Knight JH, Sarvestani AL, Ibezim C, et al. - Among children with aortic valve disease, the best long-term (up to 25-years) outcomes were achieved with pulmonic valve autograft, but aortic valve replacement (AVR) outcomes may rely on a centre’s experience or patient selection.

• This is a retrospective cohort study of 911 children (0–20 years old) undergoing AVR from 1982 to 2003.

• There were 10 cardiac transplants and 153 deaths, 5 post-transplant.

• Following AVR, the 25-year transplant-free survival was 87.1% for autograft vs 76.2% for mechanical AVR (M-AVR) and 72.0% for tissue (bioprosthetic or homograft).

• Post-adjustment, M-AVR continued to be associated with increased mortality/transplant vs autograft (HR=1.9).

• Lower survival in patients with M-AVR, but not autograft, was observed for those managed in centres with higher in-hospital mortality.