Objectives To compare outcomes after surgical valvuloplasty and balloon dilatation of the aortic valve in neonates and infants.Background Surgical techniques of aortic valve repair have improved and there is today controversy on the best approach to treat neonatal congenital aortic valve stenosis.Methods Retrospective review of data and follow up of 123 consecutive neonates and infants(35 females,88 males)undergoing intervention for congenital aortic stenosis.Results From 1977 to 2009,123 consecutive neonates(<30 days)and infants(31 days-1 year)underwent relief of congenitalaortic stenosis.Median age at procedure was 27 days(6-76 days).Twenty year survival was 80±7%.Fifty-four patients required a re-intervention and freedom from re-intervention was 55±6%at 10 years and 40±6%at 20 years.By multivariate analysis,having the relief of stenosis by balloon valvuloplasty and undergoing initial treatment as a neonate were predictive of re-intervention.Freedom from re-intervention at 5years was 27%after balloon valvuloplasty vs 65%after surgery.At latest follow-up,an additional 16 patients had moderate or severe stenosis and 8 had regurgitation.Freedom from re-intervention or stenosis was 39±5%at 15 years.By multivariate analysis,balloon valvuloplasty(P<0.001)and treatment as a neonate(P=0.003)were again predictive of stenosis or reintervention.Thirty-five patients ultimately needed a valve replacement.Significant predictor of the requirement of valve replacement was unicuspid aortic valve(P<0.001).Freedom from valve replacement was 55±7%at 20 years.Conclusions Surgical valvuloplasty remains the best approach to treat neonates and infants with congenital aortic stenosis.After surgery,a higher proportion of patients remain free of reintervention than after interventional catheterisation and the relief of their stenosis last longer. Objectives To compare outcomes after surgical valvuloplasty and balloon dilatation of the aortic valve in neonates and infants. Background Surgical techniques of aortic valve repair have improved and there is today controversy on the best approach to treat neonatal congenital aortic valve stenosis. Methods Retrospective review of data and follow up of 123 consecutive neonates and infants (35 females, 88 males) undergoing intervention for congenital aortic stenosis. Results From 1977 to 2009,123 consecutive neonates (<30 days) and infants (31 days-1 year) underwent relief of congenitalaortic stenosis.Median age at procedure was 27 days (6-76 days). Twenty year survival was 80 ± 7% .Fifty-four patients required a re-intervention and freedom from re-intervention was 55 ± 6% at 10 years and 40 ± 6% at 20 years.By multivariate analysis, having the relief of stenosis by balloon valvuloplasty and undergoing initial treatment as a neonate were predictive of re-intervention. Freedom from re-intervention at 5years was 27% after balloon valvuloplasty vs 65% after surgery. At latest follow-up, an additional 16 patients had moderate or severe stenosis and 8 had regurgitation. Freedom from re-intervention or stenosis was 39 ± 5% at 15 years.By multivariate Analysis of balloon valvuloplasty (P <0.001) and treatment as a neonate (P = 0.003) were again predictive of stenosis or reintervention. Thirty-five patient eventually needed a valve replacement. Significant predictor of the requirement of valve replacement was unicuspid aortic valve P <0.001) .Freedom from valve replacement was 55 ± 7% at 20 years.Conclusions Surgical valvuloplasty remains the best approach to treat neonates and infants with congenital aortic stenosis. After surgery, a higher proportion of patients remain free of reintervention than after interventional catheterisation and the relief of their stenosis last longer.