Related Experiment Video
Updated: Oct 6, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Are outcomes in congenital cardiac surgery better than ever?
Ryan M Holcomb1,2, Akif Ündar1,3
1Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.
Insights
Congenital heart surgery outcomes have improved, with overall mortality now below 3%. The focus is shifting from survival to enhancing survivors' quality of life by reducing morbidity and long-term effects.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Medical Outcomes Research
Background:
- Congenital heart disease (CHD) is the most common birth defect in the US.
- 1 in 4 infants with CHD require surgery within the first year.
- Historical mortality rates were as high as 14%.
Purpose of the Study:
- To evaluate the impact of changes in congenital cardiac surgery on patient outcomes.
- To assess improvements in mortality and morbidity rates.
- To identify trends towards standardization in the field.
Main Methods:
- A comprehensive literature search was performed using PubMed MEDLINE and Google Scholar.
- The search covered publications from inception to October 31, 2021.
- 78 publications were selected for inclusion in the analysis.
Main Results:
- Overall mortality in congenital cardiac surgery has significantly decreased to below 3%.
- Despite increased surgical complexity and patient comorbidities, survival rates have improved.
- Clinical outcomes and practices vary between institutions, highlighting a need for standardization.
Conclusions:
- Current congenital cardiac surgery demonstrates improved survival rates compared to previous eras.
- The field's focus is evolving from mere survival to improving survivors' quality of life.
- Standardization and interinstitutional collaboration are expected to drive future advancements.
Background And Aim Of The Study:
Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes?
Methods:
The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion.
Results:
The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement toward standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management.
Conclusions:
Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation toward standardization and interinstitutional collaboration, future advancements are expected.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Cardiomyopathy V: Interprofessional Care