《2020 ESC成人先天性心脏病管理指南》外科围术期管理策略解读

Interpretation of surgical perioperative management strategy of 2020 ESC guidelines for the management of adult congenital heart disease

先天性心脏病(先心病)作为最常见的出生缺陷,其诊断和管理是现代医学中一个成功的案例。随着诊断技术、外科手术、介入技术的发展,90%以上的先心病患儿可以存活到成年,导致先心病发病人群从婴儿期和儿童期转向成年期。成人先心病学不仅包括年轻人和中年人,还应包括60岁以上的老年人。规范的指南可以为成人先心病综合管理提供良好的理论支持。继《2010 ESC成人先天性心脏病管理指南》发布10年后,2020年8月《2020 ESC成人先天性心脏病管理指南》正式发布,新版指南对于疾病的分类分层、综合干预方式以及干预时机进行了更新,并且提出了一些新的概念、新的干预标准和方式。对于成人未修复或需要再次修复的先心病,手术干预指征和方式以及围术期管理对预后有巨大影响。新版指南针对不同病种的外科手术、介入干预指征和方式进行了详细说明,并阐明了高危人群的管理方式。本文尝试从外科医生这一角度对这部新版指南进行解读,对指南介绍的几个重点病种进行了梳理,力争为国内同行提供一个简明、可操作的指引。

The diagnosis and management of congenital heart disease(CHD),the most common inborn defect,has been a tremendous success of modern medicine.With the development of diagnostic techniques,surgical procedures and interventional techniques,more than 90%of CHD children can survive to adulthood.Consequently,the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood.Adult CHD cardiology is now encompassing not only young or middle-aged adults but also patients aged above 60 years.Standardized guidelines can provide good theoretical support for the comprehensive management of adult CHD.Ten years after the European Society of Cardiology guidelines for the management of grown-up CHD released in 2010,the new version was officially released in August 2020.The new version of guidelines updated the classification and stratification of diseases,comprehensive intervention methods and intervention timing,and put forward some new concepts,new intervention standards and methods.For adult CHD that has not been repaired or needs to be repaired again,the indication and mode of surgical intervention and perioperative management have a great impact on the prognosis.The new version of the guidelines provides a detailed description of the surgical and intervention indications and methods for different diseases,and clarifies the management methods for high-risk groups.This article attempts to interpret this newly updated guideline from the perspective of a surgeon,sort out several key diseases introduced by the guideline,and strives to provide a concise and actionable guideline for domestic counterparts.