Non-emergency cardiac surgery with cardiopulmonary bypass during pregnancy: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Ciyan ¹ , LUO Xiaokang ^1,2 ,  CHEN Jimei ^1,2 , ZHUANG Jian ^1,2

1. Department of Cardiac Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, 510080, P. R. China;
2. Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P. R. China;

Corresponding?author：

CHEN Jimei, Email: jimei1965@gmail.com

Keywords：

Pregnancy; cardiac surgery; cardiopulmonary bypass; gestation period; intrauterine fetal reservation

DOI：

10.7507/1007-4848.202201064

Video：

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Objective To summarize the clinical experience of cardiac surgery during pregnancy in a single center for the past 11 years. Methods The clinical data of 26 pregnant patients (mean age 28.6±4.9 years) complicated with heart diseases who underwent non-emergency cardiac surgery with cardiopulmonary bypass from 2010 to 2020 in Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were divided into two groups according to the gestational age at the time of surgery: a change group (gestational age<21 weeks) and a stable group (gestational age≥21 weeks). The hospitalization data and follow-up data of the patients were collected. Results Mean gestational age at surgery was 23.4±4.2 weeks. Eleven patients had congenital heart diseases and fifteen had valvular heart diseases. Meanpostoperative ICU stay was 2.5±2.4 d, and mean total hospital stay was 22.5±9.5 d. There were 5 postoperative fetal losses. There was no maternal death during follow-up. No statistical difference in the maternal postoperative outcomes between two groups. Conclusion The number of patients undergoing cardiac surgery during pregnancy is increasing. The maternal mortality rate is low and the prognosis is good, but the fetal loss remains concern. Cardiac surgery performed before or after the establishment of cardiopulmonary adjustment in pregnancy does not change the maternal postoperative outcomes.

Citation： XIE Ciyan, LUO Xiaokang, CHEN Jimei, ZHUANG Jian. Non-emergency cardiac surgery with cardiopulmonary bypass during pregnancy: A retrospective cohort study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 724-728. doi: 10.7507/1007-4848.202201064 Copy

1.	趙知莉, 李濤, 曾玲, 等. 妊娠合并心臟疾病預防及管理研究進展. 中國胸心血管外科臨床雜志, 2020, 27(11): 1357-1361.
2.	林建華, 繆慧嫻. 加強妊娠合并心臟病多學科協作治療模式管理, 降低孕產婦死亡率. 中國實用婦科與產科雜志, 2019, 35(11): 1185-1188.
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5.	Canobbio MM, Warnes CA, Aboulhosn J, et al. Management of pregnancy in patients with complex congenital heart disease: A scientific statement for healthcare professionals from the American Heart Association. Circulation, 2017, 135(8): e50-e87.
6.	Sliwa K, Baris L, Sinning C, et al. Pregnant women with uncorrected congenital heart disease: Heart failure and mortality. JACC Heart Fail, 2020, 8(2): 100-110.
7.	Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: Evolving trends over 10 years in the ESC registry of pregnancy and cardiac disease (ROPAC). Eur Heart J, 2019, 40(47): 3848-3855.
8.	Jha N, Jha AK, Chand Chauhan R, et al. Maternal and fetal outcome after cardiac operations during pregnancy: A meta-analysis. Ann Thorac Surg, 2018, 106(2): 618-626.
9.	韓鳳珍, 趙楊, 莊建. 妊娠期體外循環下心臟開胸手術12例臨床分析. 南方醫科大學學報, 2010, 30(12): 2777-2778.
10.	John AS, Gurley F, Schaff HV, et al. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg, 2011, 91(4): 1191-1196.
11.	Yates MT, Soppa G, Smelt J, et al. Perioperative management and outcomes of aortic surgery during pregnancy. J Thorac Cardiovasc Surg, 2015, 149(2): 607-610.
12.	Arnoni RT, Arnoni AS, Bonini RC, et al. Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg, 2003, 76(5): 1605-1608.
13.	董秀華, 程衛平, 盧家凱, 等. 保留妊娠孕婦心臟手術的麻醉處理. 心肺血管病雜志, 2017, 36(2): 123-124.
14.	Pfaller B, Sathananthan G, Grewal J, et al. Preventing complications in pregnant women with cardiac disease. J Am Coll Cardiol, 2020, 75(12): 1443-1452.
15.	Wald RM, Silversides CK, Kingdom J, et al. Maternal cardiac output and fetal doppler predict adverse neonatal outcomes in pregnant women with heart disease. J Am Heart Assoc, 2015, 4(11): e002414.
16.	Pieper PG, Balci A, Aarnoudse JG, et al. Uteroplacental blood flow, cardiac function, and pregnancy outcome in women with congenital heart disease. Circulation, 2013, 128(23): 2478-2487.
17.	Kapoor MC. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth, 2014, 17(1): 33-39.
18.	Assad RS, Lee FY, Bergner K, et al. Extracorporeal circulation in the isolated in situ lamb placenta: Hemodynamic characteristics. J Appl Physiol, 1992, 72(6): 2176-2180.

1. 趙知莉, 李濤, 曾玲, 等. 妊娠合并心臟疾病預防及管理研究進展. 中國胸心血管外科臨床雜志, 2020, 27(11): 1357-1361.
2. 林建華, 繆慧嫻. 加強妊娠合并心臟病多學科協作治療模式管理, 降低孕產婦死亡率. 中國實用婦科與產科雜志, 2019, 35(11): 1185-1188.
3. Wolfe DS. Introduction to building the cardio-obstetric team. Clin Obstet Gynecol, 2020, 63(4): 791-798.
4. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Kardiol Pol, 2019, 77(3): 245-326.
5. Canobbio MM, Warnes CA, Aboulhosn J, et al. Management of pregnancy in patients with complex congenital heart disease: A scientific statement for healthcare professionals from the American Heart Association. Circulation, 2017, 135(8): e50-e87.
6. Sliwa K, Baris L, Sinning C, et al. Pregnant women with uncorrected congenital heart disease: Heart failure and mortality. JACC Heart Fail, 2020, 8(2): 100-110.
7. Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: Evolving trends over 10 years in the ESC registry of pregnancy and cardiac disease (ROPAC). Eur Heart J, 2019, 40(47): 3848-3855.
8. Jha N, Jha AK, Chand Chauhan R, et al. Maternal and fetal outcome after cardiac operations during pregnancy: A meta-analysis. Ann Thorac Surg, 2018, 106(2): 618-626.
9. 韓鳳珍, 趙楊, 莊建. 妊娠期體外循環下心臟開胸手術12例臨床分析. 南方醫科大學學報, 2010, 30(12): 2777-2778.
10. John AS, Gurley F, Schaff HV, et al. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg, 2011, 91(4): 1191-1196.
11. Yates MT, Soppa G, Smelt J, et al. Perioperative management and outcomes of aortic surgery during pregnancy. J Thorac Cardiovasc Surg, 2015, 149(2): 607-610.
12. Arnoni RT, Arnoni AS, Bonini RC, et al. Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg, 2003, 76(5): 1605-1608.
13. 董秀華, 程衛平, 盧家凱, 等. 保留妊娠孕婦心臟手術的麻醉處理. 心肺血管病雜志, 2017, 36(2): 123-124.
14. Pfaller B, Sathananthan G, Grewal J, et al. Preventing complications in pregnant women with cardiac disease. J Am Coll Cardiol, 2020, 75(12): 1443-1452.
15. Wald RM, Silversides CK, Kingdom J, et al. Maternal cardiac output and fetal doppler predict adverse neonatal outcomes in pregnant women with heart disease. J Am Heart Assoc, 2015, 4(11): e002414.
16. Pieper PG, Balci A, Aarnoudse JG, et al. Uteroplacental blood flow, cardiac function, and pregnancy outcome in women with congenital heart disease. Circulation, 2013, 128(23): 2478-2487.
17. Kapoor MC. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth, 2014, 17(1): 33-39.
18. Assad RS, Lee FY, Bergner K, et al. Extracorporeal circulation in the isolated in situ lamb placenta: Hemodynamic characteristics. J Appl Physiol, 1992, 72(6): 2176-2180.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Non-emergency cardiac surgery with cardiopulmonary bypass during pregnancy: A retrospective cohort study in a single center

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