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Postoperative survival at 10, 20, and 30\u00a0years was 97%, 93%, and 80%. Eighty-one (40%) patients underwent multiple surgeries. Re-operation rates were lowest in patients with first valve surgery during adolescence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0076). Postoperative NYHA class\u2009&gt;\u2009I was more frequent with surgery delayed to older age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Initial corrective surgery was complicated by complete atrioventricular block (CAVB) in 17 (9%) of patients. CAVB was more likely with older age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), and tricuspid valve replacement compared to reconstruction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). CAVB was associated with all-cause death (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Cone reconstruction reduced the risk of CAVB (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008) and tricuspid valve regurgitation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared to monocusp reconstruction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This registry-based study of Ebstein\u2019s anomaly corroborates good surgical long-term results, while re-operation rates remain high. Patients operated before adolescence were at the highest risk of re-operation, while older age at the time of the first surgery increased the risk of CAVB. The cone reconstruction was associated with improved tricuspid valve function and a lower risk of CAVB compared to monocusp reconstructions. Choosing an optimal time window for surgery and use of the cone reconstruction may therefore further improve outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02874-x","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T07:12:02Z","timestamp":1772608322000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for morbidity and mortality in Ebstein\u2019s anomaly: a registry-based study of 398 patients"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2383-3593","authenticated-orcid":false,"given":"Stephan","family":"Neumann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa K.","family":"Heneka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Jerosch-Herold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerhard","family":"Sch\u00f6n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike M. 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