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Cardiopulmonary bypass in pregnancy
F Pomini1, D Mercogliano, C Cavalletti
1Department of Obstetrics and Gynecology, Università Cottolica del Sacro Cuore, Rome, Italy.
The Annals of Thoracic Surgery
|January 1, 1996
Summary
Cardiac surgery during pregnancy is feasible, with recent advancements significantly reducing maternal and fetal mortality. Maintaining normothermia during cardiopulmonary bypass is crucial for fetal survival.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Maternal-Fetal Medicine
- Critical Care Medicine
Background:
- Pregnancy in patients with heart disease poses risks, including acute heart failure.
- Open heart surgery during pregnancy necessitates cardiopulmonary bypass, potentially compromising fetal well-being.
Purpose of the Study:
- To evaluate the outcomes of cardiac operations performed during pregnancy with cardiopulmonary bypass.
- To identify factors influencing maternal and embryofetal mortality in this patient population.
Main Methods:
- A retrospective review of 69 published cases of cardiac operations during pregnancy from 1958 to 1992.
- Analysis of maternal and embryofetal mortality rates, stratified by time period and intraoperative temperature management.
Main Results:
- Overall maternal mortality was 2.9%, and embryofetal mortality was 20.2%.
- In the last 40 patients, mortality rates decreased to 0.0% for mothers and 12.5% for fetuses.
- Hypothermia during cardiopulmonary bypass was associated with a 24.0% embryofetal mortality, compared to 0.0% in normothermia, and caused uterine contractions.
Conclusions:
- Cardiac operations during pregnancy can be performed with acceptable maternal and fetal outcomes.
- Maintaining normothermia during cardiopulmonary bypass is critical for improving fetal survival.
- Pump flow and mean arterial pressure are key determinants of fetal oxygenation during cardiopulmonary bypass.