Cardiac Surgery in Pregnancy: Pre-Surgery Cesarean Could Minimize Fetal Mortality, Study Reveals
USA: In a groundbreaking study, researchers from the renowned Mayo Clinic have analyzed the safety and outcomes of cardiac surgeries performed on pregnant women over a 40-year period. The study, published in The Annals of Thoracic Surgery, sheds light on the complexities and advancements in managing cardiac conditions during pregnancy, offering hope and valuable insights for expectant mothers facing heart surgery.
The study revealed that cardiac surgery during pregnancy was linked to low rates of maternal mortality but notably higher fetal mortality.
"This extensive single-institution study suggests that performing a cesarean delivery before initiating cardiopulmonary bypass procedures—provided the fetus is of viable gestational age—could be a beneficial strategy to reduce fetal mortality," the researchers wrote.
Cardiac surgery during pregnancy is a delicate and rare scenario, with only a few centers worldwide specializing in such procedures. Kathleen A. Young, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA, and colleagues aimed to characterize maternal and fetal outcomes during pregnancy using cardiopulmonary bypass.
For this purpose, the researchers performed a retrospective review of all pregnant women who underwent cardiac surgery utilizing cardiopulmonary bypass at a single center from 1978 to 2023. A descriptive statistical analysis reported medians for continuous variables and incidence rates for dichotomous variables.
The study led to the following findings:
- Twenty-nine pregnant patients with a median age of 28 years underwent cardiac surgery using cardiopulmonary bypass at a median gestation of 25 weeks.
- Surgery was performed in the 1st trimester for 10%, 2nd trimester for 55%, and 3rd trimester for 35% of patients; 52% were emergent and 48% were urgent procedures.
- There was one (3%) maternal death two days after mechanical aortic valve thrombectomy and 17% fetal losses.
- Fourteen patients who underwent cardiac surgery using cardiopulmonary bypass with continuing pregnancy experienced a 29% fetal mortality rate, and seven patients underwent delivery before surgery and experienced 14% fetal mortality.
- Among cases of fetal loss, surgery was performed at a median of 25 weeks compared to a median of 23 weeks in cases without fetal loss.
"The findings indicate that while cardiac surgery during pregnancy is linked to low maternal mortality, it is associated with high fetal mortality. When the fetus is viable, it is advisable to consider performing a cesarean section before cardiac surgery, ideally coordinated by a specialized Pregnancy Heart Team," the researchers concluded.
Reference:
Schmitz, Katlin T., et al. "Is Cardiac Surgery Safe During Pregnancy? a 40-Year Single Institution Experience." The Annals of Thoracic Surgery, 2024.
