Long-term outcomes of aortic valve repair in children after infancy.

Abstract

We evaluated the long-term outcomes of children who underwent aortic valve repair after infancy. A retrospective, single institutional study of all children aged 1 year or more who underwent primary aortic valve repair between 1980 and 2024 was performed (N = 326). The median age of patients at time of aortic valve repair was 9.4 years (interquartile range, 4.8-14.2). Repair was achieved without patch material in 49.7% of patients (162/326). Early mortality was 0.61% (2/326). Late death was 1.85% (6/324). Median follow-up was 9.04 (interquartile range, 3.4-16.6) years. Kaplan-Meier estimated survival at 10, 15, and 20 years was 98.4%, 97.9%, and 94.9%, respectively. Freedom from aortic valve reoperation at 5, 10, 15, and 20 years was 85.6%, 74.1%, 59.1%, and 55.0%, respectively. Freedom from aortic valve replacement at 5, 10, 15, and 20 years was 92.2%, 79.5%, 65.7%, and 61.7%, respectively. Twenty-year freedom from prosthetic aortic valve replacement was 79.1%. During follow-up, 83 patients (25.5%, 83/326) underwent 101 aortic valve reoperations including 26 redo repairs, 35 Ross operations, and 40 prosthetic aortic valve replacements. Independent risk factors for aortic valve replacement were previous balloon aortic valvuloplasty (hazard ratio, 2.34; 95% CI, 1.27-4.30; P = .006), aortic valve repair requiring CardioCel patch (hazard ratio, 4.30; 95% CI, 1.89-9.74; P < .001), and subcommissural annuloplasty (hazard ratio, 3.37; 95% CI, 1.56-7.28; P = .002). In children who underwent aortic valve repair after infancy, 15-year freedom from aortic valve reoperation and replacement was 59% and 66%, respectively, with most undergoing a subsequent Ross operation or redo aortic valve repair. Thus, in the lifelong management of aortic valve disease in children after infancy, a strategy of initial aortic valve repair allowed the majority of patients to progress through childhood without further aortic valve surgery and defers prosthetic aortic valve replacement well into adult life.