Surgical management
The consideration when operating is weighing up the risk of delivering
the fetus concurrently with aortic repair for TAAD or operating with
fetus in utero . Yates et al reported their series of 11
patients who had emergency cardiac surgery requiring urgent delivery of
the fetus40. They succeeded with no maternal deaths
but reported a fetal mortality rate of 27%. The precise timing of when
to deliver varies around the age of the fetus, with some authors such as
Zeebregts suggesting between 28 – 32 weeks the option for concomitant
delivery should fetal maturity have occurred8,9,41.
Others, such as the European Society of Cardiology, recommend delivery
from 26 weeks gestation, when fetal maturity is likely to have been
reached8. In a systematic review by de Martinoet al , analysis of seven studies and 63 patients represented a
maternal and fetal mortality of 23 and 27%
respectively42. Whilst concerning, they questioned
whether the maternal mortality was similar in non-pregnant women, as
suggested by a longitudinal observational cohort study.