Pitfalls and Future Directions of Contemporary Pediatric Valve Surgery: the Case for Living Valve Substitutes

Purpose of Review Infants and young children with congenital heart disease and valvular lesions may require valve replacement when a durable repair is unlikely. The fundamental problem with currently available valve substitutes in all positions is the lack of somatic growth potential. Young patients are therefore committed to multiple reoperations for successively larger valve replacements by the time they reach adulthood. Recent Findings An emerging solution to this issue is allogeneic valve transplantation whereby the implanted valve is harvested from the heart of a deceased donor. The major advantage of this approach is the use of living tissue which grows adaptively with the child, thereby minimizing the number and additive risk of subsequent reoperations for valve exchange but incurring the risks of immunosuppression. Summary Here, we review the advantages and disadvantages of currently available valve replacement options for each of the four valves. We also discuss the potential role and future directions for allogeneic valve transplantation in pediatric valve surgery.