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

Abstract

Background In the past 3 decades, the arterial switch procedure has replaced the atrial switch procedure as treatment of choice for transposition of the great arteries. Although survival is superior after the arterial switch procedure, data on pregnancy outcomes are scarce and transposition of the great arteries after arterial switch is not yet included in the modified World Health Organization classification of maternal cardiovascular risk. Methods and Results The ROPAC (Registry of Pregnancy and Cardiac disease) is an international prospective registry of pregnant women with cardiac disease, part of the European Society of Cardiology EURObservational Research Programme. Pregnancy outcomes in all women after an arterial switch procedure for transposition of the great arteries are described. The primary end point was a major adverse cardiovascular event, defined as combined end point of maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary events, and thromboembolic events. Altogether, 41 pregnant women (mean age, 26.7±3.9 years) were included, and there was no maternal mortality. A major adverse cardiovascular event occurred in 2 women (4.9%): heart failure in one (2.4%) and ventricular tachycardia in another (2.4%). One woman experienced fetal loss, whereas no neonatal mortality was observed. Conclusions Women after an arterial switch procedure for transposition of the great arteries tolerate pregnancy well, with a favorable maternal and fetal outcome. During counseling, most women should be reassured that the risk of pregnancy is low. Classification as modified World Health Organization risk class II seems appropriate.

Outcome of Pregnancy in Women With D‐Transposition of the Great Arteries: A Systematic Review

“…Our review identified 120 pregnancies in 86 women with TGA and a history of ASO (Table 5 ). 23 , 24 , 25 , 26 Prior palliative procedures were reported in about a third of the patients, including atrial balloon septostomy, PA banding, ventricular septal defect closure, PA interventions, aortic coarctation repair, and LeCompte procedure. Of the patients, 28% had interventions after the initial ASO, including a relief of RV outflow tract obstruction and PA stenosis, ascending aorta angioplasty, mitral valve repair and replacement, and RV to PA conduit.…”

Anesthetic Care of the Pregnant Patient With Cardiovascular Disease: A Scientific Statement From the American Heart Association

“…Data from ROPAC have led to numerous publications outlining specific cardiac disease processes complicating pregnancy and, in turn, has helped clinicians better guide care for these patients. [5][6][7][8][9][10][11][12] Data from ROPAC demonstrate that although rates of maternal mortality and heart failure were high among women with particular types of CVD, 9% mortality with pulmonary arterial hypertension and 11% rate of heart failure in the entire study population overall, most patients with CVD did well, suggesting that safe pregnancy can be achieved with proper care. 13 ROPAC also highlights the high rate of obstetric and fetal complications in pregnancies complicated by CVD, at 17% and 21%, respectively.…”

Selección de lo mejor del año 2021 en cardiopatías congénitas

“…El registro europeo ROPAC ha comunicado los datos de las mujeres embarazadas con TGA 24 , 25 . El registro confirma que las mujeres intervenidas con técnica de switch arterial presentan un bajo riesgo de complicaciones (clase II de la OMSm).…”