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Anaesthesia for caesarean section and postpartum cardiovascular events in congenital heart disease: a retrospective cohort study
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  • Akito Tsukinaga,
  • Kenji Yoshitani,
  • Yosuke Kubota,
  • Eiki Kanemaru,
  • Kunihiro Nishimura,
  • Michikazu Nakai,
  • Soshiro Ogata,
  • Rie Tsukinaga,
  • Chizuko Kamiya,
  • Jun Yoshimatsu,
  • Yoshihiko Ohnishi
Akito Tsukinaga
National Cerebral and Cardiovascular Center
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Kenji Yoshitani
National Cerebral and Cardiovascular Center
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Yosuke Kubota
National Cerebral and Cardiovascular Center
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Eiki Kanemaru
National Cerebral and Cardiovascular Center
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Kunihiro Nishimura
National Cerebral and Cardiovascular Center
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Michikazu Nakai
National Cerebral and Cardiovascular Center
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Soshiro Ogata
National Cerebral and Cardiovascular Center
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Rie Tsukinaga
National Cerebral and Cardiovascular Center
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Chizuko Kamiya
National Cerebral and Cardiovascular Center
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Jun Yoshimatsu
National Cerebral and Cardiovascular Center
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Yoshihiko Ohnishi
National Cerebral and Cardiovascular Center
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Abstract

Objective To clarify the association between anaesthetic technique and maternal and neonatal outcomes in parturients with CHD. Design Retrospective observational cohort study. Setting Academic hospital. Population A total of 263 consecutive parturients with congenital heart disease (CHD) who underwent caesarean section. Methods Charts from 1994–2019 were reviewed. Main outcome measures We compared postpartum cardiovascular events (composite of heart failure, pulmonary hypertension, arrhythmia, and thromboembolic complications) and neonatal outcomes (intubation and Apgar score <7 at 1 or 5 minutes) by anaesthetic technique. Results Among 263 caesarean sections, general anaesthesia was performed in 47 (17.9%) parturients and neuraxial anaesthesia in 214 (81.3%) parturients. Cardiovascular events were more common in the general anaesthesia group (n=7; 14.9%) than in the neuraxial anaesthesia group (n=17; 7.9%). Generalized linear mixed models assuming a binomial distribution (i.e., mixed-effects logistic regression) with a random intercept for each modified World Health Organization classification for maternal cardiovascular risk revealed that general anaesthesia is not significantly associated with cardiovascular events (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.30–3.29). In addition, general anaesthesia was associated with composite neonatal outcomes (Apgar score <7 at 1 or 5 minutes or need for neonatal intubation; OR, 13.3; 95% CI, 5.52–32.0). Conclusion Anaesthetic technique is not significantly associated with postpartum composite cardiovascular events. General anaesthesia is significantly associated with increased need for neonatal intubation and lower Apgar scores. Funding No external funding was used in the conduct of this study. Keywords Anaesthesia, caesarean section, postpartum, cardiovascular events, congenital heart disease, neonatal outcomes