Short- and long-term outcomes of systemic semilunar valve replacement in neonates and infants

TL;DR

Replacing semilunar valves in newborns and infants is risky, with high mortality rates, and outcomes depend on age, weight, and surgical approach.

Contribution

This study provides the largest analysis of systemic semilunar valve replacement outcomes in neonates and infants using long-term mortality data.

Findings

In-hospital mortality rates were 23% for Ross, 49% for AVR, and 52% for TVR.

Neonates had higher mortality than infants, with surgical weight offering protection.

Earlier surgical eras and AVR procedures were associated with higher mortality.

Abstract

Systemic semilunar valve replacement in neonates and infants is rare and usually a last resort. We analyzed Pediatric Cardiac Care Consortium data for patients undergoing Ross, aortic valve replacement (AVR), or truncal valve replacement (TVR) from 1982–2011 across 35 centers, with mortality tracked via the US National Death Index through 2022. Among 167 patients, in-hospital mortality was 23% for Ross, 49% for AVR, and 52% for TVR. Twenty-five–year survival was 59%, 29%, and 41%, respectively. Neonatal age (vs. infant) was associated with increased in-hospital and long-term mortality (OR 2.5, 3.9, respectively), while higher surgical weight was protective (OR 0.67, 0.61 per kg, respectively). The earlier surgical era was associated with higher in-hospital mortality (OR 3.4). AVR had over threefold in-hospital and long-term mortality (OR 3.2, 3.4, respectively). These results highlight the historically high risk of systemic semilunar valve replacement in this population and the need for innovative surgical approaches.

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