In order to evaluate physicians' willingness to seek legal action to mandate surgery when parents refuse surgery for various congenital heart lesions, we surveyed pediatric cardiologists and cardiovascular surgeons at 4 children's hospitals. We asked whether physicians would support parental refusal of surgery for specific heart defects and, if not, whether they would seek legal action to mandate surgery. We then analyzed associations between physicians' willingness to mandate surgery and national operative mortality rates for each lesion. We surveyed 126 cardiologists and 9 cardiac surgeons at four tertiary referral centers. Overall response rate was 77%. Greater than 70% of physicians would seek legal action and mandate surgery for the following lesions: ventricular septal defect, coarctation of the aorta, complete atrioventricular canal, transposition of the great arteries, tetralogy of Fallot, and unobstructed total anomalous pulmonary venous return. Surgery for all of these lesions has reported mortality rates of < 5%. Physicians were less likely to seek legal action when parents refused surgery for Shone complex, any single ventricle lesion, or any congenital heart disease accompanied by Trisomy 13 or Trisomy 18. Among experts in pediatric cardiology, there is widespread agreement about the appropriate response to parental refusal of surgery for most congenital heart lesions, and these lesions tended to be heart defects with lower surgical mortality rates. Lesions for which there was greater consensus among experts were those with the best outcomes. There was less consensus for lesions with higher mortality rates. Such surveys, revealing disagreement among expert professionals, can provide an operational definition of the current professional "gray zone" in which parental preferences should determine treatment.

中文翻译：

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小儿心脏病专家关于先天性心脏病舒适护理可接受性的观点。

为了评估当父母拒绝对各种先天性心脏病进行手术时，医生是否愿意采取法律行动要求手术，我们对4家儿童医院的儿科心脏病专家和心血管外科医生进行了调查。我们询问医生是否会支持父母针对特定心脏缺陷拒绝手术，如果不是，他们是否会寻求法律行动来强制手术。然后，我们分析了医生要求进行手术的意愿与每个病变的国家手术死亡率之间的关联。我们在四个三级转诊中心对126位心脏病专家和9位心脏外科医师进行了调查。总体回应率为77％。超过70％的医生会就以下病变寻求法律行动并要求进行手术：室间隔缺损，主动脉缩窄，完整的房室管，大动脉移位，法洛四联症和无异常的总异常肺静脉回流。据报道，所有这些病变的手术死亡率均低于5％。当父母拒绝为Shone复合体，任何单心室病变或任何先天性心脏病伴有13三体或18三体手术而拒绝手术时，医师不大可能寻求法律诉讼。在儿科心脏病学专家中，关于对父母的适当反应已达成广泛共识大多数先天性心脏病变拒绝手术治疗，而这些病变往往是心脏缺陷，手术死亡率较低。专家一致认为的病变是那些效果最好的病变。对于死亡率较高的病变，共识较少。这样的调查