Risk factors associated with cardiac surgery during pregnancy.

BACKGROUND: This study is aimed at analyzing risk factors for fetal and maternal mortality in cardiac surgery during pregnancy. METHODS: Seventy-four pregnant women underwent cardiac surgery and 58 (78.3%) were followed. The most frequent pathology was valve disease (93.2%). Mitral valve disease was the most prevalent (72.9%), and mitral commissurotomy or replacement was required in 78% of the cases. Most were in functional class III or IV and mean gestational age was 22 weeks. RESULTS: There was functional class improvement after surgery (91% into class I or II), and 70.4% were restored to sinus rhythm. Twenty percent required reoperation. There were five maternal deaths (8.6%) and 11 fetal deaths (18.6%). Several aspects were considered as contributing risk factors for maternal mortality, such as the use of vasoactive drugs and other preoperative medications, age, kind of surgery, reoperation, and functional class. Functional class was the factor that predicted higher risk for maternal death. As to fetal mortality, several factors played a role, such as maternal age more than 35 years, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. CONCLUSIONS: Cardiac surgery during pregnancy is associated with acceptable maternal and fetal mortality rates. These rates may be even lower if the factors mentioned above are maintained under control.

Risk factors associated with cardiac surgery during pregnancy

The patients were followed by our Cardiopathy and Pregnancy Group for an average of 78 months. One patient has been followed for 260 months. A retrospective analysis of our records was performed and was subjected to a statistical analysis in order to identify risk factors associated with maternal and fetal mortality. The statistical analysis of the qualitative variables was carried out by associating the variables two by two through either the 2 or Fisher’s exact test. For the quantitative variables, we used Student’s t test (mean difference test). The significance level was 0.05. The multivariate analysis for independent variables was performed. Results After surgery, most hearts resumed sinus rhythm (38 patients [65.5%]), with improvement in quality of life and significant improvement in functional class (50 patients [86.2%] in functional class I or II). During the late follow-up period, 19.6% of the patients underwent a new surgical procedure (commissurotomy or valvular replacement). The maternal mortality rate in this group was 8.6%. Analyzing the outcomes in different decades, there were no maternal deaths between 1972 and 1981 (2 patients). In the second decade (1982 to 1991), 34 patients were operated on and 3 died (8.8%); and in the last decade (1992 to 2002), there were two deaths out of 22 operated patients (9.09%). The deaths were as follow. Two patients had endocarditis preoperatively. They underwent surgery in unfavorable conditions in functional class IV. One had had a previous cerebral event...