Aortic Dissection in Pregnancy: Management Strategy and Outcomes

Area of Science:

• Cardiology
• Obstetrics
• Vascular Surgery

Background:

• Aortic dissection during pregnancy is a rare but life-threatening condition with limited clinical data.
• This study focuses on the etiology, management, and outcomes of aortic dissection in a cohort of pregnant patients.

Purpose of the Study:

• To analyze the clinical characteristics, treatment strategies, and survival rates of pregnant women experiencing aortic dissection.
• To provide evidence-based recommendations for managing aortic dissection in pregnancy based on dissection type and gestational age.

Main Methods:

• A retrospective review of 25 pregnant patients with aortic dissection between June 1998 and February 2015.
• Classified dissections into Type A (TAAD) and Type B (TBAD), noting the high prevalence of Marfan syndrome (68%).
• Management strategies were determined by dissection type and gestational weeks (GWs).

Main Results:

• TAAD (80%) was predominantly managed surgically. Maternal mortality varied by management strategy (14.3% to 100%), with fetal survival rates also differing significantly.
• TBAD (20%) saw 60% surgical management, with no maternal deaths but 100% fetal mortality in the surgical group.
• Overall 5-year maternal survival was 68.6% in the TAAD group, with late follow-up revealing additional maternal and fetal deaths.

Conclusions:

• Marfan syndrome is a key risk factor for aortic dissection in pregnancy.
• For TAAD after 28 GWs, a "delivery first" approach followed by surgical repair optimizes maternal and fetal survival.
• For TAAD before 28 GWs, prioritizing maternal survival is crucial; nonsurgical management is preferred for TBAD in pregnancy.