Strategy and management of cardiopulmonary bypass with cardiac surgery for pregnant women / 局解手术学杂志

ABSTRACT

Objective To evaluate the strategy and management of cardiopulmonary bypass ( CPB) with cardiac surgery for pregnant women.Methods The clinical data of 4 pregnant women with severe cardiac diseases ,who received cardiac surgery with CPB in our hospital form January 2016 to June 2017 were retrospectively analyzed ,meanwhile the maternal and neonatal outcomes were reviewed also .Results Among 4 patient s,there were 1 case of subacute bacterial endocarditis ,2 cases of congenital heart disease complicated with subacute bacterial endocarditis,1 case of rheumatic heart disease.The New York Heart Association(NYHA) functional classificationthere were 2 cases with class Ⅲand 2 cases with classⅣ.Operations included 2 mitral valve replacement and tricuspid valve plasty ,1 right coronary artery fistula re-pair and aortic valve replacement ,1 patent ductus arteriosus closure and mitral valve repalcement ,aortic valve replacememnt ,pulmonary valve replacement,tricuspid valve plasty.The CPB time ranged from 85 to 287 minutes(median 135 minutes),the aortic cross clamp time ranged from 52 to 178 minutes (median 89 minutes),the gestational age of pateints received cardia surgery ranged from 25 to 32 weeks(median 29 weeks).All patients were followed up for 1 to 16months(median 6 months),with no death;4 neonatal outcomes included 3 of full-term labor with cesarean section ,all of the 3 newborns were alive and no malformation ,1 of death in the uterus and spontaneous abortion at 2 days post-operative .Conclusion Cardiac surgery can be performed with relative safety during pregnancy .According to the physiological characteristics of pregnancy ,a reasonable CPB plan should be formulated pre-operative ,better maternal and fetal survival rates may be achieved by optimized management of CPB and used fetal mornitoring perioperative ,reduce the incidence of complications .