The utility of neocuspidization in the surgical management of congenital aortic valve pathology: mid-term results of single-center experience with AVNeo procedure in children.

Abstract

Background: Aortic valve (AV) pathology in children presents a significant surgical challenge, with mid- and long-term outcomes of current techniques remaining controversial. This study evaluates our experience with aortic valve neocuspidization (AVNeo) in the pediatric population, analyzing immediate and mid-term results.

Methods: Ten children underwent AVNeo between June 2017 and August 2019. The clinical data were prospectively collected and retrospectively analyzed. The primary outcomes included failure to perform AVNeo, intraoperative conversion to the alternative technique, in-hospital mortality, and major adverse events. The secondary outcomes included aortic stenosis or regurgitation, valve-related events, reoperations, and mortality during follow-up.

Results: The median age was 9 (range: 2-17) years. AVNeo was feasible in all cases. Five children underwent previous cardiac interventions. Neocuspidization was feasible in all cases. No in-hospital mortality or significant postoperative complications occurred. Before discharge, average peak and mean pressure gradients were 13.5 mmHg and 6.5 mmHg, respectively. Aortic insufficiency was grade 0 or 1 in all cases. Seven patients required reoperation for valve dysfunction over a median follow-up of 73 months. The median time to reoperation was 62 months, with six patients undergoing mechanical valve replacement and one receiving a Ross procedure.

Conclusion: AVNeo offers excellent hemodynamic outcomes for children with AV pathology in the immediate postoperative period. However, the mid-term results revealed significant valve degeneration, necessitating reoperations in most cases. Unlike in adults, we do not consider AVNeo a definitive solution in children with AV disease. We see this technique as a valuable tool in the staged management of this congenital heart pathology.