What is the clinical evidence from this study?

Study design: Cohort. Population: Single-ventricle pediatric patients requiring common atrioventricular valve (CAVV) surgery (n=91). Intervention: Mechanical valve replacement vs. Valvuloplasty. Primary outcome: In-hospital mortality (p=>0.050).

What does this research mean for the field?

Mechanical valve replacement of the common atrioventricular valve in single-ventricle pediatric patients yields similar in-hospital mortality and overall mid-term survival compared to valvuloplasty, while offering superior valve durability. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate and compare the mid-term outcomes of mechanical valve replacement and valvuloplasty for the common atrioventricular valve in single-ventricle pediatric patients.

May 16, 2026Open Access

Mid-term outcomes of valvuloplasty versus mechanical valve replacement for the common atrioventricular valve in single-ventricle pediatric patients

Key Result

Mechanical valve replacement of the CAVV in single-ventricle pediatric patients yielded similar in-hospital mortality (15.4% vs 10.3%, P>0.050) and overall survival compared to valvuloplasty.

Key Points

To evaluate and compare the mid-term outcomes of mechanical valve replacement and valvuloplasty for the common atrioventricular valve in single-ventricle pediatric patients.
Retrospective analysis of 91 pediatric patients who underwent CAVV surgery from 2014 to 2025.
Patients were divided into valvuloplasty and mechanical valve replacement groups.
Kaplan-Meier curves were used to analyze survival and reintervention rates.
In-hospital mortality was 15.4% for the replacement group and 10.3% for the valvuloplasty group (p > 0.050).
Overall survival was similar between both groups (p = 0.280).
Eight patients required reintervention after valvuloplasty, while none needed it after valve replacement.

Study Design

Type

Cohort (n=91)

Structured PICO

Does mechanical valve replacement improve overall survival and freedom from reintervention compared to valvuloplasty in single-ventricle pediatric patients undergoing CAVV surgery?

Population

91 single-ventricle pediatric patients who underwent common atrioventricular valve (CAVV) surgery between 2014 and 2025

Intervention

Mechanical valve replacement of the common atrioventricular valve (CAVV) (n=13)

Comparator

Valvuloplasty of the common atrioventricular valve (CAVV) (n=78)

Outcome

Overall survival and freedom from reinterventionhard clinical

Mechanical valve replacement of the CAVV in single-ventricle pediatric patients provides satisfactory mid-term survival comparable to valvuloplasty, with potentially superior valve durability.

Main Result

Absolute Event Rate: 15.4% vs 10.3%

p-value: p=>0.050

Abstract

Objectives To evaluate the mid-term outcomes of mechanical valve replacement of the common atrioventricular valve (CAVV) in single-ventricle pediatric patients and compare this with valvuloplasty. Methods We conducted a retrospective study of 91 single-ventricle pediatric patients who underwent CAVV surgery between 2014 and 2025. Patients were divided into two groups according to the initial surgery: valvuloplasty and mechanical valve replacement groups. Baseline and perioperative characteristics were compared between groups. Overall survival and freedom from reintervention were analyzed using Kaplan-Meier curves. Receiver operating characteristic (ROC) curve analysis and maximally selected rank statistics were used to determine the optimal cut-off values for cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) time in predicting in-hospital and late mortality. Results There were 78 cases in valvuloplasty and 13 cases in the mechanical valve replacement group. The replacement group had significantly longer CPB and ACC time ( p 0.050). The median follow-up was 39 months. Kaplan-Meier analysis showed no significant difference in overall survival ( p =0.280) and freedom from reintervention ( p =0.270). Reintervention for recurrent regurgitation was required in eight patients after ventriculoplasty, whereas no reintervention was observed following valve replacement. ROC analysis identified a CPB time of 173.5 min as the optimal cut-off for predicting in-hospital mortality,with an area under the curve (AUC) of 0.751. Patients with CPB duration exceeding 180 min had significantly poorer survival ( p =0.003). Conclusions Mechanical valve replacement of the CAVV in single-ventricle pediatric patients provides satisfactory mid-term survival comparable to valvuloplasty, but with superior valve durability. Prolonged CPB time is associated with poorer survival and should be minimized whenever possible.