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

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.