Journal of cardiothoracic and vascular anesthesia · 2026
Perioperative Hemodynamics and Clinical Outcomes of Cesarean Delivery Under Neuraxial Anesthesia in Women with Fontan Circulation: A Single-Center Retrospective Cohort Study.
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Miyake Tomoaki, Masuda Sho, Tsukinaga Akito, Hizuka Kotaro, Aoki-Kamiya Chizuko, Yoshimatsu Jun, Ohuchi Hideo, Yoshitani Kenji, Maeda Takuma
Аннотация
OBJECTIVES: Cesarean delivery in women with Fontan circulation poses significant risks of hemodynamic instability. We aimed to characterize perioperative hemodynamic fluctuations and describe short-term maternal and neonatal outcomes in this population.
DESIGN: Single-center retrospective cohort study.
SETTING: Tertiary referral center in Japan.
PARTICIPANTS: Women with Fontan circulation undergoing cesarean delivery (2009-2025).
INTERVENTIONS: Neuraxial anesthesia and cesarean delivery.
MEASUREMENTS AND MAIN RESULTS: Twelve deliveries (11 women) were analyzed. Median gestational age was 35.5 weeks; all patients were New York Heart Association class I at the initial visit. After neuraxial anesthesia, central venous pressure (CVP) fell from 17.0 to 11.0 mmHg (-6.0 mmHg [-8.5 to -4.0], p = 0.006), and systolic blood pressure fell from 129 to 107 mmHg (-24.5 mmHg [-30.5 to -17.5], p = 0.003). With vasopressor support, clinically significant hypotension was avoided in 11 of 12 deliveries. Immediately after delivery, systolic blood pressure decreased in all cases (estimated paired difference, -21.0 mmHg; 95% CI, -25.0 to -17.0; p = 0.003), whereas CVP showed no consistent change (estimated paired difference, 0.0 mmHg; 95% CI, -7.5 to 2.0; p = 0.96). No new-onset heart failure or arrhythmias requiring treatment occurred intraoperatively, though postoperative arrhythmias developed in 25% of deliveries.
CONCLUSION: In this cohort of carefully selected patients with Fontan circulation, cesarean delivery was associated with manageable hemodynamic fluctuations and acceptable short-term outcomes when continuous CVP monitoring and timely pharmacologic interventions were implemented. These data may inform multidisciplinary peripartum management in this high-risk population.
DESIGN: Single-center retrospective cohort study.
SETTING: Tertiary referral center in Japan.
PARTICIPANTS: Women with Fontan circulation undergoing cesarean delivery (2009-2025).
INTERVENTIONS: Neuraxial anesthesia and cesarean delivery.
MEASUREMENTS AND MAIN RESULTS: Twelve deliveries (11 women) were analyzed. Median gestational age was 35.5 weeks; all patients were New York Heart Association class I at the initial visit. After neuraxial anesthesia, central venous pressure (CVP) fell from 17.0 to 11.0 mmHg (-6.0 mmHg [-8.5 to -4.0], p = 0.006), and systolic blood pressure fell from 129 to 107 mmHg (-24.5 mmHg [-30.5 to -17.5], p = 0.003). With vasopressor support, clinically significant hypotension was avoided in 11 of 12 deliveries. Immediately after delivery, systolic blood pressure decreased in all cases (estimated paired difference, -21.0 mmHg; 95% CI, -25.0 to -17.0; p = 0.003), whereas CVP showed no consistent change (estimated paired difference, 0.0 mmHg; 95% CI, -7.5 to 2.0; p = 0.96). No new-onset heart failure or arrhythmias requiring treatment occurred intraoperatively, though postoperative arrhythmias developed in 25% of deliveries.
CONCLUSION: In this cohort of carefully selected patients with Fontan circulation, cesarean delivery was associated with manageable hemodynamic fluctuations and acceptable short-term outcomes when continuous CVP monitoring and timely pharmacologic interventions were implemented. These data may inform multidisciplinary peripartum management in this high-risk population.