Pregnancy safe after arterial switch operation
Mothers or infants experienced no adverse cardiac events during 24 pregnancies completed by women who had undergone an arterial switch operation (ASO), according to a single-center, retrospective study published online Sept. 5 in JAMA Cardiology.
The ASO has been the preferred surgery to treat transposition of the great arteries (TGA) for more than 30 years, noted lead author Victoria M. Stoll, DPhil, and colleagues. For this reason, more women with an ASO are approaching childbearing age.
The authors pointed out, however, pregnancy outcomes for this population remain understudied; the largest previous case study contained only nine women and 13 successful pregnancies. Given the stress pregnancy can put on the heart, women with a past ASO could have a higher number of complications such as neoaortic root dilatation, aortic regurgitation and myocardial ischemia, Stoll et al. said.
But in this study conducted at a single clinic in the United Kingdom, only one of 14 women—who completed 24 pregnancies between them—experienced a progression of aortic regurgitation (from none to mild). Five of them, or 36 percent, had mild neoaortic root dilatation before pregnancy, but none of those cases progressed in the first year post-partum.
Each pregnancy was completed with the babies born alive and well, without any congenital heart disease. Importantly, there were no maternal adverse cardiac events, which included arrhythmia, aortic dissection, heart failure or acute coronary syndrome.
“Pregnancy is well tolerated after arterial switch operation,” Stoll and colleagues concluded. “These results provide evidence to allow reassurance of women with previous arterial switch surgery who are planning pregnancies.”
Only two deliveries were dictated by cardiac considerations for the mother, with clinicians opting to perform a caesarean section in those cases. However, the researchers noted the rate of normal vaginal deliveries for this cohort (42.1 percent) was below the UK national average (59.4 percent), with C-sections making up most of the difference (36.8 percent in the study; 27.8 percent national average).
Stoll and colleagues pointed out their study was limited by its small sample size and retrospective design. They said further long-term evaluation of both the children and the mothers could offer additional insight into the safety of pregnancy in women after ASO.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.