Arthur S. Keats Division of Pediatric Cardiovascular Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Division of Cardiothoracic Anesthesiology, Children's Hospital of Philadelphia.
Curr Opin Anaesthesiol. 2020 Jun;33(3):335-342. doi: 10.1097/ACO.0000000000000849.
The current review focuses on the new development of adult congenital heart disease (ACHD) patients in the areas of imaging, percutaneous interventions, ventricular assist devices and transplantation.
Since the last ACHD publication in the journal, several advances have been made in the evaluation and treatment of these patients. As CHD patients' longevity increases pregnancy, comorbities and acquired heart disease become a concern. Recent data show that the incidence of complications in low-risk CHD is not higher that the regular population. In addition, breakthrough research in percutaneous valve implantation has been published showing good outcomes but needing intensive care recovery in a significant number of patients. In the ACHD heart failure population, assist device and transplant fields mounting evidence shows that these therapies should not be the last resort since low-risk ACHD patient may have similar outcomes to those with acquired heart disease. Finally risk stratification is important in ACHD to define better ways to recover from surgery and anesthesia.
The field of anesthesia for ACHD is growing with new indications for diagnostic, interventional and surgical procedures. Tailoring cardiac and noncardiac care to the different risk profile in ACHD patients will be defined in the next few years.
Motta summary clip: http://links.lww.com/COAN/A65.
本综述重点关注成人先天性心脏病（ACHD）患者在影像学、经皮介入、心室辅助装置和移植等领域的新进展。
自该期刊发表上一篇 ACHD 相关内容以来，这些患者的评估和治疗取得了多项进展。随着 CHD 患者寿命的延长，妊娠、合并症和获得性心脏病成为关注点。最近的数据表明，低危 CHD 患者的并发症发生率并不高于普通人群。此外，经皮瓣膜植入的突破性研究已经发表，显示出良好的结果，但仍有相当数量的患者需要重症监护恢复。在 ACHD 心力衰竭患者中，辅助装置和移植领域的大量证据表明，这些治疗方法不应作为最后的手段，因为低危 ACHD 患者的预后可能与获得性心脏病患者相似。最后，风险分层在 ACHD 中很重要，可明确更好的术后和麻醉恢复方法。
ACHD 麻醉领域正在发展，新的诊断、介入和手术适应证不断涌现。未来几年，将根据 ACHD 患者的不同风险特征制定心脏和非心脏护理方案。
Motta 视频摘要：http://links.lww.com/COAN/A65.
