Introduction

Aortic valve repair (AVr) is an interventional strategy used to manage aortic valve disease in children and adolescents.1 Among the various choices of techniques for repair, many surgeons favor aortic cusp extension valvuloplasty (ACEV) due to its effectiveness in reducing aortic regurgitation (AR) and aortic stenosis (AS) while improving left ventricular wall mass thickness.2 While surgical techniques for repair are well documented in the literature, little clinical evidence exists in determining the optimal material for cusp extension in the pediatric population.3,4 When choosing a material for use during repair, durability and functionality must be considered in order to successfully preserve the left ventricle function and minimize the number of reoperations needed over a lifetime.5 Currently, the search for the optimal leaflet replacement material requires further exploration. 
Aortic valve repair is traditionally accomplished using autologous pericardium, which provides acceptable durability when treated with glutaraldehyde yet suffers from problems with calcification and eventual degradation.4 Bovine pericardium is a biological material that was introduced as an alternative to autologous pericardium; however, a recent study that compared the two materials demonstrated better performance of autologous pericardium with lower gradient across the aortic valve at final follow-up and less rapid degeneration in children and young adults.5 Although identification of leaflet replacement material remains a difficult endeavor, a recently FDA approved synthetic material, CorMatrix (CorMatrix Cardiovascular, Inc, Atlanta, GA), shows promise. Potential benefits include increased durability, resistance to calcification, and propagation of native tissue regeneration.6 Due to the novelty of the material, its clinical performance as compared to traditional materials remains undetermined.
To our knowledge, the current study represents the first retrospective comparison of autologous pericardium and CorMatrix material utilized for cusp extension valvuloplasty in pediatric populations. In this study, we aim to identify any predictive factors associated with type of material used for valve repair by assessing short and long-term postoperative outcomes of children and adolescents receiving either traditional autologous pericardium or CorMatrix for AV repair.