Authors: Nasr, Viviane G. et al.
Anesthesiology, October 3, 2025. DOI: 10.1097/ALN.0000000000005783
This multicenter registry study examined intraoperative cardiac events in pediatric and young adult patients with congenital heart disease (CHD) undergoing noncardiac procedures. Data were collected from 7 centers between January and December 2021, including 4,343 patients who underwent 6,455 procedures.
Intraoperative cardiac events occurred in 335 procedures (5.2%), affecting 296 patients. The most frequent event was hypotension (4.9%), while cardiac arrest was rare (0.2%). Risk factor analysis demonstrated that prematurity, comorbid gastrointestinal or respiratory conditions, preoperative ventilatory support, concurrent respiratory illness, major cardiac disease, and severe CHD significantly increased the likelihood of intraoperative cardiac complications. Severe CHD conferred the highest risk (OR 3.48, 95% CI 2.47–4.91). Emergency procedures and surgical interventions were also strongly associated with greater risk.
The study highlights that beyond previously recognized concerns about mortality, pediatric CHD patients are particularly vulnerable to intraoperative hemodynamic instability during noncardiac procedures. Identifying patient- and procedure-specific risks can guide anesthesiologists in preoperative assessment and development of mitigation strategies.
What You Should Know:
Children and young adults with severe congenital heart disease face a significantly elevated risk of intraoperative instability, even during noncardiac surgery. Careful preoperative planning, anticipation of hemodynamic complications, and institution-specific protocols are essential for improving safety in this high-risk population.
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