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. 2018 Aug 1;54(2):348-353.
doi: 10.1093/ejcts/ezy015.

The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates

James William Gaynor  1 , Samuel Parry  2 , Julie S Moldenhauer  3 , Rebecca A Simmons  4 , Jack Rychik  5 , Richard F Ittenbach  6 , William W Russell  1 , Erin Zullo  1 , John Laurenson Ward  1 , Susan C Nicolson  7 , Thomas L Spray  1 , Mark P Johnson  3
Affiliations

The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates

James William Gaynor et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Pregnancies with congenital heart disease in the foetus have an increased prevalence of pre-eclampsia, small for gestational age and preterm birth, which are evidence of an impaired maternal-foetal environment (MFE).

Methods: The impact of an impaired MFE, defined as pre-eclampsia, small for gestational age or preterm birth, on outcomes after cardiac surgery was evaluated in neonates (n = 135) enrolled in a study evaluating exposure to environmental toxicants and neuro-developmental outcomes.

Results: The most common diagnoses were transposition of the great arteries (n = 47) and hypoplastic left heart syndrome (n = 43). Impaired MFE was present in 28 of 135 (21%) subjects, with small for gestational age present in 17 (61%) patients. The presence of an impaired MFE was similar for all diagnoses, except transposition of the great arteries (P < 0.006). Postoperative length of stay was shorter for subjects without an impaired MFE (14 vs 38 days, P < 0.001). Hospital mortality was not significantly different with or without impaired MFE (11.7% vs 2.8%, P = 0.104). However, for the entire cohort, survival at 36 months was greater for those without an impaired MFE (96% vs 68%, P = 0.001). For patients with hypoplastic left heart syndrome, survival was also greater for those without an impaired MFE (90% vs 43%, P = 0.007).

Conclusions: An impaired MFE is common in pregnancies in which the foetus has congenital heart disease. After cardiac surgery in neonates, the presence of an impaired MFE was associated with lower survival at 36 months of age for the entire cohort and for the subgroup with hypoplastic left heart syndrome.

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Figures

Figure 1:
Figure 1:
Kaplan–Meier survival curve for the entire cohort (n = 135) stratified by the presence or absence of an impaired maternal–foetal environment.
Figure 2:
Figure 2:
Kaplan–Meier survival curve for the subgroup of patients with HLHS (n = 43) stratified by the presence or absence of an impaired maternal–foetal environment. HLHS: hypoplastic left heart syndrome.
See this image and copyright information in PMC

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