Obstetric Anaesthesia Annual Scientific Meeting 2025

Patient Profile

-27-year-old woman

-Known Familial Hypercholesterolaemia

-History of coronary artery disease with stent at age 15

Presentation:

-Unstable angina at 17 weeks’ gestation

-Severe narrowing of right coronary artery

Decision:

-Termination declined

-Multidisciplinary team opted for off-pump coronary artery bypass grafting (OPCABG)

Procedure:

-2-vessel OPCABG at 19 weeks

-No complications

-Fetal heartbeat confirmed post-op

Delivery:

-Vaginal delivery planned

-Category 2 caesarean delivery for fetal distress

-Both mother and baby discharged on day 3

Traditional coronary bypass: Disadvantages:

-↓ Coagulation

-↓ Organ perfusion

-↓ Temperature regulation

-Loss of pulsatile flow ➝ ↑ placental resistance

-Cooling/rewarming ➝ uterine contractions & ↓ perfusion

Conclusion

-OPCABG is a viable alternative to cardiopulmonary bypass (CPB) in pregnancy

-With careful planning, positive maternal and fetal outcomes are achievable

-As cardiac disease in pregnancy rises, awareness and preparation are key

Take-Home Messages

Off-Pump surgery may reduce fetal risk

Favor normothermic, pulsatile flow if CPB unavoidable

MDT care is essential to optimise outcomes for mother and baby

Two hearts on the line: Off-pump coronary artery bypass graft (OPCABG) in pregnancy