Impact of Cone vs. Hetzer Repair on Postoperative Outcomes in Patients With Ebstein's Anomaly: 10-Year Experience From a Single Institution

Objective: The aim of this study was to compare the early outcomes of the cone and Hetzer procedures for Ebstein's malformation.Methods: This retrospective study included patients who underwent either cone (n = 83) or Hetzer repair (n = 45) with Ebstein's malformation from January 2011 to December 2020.Results: One early death occurred in the cone group due to low cardiac output syndrome. Five cone and three Hetzer repair patients required reoperation before discharge. At discharge, the cone group had a better reduction in tricuspid valve regurgitation (TR) than the Hetzer group (74.7 vs. 51.1%, p = 0.009). Two patients in the cone group and seven patients in the Hetzer group required reoperation >30 days after their initial surgery. The cone group with no/mild TR was 75.6%, and the Hetzer group was 48.9% at the time of last follow-up (p = 0.010).Conclusion: Short-term outcomes of the cone repair are better than the Hetzer procedure. The cone repair should be the better option among patients with Ebstein's malformation who need surgical intervention.

Cone repair for Ebstein’s anomaly and atrial fibrillation ablation in an adult patient

We present a 52-year-old woman with Ebstein’s anomaly not previously treated. In this subset of patients, there are no clear guidelines regarding the best surgical strategy for treating the tricuspid valve: replace it or repair it. In this case, extensive repair of the tricuspid valve and the right ventricle is achieved using the cone repair technique popularized by Dr. José Pedro Da Silva. Because the patient also presented with symptomatic paroxysmal atrial fibrillation, a right atrial maze procedure combined with isolation of the pulmonary veins was performed using both radiofrequency and cryotherapy. At the last follow-up, 2 years after the repair, the patient is asymptomatic and maintains sinus rhythm. The last echocardiogram showed mild tricuspid regurgitation with normal right ventricular function.

Recent Surgical Outcomes of Ebstein’s Anomaly: A Focus on Changes in Outcomes Due to Cone Repair

Background: Ebstein’s anomaly exhibits a wide variety of clinical features, and therefore, proposing a standardized treatment for it is difficult. This study was conducted to determine whether Cone repair, which has been implemented in our hospital since 2008, is more effective than conventional repair.Methods: We retrospectively analyzed the clinical information of patients with Ebstein’s anomaly who were followed-up at the hospital from 2000 to 2019. A total of 61 patients who had undergone tricuspid valve repair after 2000 were divided into the conventional and Cone repair groups and their clinical outcomes were compared.Results: Of the 170 patients, 82 (48.2%) patients received surgical treatment for the tricuspid valve, whereas 75 patients received only medical treatment. The median follow-up duration was 5.89 years. After surgery, tricuspid valve regurgitation decreased and aortic stroke volume increased in both the Cone and conventional repair groups. In the Cone repair group, no mortality and postoperative complete atrioventricular block occurred and significantly fewer cases of moderate to severe tricuspid valve regurgitation were noted after surgery compared with the conventional repair group.Conclusions: Cone repair is thought to be a method with less mortality and less occurrence of complete atrioventricular block than conventional repair.