Key result
The cone procedure resulted in an 85% reduction in tricuspid valve regurgitation at discharge compared to a 56% reduction with conventional surgery (P=.004).
Why the study?
Does the cone procedure improve short-term outcomes compared to conventional surgery in patients with Ebstein's malformation?
Cohort (n=32)
No
Does the cone procedure improve short-term outcomes compared to conventional surgery in patients with Ebstein's malformation?
Absolute Event Rate: 85% vs 56%
p-value: p=.004
The cone procedure for Ebstein's malformation yields similar short-term clinical outcomes to conventional surgery but provides significantly greater early reduction in tricuspid valve regurgitation.
Cone procedure linked to greater early TR reduction in Ebstein's; similar short-term outcomes leave open need for randomized confirmation.
OBJECTIVES: We report our analysis of conventional surgery and the cone procedure for Ebstein's malformation (EM) of the tricuspid valve at a single institution. Previous conventional surgery for EM, including use of bioprosthetic valves, has inherent problems especially in pediatrics. The newer cone procedure aims to construct a funnel-like valve out of native leaflets, obviating problems with artificial valves. METHODS: This is a retrospective cohort study to examine short-term outcomes of both surgeries for EM. RESULTS: Nineteen patients (our initial cohort) had the cone procedure, and 13 had conventional tricuspid valve repair or replacement. No early deaths occurred in either group. Three cone and one conventional repair patients required reoperation. Two of 19 patients in the cone and one of 13 in the conventional group died suddenly >30 days after operation, assumed secondary to dysrhythmias. At discharge, by two-dimensional echocardiography, the cone group had 85% reduction in tricuspid valve regurgitation (TVR), and the conventional group had 56% reduction, P= .004. This decrease of TVR persisted to a greater extent in the cone group. DISCUSSION: Short-term results for the cone procedure are similar to conventional surgery. The cone procedure uses autologous tissue; hypothetically, early favorable improvement in reduction of TVR should persist.
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Vogel et al. (2011) conducted a cohort in Ebstein's malformation of the tricuspid valve (n=32). Cone procedure vs. Conventional tricuspid valve repair or replacement was evaluated on Reduction in tricuspid valve regurgitation (TVR) at discharge (p=.004). The cone procedure resulted in an 85% reduction in tricuspid valve regurgitation at discharge compared to a 56% reduction with conventional surgery (P=.004).
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