title: Aortic valve replacement in neonates and infants: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
abstract: OBJECTIVE
  We sought to describe early outcomes of aortic valve replacement in neonates and infants across a large multicenter cohort.
  
  
  METHODS
  Neonates and infants in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing nontruncal aortic valve replacement with the Ross-Konno procedure, Ross procedure, or homograft replacement from 2000 to 2009 were included. Preoperative characteristics, operative data, and early outcomes are described.
  
  
  RESULTS
  A total of 160 patients (43 neonates, 117 infants) from 47 centers were included. Society of Thoracic Surgeons-defined preoperative risk factors were present in 76 patients (48%) and were most prevalent in neonates (67%) and patients undergoing homograft aortic valve replacement (93%). Concomitant arch repair or mitral valve surgery was performed in 30 patients (19%) and 19 patients (12%), respectively. Postoperative mechanical circulatory support was used in 17 patients (11%). Overall in-hospital mortality was 18% and was highest for neonates (28%) and patients undergoing homograft aortic valve replacement (40%). Concomitant arch repair was associated with higher in-hospital mortality (33% vs 15%, P = .02), whereas concurrent mitral valve surgery was not (21% vs 18%, P = .73). Postoperative mechanical circulatory support was also associated with increased in-hospital mortality (65% vs 13%, P < .0001).
  
  
  CONCLUSIONS
  Neonates and infants undergoing aortic valve replacement are a high-risk group, with hospital mortality comparable with some of the highest risk procedures in this age group. The requirement for arch repair or postoperative mechanical circulatory support was associated with an increased risk of death in this cohort.
authors.affiliation: Department of Surgery, Cardiothoracic Surgery, Children's Hospital Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA. rwoods@chw.org
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Woods
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.forename: Erle H
authors.initials: EH
authors.lastname: Austin
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Mary
authors.initials: M
authors.lastname: Krolikowski
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mitchell
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
mesh_terms: D000367:Age Factors; D001013:Aorta, Thoracic / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001243:Assisted Circulation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009656:North America; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality