Circulation:Cardiovascular Quality and OutcomesAHA SCIENTIFIC STATEMENTPerioperative Considerations for PediatricPatients With Congenital Heart DiseasePresenting for Noncardiac Procedures:A Scientific Statement From the American HeartAssociationViviane G.Nasr,MD,MPH,Chair;Larry W.Markham,MD,Vice Chair;Mark Clay,MD;James A.DiNardo,MD;David Faraoni,MD,PhD,FAHA;Danielle Gottlieb-Sen,MD,MPH,MS;Wanda C.Miller-Hance,MD;Nancy A.Pike,PhD,CPNP-AC/PC,FAHA;Chloe Rotman,MLIS;on behalf of the American Heart Association Council onLifelong Congenital Heart Disease and Heart Health in the Young and Council on Cardiovascular Radiology and InterventionABSTRACT:Continuous advances in pediatric cardiology,surgery,and critical care have significantly improved survival rates forchildren and adults with congenital heart disease.Paradoxically,the resulting increase in longevity has expanded the prevalenceof both repaired and unrepaired congenital heart disease and has escalated the need for diagnostic and interventionalprocedures.Because of this expansion in prevalence,anesthesiologists,pediatricians,and other health care professionalsincreasingly encounter patients with congenital heart disease or other pediatric cardiac diseases who are presenting for surgicaltreatment of unrelated,noncardiac disease.Patients with congenital heart disease are at high risk for mortality,complications,and reoperation after noncardiac procedures.Rigorous study of risk factors and outcomes has identified subsets of patientswith minor,major,and severe congenital heart disease who may have higher-than-baseline risk when undergoing noncardiacprocedures,and this has led to the development of risk prediction scores specific to this population.This scientific statementfromreviews contemporary data on risk from noncardiac procedures,focusing on pediatric patients with congenital heart diseaseand describing current knowledge on the subject.This scientific statement also addresses preoperative evaluation and testing.httpperioperative considerations,and postoperative care in this unique patient population and highlights relevant aspects of thepathophysiology of selected conditions that can influence perioperative care and patient management.Key Words:AHA Scientific Statements anesthesiologists critical care heart defects,congenital perioperative carennovations and technical advancements in the pastData from 2004 to 2012 highlight that almost half ofdecades have led to multidisciplinary improvements inpatients(41%)who underwent cardiac surgical proce-the treatment of congenital heart disease (HD).As adures in the first year of life also underwent at least 1result,the natural history and survival rates of patientsnoncardiac operative intervention by 5 years of age.3-5 Awith congenital HD have evolved such that >90%ofquery of the Pediatric Health Information System data-children bom with congenital HD now survive intobase confirmed a significant increase in the number ofadulthood.:Improved longevity i
