Aortic valve reconstruction in the pediatric population presents significant surgical challenges as the ideal repair requires an individualized approach considering various factors. This study aims to analyze the factors influencing outcomes of aortic valve neocuspidization (AV Neo) in pediatric patients. A retrospective cohort study involving pediatric patients who underwent neocuspidization (congenital and acquired) between 2016 and 2023. Clinical outcomes assessed included mortality, reintervention, structural valve degeneration and infective endocarditis. Echocardiographic measurements included peak and mean gradient, indexed vena contracta jet width, annular diameter, and coaptation height. Freedom from events was analyzed using Kaplan–Meier analysis. Outcomes were compared based on congenital or acquired valve lesions. AV neo was performed in 53 patients with a mean age of 10.7 ± 3.91 years, of which 29 had congenital aortic valve disease. There was one early in-hospital mortality. At discharge, the mean coaptation height was 9.9 ± 1.0 mm, the peak gradient was 12.0 mmHg, and less than mild regurgitation was observed. The median follow up period was 27.4 months. Forty-four patients (83%) remained event-free. A Significant aortic annular growth was noted, with rheumatic etiology patients showed the most stable coaptation height over time. Truncus arteriosus patients demonstrated rapid growth of the annulus leading to accelerated truncal valve regurgitation progression. AV Neo is feasible with acceptable short-term results in pediatric patients with congenital and acquired etiology. The procedure allows significant physiological annular growth, particularly benefiting patients with rheumatic aortic valve disease, but less favorable among patients with truncal valve pathology.
