Guidelines for anaesthesia of adults with congenital heart disease in non-cardiac surgery

Nadir Tafer¹, Elise Langouet², Xavier Alacoque³, Pascal Amedro⁴, Miréla Bojan⁵, Marie Bruyère⁶, Bernard Cholley⁷, Catherine Koffel⁸, Magalie Ladouceur⁹, Stéphane Lebel¹⁰, Bertrand Leobon¹¹, Loïc Mace¹², Estelle Morau¹³, Caroline Ovaert¹⁴, Jean-Benoît Thambo⁴, Diane Zotnik¹⁵, Hugues de Courson¹⁶, Marc-Olivier Fischer¹⁷

Affiliations

¹ Department of Cardiovascular Anesthesia and Critical Care, Bordeaux University Hospital, Bordeaux, France. Electronic address: nadir.tafer@chu-bordeaux.fr.
² Department of Cardiovascular Anesthesia and Critical Care, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France.
³ Department of Anaesthesiology, University Hospital of Toulouse, Toulouse, France.
⁴ IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France; Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Bordeaux University Hospital, France.
⁵ Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, M3C, GHPSJ, University Paris-Saclay, Le Plessis-Robinson, France.
⁶ Department of Anesthesiology Intensive Care and Perioperative Medicine, AP-HP, Université Paris Saclay, Hôpital Bicêtre 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France.
⁷ Department of Anaesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France; 2 Université Paris Cité, INSERM UMR-S1140 "Innovations Thérapeutiques en Hémostase", Paris, France.
⁸ Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
⁹ Cardiology Department, University Hospitals of Geneva, Geneva, Switzerland.
¹⁰ Department of Pediatric Anesthesia and Intensive Care Unit, APHM La Timone, Marseille, France.
¹¹ Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Bordeaux University Hospital, France.
¹² Department of Cardiac Surgery, La Timone Hospital, AP-HM, Aix Marseille Univ, Marseille, France; M2P2, Centrale Marseille, CNRS, Aix Marseille Univ, Marseille, France.
¹³ Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France.
¹⁴ Pediatric and Congenital Cardiology, Timone Hospital, Assistance Publique Hôpitaux de Marseille (APHM), Aix Marseille University, France; Marseille Medical Genetics, Inserm UMR1251, Aix Marseille University, France.
¹⁵ Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France; INSERM- UMR_S1140, Innovative Therapies in Haemostasis, Paris University, Paris, France.
¹⁶ Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, Troisième Étage Aile 1, 33000, Bordeaux, France; INSERM, BPH, U1219, Univ. Bordeaux, 33000, Bordeaux, France.
¹⁷ Institut Aquitain du Cœur, Clinique Saint-Augustin, Elsan, 114 Avenue d'Arès, 33074 Bordeaux Cedex, France.

PMID: 40311847
DOI: 10.1016/j.accpm.2025.101540

Practice Guideline

Guidelines for anaesthesia of adults with congenital heart disease in non-cardiac surgery

Nadir Tafer et al. Anaesth Crit Care Pain Med. 2025 Aug.

. 2025 Aug;44(4):101540.

doi: 10.1016/j.accpm.2025.101540. Epub 2025 Apr 29.

Authors

Affiliations

¹ Department of Cardiovascular Anesthesia and Critical Care, Bordeaux University Hospital, Bordeaux, France. Electronic address: nadir.tafer@chu-bordeaux.fr.
² Department of Cardiovascular Anesthesia and Critical Care, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France.
³ Department of Anaesthesiology, University Hospital of Toulouse, Toulouse, France.
⁴ IHU Liryc, INSERM 1045, University of Bordeaux, Bordeaux, France; Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Bordeaux University Hospital, France.
⁵ Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, M3C, GHPSJ, University Paris-Saclay, Le Plessis-Robinson, France.
⁶ Department of Anesthesiology Intensive Care and Perioperative Medicine, AP-HP, Université Paris Saclay, Hôpital Bicêtre 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France.
⁷ Department of Anaesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France; 2 Université Paris Cité, INSERM UMR-S1140 "Innovations Thérapeutiques en Hémostase", Paris, France.
⁸ Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
⁹ Cardiology Department, University Hospitals of Geneva, Geneva, Switzerland.
¹⁰ Department of Pediatric Anesthesia and Intensive Care Unit, APHM La Timone, Marseille, France.
¹¹ Pediatric and Congenital Cardiology Department, M3C National Reference CHD Centre, Bordeaux University Hospital, France.
¹² Department of Cardiac Surgery, La Timone Hospital, AP-HM, Aix Marseille Univ, Marseille, France; M2P2, Centrale Marseille, CNRS, Aix Marseille Univ, Marseille, France.
¹³ Department of Anesthesiology Intensive Care and Perioperative Medicine, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nimes, University Montpellier, Nimes, France.
¹⁴ Pediatric and Congenital Cardiology, Timone Hospital, Assistance Publique Hôpitaux de Marseille (APHM), Aix Marseille University, France; Marseille Medical Genetics, Inserm UMR1251, Aix Marseille University, France.
¹⁵ Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France; INSERM- UMR_S1140, Innovative Therapies in Haemostasis, Paris University, Paris, France.
¹⁶ Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, Troisième Étage Aile 1, 33000, Bordeaux, France; INSERM, BPH, U1219, Univ. Bordeaux, 33000, Bordeaux, France.
¹⁷ Institut Aquitain du Cœur, Clinique Saint-Augustin, Elsan, 114 Avenue d'Arès, 33074 Bordeaux Cedex, France.

PMID: 40311847
DOI: 10.1016/j.accpm.2025.101540

Abstract

Objective: To provide guidelines for the anesthetic management of adults with congenital heart disease for non-cardiac surgery.

Design: A consensus committee of 16 experts was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE®) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.

Methods: The committee studied 10 questions within 4 fields: preoperative evaluation, intraoperative management, postoperative care, and obstetrics. Each question was formulated in a PICO (Patients Intervention Comparison Outcome) format and evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.

Results: The experts' synthesis work and the application of the GRADE® method resulted in 11 expert opinions. Some of the questions did not find any response in the literature. After one round of scoring, a strong agreement was reached for all recommendations.

Conclusions: There was strong agreement among experts for 10 recommendations to improve practices for the anesthetic management of adults with congenital heart disease for non-cardiac surgery.

Keywords: Anesthesia; Congenital heart disease; Guidelines; Non-cardiac surgery.

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Guidelines for anaesthesia of adults with congenital heart disease in non-cardiac surgery

Affiliations

Guidelines for anaesthesia of adults with congenital heart disease in non-cardiac surgery

Authors

Affiliations

Abstract

Publication types

MeSH terms