Aortic valve neocuspidization in children: A systematic review and meta-analysis

Aortic valve neocuspidization (AVNeo) has emerged as a reconstructive alternative for children with aortic valve disease who are poor candidates for prosthetic replacement or the Ross procedure. Although early clinical results appear favorable, concerns persist regarding mid-term durability and material-related valve degeneration. To clarify these uncertainties, we systematically evaluated global pediatric AVNeo outcomes, focusing on early performance, mid-term reintervention rates, and the influence of pericardial material on valve longevity.

A systematic search of PubMed, Embase, Scopus, the Cochrane Library, and preprint servers (January 2000-October 2025) identified studies reporting neocuspidization in patients age ≤18 years. Two reviewers independently screened and extracted data. Pooled proportions were calculated with a random-effects model; heterogeneity was assessed with the I ² statistic. Risk ratios compared reoperation rates between autologous and xenopericardial reconstructions, and comparative cohorts versus the Ross operation were summarized narratively.

Twelve studies including 336 children met the inclusion criteria. Early mortality was 1.2%, and late mortality was 1.1%. The pooled reoperation rate was 15.4% (95% confidence interval [CI], 5.4%-29.2%; I ² = 86%). Reoperation was 7-fold more frequent after xenopericardial reconstruction (risk ratio, 7.09; 95% CI, 2.95-17.06). Comparative series consistently favored the Ross operation for mid-term durability.

AVNeo provides excellent early outcomes but limited mid-term durability, particularly with xenopericardium. Autologous pericardium markedly reduces reoperation risk and should remain the preferred material.