Developmental outcomes after early surgery for complex congenital heart disease: a systematic review and meta-analysis.

Most included studies were observational, limiting causal inference. High heterogeneity across studies in diagnosis, age at testing, and assessment tools. Significant attrition in long-term follow-up studies, with only four studies tracking children longitudinally over extended periods. No studies from Asia or Africa, limiting generalizability to global populations. Chromosomal abnormalities were excluded from most studies, so outcomes for children with both CHD and genetic syndromes are not addressed. Perioperative risk factors were inconsistently reported, making it difficult to determine their specific impact on development. Language and speech outcomes were not assessed in adolescence, leaving a gap in understanding long-term communication development.

The authors declared no conflicts of interest. The review was not funded by a commercial entity. The search and data extraction were performed by academic researchers at the University Medical Center Groningen.

Do not assume that improved surgical techniques have led to better developmental outcomes. The meta-analysis found that infant motor and cognitive scores actually decreased in more recent surgical eras, likely because more vulnerable infants are now surviving to be tested. This means the population being assessed is now higher-risk, not that care has worsened.