Clinical practical advice for anaesthetic management of adults with congenital heart disease undergoing non-cardiac surgery: A clinical consensus statement of the ESC Working Group on Adult Congenital Heart Disease, the European Society of Anaesthesiology and Intensive Care, the European Association of Cardiothoracic Anaesthesiology and Intensive Care and the International Society of Adult Congenital Heart Disease

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Abstract
Adult congenital heart disease (ACHD) patients often require non-cardiac surgery (NCS) and the need of such interventions is growing as the population ages. The intricacies inherent to their distinct physiology pose ACHD patients at a higher risk of perioperative complications, perioperative mortality, longer length of stay, and higher hospital charges compared with the general population. While 2020 ESC guidelines comprehensively address most aspects of ACHD care, they do not cover this specific area. Furthermore, although risk assessment for non-cardiac surgery is included in the 2022 ESC Guidelines on Cardiovascular Assessment and Management of Patients Undergoing Non-Cardiac Surgery, the unique pathophysiology of ACHD patients necessitates tailored considerations. The aim of this clinical consensus statement is to address the specific situations and needs of ACHD patients undergoing NCS from a multidisciplinary and practical point of view and to describe the organization of care for this complex group of patients. A group of experienced professionals from 4 cardiology and anaesthesiology scientific societies [the ESC Working Group on ACHD, the European Society of Anaesthesiology and Intensive Care (ESAIC), the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC), and the International Society of Adult Congenital Heart Disease (ISACHD)] have evaluated the available scientific data and reached expert consensus in areas of gaps in evidence.

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