In May 2014, Evans et al reported that children with Down syndrome had lower rates of in-hospital death after cardiac surgery, compared with children without Down syndrome. Forty years ago, these results would have been unthinkable, as heart defects were not repaired in the majority of children with Down syndrome. However, as the field of cardiac surgery evolved, equal postoperative outcomes were reported between children with Down syndrome and those without. The historical question of whether we ought to offer cardiac repairs to infants with Down syndrome was influenced by a complex web of ethical, social, and legal considerations that changed over time, resulting in the current standard of care in which children with and without Down syndrome have the same opportunity for cardiac repair.

Complex intracardiac surgery in infants was not routinely performed until the early 1970s, and Pediatrics published the first report on cardiac repairs in infants...

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