The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly Roland Hetzer, MD, PhD, Paul Hacke, Mariano Javier, Oliver Miera,

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The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly Roland Hetzer, MD, PhD, Paul Hacke, Mariano Javier, Oliver Miera, MD, Katharina Schmitt, MD, PhD, Yuguo Weng, MD, PhD, Eva Maria Delmo Walter, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 5, Pages 1212-1219 (November 2015) DOI: 10.1016/j.jtcvs.2015.08.036 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Repair techniques. A, Posterior annulorrhapy: a row of sutures placed from the anterior annulus to the true annulus above the atrialized chamber, resulting in obliteration of the posterior half of the anatomic orifice (lateral view), adding the atrialized chamber to the RV. B, Atrial view showing the row of sutures along the true annulus. C, Under ventricular filling, the anterior leaflet closes the new ostium. D, Atrial view showing a competent TV. E, Sebening stitch is performed by placing a mattress suture from the anterior ventricular wall to the IVS, bringing together the tips of the anterior papillary muscles and fibrous remnants of the opposite septal leaflet. F, Double-orifice valve technique: sutures placed from the middle of the true anterior annulus to the opposite true annulus above the septal leaflet. G, Atrial view showing several sutures placed to create a double-orifice valve. H, Lateral view of the double-orifice valve technique showing a row of annular sutures and the Sebening stitch below. I, Atrial view of completed double-orifice valve technique. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1212-1219DOI: (10.1016/j.jtcvs.2015.08.036) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan–Meier curves at 95% confidence interval showing (A) cumulative survival and (B) freedom from reoperation. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1212-1219DOI: (10.1016/j.jtcvs.2015.08.036) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Functional outcomes. A, Change in NYHA functional class. B, Change in severity of tricuspid regurgitation. C, Exercise tolerance tests. D, Oxygen saturation. NYHA, New York Heart Association; VO2max, maximal oxygen consumption; O2, oxygen. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1212-1219DOI: (10.1016/j.jtcvs.2015.08.036) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Ventricular function tests by TDI. A, RV contractility, measured by pulmonary flow velocity time integral. B, LV contractility, measured by aortic flow velocity time integral. VTI, velocity time integral; RV, right ventricle/ventricular; LV, left ventricle/ventricular. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1212-1219DOI: (10.1016/j.jtcvs.2015.08.036) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Posterior annulorrhaphy at the level of the true tricuspid annulus in Ebstein's anomaly. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1212-1219DOI: (10.1016/j.jtcvs.2015.08.036) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions