Perioperative considerations for pediatric patients with congenital heart disease presenting for noncardiac procedures: AHA statement
A recent scientific statement from the American Heart Association (AHA) outlines the state of knowledge about the range of treatment these individuals could need before, during, and after noncardiac surgery as the number of young patients with congenital heart disease (CHD) rises.
Although a patient's cardiologist frequently refers them for procedures, there are frequently "multiple providers from multiple specialties involved. The statement's main objective is to highlight the mortality and morbidity concerns these patients may encounter while receiving noncardiac treatments. It was published in Circulation: Cardiovascular Quality and Outcomes. Additionally, the authors aimed to help doctors who treat these patients but lack training in cardiac anesthesia do so safely and know when to seek assistance.
The study demonstrates that although noncardiac inpatient and outpatient visits for patients with CHD have progressively increased in recent years—the most frequent of which are gastrointestinal and otolaryngological procedures—their death rates have decreased.
Patient age is the main variable that affects the risk of death and morbidity, with younger patients, particularly those under one year old, being more sensitive. However, the type of cardiac lesion and the anatomy of the patient also matter, according to the authors, who place single-ventricle patients or those with single-ventricle physiology in a higher risk category.
Preoperative evaluations of these individuals should be extensive in order to evaluate the risks associated with anesthetic treatment as well as "any potential implications of the noncardiac procedure." The authors' approach also allows patients to be further categorized as having a low or high risk for surgery based on whether they have a minor, major, or severe cardiac classification.
According to the statement, those who are at low risk may be handled with an outpatient strategy and may not need a consultation with a pediatric cardiology-trained anesthesiologist or an ICU bed. The authors note that high-risk patients need specialized multidisciplinary treatment from healthcare professionals with CHD training and should get their care in a facility with access to ICU beds and postoperative inpatient monitoring.
Although some studies have focused on the best setting for CHD patients to undergo noncardiac procedures, it is still unclear whether they should always be treated at specialized cardiac centers.
When a kid is harmed or fractures an elbow swinging at the playground, does it matter if surgical and cath lab [treatment] is now more regional and assigned to specialized facilities, or can they simply go to the nearby hospital? One of the things influencing this is that. If it does, how would you go about optimizing both the result and the area in which they reside?
This is why it's crucial that doctors treating CHD patients with less severe abnormalities get some information right away. To enable more seasoned anesthesiologists to handle patients with difficult diseases, there should be enough personnel educated to care for the rising cardiac population, particularly patients with simple condition who have been cured and are now acting like normal patients.
Reference –
Nasr VG, Markham LW, Clay M, et al. Perioperative considerations for pediatric patients with congenital heart disease presenting for noncardiac procedures: a scientific statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2022;15:e000113.
