Durability of Bioprosthetic and Mechanical Valves Implanted for Aortic Valve Replacement in Pediatric Patients

BACKGROUND: There is limited published information on bioprosthetic aortic valve durability. The purpose of this study was to assess the durability of bioprosthetic valves used for aortic valve replacement (AVR) in pediatric patients. METHODS: We reviewed all surgical AVR procedures performed from May 2002 to July 2024 in patients ≤21 years of age using a mechanical valve or bioprosthesis. Long-term valve-related outcomes were assessed with propensity-score-adjusted analysis. RESULTS: During the study period, 180 AVR procedures were performed in pediatric patients (median age, 14.3 years) using a bioprosthetic valve (n=79) or mechanical prosthesis (n=101). Freedom from reintervention was significantly shorter in patients with a bioprosthetic valve (77% at 5 years, 29% at 10 years) than those with a mechanical valve (88% at 5 years, 82% at 10 years; P <0.001). By propensity score-adjusted multivariable Cox regression, a bioprosthetic valve (hazard ratio, 4.66 [95% CI, 2.26–9.62]; P <0.001) and age <12 years at AVR (3.26 [1.81–5.87]; P <0.001) were associated with shorter freedom from reintervention. Endocarditis was diagnosed in 16 patients, and thromboembolic or bleeding complications were reported in 8. CONCLUSIONS: In pediatric patients undergoing AVR, bioprosthetic valves have significantly worse durability than mechanical prostheses, with the disparity most pronounced in younger patients. Valve-related mortality and complications were relatively common. These findings should focus attention on the need for better replacement valves or therapeutic options in young patients with aortic valve disease.