Outcome after aortic valve replacement in children: A systematic review and meta-analysis
Open accessAbstract
Objective Despite an increasing interest in pediatric aortic valve repair, aortic valve replacement in children may be unavoidable. The evidence on outcome after pediatric aortic valve replacement is limited and usually reported in small case series. This systematic review and meta-analysis aims to provide an overview of reported outcome of pediatric patients after aortic valve replacement. Methods A systematic literature search for publications reporting outcome after pediatric aortic valve replacement published between January 1990 and May 2015 was conducted. Studies written in English with a study size of more than 30 patients were included. Results Thirty-four publications reporting on 42 cohorts were included in this review: 26 concerning the Ross procedure (n = 2409), 13 concerning mechanical prosthesis aortic valve replacement (n = 696), and 3 concerning homograft aortic valve replacement (n = 224). There were no studies on bioprostheses that met our inclusion criteria. The pooled mean patient age was 9.4 years, 12.8 years, and 8.9 years for Ross, mechanical prosthesis, and homograft recipients, respectively. Pooled mean follow-up was 6.6 years. The Ross procedure was associated with lower early (4.20%; 95% confidence interval [CI], 3.37-5.22 vs 7.34%; 95% CI, 5.21-10.34 vs 12.82%; 95% CI, 8.91-18.46) and late mortality (0.64%/y; 95% CI, 0.49-0.84 vs 1.23%/y; 95% CI, 0.85-1.79 vs 1.59%/y; 95% CI, 1.03-2.46) compared with mechanical prosthesis aortic valve replacement and homograft aortic valve replacement, respectively. No significantly different aortic valve reoperation rates were observed between the Ross procedure and mechanical prosthesis aortic valve replacement (1.60%/y; 95% CI, 1.27-2.02 vs 1.07%/y; 95% CI, 0.68-1.68, respectively), whereas homograft aortic valve replacement was associated with significantly higher aortic valve reoperation rates (5.44%/y; 95% CI, 4.24-6.98). The Ross procedure-associated right ventricular outflow tract reoperation rate was 1.91% per year (95% CI, 1.50-2.44). Conclusions This systematic review illustrates that all currently available aortic valve substitutes are associated with suboptimal results in children, reflecting the urgent need for reliable and durable repair techniques and innovative replacement solutions for this challenging group of patients.
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ECM bioscaffolds provide an alternative to congenital infant defects such as those related to heart valves, given their prominent integration with the host's tissue and prevention of inflammation.
“On the other hand, ECM bioscaffolds provide an alternative to congenital infant defects such as those related to heart valves [209,210], given their prominent integration with the host's tissue and prevention of inflammation.”
From Immune Response to Extracellular Matrix Bioscaffolds: A Comprehensive Review (2025) · cites this paper as [210]
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Selection of prosthetic aortic valve and root replacement in patients younger than age 30 years
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Indications and Practical Considerations for Partial Heart Transplantation
Rajab, T. K., Kalfa, D. M., Mery, C. M., Emani, S. M., & Reemtsen, B. L. (2025) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2025.01.037 · Cited by 2 · see citing works
Role of Right Atrial Appendage Tissue for Valve Reconstruction in Children
Wang, Z., Fu, H., & Li, S. (2025) · Pediatric Cardiology · doi:10.1007/s00246-025-03967-6 · Cited by 2 · see citing works
Awad, A. K., Mathew, D. M., Fusco, P. J., Varghese, K. S., Abdelnasser, O., Awad, A. K., Giannaris, P. S., Mathew, S. M., & Ahmed, A. (2023) · The Egyptian Heart Journal · doi:10.1186/s43044-023-00391-0 · Cited by 2 · see citing works
Iranian homograft heart valves: assessment of durability and late outcome
Rouchi, A. H., Radmehr, H., Tavakoli, A. H., Kashi, T. S. J., & Mahdavi‐Mazdeh, M. (2016) · Cell and Tissue Banking · doi:10.1007/s10561-016-9573-6 · Cited by 2 · see citing works
Peri‐operative changes in diastolic function and outcomes in congenital aortic valve surgery
Pesce, M., LaPar, D. J., Kalfa, D. M., BACHA, E. A., & Freud, L. R. (2022) · Echocardiography · doi:10.1111/echo.15274 · Cited by 2 · see citing works
Commentary: Continue to imitate the nature: We are getting closer
Yerebakan, C. (2020) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2019.12.105 · Cited by 2 · see citing works
Requirement for repetitive surgical approaches at supravalvular aortic stenosis
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- Authors
- Etnel, J. R. G., Elmont, L. C., Ertekin, E., Mokhles, M. M., Heuvelman, H. J., Roos-Hesselink, J. W., de Jong, P. L., Helbing, W. A., Bogers, A. J. J. C., & Takkenberg, J. J. M.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Takkenberg, Johanna J.M.
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 151
- Issue
- 1
- Pages
- 143-152.e3
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2113018842
- Cited by
- 140
- References
- 74
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 11 · 2023: 24 · 2022: 12 · 2021: 18 · 2020: 18 · 2019: 9 · 2018: 11 · 2017: 3 · 2016: 6 · 2015: 1 · 2014: 1 · 2012: 3
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Keywords
- Ross procedure, mechanical aortic valve prosthesis, mortality, aortic valve reoperation, long-term outcomes, congenital heart disease
- MeSH terms
- Adolescent, Age Factors, Aortic Valve, Child, Child, Preschool, Heart Valve Diseases, Heart Valve Prosthesis, Hemodynamics, Humans, Infant, Postoperative Complications, Prosthesis Design, Reoperation, Risk Factors, Time Factors, Chi-Square Distribution, Treatment Outcome, Heart Valve Prosthesis Implantation, Allografts
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