Urgent Cardiac Surgery During Pregnancy: A Continuous Challenge

Background. Cardiac surgery during pregnancy is reserved for cases of failure of medical treatment due to its detrimental maternal and fetal effects. Methods. Between March 2003 and December 2012, 23 pregnant women with severe valve malfunction required open heart surgery. The mean age was 30.3 +/- 4.9 years. Gestational age ranged from 14 to 39 weeks. Twenty patients (87%) presented with signs of right ventricular failure. The main presenting lesion was severe aortic stenosis in 3 patients (13%), mitral stenosis in 3 patients (13%), and stuck mechanical mitral valve prosthesis in 17 patients (73.9%). Results. Fourteen patients were operated upon on emergency basis, and 9 patients on urgent basis. Two patients have continued their pregnancy to full term after cardiac surgery. Delivery was done immediately before surgery in 11 patients (47.8%). There were 10 intrauterine fetal deaths, all at gestational age below 28 weeks, 4 were confirmed before induction of anesthesia and 6 after surgery. There were 13 surviving babies, 7 premature babies (30.4%), and 6 full term babies (26.1%). Neonatal complications included respiratory distress syndrome in (38.5%) and prolonged hospital stay (46.2%). Maternal hospital morbidities included oliguria (65.2%), bleeding (30.4%), prolonged intensive care stay (56.5%), and prolonged hospital stay (26.2%). The in-hospital mortality was 8.7%. Conclusions. Urgent and emergency valve replacement in pregnant women can be achieved with good maternal morbidity and mortality; however, high incidence of fetal losses might be expected when surgery is performed at an early gestational age. (C) 2014 by The Society of Thoracic Surgeons