O1002: Short- and long-term outcomes of semilunar valve replacement in neonates and infants, an unresolved challenge

Background: Semilunar valve replacement (SVR) in neonates and infants is rare and used as a last resort. Due to its infrequency, outcomes remain poorly understood.

Methods: The Pediatric Cardiac Care Consortium (PCCC) was queried for neonates and infants who had SVR from 1982 to 2011. Data from 35 centers assessed in-hospital and long-term mortality, with deaths tracked through 2022 via the US National Death Index.

Results: A total of 229 patients met the inclusion criteria. In-hospital mortality rates were 33% (7/21) for neonates and 22% (16/74) for infants undergoing the Ross procedure (n=95); 75% (9/12) and 43% (15/35) for aortic valve replacement (AVR, n=47); 67% (6/9) and 9% (5/53) for pulmonary valve replacement (PVR, n=62); and 67% (8/12) and 39% (5/13) for truncal valve replacement (TVR, n=25), respectively. The estimated 25-year survival was 59% for Ross, 29% for AVR, 68% for PVR, and 41% for TVR. Increased in-hospital mortality was associated with neonatal age (vs. infant), AVR and TVR (vs. Ross), and earlier surgical era (odds ratios [OR] 3.7, 3.2, 3.6, and 3.4, respectively). Higher surgical weight was linked to reduced in-hospital and late mortality (OR 0.64 and 0.68 per 1 kg increase, respectively).

Conclusion: SVR in neonates and infants is associated with high early and late mortality. Neonatal age, early surgical era, lower surgical weight and AVR/TVR (vs. Ross) were associated with increased mortality.