title: Ebstein's malformation of the tricuspid valve: short-term outcomes of the "cone procedure" versus conventional surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  This is a retrospective cohort study to examine short-term outcomes of both surgeries for EM.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Cardiology and Cardiac Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115,USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Vogel
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Marx
authors.forename: Wayne
authors.initials: W
authors.lastname: Tworetzky
authors.forename: Frank
authors.initials: F
authors.lastname: Cecchin
authors.forename: Dionne
authors.initials: D
authors.lastname: Graham
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Del Nido
mesh_terms: D000293:Adolescent; D000328:Adult; D001900:Boston; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D058385:Cardiac Valve Annuloplasty; D002648:Child; D002675:Child, Preschool; D004437:Ebstein Anomaly / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D014463:Ultrasonography; D055815:Young Adult