This retrospective review describes a 13-year experience of 142 pediatric patients undergoing aortic valve repair from 1996–2009 in a center that favored primary repair over valve replacement and transcatheter balloon valvuloplasty.

The authors acknowledge that most other centers prefer balloon valvuloplasty as the first choice. There was no contemporary transcatheter balloon aortic valvuloplasty comparison group in this series.

The authors’ goal was to postpone valve replacement to either use larger valves or perform the Ross procedure in the teenage years or later.

Of the 142 patients, 96 required patches with autologous pericardium for either cusp extension (n = 51) or other repair (n= 45); 47 patients had no patch.

Survival at ten years was 95%. Freedom from reintervention at seven years was 80%.

For historical comparison, the authors quote 50% freedom from reintervention at ten years in balloon valvuloplasty.

For this surgical cohort of aortic valve repair subjects, the only two predictors for reintervention were the cusp extension technique and age < 1 year.

Freedom from valve replacement was 81 % at seven years.

They describe two early deaths and three other patients who developed post-operative ischemia; these five patients all underwent tricuspidisation of a bicuspid valve with leaflet extension. The authors believe that obstruction of the coronary orifices may have been the culprit, and they recommend caution in using leaflet extension in this subset. They did not find major problems in using leaflet extension in patients with symmetric tricuspid aortic valves.

However, the authors believe that their results with repair are either superior or equivalent to best practices with balloon valvuloplasty, and they recommend surgical repair as the best option for primary intervention in infants and children.

All editors: B. Rush Waller, III, MD, FSCAI