Reoperation after previous aortic valve repair in children: Redo repair versus Ross procedure

The study objective was to compare the long-term outcomes of redo aortic valve repair versus the Ross procedure in children requiring reintervention after prior aortic valve repair.

We performed a retrospective, single-center cohort study of patients aged less than 18 years who underwent primary aortic valve repair between 1980 and 2024. Patients were included if their first aortic valve reoperation was redo repair or a Ross procedure. Outcomes of interest were survival free from heart transplantation, freedom from semilunar valve reoperation, and freedom from recurrent 2+ or greater aortic stenosis or aortic regurgitation. Time-to-event outcomes were analyzed using Kaplan-Meier methods and Cox proportional hazards regression.

Among 512 patients undergoing primary repair, 138 required reintervention, including 72 redo repairs and 66 Ross procedures. Median age at reoperation was similar between groups (8.0 vs 7.7 years; P = .38). Survival free from transplantation at 20 years was 88% in both groups (P = .97). Freedom from semilunar valve reoperation at 15 years was worse after redo repair than after the Ross procedure (36% vs 73%; P < .001). In a sensitivity analysis excluding patients with suboptimal immediate repair results, 15-year freedom from reoperation improved to 53% but remained inferior to the Ross group (P = .002). At 10 years, freedom from recurrent 2+ or greater aortic stenosis or aortic regurgitation was 18% after redo repair versus 86% after the Ross procedure (P < .001).

In children requiring reintervention after prior aortic valve repair, the Ross procedure provides superior long-term valve durability and freedom from reoperation compared with redo native valve repair.