, some patients aged ≥ 50 years are unsuitable for repair due to severe leaflet dysplasia, marked annular dilation, or impaired right ventricular function. This study evaluates the clinical outcomes of domestic bioprosthetic valve replacement in patients aged ≥ 50 years with EA.

A retrospective analysis was conducted on 15 consecutive patients aged ≥ 50 years with EA who underwent initial bioprosthetic tricuspid valve replacement at the Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Medical University, from June 2019 to August 2024. Preoperative evaluations included electrocardiography, echocardiography, chest CT, and coronary angiography. Operative times, cardiopulmonary bypass time, aortic cross-clamp time, perioperative complications, and mortality were recorded. Follow-up assessed cardiac function, valve performance, and cardiac chamber dimensions.

Among the 15 patients (11 females, 4 males; mean age 55.0 ± 4.2 years), cardiopulmonary bypass time was 127.9 ± 20.4 min and aortic cross-clamp time 69.5 ± 17.5 min. One patient died of cardiogenic shock on postoperative day 8. The remaining 14 were discharged alive. During follow-up (1-39 months), 13 patients (92.6%) of 14 survivors were followed; no late deaths or reoperations occurred. Symptomatic improvement was observed in 12 patients. No moderate or severe tricuspid regurgitation or bioprosthetic stenosis was detected.

Bioprosthetic valve replacement appears feasible with acceptable early outcomes in patients aged ≥ 50 years with EA who are unsuitable for cone reconstruction, significantly improving symptoms in most patients. These preliminary findings require validation in larger studies with longer follow‑up.