What is the best surgical strategy for aortic valve disease in children

Aortic valve disease in children is a hot topic in the field of cardiac surgery. The surgical treatment of aortic valve disease in children is affected by age, severity of the disease, and technology. The main purpose of surgical repair is to improve the symptoms of children and avoid or delay prosthetic valve replacement and reoperation as much as possible. At the same time, surgical repair should take into account the sustainability of the surgical effect and the growth ability of the aortic valve after surgery. At present, there is still a lack of a consistent surgical treatment concept and a universal surgical treatment strategy. Based on the current published literature, we conclude that for children younger than 1 year, valve repair is the first choice to avoid premature valve replacement. However, for experienced medical centres and surgeons, the Ross procedure can be attempted to treat aortic valve disease in children younger than 1 year and the long-term effect is comparable to aortic repair. In children older than 1 year, overall outcomes were similar with repair and the Ross procedure. When an acceptable intraoperative result was achieved, the outcomes of repair were favourable. However, when the intraoperative result of repair was suboptimal, the Ross procedure showed better results. For patients with suboptimal aortic valve repair, contraindications to the Ross procedure, and unwillingness to take anticoagulants, Ozaki procedure may also be an option to delay mechanical valve replacement. Compared with aortic valve repair and the Ross procedure, mechanical or homograft aortic valve replacement has a poor prognosis and is considered as a last resort option for surgical treatment of aortic valve disease in children. This article reviews the current status, advantages and disadvantages, and suitable population of several different surgical procedures for aortic valve disease in children.