Predicting Suboptimal Outcomes After Initially Acceptable Aortic Valve Repair in Children

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Aortic valve repair is the preferred treatment for congenital aortic valve disease in children.
• Durability of aortic valve repair can be limited, leading to late failures.
• Identifying risk factors for suboptimal outcomes after initial repair is essential.

Purpose of the Study:

• To identify predictors of late suboptimal outcomes after initially acceptable aortic valve repair in pediatric patients.
• To develop a risk stratification tool for patients with pure aortic stenosis.

Main Methods:

• Retrospective review of 287 pediatric patients undergoing primary aortic valve repair (2014-2023).
• Defined acceptable repair as < moderate aortic stenosis (AS) and mild or less aortic insufficiency (AI).
• Used Cox analysis to identify predictors of suboptimal outcomes (defined as > moderate AS/AI or reintervention).

Main Results:

• An acceptable initial repair was achieved in 64% of patients.
• Acceptable repair showed superior 4-year freedom from suboptimal outcomes compared to residual lesions (75% vs 51%).
• In pure AS patients with acceptable repair, smaller preoperative annulus z-score, higher preoperative peak gradient, and prior balloon aortic valvuloplasty independently predicted suboptimal outcomes.

Conclusions:

• While an acceptable initial aortic valve repair is vital, it does not ensure long-term success.
• Preoperative annulus z-score, peak gradient, and history of balloon aortic valvuloplasty are key predictors of subsequent valve failure in pure AS.
• These identified factors can aid in risk stratification and guide surveillance intensity for pediatric patients undergoing aortic valve repair.