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
Tutarel O, Ramlakhan KP, Baris L, Subirana MT, Bouchardy J, Nemes A, Vejlstrup NG, Osipova OA, Johnson MR, Hall R, Roos-Hesselink JW; ROPAC (Registry of Pregnancy and Cardiac Disease) Investigators Group *.J Am Heart Assoc. 2021 Jan 5;10(1):e018176. doi: 10.1161/JAHA.120.018176. Epub 2020 Dec 22.PMID: 33350866 Free article.
Take Home Points:
- Women with Transposition of the Great Arteries post arterial switch operation can be reassured that pregnancy is safe with a low risk of maternal cardiac complications.
- Similar to other cardiac pregnancies, premature delivery (17.1%) and low birth weight (14.6%) are the most significant fetal complications.
- The impact of pregnancy on maternal valvular and ventricular function in the TGA post arterial switch population remains unknown.
Commentary from Dr. Jasmine Grewal (Vancouver, BC, Canada), section editor of Cardio-Obstetrics Journal Watch: This prospective study reports the maternal and fetal outcomes of 41 pregnancies in women with Transposition of the Great Arteries post arterial switch from the ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Program. Data on pregnancy outcomes in this population have been limited and hence no formal risk stratification in the modified WHO classification. Of the 5739 patients included in the ROPAC registry between 2007-2018, 41 were post arterial switch. As compared to the rest of the cohort in which 40% were from an emerging country, 5% in the study group were from an emerging country. The vast majority (97.6%) were NYHA I/II and 24% were on a cardiac medication pre-pregnancy. Maternal outcomes were very good with no maternal mortality during pregnancy and up to 6 months post-partum. A major cardiovascular event occurred in 2 women (5%): one acute heart failure admission thought to be related to reduced systemic ventricular function and one ventricular tachycardia treated with beta-blockers as an outpatient. One fetal loss was reported with no neonatal loss. Other fetal complications of premature birth (17%) and low birth weight (14.6%) were not statistically different than the rest of the ROPAC cohort. The current study is reassuring with favorable maternal and fetal outcomes in this population. However, there is limited data available on the trajectory of valve and ventricular function over the course of pregnancy and into the post-partum period.