Outcomes of heart valve surgery during pregnancy

Van Hung Dung, Hoang Anh Khoi, Nguyen Thi Nhu Ha, Nguyen Tien Hao

Main Article Content

Abstract

Background: Cardiac surgery during pregnancy often carries a high risk of death for both mother and baby. Herein, we report our experience of valvular surgery in pregnant patients. 


Methods: we retrospective review all of the pregnant patients associated with valvular surgery between 1998 and 2018 at Ho Chi Minh City Heart Institute. Both fetal and maternal outcomes have assessed to determine the effectiveness of surgical treatment.


Results: The total number of patients was 78, including 15 patients who had close mitral valvulotomy and 63 patients who had valvuloplasty or valvular replacement. The maternal and fetal mortality rate were 4.7% and 10.1%. Maternal outcomes were 20.5% (16) including low cardiac output, cardiac arrhythmia, and acute pulmonary edema. Fetal outcomes were 36.8% (28) including termination by cesarean (4), miscarriage (6), threatened abortion (13), pre-term delivery (3), and stillbirth (2). Factors that affect maternal mortality include pre-operative NYHA (p= 0.037) and type of operation (p =0.034). Factors that affect fetal outcomes include CPB time (p = 0.003) and aortic clamp time (p= 0.01). The average follow-up was 104.25 ± 68.7 months (range 12- 238) with 95% complete of follow-up.


Conclusions: Surgical treatment for pregnant patients with valvular heart disease remains a big challenge. The coordination of many medical specialists, optimization of CPB, optimization timing of surgery to give the best results for both mother and fetus.

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References

1. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in
women with heart disease. Circulation. 2001; 104: 515-21.
2. Regitz-Zagrosek V (Chairperson), Roos-Hesselink JW (Co-Chairperson) et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Euro Heart J. 2018; 39: 3165-3241.
3. Suwanrath C, Thongphanang P, Pinjaroen S, Suwanugsorn S. Validation of modified World
Health Organization classification for pregnant women with heart disease in a tertiary care center in southern Thailand. Intern J Women’s Health. 2018; 10: 47-53.
4. de Souza JAM, Martinez EE Jr, Ambrose JA, Alves CMR, Born D, Buffolo E, et al. Percutaneous Balloon Mitral Valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy. J Am Coll Cardiol 2001;37: 900-3.
5. Sharmaa JB, Yadava V, Mishrab S, Kriplania A, Bhatlaa N, Kachhawaa G, et al. Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. Indian Heart J. 2018; 70: 685-689.
6. van Hagen IM, Thorne SA, Taha N, Youssef G, Elnagar A, Gabriel H et al. Pregnancy outcomes
in women with rheumatic mitral valve disease. Results from the Registry of Pregnancy and Cardiac
Disease. Circulation. 2018; 137: 806-816.
7. Diao M, Kanea A, Ndiayea MB, Mbayea A, Bodiana M, Mounir Dia M, et al. Pregnancy in women with heart disease in sub-Saharan Africa. Arc Cardiovasc D. 2011; 104: 370-374.
8. Parry AJ, and Westaby S. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg. 1996;
61: 1865-9.
9. Weiss BM, von Segesser LK, Alon E, Seifert B, and Turina MI. Outcome of cardiovascular surgery and pregnancy: A systematic review of the period 1984-1996. Am J Obstet Gynecol. 1998; 179: 1643-53.
10. John AS, Gurley F, Schaff HV, Warnes CA, Phillips SD, Arendt KW, et al. Cardio-pulmonary bypass during pregnancy. Ann Thorac Surg. 2011; 91: 1191-7.
11. Jha N, Kumar Jha A, Chauhan RC, and Chauhan NS. Maternal and Fetal outcome after cardiac operations during pregnancy: a meta-analysis. Ann Thorac Surg. 2018; 106: 618-27.
12. Sepehripour AH, Lo TT, Shipolini AR, Mc Cormack DJ. Can pregnant women be safely
placed on cardiopulmonary bypass? Interact Cardiovasc Thorac Surg 2012; 15(6): 1603-70.
13. Avila WS, Milani Gouveia AM, Pomerantzeff P, Bortolotto MRL, Grinberg M, Stoli N et al. Maternal-Fetal outcome and prognosis of cardiac surgery during pregnancy. Arq Bras Cardio. 2009; 93(1): 8-13.
14. Hosseini S, Kashfi F, Samiei N, Khamoushi A, Ghavidel AA,Yazdanian F et al. Feto-maternal outcomes of urgent open-heart surgery during pregnancy. J Heart Valve Dis. 2015; 24(2): 253-9.
15. Arnoni RT, Arnoni AS, Bonini RCA, de Almeida AFS, Neto CA, Dinkhuysen JJ, et al. Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg. 2003; 76:1605-8.
16. Elassy SMR, Elmidany AA, and Elbawab HY. Urgent cardiac surgery during pregnancy: A continuous challenge. Ann Thorac Surg. 2014; 97: 1624-9.
17. Elsayed AA, Abdelaal KH, Abdelghaffar AM, Mohamed EH, Mahran TM, Ahmed MS, et al. Poor outcome of surgical management of acute malfunctioning mechanical mitral valve during pregnancy. Should centers with limited resources find different options? Heart Surg Forum 2019; 22(5) E405-E410.doi: 10.1532/hsf.2497.