Outcome of cardiovascular surgery and pregnancy: A systematic review of the period 1984-1996,☆☆

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Abstract

The outcomes of cardiovascular operations during pregnancy, at delivery, and post partum were reviewed from published material in the period 1984-1996. Surgery during pregnancy resulted in fetal-neonatal morbidity and mortality of 9% and 30%, respectively, and in maternal morbidity and mortality of 24% and 6%, respectively. Duration of pregnancy at surgery and duration and temperature of cardiopulmonary bypass did not influence fetal-neonatal outcome. Maternal complications and mortality of surgery immediately after delivery were 29% and 12%, respectively, and for surgery performed with a postpartum interval the respective rates were 38% and 14%. Hospitalization after week 27 of gestation and extreme emergency contributed significantly to poor maternal outcome. Maternal deaths were reported in 9% of valvular procedures and in 22% of aortic or arterial dissection repairs and pulmonary embolectomies. Fetal-neonatal risks of maternal surgery during pregnancy are high and unpredictable. Maternal risks of cardiovascular procedures during pregnancy are moderate, significantly increase if an operation is performed at or after delivery, and, overall, should be considered as higher than those in nonpregnant cardiovascular surgical patients. (Am J Obstet Gynecol 1998;179:1643-53.)

Section snippets

Search and analysis of the material

The original publications, describing a cardiovascular surgical procedure during pregnancy or after delivery, were identified in the database of the National Library of Medicine (MEDLINE) from January 1984 to December 1996. For the search the Key words pregnancy and cardiovascular surgery, cardiopulmonary bypass, anesthesia, cardiac disease, vascular disease, congenital heart disease, valvular heart disease, endocarditis, valve replacement, aortic dissection, aneurysm, Marfan’s syndrome,

Cardiovascular surgical cases and pregnancy, 1984-1996

A total of 161 cases (137 with and 24 without cardiopulmonary bypass) of various cardiovascular operations qualified for the review. Tables I and II show the duration of pregnancy on admission, at surgery, and at delivery and the maternal and fetal-neonatal outcome, respectively, according to the timing of surgery, whether performed during pregnancy or at delivery or delayed to the postpartum period. Table III presents the fetal-neonatal outcome of cardiopulmonary bypass procedures during

Limitations of the systematic review

Despite intensive search for published references, some reports certainly remained hidden because of the nonuniform Key words and the large numbers of sources. It is likely that more patients were operated on than reported in the study period. A good outcome obtained by an experienced team may be considered a routine success, not worthy of publication. Otherwise, a bias to report may depend on the outcome and result in a preferential number of successful procedures and an underreporting of

Acknowledgements

Robert A. Strickland, MD (Department of Anesthesiology, Mayo Clinic, Rochester, Minn), provided a detailed description of cases treated from 1985 to 1989 (see reference 7). Ms Machiko Hafner-Nakai (Zurich, Switzerland) translated the Japanese publications. Renate Huch, MD (Department of Perinatal Physiology and Obstetrics, University Hospital, Zurich, Switzerland), reviewed the manuscript and made valuable comments.

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    Reprint requests: Branko M. Weiss, MD, Department of Anesthesiology, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland.

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