Key result
Prosthesis-free cone reconstruction linked to ~34% higher odds of TR reduction in pediatric Ebstein anomaly.
Why the study?
The study was designed to evaluate the surgical outcomes of cone reconstruction in paediatric patients with Ebstein anomaly.
Does cone reconstruction without prosthetic annuloplasty materials improve tricuspid valve function and biventricular remodeling in paediatric patients with Ebstein anomaly?
Cohort (n=17)
Does cone reconstruction without prosthetic annuloplasty materials improve tricuspid valve function and biventricular remodeling in paediatric patients with Ebstein anomaly?
Cone reconstruction without prosthetic annuloplasty materials in pediatric patients with Ebstein anomaly provides durable reduction of tricuspid regurgitation and allows for sustained tricuspid valve growth over long-term follow-up.
Answers are grounded in this paper and cite their sources.
May support cone reconstruction in pediatric Ebstein anomaly; leaves open confirmation by prospective randomized trials.
OBJECTIVES: This study aimed to evaluate the surgical outcomes of cone reconstruction (CR) in paediatric patients with Ebstein anomaly (EA). METHODS: We retrospectively reviewed seventeen paediatric patients (<18 years) with EA (Carpentier types A, B, and C in 3, 12, and 2, respectively) who underwent CR without prosthetic annuloplasty materials between January 2014 and December 2024. Clinical outcomes, including tricuspid valve (TV) and biventricular function and size, were evaluated using echocardiography and cardiac magnetic resonance imaging (CMR). RESULTS: The median age and body weight at surgery were 7.8 years and 21.2 kg, respectively. No operative mortality occurred; however, three patients required permanent pacemaker implantation before discharge. No late deaths, reoperations, or significant tricuspid regurgitation (TR, ≥moderate) or stenosis (mean pressure gradient ≥5 mmHg) occurred during the 8.2-year median follow-up. TR was significantly reduced postoperatively (odds ratio 1.34, 95% confidence interval: 1.10 to 1.64, p = 0.008) and remained stable without recurrence of significant TR during follow-up. The mean TV annulus z-score decreased significantly after CR (1.81 [1.19] preoperatively versus -1.74 [0.92] at discharge, mean difference: -3.55, 95% confidence interval: -4.30 to -2.80, p < 0.001) and remained within the normal range during follow-up (-1.74 [0.92] at discharge versus -1.61 [1.11] at the last follow-up, mean difference: 0.04, 95% confidence interval: -0.02 to 0.10, p = 0.207). Postoperative CMR demonstrated significantly reduced TR fraction and right heart volumetric parameters, except functional right ventricular end-systolic volume and pulmonary forward flow volume indices. Based on CMR, left ventricular end-diastolic (change 2.40, 95% confidence interval: 0.52 to 4.27, p = 0.014) and systolic (change 1.75, 95% confidence interval: 0.74 to 2.76, p = 0.002) volume indices significantly increased over time. CONCLUSIONS: Long-term outcomes after CR without prosthetic annuloplasty materials were favourable in paediatric patients with EA. CR can achieve durable reduction of TR with sustained TV growth, potentially facilitating biventricular reverse remodelling.
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Lee et al. (2026) conducted a cohort in Ebstein anomaly (n=17). Cone reconstruction without prosthetic annuloplasty materials was evaluated on Tricuspid regurgitation reduction (OR 1.34, 95% CI 1.10 to 1.64, p=0.008). Cone reconstruction without prosthetic annuloplasty materials in paediatric patients with Ebstein anomaly significantly reduced tricuspid regurgitation (OR 1.34; 95% CI 1.10-1.64; p=0.008).
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