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Anesthesia in adults with congenital heart disease

Torsten Baehner1, Richard K Ellerkmann

  • 1Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany.

Current Opinion in Anaesthesiology
|March 18, 2017
PubMed

Insights

Adults with congenital heart disease (CHD) now outnumber children, complicating noncardiac surgery. Preoperative risk assessment and biomarker use, like NT-proBNP, are crucial for managing these complex patients.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Public Health

Background:

  • The demographic landscape of congenital heart disease (CHD) has shifted, with adults now exceeding pediatric populations.
  • This epidemiological change necessitates a re-evaluation of healthcare provision for noncardiac surgical procedures in adults with CHD (ACHD).

Purpose of the Study:

  • To review global demographic trends in CHD.
  • To examine current healthcare provision for noncardiac surgery in ACHD patients.
  • To analyze anesthetic and perioperative care strategies for ACHD undergoing noncardiac surgery.

Main Methods:

  • Literature review focusing on recent trends in CHD demographics.
  • Analysis of healthcare provision and anesthetic/perioperative care for noncardiac surgery in ACHD.
  • Evaluation of risk assessment tools, including clinical evaluation, echocardiography, and biomarkers.

Main Results:

  • Adults with CHD (ACHD) now outnumber children with CHD, expanding the scope of care beyond specialized centers.
  • Preoperative risk assessment for ACHD undergoing noncardiac surgery is complex, influenced by cardiac and noncardiac comorbidities.
  • Biomarkers like NT-proBNP show promise in estimating heart failure severity, with high negative predictive value for screening.
  • Arrhythmias are a primary cause of morbidity and mortality in ACHD, impacting perioperative management.
  • Adverse events and mortality in ACHD surgery are often linked to intraoperative anesthetic management.

Conclusions:

  • Advances in CHD treatment have shifted the burden of morbidity and mortality to adulthood.
  • Further research on risk stratification for ACHD is essential for optimizing perioperative management in noncardiac surgery.
  • Improved strategies are needed for both low-risk and high-risk ACHD patients undergoing noncardiac procedures.
Abstract

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