Tricuspid aortic valve morphology predicts favorable midterm outcomes after aortic valve neocuspidization in children.
- 1Pediatric Cardiac Surgery Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- 2Adult Cardiac Surgery Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- 3Department of Echocardiography, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Abstract
Objective
To evaluate the midterm outcomes of the aortic valve neocuspidalization (AVNeo) procedure for aortic valve reconstruction in 83 pediatric patients with complex aortic valve disease and to identify risk factors associated with the outcomes.Methods
A retrospective analysis was conducted on pediatric patients who underwent the AVNeo procedure between January 2017 and June 2025. The composite primary end point included all-cause mortality, reoperation, or moderate-to-severe aortic valve dysfunction (regurgitation or stenosis). Univariate and multivariate Cox proportional hazards models were used to identify risk factors.Results
Among the 83 patients (mean age 7.0 ± 3.7 years; 67.5% male) included in the analysis, the predominant preoperative pathology was moderate-to-severe aortic regurgitation (88.0%). Single-leaflet reconstruction (65.1%) using autologous pericardium (94.0%) was the most common surgical approach. Over a mean follow-up of 28.4 ± 23.9 months, 27 patients (32.5%) met the composite end point, including 2 late deaths, 18 cases of moderate-to-severe regurgitation, and 9 cases of moderate-to-severe stenosis; 10 patients underwent reoperation. The probability of freedom from the primary end point was 83.6%, 64.5%, and 54.4% at 1, 3, and 6 years, respectively. Multivariable analysis identified tricuspid aortic valve morphology as an independent protective factor against the primary end point (hazard ratio, 0.408; 95% CI, 0.178-0.935, P = .034), whereas the use of autologous pericardium showed a strong protective trend (hazard ratio, 0.284; 95% CI, 0.078-1.037, P = .057).Conclusions
AVNeo provides midterm outcomes that support its use as an alternative strategy. Tricuspid aortic valve morphology is a strong predictor of favorable outcomes, and the use of autologous pericardium demonstrates significant potential as a protective factor.
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BibTeX
@article{wang2026tricuspid,
title = {{Tricuspid aortic valve morphology predicts favorable midterm outcomes after aortic valve neocuspidization in children.}},
author = {Guanxi Wang and Sen Zhang and Kai Ma and Kunjing Pang and Benqing Zhang and Keming Yang and Shoujun Li},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101958},
url = {https://europepmc.org/article/MED/42948439},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Tricuspid aortic valve morphology predicts favorable midterm outcomes after aortic valve neocuspidization in children.
AU - Guanxi Wang
AU - Sen Zhang
AU - Kai Ma
AU - Kunjing Pang
AU - Benqing Zhang
AU - Keming Yang
AU - Shoujun Li
PY - 2026
DA - 2026/07/09
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101958
UR - https://europepmc.org/article/MED/42948439
AB - Objective To evaluate the midterm outcomes of the aortic valve neocuspidalization (AVNeo) procedure for aortic valve reconstruction in 83 pediatric patients with complex aortic valve disease and to identify risk factors associated with the outcomes.Methods A retrospective analysis was conducted on pediatric patients who underwent the AVNeo procedure between January 2017 and June 2025. The composite primary end point included all-cause mortality, reoperation, or moderate-to-severe aortic valve dysfunction (regurgitation or stenosis). Univariate and multivariate Cox proportional hazards models were used to identify risk factors.Results Among the 83 patients (mean age 7.0 ± 3.7 years; 67.5% male) included in the analysis, the predominant preoperative pathology was moderate-to-severe aortic regurgitation (88.0%). Single-leaflet reconstruction (65.1%) using autologous pericardium (94.0%) was the most common surgical approach. Over a mean follow-up of 28.4 ± 23.9 months, 27 patients (32.5%) met the composite end point, including 2 late deaths, 18 cases of moderate-to-severe regurgitation, and 9 cases of moderate-to-severe stenosis; 10 patients underwent reoperation. The probability of freedom from the primary end point was 83.6%, 64.5%, and 54.4% at 1, 3, and 6 years, respectively. Multivariable analysis identified tricuspid aortic valve morphology as an independent protective factor against the primary end point (hazard ratio, 0.408; 95% CI, 0.178-0.935, P = .034), whereas the use of autologous pericardium showed a strong protective trend (hazard ratio, 0.284; 95% CI, 0.078-1.037, P = .057).Conclusions AVNeo provides midterm outcomes that support its use as an alternative strategy. Tricuspid aortic valve morphology is a strong predictor of favorable outcomes, and the use of autologous pericardium demonstrates significant potential as a protective factor.
SN - 2666-2736
ER -