2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of Adults With Congenital Heart Disease

The 2025 guideline replaces the 2018 ACHD document and, like the ESC 2020 guideline, is written for a population that has outlived its evidence: almost nothing here has been settled by a randomised trial. It keeps the American anatomic-physiologic (AP) classification — a two-axis system that grades lesion complexity and physiological stage separately, and has no ESC counterpart — and adds new measurement criteria for atrial septal defect closure, expanded guidance on pregnancy and delivery, and structured surveillance for Fontan-associated liver disease. The randomised exceptions are the pulmonary vasodilator trials in Eisenmenger syndrome and the Fontan circulation, plus the mechanical-valve anticoagulation question, grouped below.

This guideline cites 3 of the 199 landmark trials in our Cardiology register.

Source

Gurvitz M, Krieger EV, et al. Circulation. 2026;153(8):e115–e251. Published online 18 December 2025.

DOI

10.1161/CIR.0000000000001402