{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:41:32Z","timestamp":1791902492844,"version":"4.3.4"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study compared long-term outcomes of surgical management for Ebstein\u2019s anomaly before and after the introduction of an individualized surgical approach at our centre, including Cone repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, single-centre analysis of patients who underwent surgery for Ebstein\u2019s anomaly between 1988 and 2022. Since 2012, early intervention to preserve right ventricular (RV) function before severe deterioration was prioritized. Survival was characterized using Kaplan-Meier estimates, and restricted mean survival time (RMST) was computed up to a specified time horizon. Covariate-adjusted hazard ratios (HRs) were modelled using Cox proportional hazards regression with LASSO-based variable selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 162 patients screened, 141 (median age: 14 years; IQR: 5-33 years) were included; 74 underwent surgery before 2012 and 67 after. Patients operated after 2012 were younger (median 7, IQR 1-14 vs 22, IQR 14-44 years; P\u2009&amp;lt;\u20090.001) and more frequently received Cone repair, either alone or combined with a bidirectional Glenn procedure (BDG). Five-year survival improved progressively over the analysed periods: from 81.7% (95% CI: 63.7%-91.3%) before January 2000, to 90% (95% CI: 75.4%-96.1%) between January 2000 and August 2012, reaching 98.5% (95% CI: 89.9%-99.8%) after August 2012. The survival difference before and after 2012 was significant (RMST-based log-rank test: P\u2009=\u20090.0094). Cox regression identified Carpentier classification above type B (HR: 6.19; 95% CI: 1.69-22.68; P\u2009=\u20090.006) and postoperative sepsis within 30 days (HR: 7.75; 95% CI: 2.09-28.75; P\u2009=\u20090.002) as risk factors for increased mortality. Cone repair itself was not associated with increased mortality (HR: 1.01; 95% CI: 0.11-9.57; P\u2009=\u20090.991), whereas BDG was associated with a lower hazard (HR: 0.11; 95% CI: 0.01-0.92; P\u2009=\u20090.041).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An individualized strategy that favoured earlier intervention, including Cone repair with or without BDG, was associated with improved survival. These findings highlight the importance of tailoring surgical strategies to anatomical and haemodynamic status in Ebstein\u2019s anomaly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf306","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:54:42Z","timestamp":1765976082000},"source":"Crossref","is-referenced-by-count":1,"title":["Treatment Strategies in Ebstein\u2019s Anomaly: An Observational Study Over Three Decades"],"prefix":"10.1093","volume":"41","author":[{"given":"Peter","family":"Murin","sequence":"first","affiliation":[{"name":"Department of Congenital Heart Surgery\u2014Pediatric Heart Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]},{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna , 1090 Vienna,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Lorenzen","sequence":"additional","affiliation":[{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]},{"name":"Department of Congenital Heart Disease\u2014Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Romanchenko","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Surgery\u2014Pediatric Heart Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Winter","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Surgery\u2014Pediatric Heart Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]},{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna , 1090 Vienna,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoria","family":"Weixler","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Surgery\u2014Pediatric Heart Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislav","family":"Ovroutski","sequence":"additional","affiliation":[{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]},{"name":"Department of Congenital Heart Disease\u2014Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi-Young","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Surgery\u2014Pediatric Heart Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titus","family":"K\u00fchne","sequence":"additional","affiliation":[{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]},{"name":"Department of Congenital Heart Disease\u2014Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Berger","sequence":"additional","affiliation":[{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]},{"name":"Department of Congenital Heart Disease\u2014Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Photiadis","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Surgery\u2014Pediatric Heart Surgery, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Kelm","sequence":"additional","affiliation":[{"name":"Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin , 13353 Berlin,","place":["Germany"]},{"name":"Department of Congenital Heart Disease\u2014Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]},{"name":"Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charit\u00e9 , 13353 Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"2026012304320962500_ivaf306-B1","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/S0022-5223(19)40958-6","article-title":"The spectrum of Ebstein\u2019s anomaly of the tricuspid valve","volume":"77","author":"Zuberbuhler","year":"1979","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026012304320962500_ivaf306-B2","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/S0022-5223(99)70480-0","article-title":"Morphologic spectrum of Ebstein\u2019s malformation: revisitation relative to surgical 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The operation: early and midterm results","volume":"133","author":"da Silva","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026012304320962500_ivaf306-B13","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.xjtc.2020.05.033","article-title":"Ebstein repair: how I do it","volume":"3","author":"Dearani, Joseph","year":"2020","journal-title":"JTCVS Tech"},{"key":"2026012304320962500_ivaf306-B14","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.athoracsur.2012.04.146","article-title":"Anatomic repair of Ebstein\u2019s malformation: lessons learned with reconstruction","volume":"95","author":"Dearani","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2026012304320962500_ivaf306-B15","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.athoracsur.2017.09.058","article-title":"Improving results of surgery for Ebstein anomaly: where are we after 235 cone repairs?","volume":"105","author":"Holst","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2026012304320962500_ivaf306-B16","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1016\/j.athoracsur.2009.07.019","article-title":"Selective right ventricular unloading and novel technical concepts in Ebstein\u2019s anomaly","volume":"88","author":"Malhotra","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"2026012304320962500_ivaf306-B17","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1093\/ejcts\/ezu472","article-title":"Da Silva\u2019s cone repair for Ebstein\u2019s anomaly: effect on right ventricular size and function","volume":"48","author":"Lange","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012304320962500_ivaf306-B18","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.jtcvs.2014.12.074","article-title":"Cone reconstruction for Ebstein\u2019s anomaly: patient outcomes, biventricular function, and cardiopulmonary exercise capacity","volume":"149","author":"Ibrahim","year":"2015","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026012304320962500_ivaf306-B19","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/j.jtcvs.2020.05.032","article-title":"Cone versus conventional repair for Ebstein\u2019s anomaly","volume":"160","author":"Burri","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026012304320962500_ivaf306-B20","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.jtcvs.2012.06.029","article-title":"An empirically based tool for analyzing morbidity associated with operations for congenital heart disease","volume":"145","author":"Jacobs","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026012304320962500_ivaf306-B21","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1093\/icvts\/ivy102","article-title":"Statistical primer: how to deal with missing data in scientific research?","volume":"27","author":"Papageorgiou","year":"2018","journal-title":"Interact CardioVasc Thorac Surg"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf306\/66015020\/ivaf306.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/1\/ivaf306\/66015020\/ivaf306.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/1\/ivaf306\/66015020\/ivaf306.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:32:19Z","timestamp":1769160739000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf306\/8383905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,6]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf306","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,12,18]]},"article-number":"ivaf306"}}