Kimberly A. Holst, MD, Joseph A. Dearani, MD, Sameh Said, MD, Roxann B

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Presentation transcript:

Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs? Kimberly A. Holst, MD, Joseph A. Dearani, MD, Sameh Said, MD, Roxann B. Pike, MD, Heidi M. Connolly, MD, Bryan C. Cannon, MD, Kristen L. Sessions, BS, Megan M. O'Byrne, MA, Patrick W. O’Leary, MD The Annals of Thoracic Surgery Volume 105, Issue 1, Pages 160-168 (January 2018) DOI: 10.1016/j.athoracsur.2017.09.058 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10. 1016/j The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10.1016/j.athoracsur.2017.09.058) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Tricuspid valve (TV) leaflet augmentations. Tricuspid valve leaflet augmentation can be performed using either autologous pericardium or CorMatrix membrane (A) to increase height of the anterior TV leaflet or (B) to increase diameter of TV annulus. (C) Autologous neochordae may be created when there is a linear attachment of the leading edge of the anterior leaflet to the right ventricular endocardium. (Reprinted from [8] with permission from The Society of Thoracic Surgeons.) The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10.1016/j.athoracsur.2017.09.058) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Inhospital early reoperation for recurrent tricuspid valve (TV) regurgitation. The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10.1016/j.athoracsur.2017.09.058) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Serial changes in indexed apical right ventricle diastolic area (gray bars) and apical fractional area change (black bars). Mean difference ± SD in apical right ventricle fractional area change was −13.5% ± 8.6%, 6.1% ± 8.5%, and −7.6% ± 8.9%; and indexed apical right ventricle diastolic area was −8.8 ± 6.3 cm2, −3.0 ± 5.3 cm2, and −11.7 ± 7.9 cm2 when comparing preoperative (Preop) with dismissal, dismissal with late, and preoperative with late echocardiograms, respectively (p < 0.0001 for all comparisons). (FAC = fractional area change; preop = preoperative; RV = right ventricle.) The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10.1016/j.athoracsur.2017.09.058) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Paired comparisons of echocardiographic changes after cone repair for Ebstein anomaly: (A) tricuspid valve regurgitation; (B) right ventricle enlargement; and (C) right ventricle dysfunction. Black bars indicate better; light gray bars indicate same; dark gray bars indicate worse. (RV = right ventricle; TV = tricuspid valve.) The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10.1016/j.athoracsur.2017.09.058) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Late survival: overall (black line), pediatric patients (green line); and adult patients (red line). (No. = number; Peds = pediatric patients.) The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10.1016/j.athoracsur.2017.09.058) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Freedom from reoperation: overall (black line), pediatric patients (green line); and adult patients (red line). (No. = number; Peds = pediatric patients; Re-ops = reoperations.) The Annals of Thoracic Surgery 2018 105, 160-168DOI: (10.1016/j.athoracsur.2017.09.058) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions