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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Patients with adult congenital heart disease presenting for noncardiac surgery
Christian Refakis1, Benjamin Marsh1, Anjalee Dave1
1Northwell Department of Anesthesiology, Cohen Children's Medical Center, New Hyde Park, New York.
Insights
Adults with congenital heart disease (ACHD) face increased surgical risks. Anesthesiologists must understand ACHD complexities for safe perioperative care, including pregnancy considerations for women with ACHD.
Area of Science:
- Anesthesiology
- Cardiology
- Adult Congenital Heart Disease
Background:
- Advances in medical and surgical care have increased survival for patients with congenital heart disease (CHD) into adulthood.
- The population of adult congenital heart disease (ACHD) patients undergoing noncardiac surgery is growing.
- Anesthesiologists will increasingly encounter ACHD patients in diverse practice settings.
Purpose of the Study:
- To review the literature on long-term outcomes in CHD.
- To identify risk and management issues for ACHD patients undergoing noncardiac surgery.
- To highlight unique issues for women with ACHD during pregnancy.
Main Methods:
- Literature review focusing on adult congenital heart disease.
- Analysis of perioperative risks and management strategies.
- Examination of outcomes and specific population considerations (e.g., pregnancy).
Main Results:
- Adults with CHD undergoing noncardiac surgery have a higher risk of perioperative morbidity and mortality.
- Key themes include long-term outcomes, risk stratification, and management strategies.
- Specific challenges related to pregnancy in women with ACHD are identified.
Conclusions:
- Understanding ACHD complexities is critical for safe anesthesia.
- Guidance is provided for anesthesiologists on patient selection, care location, and perioperative management.
- Enhanced knowledge and skills are encouraged for optimal care of ACHD patients.
Purpose Of Review:
With advances in surgical, medical, and anesthetic management, most patients born with congenital heart disease survive into adulthood. Patients with adult congenital heart disease (ACHD) present in increasing numbers for noncardiac surgery. As this population continues to grow, anesthesiologists in every practice will come into contact with them. Understanding the complex challenges ACHD patients pose is critical to providing safe anesthesia.
Recent Findings:
This literature review brings to light themes of long-term outcomes in CHD, risk and management issues in providing care for ACHD undergoing noncardiac surgery, and the unique issues women with ACHD face during pregnancy, and can be used to assist anesthesiologists in decision making and perioperative planning.
Summary Implications:
Adults with CHD who present for noncardiac surgery carry an increased risk for significant morbidity and mortality in the perioperative phase. This paper can help anesthesiologist inform their decisions on who should care for these patients and where that should occur. It also provides guidance on how to provide care. Readers are encouraged to further obtain there required knowledge and skill to care for patients with ACHD.
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