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.