[Heart surgery under cardiopulmonary bypass during the neonatal period remains a high-risk procedure]

Congenital Heart disease with a poor prognosis has to be operated early but with an acceptable surgical risk and a good chance of survival. The aim of this study was to analyse the indications, the operative mortality and medium-term survival of neonates undergoing cardiac surgery under cardiopulmonary bypass from 1991 to 1998. Three hundred and twenty nine operations were programmed in 326 neonates, 18% (329/1805) of all open heart surgical procedures. Anatomical detransposition of the great arteries was the commonest operation (N = 226). Correction was complete (biventricular) in 97% of cases (317/326). Twenty-eight neonates died. The operative mortality was 8.5%, much higher than that of children of 3 months or over (1.5%; p < 0.0001). There were 8 late deaths, all in the first postoperative year. The overall medium-term survival rate was 88.9 +/- 1.7%. It was 100% after correction of truncus arteriosus without interruption of the aortic arch; 94.2 +/- 1.5% after anatomical detransposition; 85.7 +/- 9.4% after commissurotomy of aortic stenosis; 79.2 +/- 8.3% for all the complex forms of interruption of the aortic arch; 75 +/- 9.7% for total anomalous pulmonary venous drainage and 42.9 +/- 18.7% after the Norwood palliative procedure of hypoplastic left heart syndrome. The authors conclude that early cardiac surgery saves the large majority of neonates suffering from complex congenital cardiac disease with poor prognosis. Survival stabilises one year after the operation. Other techniques or treatments are necessary to lower present surgical risk (8.5%) to that of surgery under cardiopulmonary bypass of children over 3 months of age (1.5%).