Opinion: No Longer Children, Not Quite Typical Adults-Building a Unified, Collaborative Model of Perioperative Care for Patients With Adult Congenital Heart Disease.

Advances in congenital heart disease care have resulted in a rapidly expanding population of adolescents and adults with adult congenital heart disease (ACHD) who increasingly present for noncardiac surgery. These patients often possess complex physiology that does not align neatly with traditional pediatric or adult perioperative frameworks, creating challenges in care continuity, risk stratification, and perioperative planning. Although guidelines recommend involvement of anesthesiologists with ACHD expertise for higher-risk patients, access to specialized centers and dual-trained providers remains limited, and most care occurs outside dedicated ACHD programs. This article examines current gaps in perioperative ACHD care and proposes a collaborative, shared-care model that leverages the complementary expertise of pediatric and adult cardiac anesthesiologists. Key components include structured preoperative triage, an ACHD anesthesia point person, scalable workforce strategies such as "ACHD-lite" teams, and portable clinical documentation through anesthesia-focused health passports. Aligning training, institutional systems, and reimbursement models around collaborative care offers an opportunity to improve safety, continuity, and outcomes for this growing and medically complex population.