Aortic valve surgery in adolescents and young adults: analysis of early operative data from the European Congenital Heart Surgeons Association database

OBJECTIVES Aortic valve surgery is a crucial treatment for congenital and acquired aortic disease in adolescents and young adults. This study evaluated outcomes in this group by analysing data from the European Congenital Heart Surgeons Association Congenital Cardiac Database (ECCDB). METHODS A retrospective review included patients aged 10-18 years from the ECCDB who underwent aortic valve surgery between 2013 and 2022. The primary outcome was operative mortality, defined as death within 30 days or during hospitalization. Secondary outcomes included reoperations and postoperative complications. Risk factors for mortality were identified using multivariable logistic regression analysis, and surgical trends were evaluated. RESULTS A total of 2129 patients were included, with the majority undergoing valve replacement, followed by valve repair and the Ross procedure. Patients receiving valve replacement were typically older and larger. Over the decade, there was an increase in the use of the Ross procedure. Reoperations were more frequent in the repair group, while postoperative complications were more common in the replacement group. The overall mortality rate was 1.5%. Independent risk factors for mortality included longer cardiopulmonary bypass (CPB) times (odds ratio 1.1, P < 0.001) and annulus enlargement (odds ratio 3.8, P = 0.02). CPB durations exceeding 240 min increased the risk of death. The Ross procedure, particularly in isolated cases without annulus enlargement, was associated with a low mortality rate of 0.4%. CONCLUSIONS Aortic valve surgery in adolescents and young adults is complex, with outcomes influenced by CPB time and annulus enlargement. The Ross procedure shows excellent results despite its technical demands.