Vogel Melanie, Marx Gerald R, Tworetzky Wayne, Cecchin Frank, Graham Dionne, Mayer John E, Pigula Frank A, Bacha Emile A, Del Nido Pedro J
Departments of Cardiology and Cardiac Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115,USA.
Congenit Heart Dis. 2012 Jan-Feb;7(1):50-8. doi: 10.1111/j.1747-0803.2011.00603.x. Epub 2011 Dec 18.
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.
This is a retrospective cohort study to examine short-term outcomes of both surgeries for EM.
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.
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.
我们报告了在单一机构对三尖瓣埃布斯坦畸形（EM）进行传统手术和圆锥手术的分析。先前针对EM的传统手术，包括使用生物瓣膜，存在固有问题，尤其是在儿科患者中。更新的圆锥手术旨在用天然瓣叶构建一个漏斗状瓣膜，从而避免人工瓣膜的问题。
这是一项回顾性队列研究，旨在检查两种治疗EM手术的短期结果。
19例患者（我们的初始队列）接受了圆锥手术，13例接受了传统三尖瓣修复或置换术。两组均未发生早期死亡。3例接受圆锥手术和1例接受传统修复手术的患者需要再次手术。圆锥手术组的19例患者中有2例，传统手术组的13例患者中有1例在术后30天以上突然死亡，推测是心律失常所致。出院时，通过二维超声心动图检查，圆锥手术组的三尖瓣反流（TVR）减少了85%，传统手术组减少了56%，P = .004。TVR的这种降低在圆锥手术组中持续的程度更大。
圆锥手术的短期结果与传统手术相似。圆锥手术使用自体组织；假设TVR减少的早期良好改善应该会持续。
