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

Abstract

To evaluate outcomes of Da Silva cone repair (CR) using autologous pericardial patch for septal leaflet augmentation in Ebstein anomaly (EA) and identify tricuspid valve (TV) morphology associated with patch use. This single-site retrospective study included patients undergoing CR for EA between January 2016 and November 2024. Patients with a prior Starnes procedure or TV surgery were excluded. Patients were categorized into patch and nonpatch groups. The primary outcome was TV function (stenosis or regurgitation) at the latest follow-up, with a secondary composite outcome including reoperation or >moderate residual tricuspid regurgitation (TR). Adjusted regression analyses identified factors associated with outcomes and patch augmentation. Of 134 patients identified, 108 were included in our analysis (50 patch, 58 nonpatch). Patch patients were older (13.1 vs 6.9 years; P = .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 reoperation rates were comparable in the patch and nonpatch groups (6.0% vs 1.7%; P > .05), with a median follow-up of 1.1 years (interquartile range, 0.6-3.2 years). Intraoperative factors associated with patch use were multiple TV orifices (odds ratio [OR], 4.24; 95% confidence interval [CI], 1.59-11.27; P < .01), absence of severe inferior leaflet displacement (OR, 3.24; 95% CI, 1.11-9.47; P = .03), and absence of extreme TV rotation (OR, 3.19; 95% CI, 1.21-8.41; P = .02). Autologous pericardial patch augmentation of the septal leaflet provides comparable early TV function and freedom from reoperation, making it an effective complement during CR.