KEYNOTE: Innovation in pediatric heart valve repair and replacement

Pediatric heart valve disease presents unique challenges not seen in adult populations, including issues of somatic growth and limited durability of current prosthetic materials. Current valve technologies, largely adapted from adult models, often necessitate multiple interventions throughout a child’s life. Addressing this gap requires a fundamentally different paradigm—one focused on design innovation rather than novel materials. Key priorities in pediatric valve innovation include the development of valves that can grow with the patient and maintain durability for over a decade. Insights from native human venous valves and bioinspired engineering are driving this shift. An example is the expandable annuloplasty ring under development, which combines absorbable and non-absorbable components to allow for controlled annular growth in children. Reconstructive surgical techniques are also advancing with the aid of modern imaging and computational modeling. Techniques like 3D valve segmentation, computational fluid dynamics (CFD) of the Fontan circulation, and preoperative planning using CT-based quantitative analysis are enhancing the precision and outcomes of complex surgeries. These approaches allow surgeons to move from empirical to quantitative decision-making. Furthermore, the symmetric bicuspidization technique for aortic valve repair exemplifies how tailored reconstructive approaches can address congenital morphologies effectively. This is complemented by CT-guided planning in mitral valve repair, offering precise geometric assessments to guide surgical correction. In conclusion, pediatric valve therapy is undergoing a transformation, driven by a convergence of surgical innovation, device development, and advanced imaging technologies. The path forward lies in designing solutions specifically for children—solutions that anticipate growth, reduce reinterventions, and improve long-term outcomes.