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You are here: Contents > 2015 > Volume 24 Number 2 March 2015 > MISCELLANEOUS > Feto-Maternal Outcomes of Urgent Open-Heart Surgery During Pregnancy

Feto-Maternal Outcomes of Urgent Open-Heart Surgery During Pregnancy

Saeid Hosseini1, Fahimeh Kashfi1,2, Niloufar Samiei1, Amirjamshid Khamoushi3, Alireza Alizadeh Ghavidel1, Forouzan Yazdanian3, Yalda Mirmesdagh1, Carlos A. Mestres4

1Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, 2Department of Epidemiology and Reproductive Health at Reproductive and Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, 3Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran, 4Department of Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Barcelona, Spain

Background and aim of the study: Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy.

Methods: Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women. Eleven patients were in the first trimester, three in the second trimester, and two in the third trimester. A retrospective analysis was conducted that included maternal variables of age, gestational age, cardiac diagnosis, prior operations, surgical details, maternal morbidity and mortality and type of delivery, while fetal variables included incidence of low birth weight, prematurity, and fetal malformation. Patients were allocated to two groups: Group A (n = 9) included pregnant women with living


neonates, while group B (n = 7) included pregnant women with an aborted fetus or dead neonate. All data were compared between the groups.

Results: There was no in-hospital maternal mortality. There were no significant differences between the two groups regarding age, gestational age, previous cardiac operation, type of surgery, duration of operation, perfusion pressure and core temperature during CPB. The CPB time was longer in group B (110.3 ± 57.1 min) than in group A (62 ± 15.7 min) (p = 0.028), as was the aortic cross-clamp time (54.3 ± 27.2 min and 38.7 ± 9.3 min in groups A and B, respectively) (p = 0.014). Group B patients received higher doses of inotropes perioperatively. No congenital abnormalities were identified in any of the living neonates.

Conclusion: The durations of CPB and aortic cross-clamping may not affect maternal outcome, but shorter CPB and aortic cross-clamp times led to better fetal outcomes. Increasing the perioperative dosage of inotropes may lead to a reduced fetal survival.

The Journal of Heart Valve Disease 2015;24:253-259


Feto-Maternal Outcomes of Urgent Open-Heart Surgery During Pregnancy

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