The Evolution of Anesthesia for Congenital Heart Disease

This educational review describes the historical development of pediatric congenital cardiac anesthesia and its expanding role in the care of patients with congenital heart disease (CHD). Over the past eight decades, the specialty has evolved from an era in which few congenital heart defects were surgically treatable and perioperative mortality was high to one in which survival into adulthood is expected for most children with CHD. This transformation has been driven by parallel advances in surgical techniques, cardiopulmonary bypass technology, myocardial protection, monitoring, intensive care, and anesthetic management. From the first successful patent ductus arteriosus ligation in 1938 to the development of fetal cardiac interventions and the many major technological and scientific advances of the late twentieth and early twenty-first centuries, anesthesiologists have played a pivotal role in improving the care of patients with CHD. As survival has improved, the population of adults and elderly patients living with repaired or palliated CHD has grown, and the specialty's focus has expanded beyond reducing perioperative mortality to improving lifelong outcomes. Today, congenital cardiac anesthesiologists are integral members of multidisciplinary teams responsible for perioperative risk assessment, hemodynamic optimization, neuroprotection, coagulation management, mechanical circulatory support, and enhanced recovery. The history of the specialty highlights the importance of multidisciplinary collaboration and continued scientific progress in improving patient safety, recovery, and long-term outcomes.