What question did this study set out to answer?

This study evaluates the reoperation strategies and long-term outcomes for pediatric patients with congenital aortic stenosis following initial aortic valve repair.

January 10, 2026BMC Pediatrics0 citationsOpen Access

The journey from repair to replacement in pediatric aortic valve stenosis: a 10-year single-center experience

GZGuowei ZengShanghai Jiao Tong University XZXinjie ZhangShanghai Jiao Tong University LHLongming HuangShanghai Jiao Tong University

Key Result

The 10-year freedom from reoperation in pediatric patients after aortic valve repair was 50.9%, with replacement associated with better long-term outcomes (P = 0.001).

Key Points

This study evaluates the reoperation strategies and long-term outcomes for pediatric patients with congenital aortic stenosis following initial aortic valve repair.
Retrospective analysis of clinical data from patients with isolated aortic stenosis who underwent initial aortic valve repair from 2013 to 2024.
Primary outcome measures included the rate of freedom from reoperation and aortic valve replacement.
Secondary outcomes included mortality rates and rates of aortic regurgitation.
Among 203 patients, the 10-year freedom from aortic valve reoperation was 50.9%.
The 10-year freedom from aortic valve replacement was 62.7%.
For patients who underwent secondary procedures, 87.9% were free from reoperation for 10 years.
Patients who opt for aortic valve replacement exhibited improved long-term outcomes over those who had a repair.

Structured PICO

Does aortic valve replacement provide superior long-term outcomes compared to repeat aortic valve repair in pediatric patients requiring reoperation for congenital aortic stenosis?

Population

203 pediatric patients with isolated congenital aortic stenosis (AS) who underwent initial aortic valve (AoV) repair. Median age 2.4 years, 65.5% male. Excluded patients with concomitant moderate or greater aortic regurgitation (AR), non-congenital AS, previous AoV surgery, or complex congenital heart diseases.

Intervention

Initial aortic valve (AoV) repair (aortic valvotomy or valvuloplasty). For the reoperation cohort (n=48), secondary AoV replacement (Ross procedure or mechanical aortic valve replacement).

Comparator

For the reoperation cohort, secondary AoV repair (n=20) was compared to AoV replacement (n=28).

Outcome

Rate of freedom from reoperation after the initial procedure and secondary surgeries.hard clinical

Initial aortic valve repair in pediatric congenital aortic stenosis provides excellent early survival, but nearly half require reoperation within 10 years, at which point valve replacement offers superior long-term outcomes compared to repeat repair.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Objective The optimal reoperation strategy and long-term outcomes of pediatric patients with congenital aortic stenosis (AS) have not been well elucidated. This study aimed to evaluate the reintervention outcomes and long-term prognosis in patients with isolated AS following their initial aortic valve (AoV) repair. Methods A retrospective analysis was conducted on the clinical data of all patients with isolated AS who underwent initial AoV repair between 2013 and 2024. The primary outcome was the rate of freedom from reoperation after the initial procedure and secondary surgeries. Results A total of 203 patients who underwent initial AoV repair were included. The median age at initial surgery was 2.4 (0.6, 4.7) years. The 30-day mortality rate was 0.5% (1/203). The 10-year freedom from AoV reoperation rate was 50.9% (95% CI: 36.2%-65.6%; n = 48/203). The 10-year freedom from AoV replacement rate was 62.7% (95% CI: 46.0%-79.4%; n = 28/203). Among the 48 patients who underwent reoperation, 20 underwent AoV repair and 28 underwent AoV replacement. Patients in the AoV replacement group were older (9.4 ± 4.0 years vs. 6.7 ± 3.6 years, P = 0.022) and had higher body weight (32.2 ± 14.3 kg vs. 22.8 ± 12.1 kg, P = 0.021). The 10-year freedom from AoV reoperation rate after the secondary procedure was 87.9% (95% CI: 73.4%-100.0%; n = 3/45). The 10-year freedom from moderate or greater AS/ aortic regurgitation was 50.2% (95% CI: 30.8%-69.6%; n = 15/45). Compared with secondary AoV repair, AoV replacement was associated with superior long-term outcomes (P = 0.001). Conclusion Favorable outcomes are achieved in patients with AS after initial AoV repair; however, nearly half of the patients may require reoperation within 10 years. For reoperations, AoV replacement is more likely to provide desirable long-term quality of life.

Ask AI

Helpful

Bookmark

View Full Paper