‘‘Learning curve’’ in congenital cardiac surgery

We congratulate Sarısoy et al. (1) for their study. We found their successful results of congenital heart surgery operations. Because these operations require a lot of effort and time. In this study, they mainly discussed the long-term results of atrioventricular septal defect (AVSD) operations. One of the issues that draw our attention is the relationship between the date of operation and the results of the operation. In this study, they mentioned the differences in the reoperation rates and postoperative left ventricular outflow tract obstruction rates between the operations performed in the early 2000s and the current operations. When we examined the study, we found that there was less success rate in terms of these parameters in the operations in the early 2000s, but there was no difference in terms of early mortality. The authors reported that their better understanding of myocardial protection methods and perfusion methods and the more frequent use of intraoperative transesophageal echocardiography (TEE) have impact on these results. At this point, we want to make some contributions to the authors. The authors’ comments, without any data in their hands, are based on their personal experience. However, we do not fully agree with these comments. The development and better understanding of myocardial protection or perfusion methods will have an absolute effect on some early postoperative data, such as early postoperative low cardiac output or inotropic support demand, early postoperative neurological complications, or, most importantly, early mortality. Other parameters that were emphasized by the authors were related to late-term results, except for early mortality