{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:54:16Z","timestamp":1789779256885,"version":"4.0.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Congenital aortic valve (AoV) disease has limited treatment options in growing children. Different initial strategies, AoV repair\/surgical valvuloplasty (SAV), AoV replacement (AVR), and Ross procedure were compared to elucidate the current best strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All paediatric patients undergoing different initial AoV surgeries from 1976 to 2024 were included. Factors including prior balloon dilation (balloon valvuloplasty [BAV]), valve morphology, and initial disease (stenosis\/regurgitation\/mixed) were analysed. Survival and incidence of AoV reoperation\/\u2265moderate AoV insufficiency\/stenosis were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 323 patients underwent 142 SAV\/33 AVR\/137 Ross at median age\/weight of 5.7 years [interquartile range, 0.5-12.6]\/19.9 kg [6.9-48.8]. Surgical valvuloplasty group was the youngest (P\u2009&amp;lt;\u2009.01). Thirty-day mortality was 2.5% (8\/323) without group differences (P\u2009=\u2009.15). Median follow-up was 9.6 years [2.7-17.8] with 10-\/20-year survival rates of 90.4% [86.1-93.4]\/87.1% [81.4-91.1] without group differences. Twenty-year cumulative incidences of AoV reoperations were higher after SAV: 78.4% [70.8-86.9] vs 24.6% [11.7-51.7] after AVR and 15% [6.8-33.1] after Ross, P\u2009&amp;lt;\u2009.01. Survivors with their native AoV at 20 years (n\u2009=\u200948, 14.8%) were younger at initial surgery (P\u2009&amp;lt;\u2009.01), had predominantly AoV stenosis (91.7%), and had fewer BAVs (P\u2009&amp;lt;\u2009.01). Cox regression demonstrated 7.8-fold higher mortality hazard after AVR (P\u2009&amp;lt;\u2009.01) and a lower reoperation hazard after AVR and Ross (HR 0.1 [95% CI, 0.1-0.5], P\u2009&amp;lt;\u2009.01 and HR 0.1 [95% CI, 0.1-0.3], P\u2009&amp;lt;\u2009.01) compared to SAV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>All initial AoV surgeries brought excellent early\/long-term survival. Aortic valve reoperations occur most frequently after SAV. In case of favourable AoV anatomy, early SAV can preserve the native valve. Ross procedure identified as safe and durable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag063","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T12:29:41Z","timestamp":1769430581000},"source":"Crossref","is-referenced-by-count":1,"title":["Over 40 Years of Experience With Aortic Valve Surgery in the Paediatric Population\u2014What Is the Current Best Strategy?"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0153-0364","authenticated-orcid":false,"given":"Viktoria","family":"Weixler","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1X8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Greenwell","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1X8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2798-3831","authenticated-orcid":false,"given":"Alison","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1E8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bana","family":"Samman","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1X8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastien","family":"Provost","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1X8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghee","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1X8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makaela","family":"Milton","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1X8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Ho","sequence":"additional","affiliation":[{"name":"Ted Rogers Computational Program, Ted Rogers Centre of Hear Research, Peter Munk Cardiac Centre, University Health Network , Toronto, M5G 2C4,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Runeckles","sequence":"additional","affiliation":[{"name":"Ted Rogers Computational Program, Ted Rogers Centre of Hear Research, Peter Munk Cardiac Centre, University Health Network , Toronto, M5G 2C4,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel D","family":"Vanderlaan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, The Hospital of Sick Children , Toronto, ON M5G 1X8,","place":["Canada"]},{"name":"Department of Surgery, University of Toronto , Toronto, ON M5G 1L5,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9716-8197","authenticated-orcid":false,"given":"Christoph","family":"Haller","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Labatt Family Heart Center, 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