Skip to main content
Top
Published in: Current Cardiology Reports 4/2020

01-04-2020 | Atrial Septal Defect | Congenital Heart Disease (RA Krasuski, Section Editor)

What Every Cardiologist Should Know About the 2018 Updated Adult Congenital Cardiology Guidelines

Authors: Stephen J. Dolgner, Jonathan Buber, Karen K. Stout, Zachary L. Steinberg

Published in: Current Cardiology Reports | Issue 4/2020

Login to get access

Abstract

Purpose of Review

Review the recently updated guidelines for the management of patients with adult congenital heart disease (ACHD) with a focus on the changes between these guidelines and the prior guidelines.

Recent Findings

The 2018 guidelines for the management of patients with ACHD focused on utilizing the available data and limiting the number recommendations based only on expert opinion. These guidelines implement a new anatomic and physiological classification scheme to guide management of patients, which takes into account both the underlying anatomy as well as residual cardiac disease and symptoms. Given a lack of robust outcomes data for many types of CHD, the new guidelines provide fewer total recommendations than the prior version, emphasizing the data that is available and drawing attention to the need for additional data.

Summary

The 2018 guidelines provide the field with a comprehensive update in the management of ACHD patients with an emphasis on the available data.
Literature
1.
go back to reference Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, 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). Circulation. 2008;118:e714–833.PubMed Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, 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). Circulation. 2008;118:e714–833.PubMed
2.
go back to reference •• Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:e81–e192 The 2018 guidelines for the management of ACHD patients are the basis for this review and provide comprehensive management recommendations for this population.CrossRef •• Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:e81–e192 The 2018 guidelines for the management of ACHD patients are the basis for this review and provide comprehensive management recommendations for this population.CrossRef
3.
go back to reference Mylotte D, Pilote L, Ionescu-Ittu R, Abrahamowicz M, Khairy P, Therrien J, et al. Specialized adult congenital heart disease care: the impact of policy on mortality. Circulation. 2014;129:1804–12.CrossRef Mylotte D, Pilote L, Ionescu-Ittu R, Abrahamowicz M, Khairy P, Therrien J, et al. Specialized adult congenital heart disease care: the impact of policy on mortality. Circulation. 2014;129:1804–12.CrossRef
4.
go back to reference Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.CrossRef Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.CrossRef
5.
go back to reference Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines. J Am Coll Cardiol. 2019;73:1494–563.CrossRef Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines. J Am Coll Cardiol. 2019;73:1494–563.CrossRef
6.
go back to reference • Zaragoza-Macias E, Zaidi AN, Dendukuri N, Marelli A. Medical Therapy for Systemic Right Ventricles: A Systematic Review (Part 1) for the 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:1564–78 This companion article to the 2018 ACHD guidelines did not find conclusive evidence of a beneficial effect of medical therapy among patients with systemic right ventricular dysfunction, though the available data was quite limited due to an absence of high quality studies. CrossRef • Zaragoza-Macias E, Zaidi AN, Dendukuri N, Marelli A. Medical Therapy for Systemic Right Ventricles: A Systematic Review (Part 1) for the 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:1564–78 This companion article to the 2018 ACHD guidelines did not find conclusive evidence of a beneficial effect of medical therapy among patients with systemic right ventricular dysfunction, though the available data was quite limited due to an absence of high quality studies. CrossRef
7.
go back to reference • Oster M, Bhatt AB, Zaragoza-Macias E, Dendukuri N, Marelli A. Interventional therapy versus medical therapy for secundum atrial septal defect: a systematic review (Part 2) for the 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:1579–95 Based on the available limited data, this companion publication to the 2018 ACHD guidelines found evidence for improved functional status and right ventricular size after ASD repair, but noted insufficient data to determine the effect of ASD repair on mortality.CrossRef • Oster M, Bhatt AB, Zaragoza-Macias E, Dendukuri N, Marelli A. Interventional therapy versus medical therapy for secundum atrial septal defect: a systematic review (Part 2) for the 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:1579–95 Based on the available limited data, this companion publication to the 2018 ACHD guidelines found evidence for improved functional status and right ventricular size after ASD repair, but noted insufficient data to determine the effect of ASD repair on mortality.CrossRef
Metadata
Title
What Every Cardiologist Should Know About the 2018 Updated Adult Congenital Cardiology Guidelines
Authors
Stephen J. Dolgner
Jonathan Buber
Karen K. Stout
Zachary L. Steinberg
Publication date
01-04-2020
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 4/2020
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-020-1272-z

Other articles of this Issue 4/2020

Current Cardiology Reports 4/2020 Go to the issue

Ischemic Heart Disease (D Mukherjee, Section Editor)

Effects of Sleep Duration on Cardiovascular Events

Nuclear Cardiology (V Dilsizian, Section Editor)

How Do PET Myocardial Blood Flow Reserve and FFR Differ?

Regenerative Medicine (SM Wu, Section Editor)

Diversity of Organism-Wide and Organ-Specific Endothelial Cells

Ischemic Heart Disease (D Mukherjee, Section Editor)

Sex Differences in Coronary Artery Calcium and Long-term CV Mortality