Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

The spectrum of cardiac surgery for adults with congenital heart disease (ACHD) changed over time. In the beginning of heart surgery in the 1950s and 1960s, surgery was performed almost exclusively for correction of CHD (1). At that time, mainly septal defects or aortic coarctation were corrected in older children and adults. In the following decades, the patients’ age at the time of surgery decreased, until neonatal heart surgery was introduced into clinical practice in the 1980s (2). Today the majority of ACHD had total repair or definitive palliation during childhood. Therefore, the spectrum of surgery in ACHD has shifted from primary repair to the treatment of residual defects or sequelae of the initial pathology or previous treatment. As a consequence, since the year 2000, more than half of all operations performed on ACHD require repeat sternotomy (3). Moreover, patients with shunts on the atrial level, who did not undergo closure during childhood, are now often eligible for shunt closure with the use of catheter-based techniques (4). Hence, primary correction of the heart defect nowadays accounts for less than 25% of all operations in ACHD (3)