Open Access

REVIEW

Advances in Pediatric Heart Valve Replacement: A State-of-the-Art Review

Baker M. Ayyash¹, Yen Chuan Chen², Ahmad Sallehuddin², Ziyad M. Hijazi^1,*

1 Department of Cardiovascular Diseases, Sidra Medicine, Doha, 2699, Qatar
2 Department of Cardiothoracic and Vascular Surgery, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, 50400, Malaysia

* Corresponding Author: Ziyad M. Hijazi. Email:

Congenital Heart Disease 2025, 20(2), 143-179. https://doi.org/10.32604/chd.2025.064599

Received 19 February 2025; Accepted 07 April 2025; Issue published 30 April 2025

Abstract

Pediatric heart valve replacement (PHVR) remains a challenging procedure due to the unique anatomical and physiological characteristics of children, including growth and development, as well as the long-term need for durable valve function. This review provides an overview of both surgical and transcatheter options for aortic, mitral, pulmonary, and tricuspid valve replacements in pediatric patients, highlighting the indications, outcomes, and advancements in technology and technique. Surgical valve replacement traditionally involves the implantation of biological or mechanical prosthetic valves, with biological valves being preferred in children to reduce the need for lifelong anticoagulation therapy. However, the limitation of biological prostheses, namely their inability to grow with the child, necessitates the frequent need for reoperations. Recent innovations in valve engineering, such as the development of tissue-engineered and expandable valves, aim to address these issues. Transcatheter valve replacement (TVR) has emerged as a promising alternative, particularly for patients with complex anatomy or those who are high-risk for traditional surgery. While the use of transcatheter devices in children remains limited due to the smaller vascular size and limited long-term data, several studies have demonstrated the feasibility and safety of the procedure in certain patient populations. Despite these advancements, challenges related to valve size, durability, and the need for individualized treatment planning persist. The future of pediatric heart valve replacement will likely involve a multidisciplinary approach combining surgical, transcatheter, and regenerative medicine strategies, aimed at optimizing outcomes, reducing the need for reinterventions, and improving long-term quality of life for pediatric patients with valvular heart disease. This article discusses all options available for patients with valvular dysfunction, making it easy for parents/patients to go to as a reference source of information.

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