Anesthesia management for cesarean delivery in patients with an arterial switch operation: a single center case series (2015-2023).

Background: Arterial switch operation (ASO) for dextro-transposition of the great arteries was developed four decades ago, and women with ASO have reached childbearing age. Although over 40% of the pregnant women who received ASO gave birth via cesarean delivery, detailed information about anesthesia management has not been reported. This study aimed to evaluate anesthesia and perioperative outcomes in pregnant women with ASO undergoing cesarean delivery.

Methods: A retrospective chart review was conducted on pregnant women with a history of ASO with a cesarean delivery at Tokyo Women's Medical University Hospital between January 1, 2015, and May 31, 2023. Obstetric and anesthetic management, as well as maternal outcomes, were analyzed.

Results: A total of 12 cesarean deliveries among 10 ASO patients were identified. The median maternal age at cesarean delivery was 29 years (range: 26-38) and median gestational age was 37 weeks and 1 day (33 weeks and 6 days - 37 weeks and 6 days). Two patients developed arrhythmia (paroxysmal supraventricular tachycardia, non-sustained ventricular tachycardia, and atrial tachyarrhythmia) during pregnancy. Five patients presented with moderate to severe valvular regurgitation, three of which worsened during pregnancy. All patients received neuraxial anesthesia for the cesarean delivery. Spinal induced hypotension occurred in four cases, which was immediately treated with vasopressors. No patient developed heart failure or arrhythmias postoperatively.

Conclusion: Neuraxial anesthesia for cesarean delivery in pregnant women with a history of ASO resulted in favorable maternal outcomes with no postoperative cardiac complications.