title: Perioperative management and outcomes of aortic surgery during pregnancy.
abstract: OBJECTIVE
  Pathology of the aortic valve and ascending thoracic aorta is an uncommon but life-threatening complication of pregnancy. Cardiac surgery during pregnancy is known to carry a high risk of mortality to both the mother and fetus. We present our experience of performing aortic surgery during the patients' pregnancy.
  
  
  METHODS
  All patients undergoing aortic surgery during pregnancy at St George's Hospital, from January 2004 until October 2013, were identified. Surgery was performed using cardiopulmonary bypass at 36°C, with pulsatile perfusion at 70 mm Hg. Fetal blood flow parameters were serially monitored during surgery, via transabdominal and/or transvaginal Doppler ultrasonography. Surgery was performed in the second trimester when possible to allow completion of organogenesis and minimize hemodynamic compromise.
  
  
  RESULTS
  Eleven patients underwent aortic surgery. The median age was 28 years (range, 26-31 years), with gestational age 19 weeks (range, 16-21 weeks). Six patients had aortic root dilatation with aortic regurgitation, and 5 had aortic stenosis, one of whom presented with acute type A dissection. Four patients had Marfan syndrome, and 2 had undergone previous cardiac surgery. The operative procedures were aortic root replacement (tissue valve, n = 5; homograft, n = 1), aortic valve replacement (n = 3), valve-sparing root replacement (n = 1), and aortic and mitral valve replacements (n = 1). Mean cardiopulmonary bypass and cross-clamp times were 105 and 89 minutes, respectively. There were no maternal deaths; 8 healthy babies were born at term, and 3 pregnancies resulted in intrauterine demise within 1 week of surgery.
  
  
  CONCLUSIONS
  Major aortic surgery during pregnancy carries a high risk to both mother and baby. With appropriate maternal and fetal monitoring, attention to cardiopulmonary bypass, pulsatile perfusion, near-normothermia, and avoidance of vasoconstrictors, these risks may be minimized.
authors.affiliation: Department of Cardiothoracic Surgery, St George's Hospital, London, United Kingdom.
authors.forename: Martin T
authors.initials: MT
authors.lastname: Yates
authors.affiliation: Department of Cardiothoracic Surgery, St George's Hospital, London, United Kingdom.
authors.forename: Gopal
authors.initials: G
authors.lastname: Soppa
authors.affiliation: Department of Cardiothoracic Surgery, St George's Hospital, London, United Kingdom.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Smelt
authors.affiliation: Department of Anaesthetics, St George's Hospital, London, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Fletcher
authors.affiliation: Department of Anaesthetics, St George's Hospital, London, United Kingdom.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: van Besouw
authors.affiliation: Department of Foetal Medicine, St George's Hospital, London, United Kingdom.
authors.forename: Basky
authors.initials: B
authors.lastname: Thilaganathan
authors.affiliation: Department of Cardiothoracic Surgery, St George's Hospital, London, United Kingdom. Electronic address: marjan.jahangiri@stgeorges.nhs.uk.
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
mesh_terms: D000328:Adult; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000601:surgery*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014656:Vascular Surgical Procedures