The fate of survivors of cardiac surgery in infancy.

Knowledge of the long-term effects of infant cardiac surgery is essential if further progress is to be made in not only immediate, but also long-term care. We therefore analyzed the fate of 599 infants who survived 3 weeks or more after operation in the first year of life performed over the last 25 years. Actuarial survival curves were obtained for each operation for a given condition. The rate for 3-week survival in infants was also determined for the years 1972-1976. Four risk categories were established. (1) Low initial, low late survival: pulmonary artery bapding (PAB) for complete transposition of the great arteries (TGA) and ventricular septal defect (VSD)-3-week survival 83%, 5-year survival 41%; shunts for pulmonary atresia with VSD -3week survival 73%, 5-year survival 51%; shunts for tricuspid atresia 3-week survival 78%, 5-year survival 70%; PAB for VSD 3-week survival 67%, 5-year survival 81%; Blalock-Hanlon operation for TGA 3week survival 87%; 5-year survival 52%. (2) High initial, low late survival: Mustard's operation for TGA -3week survival 94%, 5-year survival 81%; shunts for tetralogy of Fallot 3-week survival 97%, 5-year survival 74%. (3) Low initial, high late survival: coarctation with or without persistent ductus arteriosus 3-week survival 81%, 5-year survival 93%; total anomalous pulmonary venous drainage 3-week survival 69%, 5-year survival 90%; pulmonary stenosis 3-week survival 63%, 5-year survival 100%. (4) High initial, high late survival: closure of VSD 3-week survival 97%, 5-year survival 97%. These results demonstrate the superiority of one-stage over two-stage repair in both VSD and TGA. PAB produced unsatisfactory overall survival in all conditions studied and therefore has limited application in future surgical management. The study provides a baseline with which future developments in therapy can be compared.