12
General Principles
Table 8. Preoperative Checklist for Noncardiac Surgery in
Patients With ACHD
Clarify clinical information related to congenital heart disease
Clarify prior procedures, residuae, sequelae, and current status, including ACHD
anatomic-physiological classification.
Develop management strategies for preoperative optimization to minimize risk and
improve postprocedural outcome.
Factors associated with increased risk for perioperative morbidity and mortality:
• Cyanosis
• Complex congenital heart disease
• Frailty
• Heart failure
• Operations on the respiratory and nervous systems
• Pulmonary hypertension
• Urgent/emergency procedures
Issues to consider:
• Arrhythmias, including bradyarrhythmias
• Abnormal venous and/or arterial anatomy affecting venous and arterial access and
blood pressure monitoring
• Adjustment of anticoagulant volume in tubes for some blood work in patients with
cyanosis
• Developmental disability
• Differential dependence on preload/afterload and impacts on ventilation and/or
insufflation strategies
• Endocarditis prophylaxis
• Erythrocytosis
• Monitoring of renal and liver function
• Need for meticulous line care (consider air filters for intravenous lines) to reduce
risk for paradoxical embolism in patients with reduced oxygen saturations because of
right-to-left shunts
• Periprocedural anticoagulation
• Persistent shunts
• Prevention of venous thrombosis
• Pulmonary vascular disease
• Valvular disease
• Ventricular function (systemic and/or subpulmonary)
Modified with permission from Stout et al. Copyright © 2018 American Heart Association, Inc.
and American College of Cardiolog y Foundation.
ACHD indicates adult congenital heart disease.
