Abstract
The growing population of adults with congenital heart disease (ACHD), estimated at
over 250000 in Germany by 2024, presents unique challenges in perioperative care.
Advances in paediatric cardiology, cardiac surgery and paediatric cardiac anaesthesia
have significantly improved survival rates, allowing many patients to reach advanced
adulthood. However, the management of these patients is often complicated by their
elevated risk of cardiac and extracardiac comorbidities, resulting in a threefold
increase in mortality compared to individuals without congenital heart defects. Despite
specialized care structures, studies reveal that over 50% of ACHD patients lack adequate
follow-up, underscoring the necessity for comprehensive, interdisciplinary approaches.
This paper highlights the complexity of preoperative risk stratification for non-cardiac
surgeries in ACHD patients, emphasizing the integration of the updated ACHD-AP classification,
which combines anatomical and physiological considerations. The absence of detailed
information on congenital defects and prior interventions often complicates emergency
risk assessment outside specialized centers. A multidisciplinary team, including ACHD-trained
anaesthesiologists and cardiologists, is critical for tailoring perioperative strategies.
Furthermore, the role of comorbidities such as arrhythmias, heart failure, and pulmonary
hypertension is explored as determinants of perioperative outcomes.
These findings underscore the urgent need for structured referral pathways, enhanced
collaboration among healthcare providers, and adherence to international guidelines
to optimize care for ACHD patients undergoing surgical procedures.
Die aktualisierte ESC Guideline for Management of Adult Congenital Heart Disease betont,
dass Patienten mit angeborenen Herzfehlern jeglicher Komplexität ein erhöhtes Risiko
für Mortalität und Morbidität aufweisen und eine medizinische Nachsorge über das gesamte
Erwachsenenalter hinweg benötigen. Dieser Beitrag führt aus, welche Punkte beim präoperativen
Risiko-Assessment besondere Beachtung finden müssen.
Schlüsselwörter
Erwachsene mit angeborenem Herzfehler - präoperatives Risikoassessment - ACHD-AP-Klassifikation
- perioperative Versorgung - interdisziplinärer Ansatz - kardiale Komorbiditäten
Keywords
adult congenital heart disease - preoperative risk assessment - ACHD-AP classification
- perioperative management - interdisciplinary care - cardiac comorbidities
