Essentials of paediatric cardiac surgery

Abstract The history of cardiac surgery began with procedures to treat congenital heart disease, from the Blalock–Taussig shunt in the 1940s to the first use of extracorporeal circulation in the 1950s. The whole speciality of cardiothoracic surgery has grown from the work of these early pioneers and the wider applications of cardiopulmonary bypass have led to surgery for coronary artery disease and degenerative valvular disease in adults. Surgery for congenital heart disease now accounts for 10–15% of all cardiac surgery and continues to be at the forefront of the speciality in terms of innovation and evolving approaches. The speciality has advanced in parallel with advances in neonatal medicine and paediatric intensive care that have enabled an increasingly more complex range of conditions to become treatable. Outcomes have steadily improved, although this remains one of the most high-risk areas of modern surgery. Major congenital heart disease is a very serious condition and only 15% of children survived infancy prior to the surgical era. Now over 85% of children survive into adulthood and, for the first time, there are now more adults alive with congenital heart disease than there are children. Caring for these patients has led to the development of ‘adult congenital heart disease’ as an emerging specialist area. Surgery has become increasingly specialized and technically demanding with a trend to repair lesions at an earlier age and to aim for complete anatomical repair in infancy rather than a series of staged procedures. Over two-thirds of all procedures are now carried out before the age of 1 year.