Is Cardiac Surgery Safe during Pregnancy? A 40-Year Experience

E. H.. Stephens¹, K. Schmitz¹, J. Dearani¹, S. Patlolla², C. Rose¹, E. Bendel-Stenzel¹, W. Mauermann¹, K. Arendt¹, H. M. Connolly¹, H. V. Schaff¹, J. Crestanello¹, K. Young^1
1Mayo Clinic, Rochester, Minnesota ²Mayo Clinic, STATEN ISLAND, New York

Purpose: Cardiovascular disease is a leading cause of maternal mortality. Rarely cardiac surgery may be necessary during pregnancy, but limited data exist to characterize maternal and fetal outcomes after cardiopulmonary bypass (CPB) surgery during pregnancy and guide management. We aimed to analyze maternal and fetal outcomes of cardiac surgery during pregnancy.

Methods: Retrospective review was performed of all women who underwent CPB surgery during pregnancy at a single quaternary care center from 1978 to 2022. The decision to perform cardiac surgery and timing was made via multi-disciplinary review including all relevant specialists, along with shared decision-making with the patient and family. Demographic, clinical, obstetrical, and surgical data were collected. Descriptive statistical analysis was performed with median (interquartile range) reported for continuous variables and incidence (%) for dichotomous variables.

Results: Twenty-nine women with median age of 28 (25, 32) years underwent CPB surgery at a median gestation of 25 (16, 29) weeks. Surgery was performed in the 1st trimester for 3 (10%), 2nd trimester for 16 (55%), and 3rd trimester for 10 (35%); 15 (52%) were emergent and 14 (48%) urgent. Operations are shown in Table. Median bypass and cross-clamp time were 53 (37, 102) and 40 (23, 65) minutes, respectively. There was 1 (3%) early maternal death two days after emergent surgery for mechanical aortic valve thrombectomy and 4 late maternal deaths 2, 11, 18, and 33 years after surgery. Timing and method of delivery relative to surgery are shown in Figure. There were 5 (17%) fetal losses, surgery was during second trimester in 4 (80%) and 3rd trimester for 1 (20%). Three (60%) were emergent procedures and 2 (40%) were urgent. Of 7 pre-CPB deliveries, there was 1 death (14%), while among 14 post-CPB deliveries there were 4 (29%) deaths, all within 72 hours of surgery. Among cases of fetal loss, surgery was performed at a median of 25 (21, 26) weeks compared to median 23 (20, 29) weeks in cases without fetal demise.

Conclusion: Cardiac surgery during pregnancy occurs infrequently with low early maternal mortality but significant fetal mortality. If the pregnancy is viable, pre-cardiopulmonary bypass c-section may be preferable due to less associated fetal mortality. Further research is warranted to optimize outcomes in this challenging population.

Identify the source of the funding for this research project: none