title: Outcomes and associated risk factors for aortic valve replacement in 160 children: a competing-risks analysis.
abstract: BACKGROUND
  We sought to define patient characteristics, outcomes, and associated risk factors after aortic valve replacement (AVR) in children.
  
  
  RESULTS
  Clinical records from children undergoing AVR from 1974 to 2004 at our institution were reviewed. Competing-risks methodology determined the time-related prevalence of 3 mutually exclusive end states: death, repeated replacement, and survival without subsequent AVR and their associated risk factors. Longitudinal echocardiographic data were analyzed by mixed linear-regression models. Children (n=160) underwent 198 AVRs, with 33 having >1. Competing-risks analysis predicted that 10 years from the initial AVR, 19% had died without subsequent AVR, 34% underwent a second AVR, and 47% remained alive without replacement. Risk factors for death without a second AVR included lower weight (P<0.001) and younger age at AVR (P=0.04), performance of aortic arch reconstruction together with AVR (P=0.03), and nonautograft use (P=0.03). Risk factors for a second AVR included earlier operation year (P=0.04) and implantation of a bioprosthetic or homograft valve (P=0.004). Analysis of serial echocardiographic measurements showed that pulmonary autograft use was associated with slower progression of peak aortic gradient (P=0.002), smaller left ventricular dimension (P=0.04), and decreased prevalence of aortic regurgitation (P=0.04).
  
  
  CONCLUSIONS
  Mortality and repeated valve replacement are common after initial AVR in children, especially in younger patients and those with bioprosthetic or homograft valves. Pulmonary autograft use is associated with decreased mortality, slower gradient progression, and smaller left ventricular dimension.
authors.affiliation: Division of Cardiovascular Surgery, Department of Pediatrics, University of Toronto, The Hospital of Sick Children, Toronto, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.forename: Karen
authors.initials: K
authors.lastname: Jang
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.forename: Glen
authors.initials: G
authors.lastname: Van Arsdell
authors.forename: John G
authors.initials: JG
authors.lastname: Coles
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome