Autologous pericardial patch augmentation during Da Silva cone repair yielded comparable early TV function and re-operation rates (6.0% vs. 1.7%, p>0.05) compared to non-patch repair.
Cohort (n=108)
No
Does autologous pericardial patch augmentation during Da Silva Cone repair improve tricuspid valve function in patients with Ebstein's anomaly?
Autologous pericardial patch augmentation of the septal leaflet during Da Silva Cone repair provides comparable early tricuspid valve function and freedom from re-operation compared to non-patch repair.
Absolute Event Rate: 6% vs 1.7%
p-value: p=>0.05
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.
Stoll et al. (Sun,) conducted a cohort in Ebstein's anomaly (n=108). Da Silva Cone repair with autologous pericardial patch for septal leaflet augmentation vs. Non-patch repair was evaluated on TV function (stenosis or regurgitation) and TV-related re-operation (p=>0.05). Autologous pericardial patch augmentation during Da Silva cone repair yielded comparable early TV function and re-operation rates (6.0% vs. 1.7%, p>0.05) compared to non-patch repair.