Updates in the management of congenital heart disease in adult patients

Q: What does this research mean for the field?

The management of adult congenital heart disease requires improved access to specialist care, advanced therapies, and novel technologies to address prevalent challenges such as arrhythmias, sudden cardiac death, and heart failure. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Danielle Massarella; Rafael Alonso-González

doi:10.1080/14779072.2022.2125870

September 2, 2022Expert Review of Cardiovascular Therapy

Updates in the management of congenital heart disease in adult patients

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Why the study?

Optimal management approaches for challenges such as arrhythmia, sudden cardiac death, heart failure, transplant, advanced therapies, and unrepaired shunt lesions in adults with congenital heart disease are incompletely established.

Key Points

To synthesize current evidence regarding management strategies for adult congenital heart disease and outline priority areas for future investigation.
Narrative review of literature indexed across Medline, EMBASE, and PubMed databases.
Search strategy focused on arrhythmias, sudden cardiac death, heart failure, cardiac transplantation, ventricular assist devices, mechanical circulatory support, and intracardiac shunts.
Heart failure constitutes a leading cause of morbidity and mortality, requiring expanded access to advanced therapies, mechanical circulatory support, and cardiac transplantation.
Novel diagnostic and therapeutic technologies for arrhythmia management show progressive clinical benefit, while sudden cardiac death remains a persistent, poorly predicted hazard.
Cardio-obstetrics is increasingly critical to deliver evidence-based reproductive and maternal care for women with congenital heart lesions.

Structured PICO

P

Population

Adults with congenital heart disease

I

Intervention

Management approaches for arrhythmia, sudden cardiac death, heart failure, transplant, advanced therapies, and unrepaired shunt lesions

Implication

This review summarizes current management strategies and highlights the need for improved access to specialist care and advanced therapies for adults with congenital heart disease.

Abstract

INTRODUCTION: Adults with congenital heart disease represent a highly diverse, ever-growing population. Optimal approaches to management of problems such as arrhythmia, sudden cardiac death, heart failure, transplant, application of advanced therapies and unrepaired shunt lesions are incompletely established. Efforts to strengthen our understanding of these complex clinical challenges and inform evidence-based practices are ongoing. AREAS COVERED: This narrative review summarizes evidence underpinning current approaches to congenital heart disease management while highlighting areas requiring further investigation. A search of literature published in 'Medline,' 'EMBASE,' and 'PubMed' using search terms 'congenital heart disease,' 'arrhythmia,' 'sudden cardiac death,' 'heart failure,' 'heart transplant,' 'advanced heart failure therapy,' 'ventricular assist device (VAD),' 'mechanical circulatory support (MSC),' 'intracardiac shunt' and combinations thereof was undertaken. EXPERT OPINION: Application of novel technologies in the diagnosis and management of arrhythmia has and will continue to improve outcomes in this population. Sudden death remains a prevalent problem with many persistent unknowns. Heart failure is a leading cause of morbidity and mortality. Improved access to specialist care, advanced therapies and cardiac transplant is needed. The emerging field of cardio-obstetrics will continue to define state-of-the-art care for the reproductive health of women with heart disease.