There is limited data on the outcomes of children who undergo surgery for aortic valve
infective endocarditis (IE), and the optimal surgical approach remains controversial.
We investigated the long-term outcomes of surgery for aortic valve IE in children,
with a particular focus on the Ross procedure. A retrospective review of all children
who underwent surgery for aortic valve IE was performed at a single institution. Between
1989 and 2020, 41 children underwent surgery for aortic valve IE, of whom 16 (39.0%)
underwent valve repair, 13 (31.7%) underwent the Ross procedure, 9 (21.9%) underwent
a homograft root replacement, and 3 (7.3%) underwent a mechanical valve replacement.
Median age was 10.1 years (interquartile range [IQR], 5.4-14.1). The majority of children
(82.9%, 34/41) had underlying congenital heart disease, while 39.0% (16/41) had previous
heart surgery. Operative mortality was 0.0% (0/16) for repair, 15.4% (2/13) for the
Ross procedure, 33.3% (3/9) for homograft root replacement, and 33.3% (1/3) for mechanical
replacement. Survival at 10 years was 87.5% for repair, 74.1% for Ross, and 66.7%
for homograft (p>0.05). Freedom from reoperation at 10 years was 30.8% for repair,
63.0% for Ross, and 26.3% for homograft (p=0.15 for Ross vs. repair, p=0.002 for Ross
vs. homograft). Children undergoing surgery for aortic valve IE have acceptable long-term
survival, although the need for long-term reintervention is significant. The Ross
procedure appears to be the optimal choice when repair is not feasible.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations:
IE (infective endocarditis), MSSA (methicillin-sensitive Staphylococcus aureus), NYHA (New York Heart Association), RV-PA (right ventricle to pulmonary artery), RVOT (right ventricular outflow tract)To read this article in full you will need to make a payment
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Article info
Publication history
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Funding and Disclosures: Dr. Wu is a recipient of an Australian Government Research Training Program Scholarship.
Conflicts of Interest: Prof. Brizard serves on the advisory board of Admedus. No other disclosures.
Ethics: Ethics approval was obtained from the Human Research Ethics Committee at the Royal Children's Hospital, Melbourne, Australia (No. 36250A) on the 30th of August, 2016.
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