Perioperative Care of Adults with Congenital Heart Disease for Non-cardiac Surgery

Abstract

In 2010 it was estimated that 1.2 million young adults in the United States have some form of congenital heart disease (CHD). Data from large adult congenital heart disease (ACHD) centers show that as many as 50 % of these patients are over 40 years of age. As this population ages, physicians are likely to encounter such patients in their practice. Risk stratification and an interdisciplinary approach are paramount in achieving safe outcomes. The assessment of the patient must consider the variable expression of CHD. As most lesions are “fixed but not cured” the altered physiology of the heart and the physiological challenges of surgical interventions must be considered. The 2008 AHA/ACC guidelines for the Management of Adults with CHD establish for the first time a streamlined approach to the care of these patients. This review will apply these guidelines to the ACHD patient undergoing non-cardiac surgery.