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However, it remains unclear whether these devices provide better outcomes rather than their precursors. The study assessed the benefit from programmability of gravitational valve, i.e., programmable-SHUNTASSISTANT (proSA\u00ae) vs. SHUNTASSISTANT\u00ae (SA\u00ae).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Clinical records and imaging of pediatric patients with hydrocephalus of non-tumoral etiology treated with fixed (SA\u00ae) or programmable (proSA\u00ae) gravitational valves between January 2006 and January 2022 were analyzed in a retrospective single-center study. Valve survival was compared in relation to age and etiology. Lately explanted valves received biomechanical analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 391 gravitational valves (254 SA\u00ae and 137 proSA\u00ae) were inserted in 244 patients (<jats:italic>n<\/jats:italic>\u2009=\u2009134 males). One hundred thirty-three SA\u00ae (52.4%) and 67 proSA\u00ae (48.9%) were explanted during a follow-up of 81.1\u2009\u00b1\u200946.3\u00a0months. Valve survival rate at 1 and 5\u00a0years with proSA\u00ae was 87.6% and 60.6% compared to 81.9% and 58.7% with SA\u00ae, with mean survival time 56.4\u2009\u00b1\u200935.01 and 51.4\u2009\u00b1\u200943.0\u00a0months, respectively (<jats:italic>P<\/jats:italic>\u2009=\u20090.245). Age\u2009&lt;\u20092\u00a0years at implantation correlated with significantly lower valve survival rates (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), while HC etiology showed no significant impact. Overdrainage alone accounted for more SA\u00ae revisions (39.8% vs. 3.1%, <jats:bold><jats:italic>P<\/jats:italic><\/jats:bold>\u2009&lt;\u20090.001), while dysfunctions of the adjustment system represented the first cause of valve replacement in proSA\u00ae cohort (45.3%). The biomechanical analysis performed on 41 proSA\u00ae and 31 SA\u00ae showed deposits on the valve\u2019s internal surface in 97.6% and 90.3% of cases.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our comparative study between proSA\u00ae and SA\u00ae valves in pediatric HC demonstrated that both valves showed similar survival rates, regardless of etiology but only with young age at implantation. The programmability may be beneficial in preventing sequelae of chronic overdrainage but does not reduce need for valve revision and proSA\u00ae valve should be considered in selected cases in growing children older than 2\u00a0years.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00701-023-05751-y","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T03:27:10Z","timestamp":1693279630000},"page":"4031-4044","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Programmable (proSA\u00ae) vs. fixed (SHUNTASSISTANT\u00ae) gravitational valves in pediatric patients with hydrocephalus: a 16-year retrospective single-center comparative study with biomechanical analysis"],"prefix":"10.1007","volume":"165","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7420-1647","authenticated-orcid":false,"given":"Mohammed","family":"Issa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Paggetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"August","family":"von Hardenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Miethke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas W.","family":"Unterberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"El Damaty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"key":"5751_CR1","doi-asserted-by":"publisher","first-page":"e1167","DOI":"10.1542\/peds.2007-0423","volume":"121","author":"I Adams-Chapman","year":"2008","unstructured":"Adams-Chapman I, Hansen NI, Stoll BJ, Higgins R (2008) Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. 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KG and supervised the valve analysis. The authors declare no conflict of interest.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}