Non-Cardiac vs Cardiac

(v2022)

Pathophysiology that will routinely NOT require cardiac anesthesia:

• Unrepaired simple congenital heart disease (ASD, VSD, PDA, etc.) without hemodynamic compromise/evidence of heart failure
• Patients with repaired congenital heart disease without significant residual lesions and preserved ventricular function (EF > 35%)
• Patients with stable Kawasaki disease without clinically significant aneurysms and no evidence of ischemia
• Patients with pacemakers or AICDs
• Patients with the diagnosis of cardiomyopathy or compromised ventricular function whose EF is greater than 35%
• Patients with Williams syndrome with no significant known or residual aortic or pulmonary stenosis and no known coronary artery disease/abnormalities
• Mild aortic or mitral stenosis including artificial valves
• Heart transplant recipients with preserved ventricular function
• Patients with free pulmonary insufficiency in the setting of preserved (normal) RV function
• Patients with pulmonary hypertension < 2/3 systemic

Pathophysiology that will routinely REQUIRE cardiac anesthesia care:

• Children with non-palliated single ventricle physiology, including ductal dependent lesions
• Children with complex, unrepaired congenital heart disease (TGA, TOF, DORV)
• Patients with staged, palliated single ventricle physiology (Glenn, Fontan)
• Patients with pulmonary hypertension that is >2/3 systemic (excluding normal neonatal physiology)
• Patients the diagnosis of cardiomyopathy or compromised ventricular function whose EF is less than 35%
• Moderate to severe mitral valve stenosis
• Moderate to severe left sided obstructive lesions including valvar, subvalvar, and supravalvar aortic stenosis and coarctation of the aorta
• Patients cared for in the CICU, CVOR or Cath Labs

Consultation with a cardiac anesthesiologist for appropriate stratification should occur in the following settings:

• Patients with a history of heart failure requiring ongoing medical management, or symptoms of heart failure in the face of an elevated BNP > 500
• Patients with compromised ejection fraction (35-45%) undergoing surgery for > 4 hours and/or in which significant fluid shifts are anticipated
• Any patient who does not clearly fit into one of the above categories