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

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.