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Updated: Feb 12, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Over 40 Years of Experience With Aortic Valve Surgery in the Paediatric Population-What Is the Current Best Strategy?

Viktoria Weixler1, Amanda Greenwell1, Alison Howell2

  • 1Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children, Toronto, ON M5G 1X8, Canada.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|February 10, 2026
PubMed

Insights

Congenital aortic valve disease in children has limited options. Surgical valvuloplasty (SAV) leads to more reoperations, while the Ross procedure is safe and durable, preserving native valves in suitable cases.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Cardiac Surgery

Background:

  • Congenital aortic valve (AoV) disease presents limited therapeutic options for pediatric patients.
  • Evaluating initial surgical strategies is crucial for long-term outcomes in growing children.

Purpose of the Study:

  • To compare the effectiveness of different initial surgical strategies for congenital aortic valve disease in children.
  • To determine the optimal treatment strategy balancing survival and reoperation rates.

Main Methods:

  • A retrospective analysis of pediatric patients undergoing aortic valve surgery (SAV, AVR, Ross procedure) from 1976 to 2024.
  • Evaluation of factors like prior balloon valvuloplasty (BAV), valve morphology, and disease type (stenosis/regurgitation).
  • Assessment of survival rates and incidence of reoperation, moderate aortic valve insufficiency, and stenosis.

Main Results:

  • Excellent 10- and 20-year survival rates (90.4% and 87.1%) were observed across all initial surgical groups.
  • Surgical valvuloplasty (SAV) had a significantly higher incidence of reoperations at 20 years (78.4%) compared to aortic valve replacement (AVR) (24.6%) and the Ross procedure (15%).
  • Favorable aortic valve anatomy and stenosis were associated with native valve survival at 20 years.

Conclusions:

  • All initial surgical approaches for congenital aortic valve disease offer excellent short- and long-term survival.
  • The Ross procedure is identified as a safe and durable option with a lower reoperation rate.
  • Early surgical valvuloplasty can preserve the native valve in cases with favorable anatomy.
Abstract

Keywords:
Ross procedureaortic valve repairaortic valve replacementcongenital aortic valve disease

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