Report of the Pediatric Heart Network and National Heart, Lung, and Blood Institute Working Group on the Perioperative Management of Congenital Heart Disease

The survival of patients with congenital heart disease (CHD) has significantly improved during the past several decades (the Figure). This accomplishment is directly attributable to the net effect of individual therapeutic successes from the innovative work of surgeons and cardiologists and the courageous devotion of patients and families. However, as the field moves forward, the need for evidence-based medicine derived from multi-institutional collaborations to address more subtle and complex questions such as functional outcome and quality of life and to provide data to guide individual practitioners has become paramount. Recognizing this, the National Heart, Lung, and Blood Institute (NHLBI) established the Pediatric Heart Network (PHN) in 2001 to provide a collaborative platform for conducting clinical studies. The need for evidence-based care and the ability of the PHN to provide this evidence were demonstrated by recent developments in the surgical management of hypoplastic left heart syndrome. Hypoplastic left heart syndrome was a uniformly fatal defect before Norwood’s innovative surgical approach in which the diminutive aorta is reconstructed using the pulmonary artery trunk and pulmonary blood flow is provided by a Blalock-Taussig shunt. 2 Recently, a previously described modification to this procedure in which pulmonary blood flow is provided by a right ventricle to pulmonary artery shunt has seen renewed interest. 3 This modification has been widely adopted but has yielded conflicting results. 4–7 In May 2005, the PHN launched the Single Ventricle Reconstruction (SVR) trial, a randomized trial comparing these 2 surgical strategies. 8 In just over 3 years, 555 infants were