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Adults with congenital heart disease (ACHD) are increasingly represented in non-cardiac surgical admissions and face varying levels of pre-operative risk based on their condition and surgery type. Risk stratification categorizes patients into minor, intermediate, and severe risk groups, with recommendations for specialist consultation and experienced surgical centers for higher-risk procedures. Recent data indicates a mortality rate exceeding 4% for ACHD patients undergoing non-cardiac surgery.

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sorbant1980
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6 views1 page

٤

Adults with congenital heart disease (ACHD) are increasingly represented in non-cardiac surgical admissions and face varying levels of pre-operative risk based on their condition and surgery type. Risk stratification categorizes patients into minor, intermediate, and severe risk groups, with recommendations for specialist consultation and experienced surgical centers for higher-risk procedures. Recent data indicates a mortality rate exceeding 4% for ACHD patients undergoing non-cardiac surgery.

Uploaded by

sorbant1980
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Adults with con­gen­i­tal heart dis­ease (ACHD) rep­re­sent an in­creas­ing pro­por­tion of non-​car­diac sur­gi­cal ad­mis­sions and

might be at high risk for CV events. Pre-​op­er­a­tive risk as­sess­ment in ACHD needs to fo­cus on the un­der­ly­ing dis­ease, type
of surgery, resid­ua, and se­que­lae. Co­ex­is­tence of HF, pul­monary hy­per­ten­sion, ar­rhyth­mia, hy­pox­aemia, dam­age to oth­er or­‐
gans, and en­do­cardi­tis may con­sid­er­ably in­flu­ence the base­line risk of these pa­tients from no ad­di­tion­al risk to very high
risk for worse prog­no­sis. In a re­cent re­port, ab­so­lute mor­tal­i­ty in ACHD pa­tients un­der­go­ing NCS ex­ceed­ed 4%. The clas­si­fi­‐
ca­tion in Table 9 is pro­posed for risk strat­i­fi­ca­tion.

Table 9 Risk strat­i­fi­ca­tion for non-​car­diac surgery in adults with con­gen­i­tal heart dis­ease

Pa­tients with small, un­cor­rect­ed de­fects, and no need for med­i­ca­tion or any oth­er
Mi­nor risk treat­ment. Pa­tients with suc­cess­ful­ly cor­rect­ed CHD with no symp­toms, no rel­e­vant
resid­ua, and no need for med­i­ca­tion

Pa­tients with cor­rect­ed or un­cor­rect­ed con­di­tions with resid­ua


­ l haemo­dy­nam­ic ab­‐
In­ter­me­di­ate risk
nor­mal­i­ty, with or with­out med­i­ca­tion

Pa­tients with un­cor­rect­ed cyan­ot­ic heart dis­ease, pul­monary hy­per­ten­sion, oth­er


Se­vere risk com­plex con­gen­i­tal heart dis­ease, ven­tric­ul­ar dys­func­tion re­quir­ing med­i­ca­tion, and
pa­tients list­ed for heart trans­plan­ta­tion

Rec­om­men­da­tions for man­age­ment of pa­tients with adult con­gen­i­tal heart dis­ease un­der­go­ing non-​car­diac surgery

Rec­om­men­da­tions Classa Lev­ela

In pa­tients with ACHD, a con­sul­ta­tion by an ACHD spe­cial­ist is rec­‐


I C
om­mend­ed be­fore in­ter­me­di­ate-​or high-​risk surgery.

In pa­tients with ACHD, it is rec­om­mend­ed that in­ter­me­di­ate-​and


high-​risk elec­tive surgery is per­formed in a cen­tre with ex­pe­ri­ence in I C
the care of ACHD pa­tients.

ACHD, Adults with con­gen­i­tal heart dis­ease.


a
Class of rec­om­men­da­tion and lev­el of ev­i­dence as de­fined in Ta­bles 1 and 2.

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