CLINICAL STATEMENTS AND GUIDELINES entary behavior as appropriate for the patient s clinical status is essential when counseling patients with con- genital heart defects.S3.10-9 Interestingly, most patients with ACHD lead healthier lifestyles compared with con- suggesting that this patient popula- tion may be receptive to advice and may continue to benefit from recommendations about diet, activity, and modifiable risk factors. See Online Data Supplement 17 for referenced studies. 3.11. Noncardiac Medical Issues Recommendation for Noncardiac Medical Issues Referenced studies that support the recommendation are summarized in Online Data Supplement 18. COR LOE Recommendation I C-LD Patients with ACHD at risk for hepatitis C should be screened and vaccinated for viral hepatitis and treated as appropriate.S3.11-1 Recommendation-Specific Supportive Text 1. Patients with ACHD are at risk of hepatitis C be- cause of blood exposure during cardiac surgery. Hepatitis screening is warranted especially in those with exposure to blood products before universal screening for hepatitis C, which began in 1992. Hepatitis vaccination and/or consultation with a hepatologist should also be offered where ap- propriate, particularly in patients with ACHD with concomitant liver disease (eg, Fontan patients). 3.12. Noncardiac Surgery Recommendations for Noncardiac Surgery Referenced studies that support recommendations are summarized in Online Data Supplement 18. COR LOE Recommendations I C-LD Optimization before and close surveillance after invasive procedures, regardless of the complexity of the anatomic defect or type of procedure is beneficial for patients with I B-NR In patients with ACHD AP classification IB-D, IIA-D, and IIIA-D* noncardiac surgical and interventional procedures should be performed in a hospital with or in consultation with experts in ACHD when *See Tables 3 and 4 for details on the ACHD AP classification system. Synopsis Patients with ACHD may have greater operative risk than patients without ACHD. 