Abstract 1806: Cardiac Surgery During Pregnancy: The Mayo Clinic Experience 1976–2005
Objective: Antepartum cardiac surgery carries significant maternal and fetal risk. We reviewed our experience with these patients.
Methods and Results: Seventeen patients underwent cardiothoracic surgery during pregnancy (1976–2005). Median age was 28 years (range 20 – 40). Five patients had previous cardiac surgery; one had 2 prior operations. Median gestational age (GA) was 21 weeks (range 7–35). Median preop NYHA class was III. Surgeries included 5 aortic valve replacements (AVR) (one with CABG), 5 mitral valve (MV) repair/replacements, 2 myxoma excisions, 1 PFO closure, 1 myectomy, 2 thoracoabdominal aortic aneurysm (TAA) repairs (not Marfan), and 1 AVR thrombectomy . Median bypass time 49.5 minutes (range 16 –185), median cross-clamp time 31 minutes (range 9 –128), median flow rate 2.4 l/min/m2 (range 2.2–2.6) and median perfusate temperature 37°C (range 20 –37). Eight patients (47%) required emergent or urgent surgery, four underwent cesarean section (CS) immediately prior to sternotomy delivering viable infants (median GA 32 wks). There were 3 fetal deaths; one (GA 7wk) was associated with TAA repair using partial bypass (surgery duration 340 minutes) in a methamphetamine user, the second occurred in a poorly controlled Type 1 DM undergoing AVR and CABG (GA 15 wk), and the third occurred after MV replacement (1986) using deep hypothermic circulatory arrest (DHCA) at 28°C (GA 26 wk). Six of the remaining 10 fetuses were delivered alive vaginally (median GA 39 wks), 2 were delivered alive by CS (median GA 36 wks), and 2 were lost to follow-up. There was only one early maternal death 2 days after emergent AVR thrombectomy (1985); a viable infant was delivered by CS prior to cardiac surgery. Patients were followed for a median of 16 months (range 3–305), all improved to NYHA functional class I or II. There were 2 late maternal deaths 10 and 19 years postoperatively; 1 due to congestive heart failure and 1 from thrombosis of a prosthetic MV.
Conclusions: Cardiothoracic surgery can be performed with relative safety during pregnancy. Fetal demise is associated with urgent, high-risk surgery, maternal comorbidities and early gestational age. Emergent surgery, advanced NYHA class, and DHCA confer a higher risk of maternal death.