| Limited availability of conduits | Delaying initial corrective operations for conditions requiring conduits, using the bidirectional Glen shunt—as a venous shunt—as interim palliation for longer durations |
| Greater emphasis on alternatives for corrective operations that do not involve the use of conduits—for example, the double barrel repair for tetralogy of Fallot with coronary crossing right ventricular outflow tract-conduit, Barbero-Marcials repair for persistent truncus arteriosus |
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| Cost of imported bypass disposables | Re-sterilisation and reuse of tubings and cannulas for 3–4 uses; performing the bidirectional Glen operation under right heart bypass without the use of a oxygenator |
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| Cost of suture materials | Indigenous suture materials |
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| Human resources for intensive care unit care | Multitasking—for example, in absence of dedicated paediatric cardiac intensivists, postoperative care is often delivered by cardiac surgeons, cardiologists and anaesthesiologists |
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| Complex heart defects requiring single/multistage corrections | Attempts to perform single-stage corrections albeit at marginally higher risk—for example, performing aortic arch repair with correction of intracardiac defects such as ventricular septal defects closure or arterial switch options |
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| Prosthetic materials | Pericardial autografts as alternatives to expensive synthetic materials such as polytetrafluoroethylene |