Current status of open heart surgery in infancy

The enthusiasm for primary intracardiac surgery in symptomatic infants with congenital cardiac disease generated by early successful reports continues. The results obtained to data indicate that when surgery is carried out in extremely ill symptomatic infants, the mortality is high but still superior to staged procedures. When surgery is performed relatively electively, to prevent complications related to the unnatural history of the disease, the results of surgery are excellent. Profound hypothermia and circulatory arrest have contributed greatly towards facilitating technical surgery and postoperative management. An increasing number of centers are utilizing conventional cardiopulmonary bypass with hypothermia to achieve the same result. One of the major objections to using hypothermia and cardiocirculatory arrest has been the fear of cerebral complications, both neurological and psychomotor. Our follow-up studies on an unselected group of patients have shown very clearly that when the technique was applied carefully with strict attention to detail, late neurological and psychomotor complications were virtually nil. The IQs of these children fall within the normal distribution curve of a comparable group of noncardiac children. In view of these late follow-up findings, we feel that hypothermia and cardiocirculatory arrest are safe modalities in handling infants undergoing open intracardiac surgery. There is probably still a place for two-stage procedures in selected lesions and these are complex transposition of the great arteries and perhaps as a clinical trial in a randomized group of infants with tetralogy of Fallot. With the exception of these lesions, early correction of all operable symptomatic heart defects in infants is recommended.