Is Cardiac Surgery Safe During Pregnancy? A 40-Year Single-Institution Experience.

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Cardiovascular Surgery

Background:

• Limited data exist on maternal and fetal outcomes for pregnant individuals undergoing cardiac operations with cardiopulmonary bypass.
• Characterizing these outcomes is crucial for optimizing patient care and surgical decision-making.

Purpose of the Study:

• To characterize maternal and fetal outcomes in pregnant patients who underwent cardiac surgery using cardiopulmonary bypass.
• To evaluate the impact of gestational age and surgical timing on outcomes.

Main Methods:

• Retrospective review of pregnant patients undergoing cardiac surgery with cardiopulmonary bypass from 1978 to 2023.
• Descriptive statistical analysis including medians for continuous variables and incidence for dichotomous variables.

Main Results:

• Twenty-nine pregnant patients underwent cardiac surgery at a median gestation of 25 weeks.
• Maternal mortality was low (3%), but fetal loss was significant (17% overall).
• Fetal mortality was higher (29%) when pregnancy continued during surgery compared to delivery before surgery (14%).

Conclusions:

• Cardiac surgery during pregnancy is associated with low maternal mortality but significant fetal mortality.
• Cesarean delivery before cardiopulmonary bypass may minimize fetal mortality in viable gestations.
• This single-institution series supports a strategy of considering preterm delivery before cardiac surgery.