Cardiopulmonary bypass during pregnancy.

Area of Science:

• Cardiovascular Surgery
• Maternal-Fetal Medicine
• Cardiology

Background:

• Cardiac surgery in pregnancy presents significant risks to both mother and fetus.
• Intervention is typically reserved for cases where medical management has failed.

Purpose of the Study:

• To evaluate maternal and neonatal outcomes following cardiopulmonary bypass during pregnancy.
• To assess the safety and risks associated with cardiothoracic surgery in pregnant patients.

Main Methods:

• A retrospective review of 21 pregnant patients undergoing cardiothoracic surgery between 1976 and 2009.
• Analysis of maternal and neonatal outcomes, including surgical procedures, cardiopulmonary bypass times, gestational age, and survival rates.

Main Results:

• Common operations included valve replacements and aneurysm repairs. Emergent surgery was required in 57% of cases, with a median gestational age of 25 weeks.
• Seven patients delivered viable infants via Cesarean section before sternotomy (median GA 31 weeks). Three additional preterm births occurred in early-gestation surgeries (13-15 weeks).
• One early maternal death occurred post-thrombectomy; three late maternal deaths occurred years later. Fetal deaths were linked to maternal comorbidities.

Conclusions:

• Cardiothoracic surgery can be performed with relative safety during pregnancy in the current era.
• Fetal complications, including prematurity and death, are associated with urgent, high-risk procedures, maternal comorbidities, and early gestational age.
• Emergent cardiac surgery during pregnancy appears to carry an increased risk of maternal mortality.