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Congenital cardiac surgery refers to the variety of surgical methods and practices used to repair or palliate congenital heart defects (CHDs). This is a diverse field of surgery due to the many types of potential heart problems and the fact that both children and adults may benefit from surgical interventions. Congenital cardiac surgeons have made numerous advances in this field, and now offer a wide range of surgical options for many defects. There are unfortunately still some conditions that can’t be fully repaired.
Most heart defects would be fatal today without important developments in cardiac surgery and equipment. In 1945, the Blalock-Taussig Shunt was used successfully to create oxygenation in children with cyanotic or "blue baby" defects. The field also advanced with the 1950s development of cardiopulmonary bypass, which allowed surgeons to stop the heart and keep circulation supported simultaneously.
Since these advances, numerous surgical techniques have been tried and perfected to address may types of heart defects. Current congenital cardiac surgery can replace diseased valves, repair or exchange damaged arteries, and patch holes in the atrial or ventricular septum. Certain types of defects, which were once almost uniformly fatal, such as transposition of the great arteries, are now often resolved in a single surgery.
Many surgeries are undertaken in infant patients, but older children may also need congenital cardiac surgery. One factor that must often be considered is that children grow, and occasionally get too big for present repairs. This is especially the case when GORE-TEX® shunts or artificial or biological valves and arteries are used. Over time, some defects may require additional surgeries to replace parts a child has outgrown.
Though congenital defects evoke images of children or babies, congenital cardiac surgery doesn’t necessarily mean surgery on pediatric patients. A whole new field of fetal surgery is evolving that may help tackle some of the most difficult defects. By repairing defects in utero, developing hearts may grow more normally.
Alternately, some adults require congenital cardiac surgery. They may have mitral or aortic valve defects from birth that only start to cause functional problems in adulthood. In many cases, pediatric cardiothoracic surgeons still perform these surgeries because they have the most training in repairing heart problems that are congenital.
Surgical techniques have dramatically improved survival and success rates for many CHDs. Even the tiniest infants with severe heart defects may have excellent prognoses. Some defects remain difficult to fully repair with congenital cardiac surgery. These include single ventricle presentations, which typically require three palliative surgeries and result in the need for a heart transplant later in life. Even though these defects aren’t reparable, surgery may extend life into middle age.