Current surgical strategies and techniques of aortic valve diseases in children

While the long-term outcome of surgical aortic valvotomy (SAV) appears to be better than that of balloon aortic valvuloplasty (BAV) as the primary procedure of aortic valve stenosis, the surgical strategies and techniques of treating aortic valve disease in children in other situations remain controversial. Valve repair should be first considered while replacement is still unavoidable in some cases, and new repair techniques developed by innovative surgeons are gradually becoming adopted. Some complex repair procedures such as cusp extension, leaflet replacement/reconstruction have provided satisfactory outcomes. The Ozaki technique replaces aortic valve leaflets with glutaraldehyde-treated autologous pericardium instead of replacing the valve entirely. Special instruments have been developed to make the Ozaki technique more reproducible and standardized. Neonates and infants undergoing aortic valve replacement (AVR) are a high-risk group, where repair should be the primary consideration rather than replacement. Several systematic reviews reveal that all currently available aortic valve substitutes such as pulmonary autograft, mechanical prosthesis, homograft and bioprosthesis are associated with suboptimal results in children, but pulmonary autograft appeared to be superior with high freedom from reintervention and better hemodynamic performance. The strategy for treatment of aortic valve disease should be specifically analyzed based on the brief of being beneficial for children.