Current outcomes and future trends in paediatric and congenital cardiac surgery: a narrative review

Objective: To provide a narrative review of the current outcomes and future trends in paediatric and congenital cardiac surgery in a historical and multidisciplinary context. To present the paradigm shift in treating congenital heart disease that translate into improved outcomes. To identify current problems with directions of research. Background: Congenital heart disease (CHD) is the most common birth defect affecting approximately 1 neonate in every 120-166 births. More than half of CHD-patients need cardiac surgery in their lifetime; and half of the surgeries are required within the first six months of life. Methods: Narrative overview of the literature combining with current outcome data available from international databases is presented in comparison to the programme development of a newly-established tertiary-care centre. Conclusions: Congenital cardiac surgery is reconstructive surgery that aims for restoring biventricular circulation, when possible. Single-stage primary complete repair has become the central philosophy since the 1980s. In about thirty percent, physiologic and anatomical reasons do not permit repair by a single operation; these patients endure staged-repairs. Another 15% of CHD patients will require subsequent reoperations- mostly re-replacements of non-growing and/or deranged prostheses. Owing to advances of multidisciplinary treatment, CHD survival to adulthood now reaches 90-95% in high-income countries from less than 20% in the presurgical era. Treating CHD patients is a commitment for life. Research for viable and growing prostheses may solve the significant public health aspects currently associated with reoperations.