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General surgical procedures in survivors of complex congenital heart disease: A potential Pandora's box?

      In the most recent publication of the Journal, Farr and associates have reviewed the outcomes of adults with complex congenital heart disease (CHD) undergoing general surgical procedures over a 10-year period at two tertiary centers in Boston, MA.
      • Farr B.J.
      • Castillo-Angeles M.
      • Okafor B.
      • et al.
      Adult survivors of moderate and great complexity congenital heart disease undergoing general surgery procedures: how do they fare?.
      One hundred and eighteen patients with moderate and great complexity CHD as predetermined using the American College of Cardiology 2001 Bethesda Conference classification system were studied. Over 90% of the study population was New York Heart Association (NYHA) functional class I or II and 60% had a left ventricular ejection fraction greater than 55%, suggesting very good baseline functional status. The vast majority of procedures in this study were elective. Overall there was very low in-hospital morbidity and mortality in this study, which differs from previous data.
      • Maxwell B.G.
      • Wong J.K.
      • Kin C.
      • Lobato R.L.
      Perioperative outcomes of major noncardiac surgery in adults with congenital heart disease.
      In fact, the morbidity did not significantly differ from quoted NSQIP predictive scores for the general population.
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      References

        • Farr B.J.
        • Castillo-Angeles M.
        • Okafor B.
        • et al.
        Adult survivors of moderate and great complexity congenital heart disease undergoing general surgery procedures: how do they fare?.
        Am J Surg. 2022; 223: 841--845
        • Maxwell B.G.
        • Wong J.K.
        • Kin C.
        • Lobato R.L.
        Perioperative outcomes of major noncardiac surgery in adults with congenital heart disease.
        Anesthesiology. 2013; 119: 762-769
        • Cannesson Maxime
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        • Bruno Riou
        Anesthesia for noncardiac surgery in adults with congenital heart disease.
        Anesthesiology. 2009; 111: 432-440
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        • Bashore T.M.
        • et al.
        ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of cardiology/American heart association task force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Developed in collaboration with the American society of echocardiography, heart rhythm society, international society for adult congenital heart disease, society for cardiovascular angiography and interventions, and society of thoracic surgeons.
        J Am Coll Cardiol. 2008; 52: e143-e263