Wide variation in aspirin prescribing after surgical pulmonary valve replacement may influence early valve performance in young patients with congenital heart disease. Findings presented at the ACC.26 Conference showed that postoperative aspirin use remained inconsistent across clinical practice, yet patients who received aspirin appeared less likely to develop early valve dysfunction after surgical pulmonary valve replacement (SPVR). 

The retrospective analysis reviewed outcomes in 417 patients who underwent SPVR between 2014 and 2024, reflecting ongoing uncertainty regarding postoperative antiplatelet strategies in pediatric and young congenital heart disease populations. More than half of the overall cohort (52%) received aspirin at discharge, although prescribing patterns differed considerably by valve type and patient age. 

Aspirin use was more common in older patients, with a mean age of 11.2 years compared with 6.9 years among patients who did not receive aspirin (p=0.0001). Prescription rates also varied across valve categories, ranging from 33% in bioprosthetic valves to 100% in bovine pericardial valves.

Among the 347 patients with at least 6 months of follow-up, early valve dysfunction developed less frequently in the aspirin group than in the non-aspirin group (18% vs 28%; p=0.01). However, aspirin use did not significantly alter the need for subsequent valve intervention or replacement during follow-up. Rates of bacterial endocarditis, thrombotic events, and bleeding complications remained low regardless of aspirin exposure.

The findings suggest that at least 3 months of postoperative aspirin therapy may help reduce early valve dysfunction after SPVR. Prospective studies are still needed to define standardized postoperative antiplatelet strategies in young patients with congenital heart disease.