The following are key points to remember from this review discussing the differences between the 2018 American Heart Association/American College of Cardiology (AHA/ACC) and the 2020 European Society of Cardiology (ESC) guidelines for management of adults with congenital heart disease (ACHD):

1. Overall, there are numerous similarities between the two guidelines, although there are some significant differences, including in the classification of congenital heart disease as well as in disease-specific recommendations.
2. The AHA/ACC guidelines introduce a new classification scheme, which encompasses both anatomic complexity as well as physiologic stage. The European guidelines retain the anatomic classification system used previously.
3. There are some differences in the recommendations regarding closure of atrial and ventricular level shunts in patients with pulmonary hypertension. The AHA/ACC guidelines tend to make use of ratios of pulmonary artery pressure or pulmonary vascular resistance to systemic pressure or resistance, while the European guidelines focus on pulmonary vascular resistance. The AHA/ACC guidelines are more likely to recommend closure of atrial septal defects in patients with some degree of pulmonary vascular disease.
4. The guidelines differ slightly in recommendations for pulmonary valve replacement in patients with repaired tetralogy of Fallot. The ACC/AHA guidelines recommend intervention for moderate or greater pulmonary regurgitation (PR), while the ESC guidelines utilize severe PR with regurgitant fraction of >30-40%. Both guidelines provide Class I recommendations for pulmonary valve replacement in symptomatic patients with PR and Class IIA and IIb recommendations for selected asymptomatic patients.
5. The ESC guidelines are overall somewhat less likely to recommend intervention for patients with congenital coronary anomalies, requiring positive exercise testing or other high-risk features in addition to symptoms.
6. The ESC integrates measurement of biomarkers such as B-type natriuretic peptide into ACHD assessment and decision making, whereas the AHA/ACC guidelines discuss them only in the setting of patients with pulmonary hypertension.
7. The ESC guidelines at times express a preference for or emphasize the role of catheter-based therapies or describe a lower threshold for intervention if a transcatheter option is available. The AHA/ACC guidelines do not make this distinction.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, Heart Failure and Cardiac Biomarkers, Pulmonary Hypertension, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Hypertension

Keywords: Biomarkers, Cardiac Surgical Procedures, Catheters, Exercise Test, Heart Defects, Congenital, Heart Septal Defects, Atrial, Heart Valve Diseases, Hypertension, Pulmonary, Natriuretic Peptide, Brain, Pulmonary Circulation, Pulmonary Valve Insufficiency, Tetralogy of Fallot, Vascular Diseases, Vascular Resistance

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