Strategies for Tricuspid Re-Repair in Ebstein Malformation Using the Cone Technique
| Autor: | Joseph A. Dearani, Roxann B. Pike, Harold M. Burkhart, Patrick W. O'Leary, Frank Cetta, Sameh M. Said |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Treatment outcome Young Adult medicine Humans Child Aged Retrospective Studies Anterior leaflet Tricuspid valve business.industry Reproducibility of Results Retrospective cohort study Cavopulmonary Anastomosis Middle Aged medicine.disease Surgery Ebstein Anomaly Treatment Outcome medicine.anatomical_structure EBSTEIN ANOMALY Ventricle Child Preschool Heart failure Practice Guidelines as Topic Feasibility Studies Female Tricuspid Valve Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 96:202-210 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2013.02.067 |
| Popis: | Background Successful tricuspid repair for Ebstein malformation (EM) is challenging. Cone repair has recently emerged as the most anatomic repair technique. There are no data on tricuspid re-repair in EM. We reviewed our experience with tricuspid valve (TV) re-repair using a cone technique. Methods Between June 2007 and October 2012, 134 patients underwent cone repair. Prior TV repair was performed in 20 patients (10 female, 50%). Median age was 15 years (range, 4 to 68 years). Four patients (20%) had prior bidirectional cavopulmonary anastomosis (BDCPA). Preoperative heart failure was present in 8 patients (40%). Recurrent tricuspid regurgitation (TR) was due to incomplete leaflet coaptation with tethered anterior leaflet in all patients; and 10 patients (50%) had diminutive septal leaflet. Prior repair techniques consisted of annuloplasty maneuvers in all patients with no or incomplete surgical delamination in all patients. Results The TV re-repair using cone technique was possible in all patients. Plication of atrialized right ventricle was done in 6 patients (30%). Modifications included annuloplasty band in 16 patients (80%) and TV leaflet augmentation in 8 (40%). The BDCPA was performed in 3 patients (15%) and modified Cox-maze procedure was done in 10 (50%). There were no mortalities or reoperations. Mean follow-up was 7.7 ± 10.7 months; during follow-up, 18 patients had no or mild TR and 2 had moderate TR. Conclusions TV re-repair in EM using the cone technique is feasible, particularly when there has been no surgical leaflet delamination at initial operation. Leaflet augmentation facilitates and annuloplasty band stabilizes a competent TV re-repair. Longer follow-up is required to assess durability. |
| Databáze: | OpenAIRE |
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