• Syed Faaz Ashraf, Jose Pedro Da Silva, Mario Castro-Medina, Melita Viegas, Tarek Alsaied, Laura Seese, Victor O Morell, and Luciana Da Fonseca Da Silva.
• Division of Pediatric Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 22.

ObjectivesWe present a case series of Right Ventricle (RV) rehabilitation after Starnes in patients with Ebstein anomaly, applying the Cone repair of the tricuspid valve (TV) to achieve biventricular or 1.5-ventricle physiology.MethodsThis is a retrospective database analysis from two institutions in North America. We included all consecutive cases of Cone repair after the Starnes procedure. The data are expressed as median and interquartile range (IQR).ResultsEleven patients underwent RV rehabilitation between 2019 and 2023 after initial Starnes palliation with a median age of 27 months (IQR 20.5). All were critically ill before their Starnes procedure; four were on extracorporeal membrane oxygenation. Before the Cone repair, the median pre-operative regurgitant velocity at the Starnes patch was 1.65 m/s (IQR 1.3). During the Cone procedure, nine patients required a concomitant PV repair, of which three required a transannular monocusp patch. Four patients were successfully rerouted to a two-ventricle repair, and seven patients with a previous Glenn achieved 1.5 ventricle circulation. There was no heart block and no deaths. Seven patients had trivial regurgitation in a median follow-up of eleven months (IQR 21.5), three mild and one moderate tricuspid regurgitation. There was no significant TV stenosis; all patients had good functional status at the last follow-up despite severe RV dysfunction in one patient.ConclusionsAfter the Starnes procedure, the Cone repair allowed RV rehabilitation, resulting in trivial or mild TV regurgitation sustained in midterm follow-up. The Starnes procedure is a reproducible technique that no longer commits patients to lifetime single ventricle physiology.Copyright © 2024. Published by Elsevier Inc.

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