Abstract
Objectives: Durability of aortic valve neocuspidization (AVNeo) in children, adolescents, and young adults is a matter of debate. We sought to assess its viability in these age groups and identify the best fields of application. Methods: A retrospective cohort study (07/2016-08/2024) analyzed survival, reoperation rates, and AVNeo function across different age groups and also initial valve disease, surgical complexity, and material used. Results: The study included 49 patients (median age, 13.8, IQR 10.9-16.3 years), 14 (28.6%) children (1-10 years), 31 (63.2%) adolescents (11-18 years), and 4 (8.2%) young adults (19-25 years). Thirteen patients had previous surgeries. Valve leaflets were made from autologous (36/49, 73.5%) or heterologous pericardium (13/49, 26.5%). Forty-three of 49 (87.8%) patients underwent neocuspidization ± simple procedures, while 6/49 (12.2%) had complex procedures. One complex patient died, and 11 patients needed early or late AVNeo replacement. Median follow-up was 37.8 months. Redo neocuspidization was associated with higher reoperation rates (7/12, 58%) compared with first-time procedures (4/36, 11%) (P = .002). Reoperation was more frequent with heterologous pericardium (7/12, 58.3%) than autologous pericardium (4/36, 11.1%) (P < .001). AVNeo function worsened over time, with increases in both peak gradient (P = .005) and indexed vena contracta (P = .014). Preoperative aortic annular diameter inversely correlated with both peak gradient (P < .001) and indexed vena contracta (P = .022) at follow-up. Conclusions: Medium-term AVNeo dysfunction progression had no clear link with patient age, although a small aortic annulus, which is common in children, significantly impacted AVNeo function. Additionally, children had a higher reintervention rate. Therefore, neocuspidization in children should be considered only when no alternatives are available. AVNeo as a reoperation is associated with worse outcomes. Nonautologous pericardium should be avoided.