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Hypoplastic left heart: the next chapter in our unsolved problem
  1. David S Winlaw1,2,3
  1. 1 Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2 Faculty of Medicine, School of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, Australia
  1. Correspondence to Professor David S Winlaw, Heart Centre for Children, The Children’s Hospital, Westmead, NSW 2145, Australia; david.winlaw{at}sydney.edu.au

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The story of paediatric cardiac care over the last 35 years can be told through the many successes and failures in the surgical management of hypoplastic left heart (HLH). In their Heart paper, 1 Rogers and colleagues bring the second chapter to a close and foreshadow the next chapter for a specialty which, in the UK, is never far from newspaper headlines.

In chapter 1 (pre-2000), neonates with HLH faced daunting odds of survival despite consistent success in other forms of complex neonatal cardiac repair. Many services and some countries did not offer surgery for this condition and the balance between the benefits of procedural volume versus local access to care was constantly debated. The ethical foundation of treating newborns with HLH was constantly questioned, and success or failure of entire surgical programmes was predicated on acceptable early survival of this cohort.

The second chapter spans 2000–2015, when patients described in this report were born and began their surgical pathway. Consistent and excellent results were being achieved by units in the UK2 and USA. There was rapid dissemination of techniques and philosophies of care to the point where most large programmes routinely managed HLH and achieved good early outcomes.

Truly team-based care, a focus on the intensive care needs of the postsurgical neonate and tight integration of surgery with cardiology became understood as fundamental to achieve optimal outcomes. This hospital and human infrastructure lifted early outcomes for all other forms of paediatric cardiac surgery; part-time paediatric cardiac surgical practice became uncommon and expectations continued to grow.

This report of outcomes is particularly important and will be welcomed by the international community working in congenital heart disease (CHD). Unlike most other reports of outcome in HLH, this report is population based (England and Wales). Further, the raw data are derived from a …

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