Type of Ebstein’s Surgery Affects Reoperation Rate

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.

No conflict of interest has been declared by the author(s).