IMPACT OF SURGICAL TIMING ON CORRECTION OF COMPLEX CONGENITAL HEART DISEASES IN SYMPTOMATIC NEONATES

Abstract

Introduction: Complex congenital heart diseases represent a heterogeneous group of cardiac malformations that often present with severe symptoms in the neonatal period, such as cyanosis, respiratory distress, and hemodynamic instability. Surgical correction of these lesions is essential for long-term survival and development, but the optimal timing of intervention is a crucial clinical decision. Operating too early in a fragile neonate may increase the risks inherent to the procedure, while excessive delay may lead to clinical deterioration, irreversible organ damage, and secondary complications. Balancing the urgency of anatomical correction with the physiological stability of the symptomatic newborn is a constant dilemma in pediatric cardiac surgery. Objective: The objective of this systematic literature review was to analyze the impact of surgical timing on short- and long-term outcomes in symptomatic neonates with complex congenital heart diseases. Methodology: A systematic literature review was conducted following the recommendations of the PRISMA checklist. The search was performed in the electronic databases PubMed, SciELO and Web of Science, using the descriptors: "Surgical Timing", "Congenital Heart Defects", "Neonates", "Outcomes" and "Complex". Articles published in the last 10 years that fit the theme were included. Inclusion criteria consisted of studies that evaluated the impact of different surgical timings in symptomatic neonates with complex congenital heart defects, reporting mortality, morbidity or other relevant outcomes. Studies focused on simple defects, asymptomatic patients or those older than 28 days at the time of primary surgery were excluded. Results: The studies analyzed demonstrated that surgical timing significantly impacted outcomes in neonates with symptomatic complex heart defects, but the optimal timing varied depending on the specific lesion. For certain duct-dependent defects, early intervention in the first days of life was associated with better survival and lower incidence of complications. For other malformations, a brief preoperative stabilization seemed to improve results. Complications such as ventricular dysfunction, pulmonary hypertension, and neurological events were influenced by the timing of surgery and the neonate's preoperative clinical status, highlighting the need for individualized assessment. Conclusion: The timing of surgery for symptomatic neonates with complex congenital heart defects represented a critical factor that significantly influenced outcomes. The optimal decision was dependent on the type of defect and the patient's clinical status, reinforcing the importance of management in specialized centers with experience in this challenging field to optimize survival and minimize postoperative complications.