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Ann Thorac Surg 1996;61:259-268
© 1996 The Society of Thoracic Surgeons

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Current Review

Cardiopulmonary Bypass in Pregnancy

Department of Obstetrics and Gynecology, ``Università Cattolica del Sacro Cuore,'' Institute for Biomedical Technologies, National Council of Research, and Department of Neurology, University of Rome ``La Sapienza,'' Rome, Italy

The cardiopathic patient can sustain acute heart failure during pregnancy. In such cases, if open heart operation is necessary to save the patient's life, the fetus could be seriously compromised after exposure to cardiopulmonary bypass. From 1958 to 1992, 69 reports of cardiac operations during pregnancy with the aid of cardiopulmonary bypass have been published. Maternal mortality was 2.9%. Embryofetal mortality was 20.2%. Examining only the last 40 patients, maternal and embryofetal mortality were 0.0% and 12.5%, respectively. Embryofetal mortality was 24.0% when hypothermia was used, compared with 0.0% while operating in normothermia. Maternal mortality did not change. The use of hypothermia during cardiopulmonary bypass provoked uterine contractions in several patients. Hypothermia decreases O₂ exchange through the placenta. Pump flow and mean arterial pressure during cardiopulmonary bypass seem to be the most important parameters that influence fetal oxygenation. We speculate that cardiac operation is not a contraindication to pregnancy prolongation.

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