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Grand Rounds

Does a Previous Arterial Switch Procedure Increase Risk for Adverse Pregnancy Outcomes?

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BACKGROUND AND PURPOSE:

  • There are limited data on pregnancy outcomes in individuals who experienced an arterial switch procedure for transposition of great arteries (TGA) early in life
  • Tutarel et al. (Journal of the American Heart Association, 2020) assessed maternal and fetal outcomes in women with a history of arterial switch procedure

METHODS:

  • Prospective cohort study
  • Data source
    • ROPAC (Registry of Pregnancy and Cardiac disease)
  • Participants
    • Pregnant women with TGA
    • Repair using arterial switch procedure
  • Primary outcome
    • A major cardiovascular event defined as a composite of: Maternal death | Supraventricular or ventricular arrhythmias requiring treatment | Heart failure | Aortic dissection | Endocarditis | Ischemic coronary events | Thromboembolic events

RESULTS:

  • 41 pregnant women with arterial switch procedure
    • Mean (SD) age:  26.7 (3.9) years
    • Cesarean delivery; 46.3%
    • Emergency cesarean: 15% (none related to cardiovascular complications)
  • Maternal mortality: 0 cases
  • Major cardiovascular event incidence: 4.9% (2 women)
    • Heart failure: 2.4% (1 woman)
    • Ventricular tachycardia: 2.4% (1 woman)
  • Fetal loss: 1 case
  • Neonatal mortality: 0 cases
  • Most frequent fetal complications
    • Preterm birth: 17.1%
    • Low birth weight: 14.6%

CONCLUSION:

  • Pregnancy outcomes are favorable for women who have undergone a repair for TGA
  • The authors conclude
    • “…women after an arterial switch procedure for TGA should be counseled that pregnancy is low risk”
    • Classifying TGA (repaired and otherwise uncomplicated) as modified WHO risk class II (Small increased risk of maternal mortality or moderate increase in morbidity) seems appropriate | See CMQCC WHO Risk Classes below in ‘Learn More – Primary Sources’ below)

Learn More – Primary Sources:

Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme

CMQCC: Maternal Risks for Underlying Cardiovascular Disease: Key Consensus Tables

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Related ObG Topics:

Practical obstetrics info for your women's healthcare practice
Understanding Transposition of the Great Arteries
How Well Does the Prenatal Ultrasound ‘Three-Vessel View’ Work for Increasing the Detection of Cardiac Anomalies?
Heart Disease in Pregnancy: When to Deliver
Does Carrying a Fetus with a Congenital Heart Defect Increase Preeclampsia Risk?
Can Glucose Screening in Pregnancy Predict Future Risk of Cardiovascular Disease in non-GDM Women?

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