Eur J Cardiothorac Surg. 2026 Feb 5;68(2):ezag063. doi: 10.1093/ejcts/ezag063.
ABSTRACT
OBJECTIVES: Congenital aortic valve (AoV) disease has limited treatment options in growing children. Different initial strategies, AoV repair/surgical valvuloplasty (SAV), AoV replacement (AVR), and Ross procedure were compared to elucidate the current best strategy.
METHODS: All paediatric patients undergoing different initial AoV surgeries from 1976 to 2024 were included. Factors including prior balloon dilation (balloon valvuloplasty [BAV]), valve morphology, and initial disease (stenosis/regurgitation/mixed) were analysed. Survival and incidence of AoV reoperation/≥moderate AoV insufficiency/stenosis were evaluated.
RESULTS: A total of 323 patients underwent 142 SAV/33 AVR/137 Ross at median age/weight of 5.7 years [interquartile range, 0.5-12.6]/19.9 kg [6.9-48.8]. Surgical valvuloplasty group was the youngest (P < .01). Thirty-day mortality was 2.5% (8/323) without group differences (P = .15). Median follow-up was 9.6 years [2.7-17.8] with 10-/20-year survival rates of 90.4% [86.1-93.4]/87.1% [81.4-91.1] without group differences. Twenty-year cumulative incidences of AoV reoperations were higher after SAV: 78.4% [70.8-86.9] vs 24.6% [11.7-51.7] after AVR and 15% [6.8-33.1] after Ross, P < .01. Survivors with their native AoV at 20 years (n = 48, 14.8%) were younger at initial surgery (P < .01), had predominantly AoV stenosis (91.7%), and had fewer BAVs (P < .01). Cox regression demonstrated 7.8-fold higher mortality hazard after AVR (P < .01) and a lower reoperation hazard after AVR and Ross (HR 0.1 [95% CI, 0.1-0.5], P < .01 and HR 0.1 [95% CI, 0.1-0.3], P < .01) compared to SAV.
CONCLUSIONS: All initial AoV surgeries brought excellent early/long-term survival. Aortic valve reoperations occur most frequently after SAV. In case of favourable AoV anatomy, early SAV can preserve the native valve. Ross procedure identified as safe and durable.
PMID:41666304 | DOI:10.1093/ejcts/ezag063
