Cardiopulmonary bypass during pregnancy

Anitha S. John, Fionnuala Gurley, Hartzell V Schaff, Carole A. Warnes, Sabrina D. Phillips, Katherine W. Arendt, Martin D. Abel, Carl H. Rose, Heidi M. Connolly

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Background: Cardiac surgery during pregnancy carries significant maternal and fetal risk and is typically considered after failure of medical therapy. We sought to determine the maternal and neonatal outcomes of cardiopulmonary bypass during pregnancy. Methods: Twenty-one pregnant patients undergoing cardiothoracic surgery were identified from the Mayo Clinic surgical database (1976 to 2009). Maternal and neonatal outcomes were reviewed. Results: Operations included 8 aortic valve replacements, 6 mitral valve repair-replacements, 2 myxoma excisions, 1 patent foramen ovale closure, 1 myectomy, 2 aortic aneurysm repairs, and 1 prosthetic aortic valve thrombectomy. Median cardiopulmonary bypass time was 53 minutes (range 16 to 185). Twelve patients (57%) required emergent surgery with a median gestational age (GA) of 25 weeks (range 7 to 35.5). Seven patients underwent cesarean section immediately prior to sternotomy delivering viable infants (median GA 31 weeks). In the remaining patients, three additional preterm births occurred, all in operations performed at an early GA (13 to 15 weeks). Median follow-up was 16 months (range 3 to 305). All patients improved to New York Heart Association functional class I or II. One early maternal death occurred 2 days after emergent mechanical aortic valve thrombectomy and 3 late maternal deaths occurred 2, 10, and 19 years postoperatively. Three fetal deaths occurred in mothers with additional medical comorbidities. Conclusions: In the current era, cardiothoracic surgery can be performed with relative safety during pregnancy. Fetal complications (prematurity and death) are associated with urgent, high-risk surgery, maternal comorbidity, and early GA. Emergent surgery appears to confer a higher risk of maternal death.

Original languageEnglish (US)
Pages (from-to)1191-1196
Number of pages6
JournalAnnals of Thoracic Surgery
Volume91
Issue number4
DOIs
StatePublished - Apr 2011

Fingerprint

Cardiopulmonary Bypass
Maternal Death
Mothers
Gestational Age
Pregnancy
Aortic Valve
Thrombectomy
Comorbidity
Patent Foramen Ovale
Myxoma
Fetal Death
Sternotomy
Aortic Aneurysm
Premature Birth
Mitral Valve
Cesarean Section
Thoracic Surgery
Databases
Safety
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

John, A. S., Gurley, F., Schaff, H. V., Warnes, C. A., Phillips, S. D., Arendt, K. W., ... Connolly, H. M. (2011). Cardiopulmonary bypass during pregnancy. Annals of Thoracic Surgery, 91(4), 1191-1196. https://doi.org/10.1016/j.athoracsur.2010.11.037

Cardiopulmonary bypass during pregnancy. / John, Anitha S.; Gurley, Fionnuala; Schaff, Hartzell V; Warnes, Carole A.; Phillips, Sabrina D.; Arendt, Katherine W.; Abel, Martin D.; Rose, Carl H.; Connolly, Heidi M.

In: Annals of Thoracic Surgery, Vol. 91, No. 4, 04.2011, p. 1191-1196.

Research output: Contribution to journalArticle

John, AS, Gurley, F, Schaff, HV, Warnes, CA, Phillips, SD, Arendt, KW, Abel, MD, Rose, CH & Connolly, HM 2011, 'Cardiopulmonary bypass during pregnancy', Annals of Thoracic Surgery, vol. 91, no. 4, pp. 1191-1196. https://doi.org/10.1016/j.athoracsur.2010.11.037
John AS, Gurley F, Schaff HV, Warnes CA, Phillips SD, Arendt KW et al. Cardiopulmonary bypass during pregnancy. Annals of Thoracic Surgery. 2011 Apr;91(4):1191-1196. https://doi.org/10.1016/j.athoracsur.2010.11.037
John, Anitha S. ; Gurley, Fionnuala ; Schaff, Hartzell V ; Warnes, Carole A. ; Phillips, Sabrina D. ; Arendt, Katherine W. ; Abel, Martin D. ; Rose, Carl H. ; Connolly, Heidi M. / Cardiopulmonary bypass during pregnancy. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 4. pp. 1191-1196.
@article{0ae219d4e9d944be8fa16d9a12b378f8,
title = "Cardiopulmonary bypass during pregnancy",
abstract = "Background: Cardiac surgery during pregnancy carries significant maternal and fetal risk and is typically considered after failure of medical therapy. We sought to determine the maternal and neonatal outcomes of cardiopulmonary bypass during pregnancy. Methods: Twenty-one pregnant patients undergoing cardiothoracic surgery were identified from the Mayo Clinic surgical database (1976 to 2009). Maternal and neonatal outcomes were reviewed. Results: Operations included 8 aortic valve replacements, 6 mitral valve repair-replacements, 2 myxoma excisions, 1 patent foramen ovale closure, 1 myectomy, 2 aortic aneurysm repairs, and 1 prosthetic aortic valve thrombectomy. Median cardiopulmonary bypass time was 53 minutes (range 16 to 185). Twelve patients (57{\%}) required emergent surgery with a median gestational age (GA) of 25 weeks (range 7 to 35.5). Seven patients underwent cesarean section immediately prior to sternotomy delivering viable infants (median GA 31 weeks). In the remaining patients, three additional preterm births occurred, all in operations performed at an early GA (13 to 15 weeks). Median follow-up was 16 months (range 3 to 305). All patients improved to New York Heart Association functional class I or II. One early maternal death occurred 2 days after emergent mechanical aortic valve thrombectomy and 3 late maternal deaths occurred 2, 10, and 19 years postoperatively. Three fetal deaths occurred in mothers with additional medical comorbidities. Conclusions: In the current era, cardiothoracic surgery can be performed with relative safety during pregnancy. Fetal complications (prematurity and death) are associated with urgent, high-risk surgery, maternal comorbidity, and early GA. Emergent surgery appears to confer a higher risk of maternal death.",
author = "John, {Anitha S.} and Fionnuala Gurley and Schaff, {Hartzell V} and Warnes, {Carole A.} and Phillips, {Sabrina D.} and Arendt, {Katherine W.} and Abel, {Martin D.} and Rose, {Carl H.} and Connolly, {Heidi M.}",
year = "2011",
month = "4",
doi = "10.1016/j.athoracsur.2010.11.037",
language = "English (US)",
volume = "91",
pages = "1191--1196",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Cardiopulmonary bypass during pregnancy

AU - John, Anitha S.

AU - Gurley, Fionnuala

AU - Schaff, Hartzell V

AU - Warnes, Carole A.

AU - Phillips, Sabrina D.

AU - Arendt, Katherine W.

AU - Abel, Martin D.

AU - Rose, Carl H.

AU - Connolly, Heidi M.

PY - 2011/4

Y1 - 2011/4

N2 - Background: Cardiac surgery during pregnancy carries significant maternal and fetal risk and is typically considered after failure of medical therapy. We sought to determine the maternal and neonatal outcomes of cardiopulmonary bypass during pregnancy. Methods: Twenty-one pregnant patients undergoing cardiothoracic surgery were identified from the Mayo Clinic surgical database (1976 to 2009). Maternal and neonatal outcomes were reviewed. Results: Operations included 8 aortic valve replacements, 6 mitral valve repair-replacements, 2 myxoma excisions, 1 patent foramen ovale closure, 1 myectomy, 2 aortic aneurysm repairs, and 1 prosthetic aortic valve thrombectomy. Median cardiopulmonary bypass time was 53 minutes (range 16 to 185). Twelve patients (57%) required emergent surgery with a median gestational age (GA) of 25 weeks (range 7 to 35.5). Seven patients underwent cesarean section immediately prior to sternotomy delivering viable infants (median GA 31 weeks). In the remaining patients, three additional preterm births occurred, all in operations performed at an early GA (13 to 15 weeks). Median follow-up was 16 months (range 3 to 305). All patients improved to New York Heart Association functional class I or II. One early maternal death occurred 2 days after emergent mechanical aortic valve thrombectomy and 3 late maternal deaths occurred 2, 10, and 19 years postoperatively. Three fetal deaths occurred in mothers with additional medical comorbidities. Conclusions: In the current era, cardiothoracic surgery can be performed with relative safety during pregnancy. Fetal complications (prematurity and death) are associated with urgent, high-risk surgery, maternal comorbidity, and early GA. Emergent surgery appears to confer a higher risk of maternal death.

AB - Background: Cardiac surgery during pregnancy carries significant maternal and fetal risk and is typically considered after failure of medical therapy. We sought to determine the maternal and neonatal outcomes of cardiopulmonary bypass during pregnancy. Methods: Twenty-one pregnant patients undergoing cardiothoracic surgery were identified from the Mayo Clinic surgical database (1976 to 2009). Maternal and neonatal outcomes were reviewed. Results: Operations included 8 aortic valve replacements, 6 mitral valve repair-replacements, 2 myxoma excisions, 1 patent foramen ovale closure, 1 myectomy, 2 aortic aneurysm repairs, and 1 prosthetic aortic valve thrombectomy. Median cardiopulmonary bypass time was 53 minutes (range 16 to 185). Twelve patients (57%) required emergent surgery with a median gestational age (GA) of 25 weeks (range 7 to 35.5). Seven patients underwent cesarean section immediately prior to sternotomy delivering viable infants (median GA 31 weeks). In the remaining patients, three additional preterm births occurred, all in operations performed at an early GA (13 to 15 weeks). Median follow-up was 16 months (range 3 to 305). All patients improved to New York Heart Association functional class I or II. One early maternal death occurred 2 days after emergent mechanical aortic valve thrombectomy and 3 late maternal deaths occurred 2, 10, and 19 years postoperatively. Three fetal deaths occurred in mothers with additional medical comorbidities. Conclusions: In the current era, cardiothoracic surgery can be performed with relative safety during pregnancy. Fetal complications (prematurity and death) are associated with urgent, high-risk surgery, maternal comorbidity, and early GA. Emergent surgery appears to confer a higher risk of maternal death.

UR - http://www.scopus.com/inward/record.url?scp=79953112200&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953112200&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2010.11.037

DO - 10.1016/j.athoracsur.2010.11.037

M3 - Article

C2 - 21440145

AN - SCOPUS:79953112200

VL - 91

SP - 1191

EP - 1196

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 4

ER -