Open Access
ARTICLE
Preoperative Risk Assessment and Perioperative Management of Adults with Congenital Heart Disease Undergoing Non-Cardiac Surgery
Michela Palma, Giancarlo Scognamiglio*, Flavia Fusco, Assunta Merola, Anna Correra, Diego Colonna, Emanuele Romeo, Berardo Sarubbi
Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, 80131, Italy
* Corresponding Author: Giancarlo Scognamiglio. Email:
Congenital Heart Disease 2020, 15(1), 33-49. https://doi.org/10.32604/CHD.2020.011523
Received 13 May 2020; Accepted 05 June 2020; Issue published 17 June 2020
Abstract
Adults with congenital heart disease (ACHD) constitute a growing
population with complex cardiac physiopathology and frequent extra-cardiac
involvement. The recent dramatic improvement of their life expectancy has
resulted in an increasing proportion of ACHD patients requiring non-cardiac
surgery. While a large body of evidence demonstrated the importance of an
accurate risk assessment in patients with acquired heart disease before noncardiac surgery in order to reduce perioperative morbidity and mortality and
detailed algorithms have been released by international societies, no specific
guidelines are available for the perioperative management in this population.
Nonetheless, understanding the complex anatomy and unusual physiology of
both repaired and unrepaired congenital heart disease is paramount to meet the
unique needs of these patients and to ensure an adequate perioperative
management and prevention of complications. Furthermore, anaesthesiologists
and surgeons unfamiliar with congenital heart disease may be not aware of the
variety of different disease-related issues, which may arise in ACHD patients
during the hemodynamic changes of the perioperative phase, with possible
severe adverse effects on cardiac performance. We herein review the limited
evidence from the literature and summarize our personal experience in a tertiary
ACHD centre in order to propose a first structured approach for preoperative risk
assessment and perioperative management to reduce the mortality and morbidity
risk in adults with congenital heart disease undergoing non-cardiac surgery.
Keywords
Cite This Article
Palma, M., Scognamiglio, G., Fusco, F., Merola, A., Correra, A. et al. (2020). Preoperative Risk Assessment and Perioperative Management of Adults with Congenital Heart Disease Undergoing Non-Cardiac Surgery.
Congenital Heart Disease, 15(1), 33–49. https://doi.org/10.32604/CHD.2020.011523