Risk factors associated with cardiac surgery during pregnancy.
BACKGROUND
This study is aimed at analyzing risk factors for fetal and maternal mortality in cardiac surgery during pregnancy.


METHODS
Seventy-four pregnant women underwent cardiac surgery and 58 (78.3%) were followed. The most frequent pathology was valve disease (93.2%). Mitral valve disease was the most prevalent (72.9%), and mitral commissurotomy or replacement was required in 78% of the cases. Most were in functional class III or IV and mean gestational age was 22 weeks.


RESULTS
There was functional class improvement after surgery (91% into class I or II), and 70.4% were restored to sinus rhythm. Twenty percent required reoperation. There were five maternal deaths (8.6%) and 11 fetal deaths (18.6%). Several aspects were considered as contributing risk factors for maternal mortality, such as the use of vasoactive drugs and other preoperative medications, age, kind of surgery, reoperation, and functional class. Functional class was the factor that predicted higher risk for maternal death. As to fetal mortality, several factors played a role, such as maternal age more than 35 years, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time.


CONCLUSIONS
Cardiac surgery during pregnancy is associated with acceptable maternal and fetal mortality rates. These rates may be even lower if the factors mentioned above are maintained under control.
Arnoni
Renato T
RT
Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. ramoni@uol.com
Arnoni
Antoninho S
AS
Bonini
Rômulo C A
RC
de Almeida
Antônio F S
AF
Neto
Camilo A
CA
Dinkhuysen
Jarbas J
JJ
Issa
Mário
M
Chaccur
Paulo
P
Paulista
Paulo P
PP
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008428:Maternal Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000601:surgery*; D011256:Pregnancy Outcome; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome