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Reoperation After Prior Truncal Valve Repair In Children And Young Adults: Re-repair Vs Replacement
Dominic Recco, MD, Tharushihan Muhunthan, Kimberlee Gauvreau, Sitaram Emani, Pedro del Nido, Christopher Baird.
Boston Children's Hospital, Boston, MA, USA.
Objective(s): Despite high reintervention rates following truncal valve (TrV) repair, data on redo surgery remain limited. We compared long-term outcomes of re-repair vs replacement in children and young adults requiring reoperation after prior TrV repair.
Methods: Single-center study of patients ≤30yrs undergoing re-repair or replacement following primary TrV repair between 2000-2025. Endpoints were freedom from death, reoperation, recurrent >mild stenosis or regurgitation, and a composite. Time-to-event outcomes analyzed using Kaplan-Meier methods and log-rank tests.
Results: Among 78 patients undergoing primary repair at our institution, 39 required reoperation; 11 underwent initial repair elsewhere. Of 50 TrV reoperations, 32 were re-repairs, 16 replacements, and 2 Ozaki (excluded). Median age was lower with re-repair (4.8 vs 15.0;p<0.001). 12-year survival trended higher with re-repair (100% vs 75%;p=0.066). 7-year freedom from TrV reoperation was similar between groups (56% vs 73%;p=0.20) but recurrent TrV stenosis or regurgitation (17% vs 75%;p=0.004) and a composite (17% vs 69%;p=0.007) were worse after re-repair. In a sub-analysis comparing initial replacement (n=16) to subsequent prosthesis (n=10) (replacement after re-repair), all endpoints were similar (p>0.05 each).
Conclusions: Re-repair in substantially younger patients provided similar survival and freedom from reoperation compared with replacement. While replacement demonstrated superior valve function durability, delaying prosthesis may allow somatic growth without compromising outcomes. These data support a repair-first strategy, with replacement reserved for older/larger patients when durable repair is no longer achievable.
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