To the Editor,

We applaud Wernovsky et al for sharing what we strongly support as excellent guidelines for standardised testing and coordinated surveillance of patients with complex CHD.Reference Wernovsky, Lihn and Olen ¹ In the United States of America, there are currently more adults than children living with CHD, and projections indicate that this population will continue to grow.Reference Cannesson, Earing and Collange ²

CHD patients have improved life expectancy, higher healthcare utilisation rates,Reference Mackie, Pilote and Ionescu-Ittu ³ and increasingly require elective or emergent non-cardiac surgical, radiological, obstetric, and/or procedural care under anaesthesia. These patients have a higher risk of mortality compared with patients without CHD,Reference Faraoni, Zurakowski and Vo ^{4 ,} Reference Maxwell, Wong and Kin ⁵ and consequently carry with them lifetime complex medical and social issues that require multidisciplinary care.

Therefore, a perioperative care plan including consultation with an anaesthesiologist, discussion of unique patient characteristics that portend risk, anaesthetic technique, appropriate testing, and procedure location should be included in the “roadmap” for each patient. This type of patient-centred, interdisciplinary, coordinated care at our institution is implemented by the Perioperative Enhancement Team, whose projects to date have addressed patients with anaemia, diabetes, malnutrition, senior health, and chronic pain.Reference Aronson and Attarian ^{6 ,} Reference Guinn, Guercio and Hopkins ⁷ Motivated by the recommendations of Wernovsky et al, Perioperative Enhancement Team will now go forward to develop a programme to address the unique and important perioperative challenges of patients with CHD.