Children's heart services are under scrutiny Child heart surgery will stop at some hospitals to ensure patient safety under official plans put forward.
The NHS review looked at all 11 units in England amid concern expertise was being spread too thinly.
It has proposed four options - all of which involve stopping operations at either four or five hospitals.
These are now being considered by a special committee representing every NHS trust on Wednesday. It will decide which to put out to consultation.
One of the 11 - Oxford's John Radcliffe Hospital - has already stopped its operations.
The decision came after several deaths there last year.
In total, there are just 31 child heart surgeons across England. Between them, they carry out 3,600 operations each year on children in England and Wales, born with a range of heart defects.
Most children survive to adulthood, but there is widespread agreement among professional bodies that to provide a uniformly high quality of safe service, operations must be concentrated in fewer, larger centres.
Looking at the documents, one can't doubt the huge amount of work and analysis which has gone into this.
Each unit is rated in a number of different ways. And every unit, bar Oxford, continues to survive in at least one of the scenarios.
But this may give false hope to units like Leeds, which looks very unlikely to retain its surgery status.
Some might argue that it would have been better for the review team to be more prescriptive and actually list the units they think should no longer do surgery rather than this variety pack scenario.
This would enable surgeons to improve skills and share expertise.
Concerns have been raised about child heart surgery ever since the Bristol scandal in the 1990s when children having heart surgery died needlessly.
Professor Roger Boyle, the government's heart and stroke tsar, said he had "no doubt" that change was necessary.
"Unfortunately the answer is not recruiting more surgeons to the current centres. That would be a recipe for disaster as surgeons would not treat enough children to maintain their skills."
The changes have also received the backing of doctors. A joint statement from the Royal College of Surgeons and the Society of Cardiothoracic Surgery said: "England has the right number of heart surgeons treating rare heart conditions in children, but we know that they are thinly spread over too many units.
"A better service would be provided if this expertise were condensed in fewer units with the critical number of staff to support each other, disseminate new techniques and train the next generation of specialists."
Anne Keatley-Clarke, chief executive of the Children's Heart Federation, which represents parents, said she agreed.
"The majority of parents recognise that paediatric cardiac surgery is a specialist service that is best delivered on a national basis. So they support the concept of larger, but fewer centres of excellence and are willing to travel substantial
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