Reevaluating Aortic Valve Neocuspidization in Children, Adolescents, and Young Adults: A Case Series Analysis

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Biomaterials in Medicine

Background:

• Durability of aortic valve neocuspidization (AVNeo) in pediatric and young adult populations remains debated.
• Assessing AVNeo viability and optimal applications in these age groups is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the durability and functional outcomes of AVNeo in children, adolescents, and young adults.
• To identify factors influencing AVNeo success, including age, initial valve disease, surgical complexity, and material choice.

Main Methods:

• Retrospective cohort study analyzing 49 patients (median age 13.8 years) from July 2016 to August 2024.
• Data collected included survival, reoperation rates, AVNeo function, age groups, previous surgeries, and pericardium type (autologous vs. heterologous).

Main Results:

• Medium-term AVNeo dysfunction progressed, with increased peak gradient and indexed vena contracta over time.
• Smaller aortic annulus size significantly impacted AVNeo function; children had higher reintervention rates.
• Redo AVNeo and use of heterologous pericardium were associated with significantly higher reoperation rates.

Conclusions:

• AVNeo dysfunction progression was not clearly linked to patient age but was significantly affected by small aortic annulus size, common in children.
• AVNeo should be reserved for children only when no alternatives exist, as reoperations carry worse outcomes.
• Avoidance of nonautologous pericardium is recommended to improve AVNeo durability.