The diagnosis and management of congenital heart disease (CHD), the most common inborn defect, has been a tremendous success of modern medicine. With the development of diagnostic techniques, surgical procedures and interventional techniques, more than 90% of CHD children can survive to adulthood. Consequently, the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood. Adult CHD cardiology is now encompassing not only young or middle-aged adults but also patients aged above 60 years. Standardized guidelines can provide good theoretical support for the comprehensive management of adult CHD. Ten years after the European Society of Cardiology guidelines for the management of grown-up CHD released in 2010, the new version was officially released in August 2020. The new version of guidelines updated the classification and stratification of diseases, comprehensive intervention methods and intervention timing, and put forward some new concepts, new intervention standards and methods. For adult CHD that has not been repaired or needs to be repaired again, the indication and mode of surgical intervention and perioperative management have a great impact on the prognosis. The new version of the guidelines provides a detailed description of the surgical and intervention indications and methods for different diseases, and clarifies the management methods for high-risk groups. This article attempts to interpret this newly updated guideline from the perspective of a surgeon, sort out several key diseases introduced by the guideline, and strives to provide a concise and actionable guideline for domestic counterparts.
Citation：
TIAN Miao, ZENG Xiaodong, ZHANG Yong, CHEN Jimei. Interpretation of surgical perioperative management strategy of 2020 ESC guidelines for the management of adult congenital heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1393-1402. doi: 10.7507/1007-4848.202010028
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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- 1. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J, 2020. [Epub ahead of print].
- 2. Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J, 2010, 31(23): 2915-2957.
- 3. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019, 139(14): e637-e697.
- 4. Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.
- 5. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J, 2019, 53(1): 1801913.
- 6. Fuller SM, He X, Jacobs JP, et al. Estimating mortality risk for adult congenital heart surgery: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg, 2015, 100(5): 1728-1735.
- 7. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018, 39(34): 3165-3241.
- 8. Oechslin E. Management of adults with cyanotic congenital heart disease. Heart, 2015, 101(6): 485-494.
- 9. Mongeon FP, Ben Ali W, Khairy P, et al. Pulmonary valve replacement for pulmonary regurgitation in adults with tetralogy of Fallot: A meta-analysis-a report for the Writing Committee of the 2019 update of the Canadian Cardiovascular Society guidelines for the management of adults with congenital heart disease. Can J Cardiol, 2019, 35(12): 1772-1783.
- 10. Rychik J, Atz AM, Celermajer DS, et al. Evaluation and management of the child and adult with Fontan circulation: A scientific statement from the American Heart Association. Circulation, 2019. [Epub ahead of print].
