Valvular & structural heart diseaseMeta-analysis
Paediatric aortic valve replacement: a meta-analysis and microsimulation study
- Systematic review and meta-analysis with microsimulation
- microsimulation model
1 prospective and 67 retrospective cohort studies; 37 435 patient-years; median follow-up 5.9 years (range 1-21)
Authors' conclusion
Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR.
Study context
- Population
- Children undergoing aortic valve replacement (mean age <18 years), studies published 1990–2021
- Participants
- 5,259 children · 68 studies
- Comparison
- Ross procedure vs mechanical AVR (mAVR) vs homograft AVR (hAVR) in paediatric aortic valve replacement (AVR)
Pooled result
As reported in the abstract
Early mortality (<30d)
Further pooled results
| Outcome | Ross | mAVR | hAVR |
|---|---|---|---|
| Late mortality rate (>30d) · pooled | 0.5%/year (CI 0.4%-0.7%/year) | 1.0%/year (CI 0.6%-1.5%/year) | 1.4%/year (CI 0.8%-2.5%/year) |
| Microsimulation-based mean life-expectancy in first 20 years | mean 18.9 (CI 18.6-19.1 years) years | mean 17.0 (CI 16.5-17.6 years) years | |
| relative life-expectancy | 94.8% | 86.3% | Not reported in the abstract |
| Microsimulation-based 20-year risk of aortic valve reintervention | 42.0% (95% CI 39.6%–44.6%) | 17.8% (95% CI 17.0%–19.4%) | Not reported in the abstract |
Original publication
Paediatric aortic valve replacement: a meta-analysis and microsimulation study. Eur Heart J. Published 27 June 2023. doi:10.1093/eurheartj/ehad370
Summarised from the published abstract; every number is checked against it