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

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 <0.001). In-hospital mortality was 2 out of 13 (15.4%) in the replacement group and 8 out of 78 (10.3%) in the valvuloplasty group ( 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.