Maternal-fetal outcome and prognosis of cardiac surgery during pregnancy.
BACKGROUND
Cardiac surgery improves the maternal prognosis in cases refractory to medical therapy. However, it is associated with risks to the fetus when performed during pregnancy.


OBJECTIVE
To analyze maternal-fetal outcome and prognosis related to cardiac surgery performed during pregnancy and puerperium.


METHODS
The outcome of 41 gestations of women undergoing cardiac surgery during pregnancy and puerperium was studied. Fetal cardiotocography was performed throughout the procedure in patients with gestational age above 20 weeks.


RESULTS
Mean maternal age was 27.8 +/- 7.6 years; there was a predominance of patients with rheumatic valve disease (87.8%), of whom 15 (41.6%) underwent reoperation due to prosthetic valve dysfunction. Mean extracorporeal circulation time was 87.4+/- 43.6 min and hypothermia was used in 27 (67.5%) cases. Thirteen (31.7%) mothers experienced no events and gave birth to live healthy newborns. Postoperative outcome of the remaining 28 (68.3%) pregnancies showed: 17 (41.5%) maternal complications and three (7.3%) deaths; 12 (29.2%) fetal losses, and four (10%) cases of neurological malformation, two of which progressed to late death. One patient was lost to follow-up after surgery. Nine (21.9%) patients underwent emergency surgery, and this variable was correlated with maternal prognosis (p<0.001)


CONCLUSIONS
Cardiac surgery during pregnancy allowed survival of 92.7% of the mothers, and 56.0% of the patients who presented cardiac complications refractory to medical therapy gave birth to healthy children. Worse maternal prognosis was correlated with emergency surgery.
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. walkiria@incor.usp.br
Walkiria Samuel
WS
Avila
Ana Maria Milani
AM
Gouveia
Pablo
P
Pomerantzeff
Maria Rita Lemos
MR
Bortolotto
Max
M
Grinberg
Noedir
N
Stolf
Marcelo
M
Zugaib
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000601:surgery*; D011256:Pregnancy Outcome; D016019:Survival Analysis