Septal leaflet augmentation during Da Silva cone repair: Valvar function and anatomic features compared to nonpatch repair

OBJECTIVE To evaluate outcomes of Da Silva Cone repair (CR) using autologous pericardial patch for septal leaflet augmentation in Ebstein's anomaly (EA) and identify tricuspid valve (TV) morphology associated with patch use. METHODS A single-site retrospective study included patients undergoing CR for EA from Jan 2016-Nov 2024. Patients with prior Starnes procedure or TV surgery were excluded. Patients were categorized into patch and non-patch groups. The primary outcome was TV function (stenosis or regurgitation) at latest follow-up with a secondary composite outcome including re-operation or >moderate residual tricuspid regurgitation (TR). Adjusted regression analyses identified factors associated with outcomes and patch augmentation. RESULTS Of 134 patients identified, 108 were included (50 patch, 58 non-patch). Patch patients were older (13.1 vs. 6.9 years, p=0.04). TR improved from ≥moderate in 78.7% pre-CR to ≤mild in 79.0% at follow-up. TV function and follow-up TV-related re-operation rates (6.0% vs. 1.7%) were comparable between groups (p>0.05) with a median follow-up of 1.1 years (IQR 0.6-3.2). Intraoperative factors associated with patch use were multiple TV orifices (OR=4.24, 95%CI: 1.59-11.27, p<0.01), absence of severe inferior leaflet displacement (OR=3.24, 95%CI: 1.11-9.47, p=0.03), and absence of extreme TV rotation (OR=3.19, 95%CI: 1.21-8.41, p=0.02). CONCLUSIONS Autologous pericardial patch augmentation of the septal leaflet provides comparable early TV function and freedom from re-operation, making it an effective complement during CR.