[Monocentric cohort analysis of anaesthesiological management of pregnant women with congenital heart disease].

Abstract

Introduction: The number of pregnant women with adult congenital heart disease (ACHD) is increasing, posing growing challenges for obstetric anaesthesia. This study analysed anaesthetic strategies and postoperative care in ACHD patients treated at a tertiary care centre.

Methods: This retrospective single-centre study included ACHD patients who received anaesthesia for delivery, caesarean section or obstetric surgery between 2004 and 2023. A comparison group of obstetric patients without congenital heart disease was selected based on baseline characteristics.

Results: A total of 391 cases were included (131 ACHD, 260 comparison group). Most patients were classified as mWHO I (44.2%) or II (23.8%), with 20.5% mWHO II-III and 11.5% mWHO III and IV. Spinal and epidural anaesthesia were used more frequently in lower mWHO classes (p = 0.017). All mWHO IV patients required general anaesthesia provided by ACHD-experienced anaesthetists. ACHD patients more frequently required postoperative ICU or IMCU care (6.6% vs. 1.6%, p = 0.02; 13.9% vs. 3.7%, p < 0.001). Anaesthesiologic complication rates were low in both groups.

Conclusion: Obstetric anaesthesia was feasible with low complication rates, even in severe ACHD, when management was individualised and interdisciplinary. All anaesthetic procedures proved to be feasible when adapted to the risk profile.