In the past 4-5 decades, the care of children with congenital heart disease (CHD) has been transformed by advances in pediatric cardiovascular care, especially pediatric cardiac surgery. Corrective surgery offers a prospect of survival with good quality of life for children born with critical life-threatening CHD. The excellent health systems and health records of Scandinavian nations provides a unique opportunity to examine the long-term outcomes after congenital heart surgery.

This study examines the results from a nationwide pediatric cardiac surgery database and Finnish population registry of 10,964 patients undergoing 14,079 operations at <15 years of age in hospitals in Finland from 1953 to 2009. A follow-up rate of 98% was achieved. An early mortality (<30 days) of 5.6% perhaps reflects the fact that the database includes the earliest era of congenital heart surgery. The late mortality was 10.4%.

As expected, heart failure contributed to most deaths. This decreased significantly after 1990, presumably reflecting major advancements that have occurred in CHD surgery in the past three decades. Sudden death after surgery for atrial septal defect, ventricular septal defect, tetralogy of Fallot, and transposition of the great arteries decreased to zero following operations from 1990 to 2009. Deaths from neoplasms, respiratory, neurological, and infectious disease were significantly more common among study patients than controls. Pneumonia caused the majority of non–CHD-related deaths among the study population.

The results of this study should be viewed as a benchmark for the rest of the world, particularly low- and middle-income countries where comprehensive pediatric cardiac care has only now begun to take shape. Additionally, it is important to recognize that while patients operated for CHD have vastly improved outcomes, they cannot, by any means, considered as "cured".