Cardiac surgery in the critically ill infant during the first three months of life.

Major advances have been made in the treatment of congenital heart disease in the past 10 years. Management of the 20 per cent of children who become critically ill during the first 3 months of life remains a major challenge because they represent the most extreme anatomic and physiologic derangements. A review of the recent data accumulated in the NERICP showed an overall mortality of 54 per cent in infants presenting for surgery in the first 2 months of life. We have reviewed our experience with over 400 procedures during the past 5 years in infants less than three months of age, and our overall mortality is 19 per cent. Primary repair remains our goal, but a disappointingly high mortality with primary repair in this group, by us and others, has caused us to perform palliative procedures when palliation in our experience offers an overall lower mortality.