Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Abstract

Continuous advances in pediatric cardiology, surgery, and critical care have significantly improved survival rates for children and adults with congenital heart disease. Paradoxically, the resulting increase in longevity has expanded the prevalence of both repaired and unrepaired congenital heart disease and has escalated the need for diagnostic and interventional procedures. Because of this expansion in prevalence, anesthesiologists, pediatricians, and other health care professionals increasingly encounter patients with congenital heart disease or other pediatric cardiac diseases who are presenting for surgical treatment of unrelated, noncardiac disease. Patients with congenital heart disease are at high risk for mortality, complications, and reoperation after noncardiac procedures. Rigorous study of risk factors and outcomes has identified subsets of patients with minor, major, and severe congenital heart disease who may have higher-than-baseline risk when undergoing noncardiac procedures, and this has led to the development of risk prediction scores specific to this population. This scientific statement reviews contemporary data on risk from noncardiac procedures, focusing on pediatric patients with congenital heart disease and describing current knowledge on the subject. This scientific statement also addresses preoperative evaluation and testing, perioperative considerations, and postoperative care in this unique patient population and highlights relevant aspects of the pathophysiology of selected conditions that can influence perioperative care and patient management.

Association between anesthetic type and perioperative outcomes in pediatric patients undergoing elective surgery: An observational study

“…This aligns with the idea that avoiding systemic anesthetics in RA may contribute to a lower incidence of nausea, a well-documented side effect of general anesthetics. The shorter length of stay in the recovery room for RA patients is in line with the observations of Nasr et al, 12 who emphasized the significance of efficient recovery in pediatric patients with congenital heart disease. The quicker recovery associated with RA has been reported in various surgical settings, as also noted in Meyer et al,'s study, 13 where pre-operative anemia was associated with post-operative morbidity in pediatric surgical patients.…”

Risk factors for neurological complications and short-term outcomes after pediatric heart surgery: a retrospective analysis

“…In our policy, sedation is kept off till child is appropriately awake, and CT brain is performed after 24 h. Additionally, 93.3 % of the children came without open chest and the median days on ventilation was 3 days. The complexity of the cardiac defect and the surgical procedure required to correct it are the predictors for neurological complications [ 13 , 16 ]. More complex procedures require longer operating times, increased use of cardiopulmonary bypass, and higher rates of intraoperative hypotension, all of which increase the risk of neurological complications [ 16 ].…”

“…The complexity of the cardiac defect and the surgical procedure required to correct it are the predictors for neurological complications [ 13 , 16 ]. More complex procedures require longer operating times, increased use of cardiopulmonary bypass, and higher rates of intraoperative hypotension, all of which increase the risk of neurological complications [ 16 ]. Additionally, children with preexisting neurological conditions, such as epilepsy, are at a higher risk of post-operative brain injury.…”