Congenital Heart Disease After Mid-Age: From the "Grown-Up" to the Elderly

Early surgery and improved medical care have led to the increased survival of neonates with congenital heart disease (CHD), who now commonly reach adulthood. Among adults with CHD, a growing subgroup is represented by middle-aged and even elderly patients. In this elderly population, acquired cardiac and extracardiac comorbidities represent the main cause of morbidity and mortality; the control and correction of cardiovascular risk factors or an appropriate check for extracardiac complications (such as malignancies) is therefore of paramount importance. Complications and frailty syndrome appear to occur earlier in ACHD than in the general population due to a frequent discrepancy between chronological and biological age. Multiple stressors throughout life (hemodynamic abnormalities, cardiac operations and interventional procedures, the placement of foreign materials) that result in a chronic inflammatory response are among the leading causes of premature senescence. This review is aimed at assessing the characteristics and special needs of this elderly ACHD population with a view to proposing novel models for the organization of extended care.