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Heart surgery with cardiopulmonary bypass in pregnant women
E Salazar1, N Espinola, F J Molina
1Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1, 14080 México, D.F.
Objective:
Definite data in heart surgery with extracorporeal circulation during pregnancy is limited. This report analyzes our experience in this area.
Methods:
Fifteen women underwent open heart surgery under cardiopulmonary bypass during pregnancy at our institution between 1972 and 1998. Surgical procedures included valve replacement in 13 patients (12 mitral, 1 aortic), declotting of a tilting disk mitral prosthesis in one and closure, of an atrial septal defect in the remaining patient.
Results:
Thirteen patients were in New York Heart Association functional class III to IV and were operated on urgently. Eight of these women had severe acute dysfunction of either a mechanical or a biological mitral prosthesis. There were 2 maternal operative deaths for a rate of 13.3%. Fetal losses resulted at the time of these maternal deaths. Fetal deaths occurred in 5 of the 13 pregnancies (38.5%) in women who survived the surgical procedure.
Conclusions:
Because of the fetal risks, open heart surgery during pregnancy should be advised only in extreme emergencies. Although pregnancy per se does not increase the maternal risk, a high maternal mortality results from the emergency nature of the surgical intervention. Fetal mortality remains high.