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AIM: The study compared our results of two techniques of biventricular repair in pediatric patients with Ebstein anomaly. BACKGROUND: Ebstein anomaly comprise a diversity of clinical presentations and hence a multitude of surgical techniques of repair. In a group of patients who deemed candidates for biventricular repair there are two common techniques of repair the simplest is Mayo clinic repair and the other is cone repair.
METHODS: A retrospective single center review of pediatric patients who underwent biventricular repair for Ebstein anomaly Between 2008 and 2018. Exclusion criteria were neonatal presentation, Tricuspid valve replacement and patients older than 16 years old as they managed in adult cardiac center. There were 17patients done by Mayo clinic technique and 14 patients by the recently introduced cone repair. The early outcome in both groups were evaluated regarding; the post-operative course, occurrence of low cardiac output, Reopening, Cardiac morbidity, ICU length of stay and presence of Significant Tricuspid regurgitation (defined as more than mild at 6 months in postoperative follow up echocardiography).
RESULTS: there were 31 patients enrolled in the study the mean follow up period was 24.0 ±9.38 months, range ( 12- 42 months), The study included 17 patients who received Mayo clinic repair, their median age was 36 months range (9 – 137) months and median weight was 13.5 kg range (7.5 -32) kg. while in Cone group repair the results were 47 months, range (19 -127) months and 15.5 kg range (11-30) kg respectively. There were no statistically significant differences among both groups regarding the incidence of postoperative cardiac morbidities, but the differences in ICU and postoperative Tricuspid regurgitation were statistically significant.
CONCLUSION: In spite of the diversity of available techniques for biventricular repair of pediatric Ebstein anomaly the Cone repair offer both anatomical and physiologic correction of those group of patients. The leaflet to leaflet interface and the shift up annular reconstruction alleviate the pathophysiologic alterations in Ebstein anomaly.