Cone Reconstruction for Ebstein Anomaly: Ventricular Remodeling and Preliminary Impact of Stem Cell Therapy.

Abstract

OBJECTIVE:

To define the impact of tricuspid valve cone reconstruction (CR) on ventricular performance in Ebstein anomaly, both independently and after stem cell therapy.

PATIENTS AND METHODS:

The control group included 257 patients who had CR between June 2007 and December 2019. Ten subjects of a phase I stem cell therapy trial (May 2017 - March 2019) were compared with the controls to assess the echocardiographic impact on ventricular remodeling.

RESULTS:

After CR, right ventricular (RV) size decreased and left ventricular (LV) volume increased in all patients. Apical and biplane RV fractional area change (FAC) initially decreased, but rebounded by 6 months postoperation. Short-axis FAC increased early and was maintained at 6 months post-CR in the control group. At 6 months post-CR, cell therapy patients showed a significantly larger increase in short-axis FAC (24.4% vs 29.9%, P=.003). In addition, whereas LV ejection fraction (EF) was unchanged at 6 months post-CR in controls, cell therapy patients showed a significant increase in EF relative to baseline and to controls (55.6% vs 65.0%, P=.007).

CONCLUSION:

Cone reconstruction reduces tricuspid regurgitation and RV size, but is also associated with increased RV FAC and LV volume. Furthermore, injection of bone marrow-derived stem cells augmented the increase in RV FAC and was associated with improved LV EF at 6 months post-CR. This is evidence of a favorable interventricular interaction. These findings provide motivation for continued investigation into the potential benefits of stem cell therapy in Ebstein anomaly and other congenital cardiac malformations.

TRIAL REGISTRATION:

clinicaltrials.gov identifier: NCT02914171.

• Authors: Patrick W O'Leary, M Yasir Qureshi, Frank Cetta, Timothy J Nelson, Kimberly A Holst, Joseph A Dearani, Wanek Program Clinical Pipeline Group
• Journal: Mayo Clinic proceedings (Mayo Clin Proc) Vol. 96 Issue 12 Pg. 3053-3061 (12 2021) ISSN: 1942-5546 [Electronic] England
• PMID: 34479739 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Ebstein Anomaly (diagnostic imaging, surgery)
• Echocardiography
• Humans
• Middle Aged
• Plastic Surgery Procedures (methods)
• Stem Cell Transplantation (methods)
• Treatment Outcome
• Tricuspid Valve (diagnostic imaging, surgery)
• Ventricular Function, Right
• Ventricular Remodeling
• Young Adult