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Aortic and vascular disease
Original research
Management strategies and outcomes in pregnancy-related acute aortic dissection: a multicentre cohort study in China
  1. Hong Liu1,
  2. Liu Yang2,
  3. Cui-ying Chen3,
  4. Si-chong Qian4,
  5. Lu-yao Ma1,
  6. Yi-fei Diao1,
  7. Xiao-yu Wu2,
  8. Shu-yan Wu3,
  9. Zhi-qiang Dong5,
  10. Yong-feng Shao1,
  11. Hong-jia Zhang4,
  12. Li-Zhong Sun4,
  13. Jun-ming Zhu4,
  14. Jia-rong Zhang2,
  15. Haiyang Li4
  1. 1Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  2. 2Department of Obstetrics and Gynecology, Fudan University Zhongshan Hospital, Shanghai, China
  3. 3Department of Obstetrics and Gynecology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
  4. 4Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  5. 5Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, China
  1. Correspondence to Dr Hong Liu; dr.hongliu{at}foxmail.com; Dr Cui-ying Chen; chcuiyi{at}163.com; Professor Haiyang Li; ocean0203{at}163.com

Abstract

Background Acute aortic dissection (AD) in pregnancy poses a lethal risk to both mother and fetus. However, well-established therapeutic guidelines are lacking. This study aimed to investigate clinical features, outcomes and optimal management strategies for pregnancy-related AD.

Methods We conducted a retrospective multicentre cohort study including 67 women with acute AD during pregnancy or within 12 weeks postpartum from three major cardiovascular centres in China between 2003 and 2021. Patient characteristics, management strategies and short-term outcomes were analysed.

Results Median age was 31 years, with AD onset at median 32 weeks gestation. Forty-six patients (68.7%) had type A AD, of which 41 underwent immediate surgery. Overall maternal mortality was 10.4% (7/67) and fetal mortality was 26.9% (18/67). Compared with immediate surgery, selective surgery was associated with higher risk of composite maternal and fetal death (adjusted RR: 12.47 (95% CI 3.26 to 47.73); p=0.0002) and fetal death (adjusted RR: 8.77 (95% CI 2.33 to 33.09); p=0.001).

Conclusions Immediate aortic surgery should be considered for type A AD at any stage of pregnancy or postpartum. For pregnant women with AD before fetal viability, surgical treatment with the fetus in utero should be considered. Management strategies should account for dissection type, gestational age, and fetal viability.

Trial registration number NCT05501145.

  • Pregnancy
  • FETAL
  • Aneurysm, Dissecting
  • Cardiac Surgical Procedures
  • Outcome Assessment, Health Care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/heartjnl-2024-324009

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • HL, LY, C-yC, S-cQ and L-yM contributed equally.

    • Contributors HL conceptualised, designed the study and wrote and reviewed the manuscript. HL and LyM contributed to the statistical analysis. HL, S-cQ, HyL and H-jZ supported software and reviewed the draft. HL is responsible for the overall content as the guarantor. All authors made important contributions to the revision of the paper. The guarantor accepts full responsibility for the work and/or the conduct of the study and had access to the data, and controlled the decision to publish. HL is the guarantor.

    • Funding This work was supported by the National Natural Science Foundation of China (82000305), Jiangsu Province Capability Improvement Project through Science, Technology and Education (ZDXK202230) and Public Welfare Project of Nanjing Medical University Alliance for Specific Diseases (JZ23349020230306).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.