Canadian Cardiovascular Society 2022 Guidelines for Cardiovascular Interventions in Adults With Congenital Heart Disease

Ariane Marelli*, Luc Beauchesne, Jack Colman, Robin Ducas, Jasmine Grewal, Michelle Keir, Paul Khairy, Erwin Oechslin, Judith Therrien, Isabelle F. Vonder Muhll, Rachel M. Wald, Candice Silversides, David J. Barron, Lee Benson, Pierre Luc Bernier, Eric Horlick, Réda Ibrahim, Giuseppe Martucci, Krishnakumar Nair, Nancy C. PoirierHeather J. Ross, Helmut Baumgartner, Curt J. Daniels, Michelle Gurvitz, Jolien W. Roos-Hesselink, Adrienne H. Kovacs, Christopher J. McLeod, Barbara J. Mulder, Carole A. Warnes, Gary D. Webb

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)


Interventions in adults with congenital heart disease (ACHD) focus on surgical and percutaneous interventions in light of rapidly evolving ACHD clinical practice. To bring rigour to our process and amplify the cumulative nature of evidence ACHD care we used the ADAPTE process; we systematically adjudicated, updated, and adapted existing guidelines by Canadian, American, and European cardiac societies from 2010 to 2020. We applied this to interventions related to right and left ventricular outflow obstruction, tetralogy of Fallot, coarctation, aortopathy associated with bicuspid aortic valve, atrioventricular canal defects, Ebstein anomaly, complete and congenitally corrected transposition, and patients with the Fontan operation. In addition to tables indexed to evidence, clinical flow diagrams are included for each lesion to facilitate a practical approach to clinical decision-making. Excluded are recommendations for pacemakers, defibrillators, and arrhythmia-directed interventions covered in separate designated documents. Similarly, where overlap occurs with other guidelines for valvular interventions, reference is made to parallel publications. There is a paucity of high-level quality of evidence in the form of randomized clinical trials to support guidelines in ACHD. We accounted for this in the wording of the strength of recommendations put forth by our national and international experts. As data grow on long-term follow-up, we expect that the evidence driving clinical practice will become increasingly granular. These recommendations are meant to be used to guide dialogue between clinicians, interventional cardiologists, surgeons, and patients making complex decisions relative to ACHD interventions.

Original languageEnglish
Pages (from-to)862-896
Number of pages35
JournalCanadian Journal of Cardiology
Issue number7
Early online date20 Apr 2022
Publication statusPublished - 1 Jul 2022

Bibliographical note

Funding Information:
The authors acknowledge the support of the Canadian Journal of Cardiology editorial office and the outstanding work of Christiana Brooks from the Guidelines and Knowledge Translation Department of CCS; and Ashley Farrell, Information Specialist, Library and Information Services, University Health Network, Toronto, for her contributions to the evidence search/review process. The authors thank the McGill University Health Centre library for providing the reference lists. The authors also acknowledge information and library services from individual institutions that helped the primary panelists identify new relevant references; and an independent and relevant literature review performed by the Canadian Agency for Drugs and Technologies in Health (

Publisher Copyright:
© 2021 Canadian Cardiovascular Society


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