2026 SOAP Annual Meeting

INTRODUCTION

Patients with Fontan circulation are increasingly surviving to adulthood
• Concurrent rise in the rate of deliveries

• 2.4 cases per 1 million in 2000 to 30.3 in 2018

Pregnancy is not strictly contraindicated

• High risk of morbidity and mortality (modified WHO risk class III-IV)

AIM: Describe anesthetic management of parturients with Fontan circulation

METHODS

•Multicenter, retrospective, observational study using MPOG database

•Queried obstetric anesthetic records for deliveries between 2016 and 2023

•Screened for potential Fontan circulation using ICD codes for related congenital heart defects

•Manual review to verify Fontan status and to abstract management and outcome parameters

RESULTS

table

CONCLUSIONS

High burden of cesarean deliveries and general anesthetics

•Higher total cesarean rate than background population, similar labor-to-cesarean conversion rates

•31.4% under general anesthesia, not attributable to failed conversions

Anesthetic strategies mindful of Fontan physiology

•Nearly 50% of patients on anticoagulation

•All neuraxial cesareans either epidurals or sequential CSEs

•High rate of invasive BP monitoring

High rate of morbidity, but major outcomes reassuring

•25% of cases had positive modified CDC SMM index

•8.8% ICU admission rate, but no mortality

Frequency, Characteristics, and Management of Parturients with Fontan Circulation Delivering with Anesthesia: A Multicenter Retrospective Cohort Analysis