The fate of survivors of cardiac surgery in infancy.

Abstract

Knowledge of the long-term effects of infant cardiac surgery is essential if further progress is to be made in immediate and long-term care. The fate of 599 infants who survived 3 wk or more after operation in the 1st yr of life performed over the last 25 yr were analyzed. Actuarial survival curves were obtained for each operation for a given condition. The rate for 3 wk survival in infants was determined for the yr 1972-1976. Four risk categories were established: (1) low initial, low late survival: pulmonary artery banding (PAB) for complete transposition of the great arteries (TGA) and ventricular septal defect (VSD).sbd.3 wk survival 83%, 5 yr survival 41%; shunts for pulmonary atresia with VSD.sbd.3 wk survival 73%, 5 yr survival 51%; shunts for tricuspid atresia.sbd.3 wk survival 78%, 5 yr survival 70%; PAB for VSD.sbd.3 wk survival 67%, 5 yr survival 81%; Blalock-Hanlon operation for TGA.sbd.3 wk survival 87%; 5 yr survival 52%. (2) High initial, low late survival: Mustard''s operation for TGA.sbd.3 wk survival 94%, 5 yr survival 81%; shunts for tetralogy of Fallot.sbd.3 wk survival 97%, 5 yr survival 74%. (3) Low initial, high late survival: coarctation with or without persistent ductus arteriosus.sbd.3 wk survival 81%, 5 yr survival 93%; total anomalous pulmonary venous drainage.sbd.3 wk survival 69%, 5 yr survival 90%; pulmonary stenosis.sbd.3 wk survival 63%, 5 yr survival 100%. (4) High initial, high late survival: closure of VSD.sbd.3 wk survival 97%, 5 yr survival 97%. The superiority of 1 stage over 2 stage repair in VSD and TGA was demonstrated. PAB produced unsatisfactory overall survival in all conditions studied and has limited application in future surgical management. A baseline with which future developments in therapy can be compared was provided.