**22. Conclusion**

Pediatric cardiac surgery is a noble pursuit, the healing of a sick heart by surgery in a fragile child. The future remains exciting with many anticipated developments. Many complex conditions will disappear as antenatal diagnosis becomes a norm and medical termination of pregnancy the rule. There will be an explosive growth in the number of adults presenting with congenital heart disease. This would present a huge stress on the healthcare providers and we must be prepared for this.

Surgeons will have to sharpen their skills as simple conditions will disappear from their operating list, which would be dealt with by interventional cardiologist. It would be replaced by complex conditions, adolescents and adults with congenital problems, requiring reopera‐ tions. They will have to accept fresh challenges- a surgeon cannot just replace a valve, but figure out strategies and surgical techniques to repair the patient's valve. The bar is thus raised.

In the late 1990's and early part of this century, mortality rate was the parameter by which a surgeon or unit was judged. This will be replaced by tougher parameters- complication rates and success rates with the more complex congenital cardiac conditions. Genetic engineering and transplant technology will have the greatest impact on the future of congenital cardiac surgery. Emphasis will be on the quality of life of survivors and normalizing their lives as much as possible. The future is indeed exciting and full of wonderful possibilities!

### **Author details**

**5. Genetic engineering:** Valves manufactured from the patient's own genetic material will demonstrate greater durability and biocompatibility and may become available off the

**6. Heart and heart-lung transplant:** There is a huge population of patients with Eisenmeng‐ er's syndrome who will eventually require transplant. Transplant restrictions such as

**7. Advancements in perfusion, anaesthesia and intensive care:** Better perfusion technology and techniques to avoid cardiopulmonary bypass with its deleterious effects on children will improve results of cardiac surgery. Pharmocological advances and newer drugs will provide for better outcomes via improved anaesthesia and postoperative strategies.

availability of organs (genetically manufactured) and rejection will be overcome.

**21. Quality improvement and risk stratification in congenital cardiac**

morbidity rates of the hospital relative to the complexity of the cases they accept.

with those of various others across the world.

There are various risk-stratification scores in congenital cardiac surgery such as RACHS-1 and Aristotle Comprehensive Complexity Score. This places into perspective the mortality and

Databases exist such as the Society of Thoracic Surgeons database (STS) and EACTS congenital database which allows surgeons to compare the results of their surgery on various diagnoses

Pediatric cardiac surgery is a noble pursuit, the healing of a sick heart by surgery in a fragile child. The future remains exciting with many anticipated developments. Many complex conditions will disappear as antenatal diagnosis becomes a norm and medical termination of pregnancy the rule. There will be an explosive growth in the number of adults presenting with congenital heart disease. This would present a huge stress on the healthcare providers and we

Surgeons will have to sharpen their skills as simple conditions will disappear from their operating list, which would be dealt with by interventional cardiologist. It would be replaced by complex conditions, adolescents and adults with congenital problems, requiring reopera‐ tions. They will have to accept fresh challenges- a surgeon cannot just replace a valve, but figure out strategies and surgical techniques to repair the patient's valve. The bar is thus raised. In the late 1990's and early part of this century, mortality rate was the parameter by which a surgeon or unit was judged. This will be replaced by tougher parameters- complication rates and success rates with the more complex congenital cardiac conditions. Genetic engineering and transplant technology will have the greatest impact on the future of congenital cardiac

shelf.

266 Principles and Practice of Cardiothoracic Surgery

**surgery**

**22. Conclusion**

must be prepared for this.

Krishnan Ganapathy Subramaniam\* and Neville Solomon\*

\*Address all correspondence to: ganapathysubramaniamk@gmail.com

\*Address all correspondence to: nevillesolomon@gmail.com

Apollo Children's Hospital, Chennai, Tamil Nadu, India
