Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1627940
Oral Presentations
Sunday, February 18, 2018
DGTHG: Congenital – Valvular Heart Disease
Georg Thieme Verlag KG Stuttgart · New York

Type of Ebstein’s Surgery Affects Reoperation Rate

M. Burri
1   Department of Thoracic and Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany
,
Agua K. Mrad
1   Department of Thoracic and Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany
,
J. Cleuziou
1   Department of Thoracic and Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany
,
R. Lange
1   Department of Thoracic and Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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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%.

Table 1 Mortality and reoperations in the subgroups

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.