Since the previous guidelines on the management of grown-up CHD were published in 2010, new evidence has accumulated, particularly on transcatheter interventional techniques and on risk stratification with regard to timing of surgery and catheter intervention as well as medical treatment. In addition, as adult patients with CHD now present in increasing numbers at advanced ages, including the elderly, the term ‘grown-up CHD’ no longer appears appropriate and has been replaced with adult CHD (ACHD).
Other new concepts in the 2020 version include setting out specific structural and organisational healthcare requirements at expert centres that are deemed necessary to meet the needs of ACHD patients. In addition to the relevant specialist cardiologists, imagers and surgeons, ACHD teams should include specialist nurses, psychologists and social workers, as anxiety and depression are common concerns in ACHD patients.
The updated guidelines provide detailed recommendations on arrhythmias. There is greater emphasis on the importance of understanding the cause and the mechanism of the arrhythmia, and the anatomy of the underlying CHD. For optimal chronic arrhythmia management, referral to a centre with a multidisciplinary team and expertise in ACHD-related arrhythmias is seen as mandatory.
Categories of high-risk pregnancies are given in the new guidelines and it is recommended that women with CHD and confirmed pre-capillary pulmonary hypertension are counselled against pregnancy. More specific and adjusted recommendations are also given for the treatment of pulmonary arterial hypertension itself, and other specific aspects of medical treatment, such as heart failure and anticoagulation are addressed.
For over 15 different specific CHD lesion types, the new guidelines detail the optimal diagnostic work-up and indications for surgical/catheter interventional treatment, and provide follow-up recommendations and additional considerations. It is hoped that these new clearly presented guidelines will aid the decision-making process for the management of adults with CHD.
Want to know more about what’s new? The 2020 ESC Guidelines for the management of ACHD are now published in the European Heart Journal!