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. 2022 Jan;108(2):117-123.
doi: 10.1136/heartjnl-2020-318685. Epub 2021 Apr 28.

Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC)

Oktay Tutarel  1 , Lucia Baris  2 , Werner Budts  3 , Mohamad Gamal Abd-El Aziz  4 , Csilla Liptai  5 , David Majdalany  6 , Silvana Jovanova  7 , Alexandra Frogoudaki  8 , Heidi M Connolly  9 , Mark R Johnson  10 , Aldo P Maggioni  11 , Roger Hall  12 , Jolien W Roos-Hesselink  13 ; ROPAC Investigators Group
Collaborators, Affiliations

Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC)

Oktay Tutarel et al. Heart. 2022 Jan.

Abstract

Objective: Cardiac disease is a major cause of maternal mortality. Data regarding pregnancy outcomes in women with a systemic right ventricle (sRV) are scarce. We studied pregnancy outcomes in women with an sRV after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA).

Methods: The ESC EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal/fetal) in all women with an sRV are described. The primary end point was a major adverse cardiac event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischaemic coronary event and other thromboembolic events.

Results: Altogether, 162 women with an sRV (TGA n=121, CCTGA n=41, mean age 28.8±4.6 years) were included. No maternal mortality occurred. In 26 women, at least one MACE occurred, heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%) and others in 4 (2.5%). Prepregnancy signs of heart failure as well as an sRV ejection fraction <40% were predictors of MACE. One woman experienced fetal loss, while no neonatal mortality was observed. No significant differences were found between women with CCTGA and TGA. In the subset of women who had an echocardiogram before and after pregnancy, no clear deterioration in sRV was observed.

Conclusion: The majority of women with an sRV tolerated pregnancy well with a favourable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE.

Keywords: pregnancy; transposition of great vessels.

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Conflict of interest statement

Competing interests: WB reports a relationship with Proctor Abbott & Occlutech. APM reports personal fees from Novartis, personal fees from Bayer, personal fees from Fresenius, outside the submitted work.

Figures

Figure 1
Figure 1
Predictors of adverse maternal outcome. Forest plot illustrating the results of the univariate logistic regression analysis for adverse maternal outcome, defined as MACE. CCTGA, congenitally corrected transposition of the great arteries; EF, ejection fraction; MACE, major adverse cardiac events; NYHA, New York Heart Association; RV, right ventricle.
Figure 2
Figure 2
Maternal and fetal outcome. CCTGA, congenitally corrected transposition of the great arteries; SVT, supraventricular tachycardia; VT, ventricular tachycardia.
See this image and copyright information in PMC

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